Digestive and Gastrointestinal Treatment Modalities
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
The nurse administers a tube feeding to a client via the intermittent gravity drip method. The nurse should administer the feeding over at least which period of time?
30 minutes
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 primary source of microorganisms for catheter-related infections are the skin and which of the following?
Catheter hub
The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is
loose, watery stools.
Semi-Fowler position is maintained for at least which timeframe following completion of an intermittent tube feeding?
1 hours (60 min)
The nurse is to insert a postpyloric feeding tube. How can the nurse aid in placement of the tube past the pylorus?
administer prescribed metoclopramide
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."
The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every
shift
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.
The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion?
Allow the patient to sip water as the tube is being inserted.
A client is receiving a parenteral nutrition admixture that contains carbohydrates, electrolytes, vitamins, trace minerals, and sterile water and is now scheduled to receive an intravenous fat emulsion (Intralipid). What is the best action by the nurse?
Attaches the fat emulsion tubing to a Y connector close to the infusion site
A client had a central line inserted for parenteral nutrition and is awaiting transport to the radiology department for catheter placement verification. The client reports feeling anxious and has a respiratory rate of 28 breaths/minute. What is the next action of the nurse?
Auscultate lung sounds
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.
The nurse attempts to unclog a client's feeding tube. Attempts with warm water agitation and milking the tube are unsuccessful. The nurse uses evidence-based practice principles when subsequently using which technqiue to unclog the tube?
Digestive enzymes and sodium bicarbonate
When assessing whether a client is a candidate for home parenteral nutrition, what would be important to address? Select all that apply.
Family support Motivation for learning Health status Telephone access
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.
The client is receiving a 25% dextrose solution of parenteral nutrition. The infusion machine is beeping, and the nurse determines the intravenous (IV) bag is empty. The nurse finds there is no available bag to administer. What is the priority action by the nurse?
Infuse a solution containing 10% dextrose and water.
The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length?
The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process
The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly?
Keep the vent lumen above the patient's waist to prevent gastric content reflux.
When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration?
Keeping the client in a semi-Fowler's position at all times.
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 would make a recommendation when noticing which circumstance?
No land line; cell phone available and taken by family member during working hours
A nursing instructor is preparing a class about gastrointestinal intubation. Which of the following would the instructor include as reason for this procedure? Select all that apply.
Remove gas and fluids from the stomach Flush ingested toxins from the stomach Diagnose gastrointestinal motility disorders Administer nutritional substances
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 is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred?
The nurse has inadvertently inserted the tube into the trachea.
The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.)
Until bowel sound is present Until flatulence is passed Until peristalsis is resumed
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
The client is receiving 50% dextrose parenteral nutrition with fat emulsion therapy through a peripherally inserted central catheter (PICC). The nurse has developed a care plan for the nursing diagnosis "Risk for infection related to contamination of the central catheter site or infusion line." The nurse includes the intervention
Wear a face mask during dressing changes.
The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). What actions would the nurse perform while the client receives PN? Select all that apply.
Weigh the client every day Check blood glucose level every 6 hours Document intake and output.
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
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
If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first?
clamp the catheter
A nurse providing care to a patient who is receiving nasogastric tube feedings finds that the tube is clogged. Which of the following would be least appropriate to use to unclog the tube?
cranberry juice
A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply.
daily weights intake and output monitoring calorie counts for oral nutrients
The nurse on an evidence-based practice council makes recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which situation?
daily when not in use
To ensure patency of central venous line ports, diluted heparin flushes are used
daily when not in use
A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply.
diarrhea tachycardia diaphoresis
The nurse prepares to administer all of a client's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes which type of oral medication on the client's medication administration record?
enteric-coated tablets
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
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. What is the first action the nurse should take?
flush with 10 ml of water
The nurse cares for a client who receivies continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct?
monitoring the feeding closely
Which venous access device can be used for less than 6 weeks in clients requiring parenteral nutrition?
non tunneled catheters
The nurse teaches an unlicensed caregiver about bathing clients who are receiving tube feedings. The most significant complication related to continuous tube feedings is the
potential risk for aspiration
A client has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube?
sterile water at 30 ml/h
The most significant complication related to continuous tube feedings is
the increased potential for aspiration
The nurse is inserting a sump tube in a patient with Crohn's disease who is suspected of having a bowel obstruction. What does the nurse understand is the benefit of the gastric (Salem) sump tube in comparison to some of the other tubes?
the tube is radiopaque
When preparing to insert a nasogastric tube, the nurse determines the length of the tube to be inserted. The nurse nurse places the distal tip of the tube at which location?
tip of the patients nose
Hickman and Groshong are examples of which type of central venous access device?
tunneled central catheters
The nurse monitors a client with nasoenteric intubation. When should the nurse contact the physician?
urinary output 20ml/hr
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
Residual content is checked before each intermittent tube feeding. The patient would be reassessed if the residual, on two occasions, was:
greater than 200mL
The nurse collaborates with the physician and dietician to determine the best type of tube feeding for a client at risk for diarrhea due to hypertonic feeding solutions. Which type of feedings should the nurse suggest?
continuous feedings
A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, what must the nurse remain alert for?
diaphoresis, vomiting, and diarrhea.
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
The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care?
provide frequent mouth care
Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the
Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.
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 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 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.
Rebound hypoglycemia is a complication of parenteral nutrition caused by
feedings stopped too abruptly.
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 health care provider orders the insertion of a single lumen nasogastric tube. When gathering the equipment for the insertion, what will the nurse select?
levin tube
