CNSC Enteral Nutrition Notes

_______ is the most common complication following gastrostomy placement.

peristomal infection Foul-smelling drainage around the tube exit site is a sign of infection. Early recognition and treatment of exit site infections reduces morbidity and mortality. Leakage around the gastrostomy site is another common complication. Exit site care, proper outer bumper placement and prevention of tension on the tube help reduce gastrostomy exit site leakage.

Most enteral formulas designed for oral consumption are composed primarily of 1: carbohydrates. 2: protein. 3: fat. 4: vitamins.

1.

Which of the following is NOT an established risk factor for aspiration in critically ill patients? 1: Gastric residual volume <150 mL 2: Decreased level of consciousness 3: Age > 70 years 4: Gastroesophageal reflux disease

1. GRV and aspiration remains a controversial topic. Decreased level of consciousness, neurologic defect, delayed gastric emptying, gastroesophageal reflux disease, supine position, vomiting, bolus enteral feedings, mechanical ventilation, age > 70 years, poor oral care, vomiting, tracheal intubation, neuromuscular disease, persistent high gastric residual volumes, and large diameter feeding tube

A patient with short bowel and an end-jejunostomy requires the use of an oral rehydration solution (ORS) to help prevent dehydration. Which best describes the preferred composition of the ORS? 1: An iso-osmolar solution such as diluted juice with added sodium 2: A hyper-osmolar solution such as fruit juice or Kool-aid 3: A hypo-osmolar solution such as water 4: A hyper-osmolar solution such as commercially available sports drink

1. Glucose is an important component in ORS as it promotes salt and water absorption commercial sports drinks are lower in sodium and higher in carbohydrate content than ORS

Which of the following tube feeding orders best reflects the use of an intermittent schedule? 1: 240 mL administered over 45 minutes, five times per day 2: 50 mL/hr over 24 hours 3: 100 mL/hr over 12 hours 4: 240 to 480 mL administered over 15 minutes every eight hours

1. Intermittent feedings are generally 240-480 mL administered over 45 minutes several times daily with or without feeding pump. continuous feedings are delivered at a prescribed rate without interruption. Cyclic feedings are generally administered over 8-16 hours per day, depending on the patient's volume tolerance. Bolus feedings are generally 240-480 mL delivered by gravity or a syringe over 15 minutes into the stomach.

Which characteristic of enteral formulas is MOST likely to increase splanchnic blood flow in a critically ill patient? 1: High fat 2: High carbohydrate 3: High fiber 4: High osmolarity

1. Research has shown that blood flow to the bowel is maximized with use of high fat formulas over high carbohydrate formulas. An isotonic, fiber-free formula is ideal for patients at high risk for intestinal ischemia as adequate bowel perfusion is necessary for tolerance of high fiber, high osmolarity feedings.

Which of the following is a desirable feature of skin-level or low-profile enteral access devices? 1: They are more comfortable and cosmetically appealing 2: They can be placed only as an exchange tube 3: They are used solely for gastric access 4: They can be used for feedings and medications

1. Skin level or low profile devices require an access connector prior to the administration of medications or feedings which requires adequate manual dexterity. They can be placed as an exchange tube or at the time of initial tube insertion. Newer devices are available for both gastric decompression and/or jejunal feeding. These devices are held in place with an inflated internal balloon or a solid silicone internal retention bolster.

Which of the following tubes requires immediate replacement if it becomes dislodged? 1: Jejunostomy tube 2: Nasogastric tube 3: Nasojejunal tube 4: Nasoduodenal tube

1. he jejunostomy tube requires immediate replacement since the tract for the jejunostomy tube can close quickly. The first replacement of a gastrostomy or percutaneous endoscopic gastrostomy tube should be performed by the physician who inserted the tube

Drugs in microencapsulated bead or pellet form are most effectively administered through large-bore feeding tubes when mixed with 1: orange juice. 2: gingerale. 3: oral electrolyte solution. 4: warm water.

1. OJ An acidic juice such as orange juice can reduce the risk of microencapsulated beads or pellets sticking to the tube.

Which of the following is LEAST likely to be problematic for placement of a percutaneous endoscopic gastrostomy (PEG) tube in a patient with liver disease? 1: Ascites 2: Coagulopathy 3: Gastric varices 4: Hepatitis C

4. hep c appropriate assessment of risks vs. benefits of tube feeding must be made regarding esophageal and gastric varices, coagulopathy, hepatic encephalopathy, ascites, fulminant hepatic failure, and portal hypertension. The cause of liver failure does not affect the decision in placement of a PEG.

closed-system enteral formulas can hang for a maximum of ____ hours

48

hang time: ___ hours for canned or bottled sterile, liquid formulas

8 (Hang time of canned, ready-to-use formulas should be no longer than 12 hours.)

___ to ____ hours for open feeding systems

8 to 12

only an ___ to ______-hour supply of formula should be poured into an open administration set.

8 to 12

standard enteral formulas are ___ % water

84%

A diabetic patient presents with early satiety, bloating, occasional vomiting, and extensive weight loss. After a thorough GI workup, the patient is diagnosed with gastroparesis. Which type of enteral formula would be more efficacious in this patient? 1: Standard, polymeric 2: High fiber 3: Concentrated, high protein, elemental 4: High fat

1. standard Most patients with gastroparesis will tolerate a standard, polymeric formula. A concentrated formula may be used for those patients sensitive to volume. High fat and high fiber enteral formulas may decrease or delay gastric emptying exacerbating gastroparesis symptoms. Elemental formulas are typically indicated for patients with malabsorptive syndromes and/or pancreatic insufficiency.

Which of the following is the first line method to restore patency to clogged enteral access devices (EADs)? 1: Water 2: Cranberry juice 3: Mechanical declogging device 4: Pancreatic enzyme solution

1. water Pancreatic enzyme with sodium bicarbonate and mechanical declogging device are two research based methods utilized to restore patency to clogged feeding tubes.

Hang time: for blenderized formulas varies from ___ to ___ hours depending on if it is homemade or commercial

2, 8

Compared to gastric feeding, post pyloric feeding is associated with which of the following outcomes in critically ill patients? 1: Longer time to achieve target nutrition 2: Increased nutrient delivery 3: Increased gastroesophageal regurgitation 4: Decreased rate of ventilator-associated pneumonia

2.

Which of the following should always appear on the label of an enteral feeding product given to a patient in the hospital? 1: Product name, rate, volume, additives, caloric density, date and time the formula was prepared and hung 2: Patient identification, product name, administration method, route, access device, date and time the formula was prepared and hung 3: Patient's name, product name, rate, strength, osmolality, date and time the formula was prepared and hung 4: Patient's name, room number, strength, additives, volume, date and time the formula was prepared and hung

2.

Which formula is most likely to cause an occluded feeding tube? 1: Low fat formula 2: High fiber formula 3: Peptide based formula 4: Elemental formula

2. An increase in the accumulation of formula sediment in the inner lumen of the feeding tube is seen more often with a calorically dense or high fiber formula decreasing tube patency.

Which of the following medications has NOT been shown to lead to diarrhea in a patient receiving enteral nutrition? 1: Sorbitol-containing preparations 2: Alpha-2 adrenergic agonists 3: Antibiotics 4: Magnesium-containing preparations

2. High osmolality of tube feeding, rapid bolus technique or significantly compromised albumin levels have also been cited. Alpha-2 adrenergic agonists, (clonidine), have been shown to have significant antimotility effects and often prolong instead of reduce intestinal transit time

Which of the following medications would be appropriate to crush and deliver via an enteral feeding tube? 1: Nifedipine XL 2: Metoprolol immediate release 3: Enteric coated aspirin 4: Diltiazem CD

2. Only immediate release tablets should be crushed for administration via an enteral feeding tube. Enteric coated or film coated tablets do not crush well and tend to clump and increase the risk of clogging the tube. Modified release dosage forms (often designated with abbreviations such as XL, XR, SR, CD, etc.) are inappropriate to crush and give via enteral feeding tube because crushing these dosage forms destroys their modified releasing properties.

Which of the following is most likely to improve tolerance of enteral feeding in a postoperative patient with documented high gastric residual volume (GRV) receiving bolus tube feedings? 1: Provide intermittent feeding 2: Provide continuous enteral feeding 3: Initiate levofloxacin to aid with motility 4: Invert the patient to a prone position

2. Small bowel feeding may increase the amount of feeding delivered in patients with high GRVs. Continuous feeding is the preferred method as bolus and gravity feeding are poorly tolerated in the small bowel. Holding of feedings should be avoided when possible to optimize meeting calorie and protein needs. Prone positioning in a patient with elevated GRVs may increase the risk of aspiration. Prokinetic agents such as metoclopramide and erythromycin are used to increase motility and may be of benefit in this situation. Levofloxacin is an antibiotic and does not help with GI motility.

Tube feeding is often held before and after enteral administration of all the following medications EXCEPT 1: Warfarin 2: Metoprolol 3: Ciprofloxacin 4: Phenytoin

2. bioavailability of warfarin, phenytoin, carbamazepine, and fluoroquinolones, such as ciprofloxacin, may be altered w EN. The enteral feeding is often held for up to two hours before and after administration to reduce interactions.

A patient with oral cancer, who has gained 10 pounds since starting home bolus enteral feedings via gastrostomy tube complains of pain and pressure on the inside of his stomach but no redness or drainage at the exterior gastrostomy site. Which of the following is the most appropriate response for the clinician? 1: Tell the patient to take over the counter pain medication and rotate the G tube 180 degrees each day. 2: Refer the patient to the gastroenterologist or enterostomal nurse. 3: Decrease the infusion volume of the formula in half to avoid excessive distention of the stomach. 4: Change to a slower tube feed infusion by using a gravity bag for feedings.

2. Buried bumper syndrome results from erosion of the internal bolster into the gastric mucosa and/or wall and occurs in 0.3%-2.4% of patients. Excessive traction on the internal bolster slowly pulls it into the gastric wall as the mucosa grows over it. Pain may indicate the presence of infection or pressure necrosis. Weight gain after tube placement places a patient at greater risk for pressure necrosis and ulceration at the tube site due to increase in abdominal girth.

what is the optimal sodium concentration of an oral rehydration solution for patients with short bowel syndrome? 1: 54 - 80 mEq/ L 2: 90 - 120 mEq/L 3: 134 - 160 mEq/L 4: 170 - 190 mEq/L

2. The ideal sodium concentration for oral rehydration solutions depends on the segment of bowel function lost, e.g. jejunum, ileum, colon. The sodium concentration of homemade or commercial oral rehydration solutions ranges from 90 - 120 mmol/L. This amount of sodium promotes jejunal absorption.

Which of the following patient populations would most likely have difficulty tolerating a polymeric enteral formula? 1: Crohn's disease 2: Chyle leak 3: Gastroparesis 4: Celiac disease

2. chyle leak Elemental enteral formulas, which contain individual amino acids and contain <2-3% of total calories from long-chain fatty acids, are ideal for patients with chyle leaks However, most investigators recommend determining the patient's response to an elemental low fat diet before initiating parenteral nutrition. Patients with Crohn's or celiac disease most often tolerate formulas with intact macronutrients. In severe cases refractory to medical management, trial of an elemental diet may be necessary. Patients with gastroparesis most often tolerate polymeric enteral formula fed into the jejunum.

An ICU patient requires vasopressor support to maintain hemodynamic stability. The patient's mean arterial blood pressure is 50 mm Hg, vasopressor administration is decreasing and enteral nutrition (EN) is soon to be initiated. Which of the following is considered a possible early indicator of gut ischemia in this patient? 1: Decreased vasopressor support 2: Hypoactive bowel sounds 3: Increased passage of stool and flatus 4: Increased metabolic alkalosis

2. hypoactive bowel sounds

Use of a semi-elemental or elemental formula in place of a polymeric formula should be considered in all patients with 1: initiation of enteral nutrition. 2: intolerance to polymeric formula. 3: intestinal failure. 4: pancreatitis.

2. intolerance to polymeric There have been a number of studies on patients with malabsorptive disorders such as intestinal failure, Crohn's disease and pancreatitis that have shown polymeric formulas to be as well tolerated as elemental formulas. Polymeric formulas may also have more benefits than elemental formulas in patients with intestinal failure as these formulas are more isotonic and may better enhance intestinal adaptation.

Which type of insulin should be used when initiating enteral nutrition in a hospitalized diabetic patient? 1: Premixed NPH/Regular insulin 2: Regular Insulin 3: NPH Insulin 4: Insulin glargine

2. regular When initiating enteral nutrition, use of short-acting insulin (regular insulin) is typically used as tolerance and titration may be unpredictable. This type of insulin may minimize the risk of hypoglycemia resulting from continued absorption of insulin from an intermediate (premixed NPH/regular insulin, NPH insulin) or long-acting (insulin glargine) insulin product in the event that enteral nutrition is interrupted for any reason. Once enteral nutrition administration is stable, use of a basal/bolus insulin regimen is recommended to achieve safe, effective glucose control.

Use of an immune-modulating formula may be beneficial in all of the following patient scenarios EXCEPT 1: elective surgery patient. 2: severe sepsis patient. 3: traumatic brain injury patient. 4: patient with abdominal and torso injuries from motor vehicle accident.

2. severe sepsis Consideration for these formulas should be reserved for trauma patients, patients with traumatic brain injuries and surgical ICU patients. They are contraindicated in septic patients due to the adverse effects seen with arginine supplementation in these individuals.

Which of the following is an advantage of a gastrostomy feeding tube compared to a nasogastric feeding tube? 1: Reduced incidence of aspiration 2: Appropriate for long term feeding 3: More successful delivery of calories 4: Reduced incidence of gastric perforation

2. ​​ When enteral feeding is required > 4 weeks, g tubes are preferred. Feeding through a gastrostomy tube does not reduce aspiration risk. Provided the nasal feeding tube does not become frequently displaced and occluded, the calories delivered by both methods are similar. Gastric perforation is greater with a gastrostomy placed tube than a nasal placed tube.

Powdered formulas reconstituted in advance should be refrigerated immediately after preparation and discarded within ___ hours of preparation if not used; they should also be exposed to room temperature for no longer than 4 hours.

24

The feeding administration set should be changed every ___ hours and disposable feeding administration sets should not be reused

24

hang time: Closed systems have may hang for ____ to ___ hours depending on connection set.

24-48

Which of the following describes an optimal method of preparing and administering medications via an enteral feeding tube? 1: Crush tablets and add them directly into the enteral formula 2: Administer liquid formulations undiluted to minimize fluid overload 3: Administer individual crushed medications in water 4: Add crushed tablets to liquid medications and administer the mixture all together

3.

In severe acute pancreatitis, when compared to parenteral nutrition, both gastric and jejunal feeds are associated with all of the following EXCEPT 1: decreased infection rates. 2: reduced length of hospital stay. 3: decreased pain. 4: reduced mortality rates.

3. Both nasogastric feeds and jejunal feeds have been associated with a significant reduction in infectious morbidity, decreased hospital length of stay, reduced need for surgical intervention, reduced multiple organ failure, and decreased mortality. However, pain relapse is often noticed with nasogastric feeds when compared to parenteral nutrition.

A patient requiring critical care is receiving tube feeding which seem to be tolerated without gastric distension or emesis. Gastric residual volumes (GRV) are 265 mL, 250 mL, and 330 mL. What is the most appropriate recommendation? 1: Consider adding a promotility agent 2: Change to a lower fat formula 3: Continue infusing tube feeding as ordered 4: Use a smaller bore feeding tube

3. Gastric residual volumes between 250-500 mL should lead to implementation of measures to reduce the risk of aspiration including adding a promotility agent.

A patient is admitted with a traumatic brain injury and upon assessment it is determined that the patient will require enteral nutrition for the next three weeks. Which of the following is the preferred method of feeding tube placement? 1: Laparoscopic 2: Open surgical 3: Nasoenteric 4: Percutaneous endoscopic

3. Placement of a feeding tube via the open surgical route, laparoscopically, or endoscopically is not without risk. Risks include bleeding, anesthesia complication, bowel perforation, and infection. Although complications can occur with nasally placed tubes, they are much less common. If a feeding tube is required short term (i.e. less than 4 - 6 weeks), a nasally placed tube is the preferred method.

Which of the following is important for an elderly patient who is receiving a high protein enteral formula? 1: Checking weekly weights 2: Providing goal volume of formula each day 3: Providing adequate free water each day 4: Ensuring adequate bowel movements

3. Tube feeding syndrome is related to the use of high-protein tube feedings without adequate fluid provision. Inadequate fluid delivery results in an inability to sufficiently excrete the solute load which can lead to the development of azotemia, hypernatremia, and dehydration. A reduction in protein may be necessary if the ability to excrete byproducts of protein metabolism during adequate fluid provision is compromised.

On day 7 of admission, the primary care team requested an evaluation of the protein dose provided by the enteral nutrition. Enteral nutrition was the patient's sole source of nutrition and provides 136 grams (1.5gm/kg) protein per day. What is the best method to assess protein requirement and adequacy? 1: Grams protein/kg body weight 2: Pre-albumin level 3: Nitrogen balance study 4: Wound healing

3. nitrogen balance Wound healing may serve as a long-term indicator that protein needs are being met but is not effective in the acute setting. nitrogen balance = gold standard. Many factors can affect its accuracy including renal dysfunction, errors in estimating intake/output or ostomy losses.

Lactose is a common ingredient in which type of enteral formula? 1: Semi-elemental adult formula 2: Standard adult formula 3: Standard infant formula 4: Elemental infant formula

3. standard infant formula Lactose is routinely used in standard infant formula to mimic the carbohydrate found in human milk. Most adult medical nutritional products are lactose-free due to the prevalence of lactose intolerance in many populations and because lactase production may be decreased during illness.

Daily fluid requirements in an afebrile enterally fed patient can be estimated using ______ mL/kg or _____ kcal/mL.

30-40 1

An oral or nasoenteric small bore feeding tube is usually indicated when duration of EN therapy is anticipated to be less than ___ weeks

4

Exceptions include administration sets for human breast milk (change every _____ hours)

4

hang time: Hang time is limited to ___ hours at room temperature for reconstituted powdered formulas

4

Human breast milk (HBM) should have a hang time of no longer than ___ hours. In addition, administration sets used for HBM should be ___ DEHP free and the tubing and syringe should be changed every 4 hours.

4 should be di(2-ethylhexyl) phthalate (DEHP) free and the tubing and syringe should be changed every 4 hours. HBM for hospitalized neonates, infants, and children should be prepared in a clean environment using aseptic technique by specially trained personnel. Current recommendations also support the use of gloves during HBM administration.

Short term feeding tubes should be changed every ___-___weeks.

4-6

In critically ill patients receiving early enteral nutrition (EN), which is most likely to improve nutrient delivery? 1: Use of small bowel feeding 2: Use of a standard EN feeding protocol 3: Use of gastric feeding 4: Use of a volume-based EN feeding protocol

4.

Which of the following is LEAST likely to facilitate transpyloric placement of a nasoenteric feeding tube? 1: Endoscopic placement 2: Bedside electromagnetic imaging system 3: Fluoroscopic Placement 4: Weighted tube tips

4. Both fluoroscopic and endoscopic placements have the highest percentage of successful transpyloric passage. Bedside electromagnetic imaging systems have shown greater than 90% success with placement.

Which is considered appropriate management of hypergranulation around the PEG site? 1: Keeping the area dry 2: Using a tube stabilizing device 3: Applying an occlusive dressing 4: Cauterization with silver nitrate

4. Granulation tissue often forms within the tract and may grow out onto the surface of the skin around the PEG tube. Although this does not usually cause excessive exudate and drainage, it is a source of moisture underneath the bolster, which can lead to breakdown of the skin. The hypergranulation tissue may be trimmed with scissors and then treated with silver nitrate sticks or any other cautery device.

Which of the following represents modular products? 1: Safflower oil, protein, glucose, and selenium 2: Glucose, glutamine, water, and MCT oil 3: Protein, cholecalciferol, fiber, and safflower oil 4: MCT oil, glucose, fiber, and protein

4. Modular products are typically single-nutrient products and are available for use in addition to the selected oral or enteral regimens. They increase the protein, calorie, or fiber content of the feeding regimen. Vitamins, minerals, and water are required nutrients but are not considered modular products.

The use of enteral nutrition formulas enriched with branched-chain amino acids may benefit patients with 1: cirrhosis. 2: hepatic failure. 3: liver transplantation. 4: refractory encephalopathy.

4. it has been suggested that the use of these hepatic formulas be limited to patients with encephalopathy that is unresponsive to standard medical therapy (i.e. lactulose, non-absorbed antibiotics).

An enterally fed patient reports nausea and vomiting. If delayed gastric emptying is suspected as the causative factor, which of the following is LEAST likely to improve the patient's symptoms? 1: Reduce or discontinue narcotic medications 2: Switch to a low fat enteral formula 3: Reduce the rate of enteral nutrition infusion 4: Use a more concentrated enteral formula

4. the etiology of nausea and vomiting is multifactorial, delayed gastric emptying is a common source of tube feeding intolerance. Reduction or discontinuation of narcotic meds, use of low fat formulas, administering enteral formula at room temperature and reducing the rate and/or volume of tube feeding infusion may all improve gastric emptying and reduce the symptoms of N/V. Concentrated solutions generally contain more fat and can further contribute to enteral intolerance by presenting a higher osmotic load to the GI tract.

A patient with acute respiratory distress syndrome (ARDS) receiving enteral nutrition will benefit most from 1: supplemental arginine. 2: formulas containing omega-6 fatty acids. 3: formulas containing omega-3 fatty acids. 4: avoidance of overfeeding.

4. avoidance of overfeeding

Which is a benefit of using an electromagnetic placement device for nasogastric tube placement? 1: pH can be monitored 2: Checks the tip position relative to the pylorus 3: Provides a 3-dimensional localization 4: Shows a time-delayed perspective of the tube tip

Electromagnetic placement for NGT placement. The display shows a real-time perspective of the tube tip location with a 3-dimensional localization. pH is not monitored in this placement technique. The receiver is placed on the patient at the xiphoid process, therefore the magnet follows the tip placement relative to the lower esophageal sphincter, not the pylorus.

most important factors to assess adequacy of tube feeding in pregnancy

Maternal weight gain and fetal growth are the most important factors in assessing the adequacy and efficacy of enteral tube feedings in pregnancy

important factor in assessing adequate protein

Positive nitrogen balance is important in assessing provision of adequate protein.

t/f: the risk of refeeding should not delay EN initiation

T A patient thought to be at refeeding risk should be advanced slowly to goal regimen with frequent monitoring of electrolytes.

In patients with pancreatitis, which of the following parameters would be LEAST important in predicting tolerance of enteral feedings? 1: APACHE II score 2: Duration of NPO 3: Abdominal pain 4: Triglyceride level

TG level The most influential factor in determining tolerance of enteral nutrition in pancreatitis is disease severity as measured by APACHE II scores. Duration of NPO is also important as studies have shown poor tolerance in patients NPO for greater than or equal to 6 days prior to initiation of enteral feeding. Increasing abdominal pain is a clinical indication of enteral feeding intolerance in pancreatitis. Serum triglyceride levels are routinely used to measure tolerance of parenteral rather than enteral nutrition.

The osmolality of gastrointestinal secretions is approximately _____ mOsm/kg.

The osmolality of gastrointestinal secretions is approximately 300 mOsm/kg. A formula that is isotonic would have a similar osmolality to gastrointestinal secretions. 1.0 kcal/mL (300-350 mOsm/kg), 1.2 kcal/mL (400-450 mOsm/kg) 1.5 kcal/mL (500-650 mOsm/kg) 2 kcal/mL (700-800 mOsm/kg).

hospital formulas should be stored at ___ degrees C

To prevent microbial growth and contamination, hospital prepared formulas should be stored at 4° C (39° F). The danger zone for food contamination falls between 5 and 57 degrees Celsius (41° and 135° F).

____ containing formulas may increase risk for physical drug interactions

fiber

constipation meds with anticholinergic effects

medications that slow peristalsis (i.e. pain relievers, anticholinergics) -narcotics or diphenhydramine have well-documented anticholinergic effects often resulting in constipation

t/f Elevating the head of the bed to a sitting position, having the patient flex his head slightly forward once the tube tip is in the posterior nostril, and asking the patient to swallow small sips of water are all interventions utilized to prevent respiratory misplacement. Proper patient positioning during insertion narrows the airway passage to facilitate esophageal placement. Having the patient swallow during insertion decreases the risk of placing tube into the larynx. IV metoclopramide is a prokinetic agent that may assist with transpyloric tube passage.

t

t/f Placement of a direct PEJ has less potential for migration or flipping back into the stomach compared to the PEG-J method. Although gastric outlet obstruction may occur more in the PEG-J method by virtue of it crossing the pylorus, this is not the primary advantage of using direct PEJ. Bleeding risk is no different between methods. The ability to place a PEG-J depends on the skill and training of the endoscopist.

t

t/f Provided adequate transillumination is found during endoscopy, partial gastrectomy, prior PEG, and obesity are not contraindications to placement.

t

t/f The instilling of air into gastric feeding tubes is useful for increasing negative pressure when drawing GRV from small bore feeding tubes.

t

t/f Many liquid medications are hyperosmolar which can lead to diarrhea and/or may have high viscosity which can lead to tube clogging, so liquid dosage forms should be diluted with water prior to administration.

true

t/f Recent studies suggest that radiographic confirmation of placement may not be required when electromagnetic imaging technology is utilized for placement. Auscultation, pH testing, aspiration and capnography still require radiographic confirmation.

true

t/f jejunal feeding may be beneficial to patients with gastroparesis, post Whipple, and chronic pancreatitis.

true