Ch. 45: Digestive and Gastrointestinal Treatment Modalities

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 patient receiving tube feedings has prescriptions for several drugs. Which of the following drugs would the nurse expect to administer to the patient without any special preparation? Select all that apply.

-Sublingual nitroglycerin -Liquid stool softener

Semi-Fowler's position is maintained for at least which timeframe following completion of an intermittent tube feeding?

1 hour

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

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 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

What type of feeding should be administered to a patient who is at risk of diarrhea due to hypertonic feeding solutions?

Continuous feedings

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

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

For what are medium-length nasoenteric tubes are used?

Feeding

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 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 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

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

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura?

Pneumothorax

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.

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

Hickman and Groshong are examples of which type of central venous access devices?

Tunneled central catheters

The nurse inserts a nasoduodenal tube for feeding of the client. To check best for placement, the nurse:

Verifies location with an abdominal x-ray

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?

When the residual is greater than 200 mL

A graduate nurse is cleaning a central venous access device (CVAD) and is being evaluated by the preceptor nurse. The preceptor nurse makes a recommendation for relearning the skill when she notes the graduate nurse does the following action:

Wipes catheter ports from distal end to insertion site

Initially, which diagnostic should be completed following placement of a NG tube?

X-ray

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds:

enteric coated aspirin

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

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 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 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

A nurse prepares a patient for insertion of a nasoenteric tube. The nurse should position the patient:

In high-Fowler's position

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

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 newly diagnosed with acute lymphocytic leukemia has a right subclavian central venous catheter in place. The nurse who's caring for the client is teaching a graduate nurse about central venous catheter care. The nurse should instruct the graduate nurse to change the central venous catheter dressing every:

48 hours.

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 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 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