Critical Care Digestive and Gastrointestinal
Nursing students are reviewing information about various gastrointestinal tubes. They demonstrate a need for additional study when they identify which of the following as a nasogastric tube?
Dobbhoff
Which of the following is a nasoenteric feeding tube?
Dobbhoff
The nurse is to administer a cyclic feeding through a gastric tube. It is most important for the nurse to
Elevate the head of the bed to 45 degrees.
As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach?
4
A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.
42
A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use?
30-mL
A nurse is interviewing a patient to determine suitability for home parenteral nutrition. Which patient statement would alert the nurse to a potential problem?
"I have a telephone, but it has been shut off because my bill is overdue."
A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate?
"It is a vent that prevents backflow of the secretions."
A patient has a gastric sump tube inserted and attached to low intermittent suction. The physician has ordered the tube to be irrigated with 30 mL of normal saline every 6 hours. When reviewing the patient's intake and output record for the past 24 hours, the nurse would expect to note that the patient received how much fluid with the irrigation?
120
The client has the intake and output shown in the accompanying chart for an 8-hour shift. What is the positive fluid balance?
260
The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs?
6
The nurse is confirming placement of a patient's nasogastric (NG) tube using a combination of visual and pH assessment of the aspirate. The nurse determines that the NG tube remains properly placed when the pH of the aspirate is which of the following?
Acidic
The nurse is caring for a patient who has dumping syndrome from high carbohydrate foods being administered over a period of less than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome?
Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.
A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to
Auscultate lung sounds every 4 hours.
A nurse is preparing to assist a physician with a peripherally inserted central catheter. The nurse demonstrates understanding of this procedure by preparing which insertion site?
Basilic vein
The primary source of microorganisms for catheter-related infections are the skin and which of the following?
Catheter hub
The primary source of microorganisms for catheter-related infections include the skin and which of the following?
Catheter hub
A nurse is caring for a client with a long-term central venous catheter. Which care principle is correct?
Clean the port with an alcohol pad before administering I.V. fluid through the catheter.
A nurse administered a full strength feeding with an increased osmolality through a jejunostomy tube to a client. Immediately following the feeding, the client expelled a large amount of liquid brown stool and exhibited a blood pressure of 86/58 and pulse rate of 112 beats/min. The nurse
Consults with the physician about decreasing the feeding to half-strength
The nurse on an evidence-based practice council is making recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which of the following situations?
Daily when not in use
To ensure patency of central venous line ports, diluted heparin flushes are used in which of the following situations?
Daily when not in use
A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?
Diarrhea
The nurse is preparing to administer all of a patient's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes on the patient's medication administration record which of the following types of oral medication?
Enteric-coated tablets
Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube?
Enteric-coated tablets
The patient is on a continuous tube feeding. How often should the tube placement be checked?
Every shift
A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely?
Excess fluid volume
A client has been receiving intermittent tube feedings for several days at home. The nurse notes the findings as shown in the accompanying documentation. The nurse reports the following as an adverse reaction to the tube feeding:
Fasting blood glucose level
Rebound hypoglycemia is a complication of parental nutrition caused by which of the following?
Feedings stopped too abruptly
Rebound hypoglycemia is a complication of parenteral nutrition caused by which of the following?
Feedings stopped too abruptly
The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication?
Fluid volume deficit
The nurse is to discontinue a nasogastric tube that had been used for decompression. The first thing the nurse does is
Flush with 10 mL of water.
Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the:
Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration.
The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric (NG) feedings in the comatose patient?
Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.
A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following?
Gastrostomy tube
The following appears on the medical record of a male patient receiving parenteral nutrition: WBC: 6500/cu mm Potassium 4.3 mEq/L Magnesium 2.0 mg/dL Calcium 8.8 mg/dL Glucose 190 mg/dL Which finding would alert the nurse to a problem?
Glucose level
Residual content is checked before each intermittent tube feeding. The patient would be reassessed if the residual, on two occasions, was:
Greater than 200 mL.
A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate?
Hang a solution of dextrose 10% and water until the new solution is available.
A nurse prepares a patient for insertion of a nasoenteric tube. What position should the nurse place the patient in?
In high-Fowler's position
A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is
Inserted into the lungs
The nurse is conducting discharge education for a patient who is to go home with parenteral nutrition (PN). The nurse sees that the patient understands the education when the patient indicates which of the following is a sign and/or symptom of metabolic complications?
Loose, watery stools
The nurse is caring for a patient who is at receiving continuous enteral tube feedings who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. Which of the following is the correct action by the nurse?
Monitor the feeding closely.
A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and makes a recommendation when noting the following:
No land line; cell phone available and taken by family member during working hours
A patient is to receive parenteral nutrition. The duration of therapy is planned for 4 weeks. The nurse develops a teaching plan for the patient to prepare for insertion of which of the following as most likely?
Nontunneled central catheter
A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to
Notify the surgeon about the tube's removal.
The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also complains of unpleasant tastes and odors. Which of the following measures should be included in the client's plan of care?
Provide frequent mouth care.
When a central venous catheter dressing becomes moist or loose, what should a nurse do first?
Remove the dressing, clean the site, and apply a new dressing.
The nurse caring for a patient who is receiving feedings through a nasogastric (NG) tube is assessing the patient for signs and symptoms of pulmonary complications. The nurse determines that the patient may be experiencing pulmonary complications when which of the following is noted?
Respiratory rate of 30
A patient is receiving continuous tube feedings. The nurse would maintain the patient in which position at all times?
Semi-Fowler's with the head of the bed elevated 30 to 45 degrees
The nurse is teaching an unlicensed caregiver about bathing patients who are receiving tube feedings. Which of the following is the most significant complication related to continuous tube feedings?
The potential for aspiration
The nurse is monitoring a patient with nasoenteric intubation. The nurse contacts the physician when which of the following is noted?
Urinary output 20 mL/hr
The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?
When the residual is greater than 200 mL
The dumping syndrome occurs when high-carbohydrate foods are administered over a period of less than 20 minutes. A nursing measure to prevent or minimize the dumping syndrome is to administer feedings:
With the patient in semi-Fowler's position to decrease transit time influenced by gravity.
Initially, which diagnostic should be completed following placement of a NG tube?
X-ray
Which of the following is the best method for determining nasogastric tube placement?
X-ray
After teaching nursing students about methods to assess gastric tube placement, the instructor determines that the teaching was successful when the group identifies which of the following as the most accurate method?
X-ray visualization
A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:
diaphoresis, vomiting, and diarrhea.
The primary source of microorganisms for catheter-related infections are the skin and
catheter hub.
The patient is on a continuous tube feeding. The tube placement should be checked every
shift.
The most significant complication related to continuous tube feedings is
the potential for aspiration,
Intervention for a person who has swallowed strong acid includes a number of interventions depending on the type and amount of corrosive agent involved. Select all the actions that apply.
• Aspirate secretions from the pharynx if respirations are affected. • Neutralize the chemical. • Wash the esophagus with large volumes of water.
A client is scheduled to receive a 25% dextrose solution of parenteral nutrition. The nurse does all of the following. Select all that apply.
• Ensures availability of an infusion pump • Ensures completion of baseline monitoring of the complete blood count (CBC) and chemistry panel • Places a 1.5-micron filter on the tubing
A client with a nasogastric tube set to low intermittent suction is receiving D51/2NS at 100 mL/hr. The nurse has identified a nursing diagnosis of deficient fluid volume. Which of the following are data that support this diagnosis? Select all that apply.
• Urine output that decreased from 60 to 40 mL/hr • Heart rate that increased from 82 to 98 beats/min within 2 hours • Fluid output of 2150 mL and total fluid intake of 2000 mL for the past 24 hours
