Enteral nutrition ?'s
Put in order 1) Perform hand hygiene. Apply clean gloves. Draw up 30 mL of air into syringe, then attach to end of feeding tube. Flush tube with 30 mL of air. 2) Draw back on syringe and obtain 5 to 10 mL of gastric aspirate. Observe appearance of aspirate. 3) Measure pH of aspirate. Compare the color of the strip with the color on the chart provided by the manufacturer. 4) Discard used supplies, remove gloves and discard, and perform hand hygiene.
1, 2, 3, 4
a client is receiving an enteral feeding that delivers 1.5 calories/mLthe feeding is infusing at 30 ml/hr via a feeding pump.which is the maximal amount of calories the client should receive in an 8-hour period if the tube feeding is not interrupted?
360 calories rationale:multiply the milliliters per hour by the calories per milliliter.then, using the ratio/proportion method, determine teh maximal number of calories the client should receive in an 8-hour period30 mL/hr x 1.5 calories/mL = 45 calories in 1 hour45 calories : 1 hour :: x calories : 8 (hours)x= 360 calories
A group of nursing students are studying together. They are discussing the differences between parenteral and enteral nutrition. Which statement, if made by one of the students, indicates further instruction is needed? A) "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." B) "Enteral nutrition is preferred because it is less expensive than parenteral nutrition and maintains functioning of the gut." C) "An example of the parenteral route is subcutaneous or IM injections, or the IV route." D) "Gastric feedings may be given to patients with a low risk of aspiration. If there is a risk of aspiration, jejunal feeding is the preferred method. Parenteral nutrition is provided if the patient's GI tract is nonfunctional."
A
A patient had an NG feeding tube inserted 1 week ago. You notice that the patient's nasal mucosa is inflamed, and the patient complains of pain at the site of insertion. The other naris appears patent with intact skin. What is the best action to take at this time? A) Call the health care provider; get an order to remove the feeding tube and insert a new feeding tube in the opposite naris. B) Remove the feeding tube and reinsert it in the opposite naris. C) Apply triple antibiotic ointment at the site of insertion and leave the tube in place. D) Medicate the patient for pain and stop using the feeding tube.
A
A patient with lung cancer has a feeding tube to help meet nutritional needs because of difficulty swallowing since radiation treatments. The patient requests some pain medication. The patient has an order for morphine, 5 mg IV push, every 2 hours as needed, or MS Contin (extended-release morphine tablet) PO 30 mg every 8 hours as needed. The nurse returns with the injectable form to be administered IV. The patient seems upset by this, stating, "I take a morphine pill for pain; why are you bringing me a shot?" What is the nurse's best response? A) "This is the same medication only in a form that I can administer through your IV line. The pill form you took at home should never be crushed, so I am unable to administer it through your feeding tube." B) "Your health care provider has ordered pain medication that may be administered either IV or through your feeding tube. It is easier to administer the pain medication through your IV." C) "This is the same medication you have taken at home only in a form that I can administer through your IV. It will take effect quicker than if I crushed your medication and administered it through your feeding tube." D) "I have brought you pain medication that can be administered through your IV, but if you prefer to have the pill form, I can go get it."
A
For intestinal placement of a feeding tube, in what position should the nurse place the patient while waiting for radiological confirmation of correct placement? A) On the patient's right side B) In a high-Fowler's position C) In a left lateral position D) Lying flat
A
The nurse observes a confused patient pulling at her NG feeding tube. As the nurse retapes the tube to the bridge of the patient's nose, the nurse notices that the mark on the tube has moved away from the naris. What action should the nurse take? A) Advance the tube until the mark is even with the naris and verify correct tube placement. B) Secure the tape on the patient's nose well with the tube in the current location. C) Remove the tube. D) Restrain the patient's hands before leaving the room. E) Pull back on the tube.
A
The nurse suspects the patient's feeding tube has migrated. Which of the following would indicate the greatest risk related to tube migration? A) Dyspnea and decreased oxygen saturation B) Pain and gastric aspirate hemoccult positive C) Absence of bowel sounds D) Inability to flush the feeding tube
A
The patient is receiving a continuous enteral feeding. Which of the following assessment findings would require follow-up? A) Gastric residual of 275 mL B) Bowel sounds present in all 4 quadrants C) pH of gastric contents 5.0 D) Less than 10 mL of aspirate from NI tube
A
Which of the following is an appropriate nursing action to prevent a complication of NG tube feedings? A) Keep the head of the patient's bed elevated at least 30 degrees B) Leave the feeding tube unclamped and unplugged between feedings C) Allow the syringe to empty of feeding before adding more to the syringe D) Change the feeding tube bag and tubing every 72 hours for a continuous feeding
A
Which of the following nursing actions helps reduce the risk of aspiration? A) Elevating the head of the patient's bed. B) Performing nasotracheal suctioning before instilling a tube feeding. C) Encouraging the patient to deep breathe and cough. D) Keeping the patient well-hydrated.
A
Which of the following pH test results on the aspirate of a patient who receives intermittent feedings indicates that the feeding tube is in the stomach? A) pH of 1 to 5 B) pH of 6 or greater C) pH greater than 5 D) pH of 0 to 11
A
Identify signs and symptoms of accidental respiratory migration of a feeding tube. (Select all that apply.) A) Coughing B) Choking C) Decreased pulse oximetry D) Sore throat E) Distention
A, B, C
Identify the appropriate times to verify enteral tube placement by pH testing. (Select all that apply.) A) Before each intermittent feeding B) At least once every 6 hours during continuous feedings C) Before administration of medications through the tube D) Immediately after administration of medications through the feeding tube
A, B, C
When should placement of a feeding tube be verified? (Select all that apply.) A) Before administering formula through the tube B) Before administering medications through the tube C) Before administering water through the tube D) At least once every 6 hours when continuous feedings are given E) If the patient is complaining of a sore throat F) Only when the health care provider orders it
A, B, C, D
The patient is presently receiving intermittent tube feedings of 120 mL every 6 hours. The health care provider's orders state: Jevity formula feeding 240 mL every 6 hours per feeding tube, increase per patient tolerance. Which of the following assessment data indicate patient intolerance of the tube feeding and therefore inability of the rate to be increased? (Select all that apply.) A) Diarrhea B) Abdominal distention and discomfort C) Nausea D) Flatulence E) Thirst F) Residual volume greater than 250 mL
A, B, C, F
Which of the following patients may benefit from enteral nutrition? (Select all that apply.) A) A patient who has a brain injury B) A patient with oral cancer C) A patient with paralytic ileus D) A patient with burns of the lower extremities
A, B, D
For safe administration of oral medications through a feeding tube, specific attention must be paid to: (Select all that apply.) A) Proper placement of the tube B) The patient's weight C) Whether the medication can be crushed for administration through the tube D) The patient's electrolyte status
A, C
Enteral feedings may be administered by: (Select all that apply.) A) Continuous feeding pump B) Through a large vein C) Intermittent gravity drip D) Large-bore syringe (bolus) E) Through a central vascular access device
A, C, D
The nurse is teaching a program on healthy nutrition at the senior community center. Which points should be included in the program for older adults? Select all that apply. A) Avoid grapefruit and grapefruit juice, which impair drug absorption. B) Increase the amount of carbohydrates for energy. C) Take a multivitamin that includes vitamin D for bone health. D) Cheese and eggs are good sources of protein. E) Limit fluids to decrease the risk of edema.
A, C, D
You have inserted an NG feeding tube. The patient vomited during insertion and continues to gag. What action(s) should you take? (Select all that apply.) A) Suction airway as needed. B) Place patient in high-Fowler's position. C) Remove feeding tube. D) Position patient on side. E) Contact health care provider for possible chest x-ray. F) Have patient sip ice water.
A, C, D, E
The nurse is attempting to administer medication through a feeding tube but is unable to do so because of a blockage in the tube. What action(s) should the nurse take? (Select all that apply.) A) For a newly inserted tube, notify health care provider and obtain x-ray confirmation of positioning. B) Clamp the tube and try again at a later time. C) For an established tube, attempt to flush tube with large-bore syringe and warm water. D) Soak the end of the tube in warm water. E) If unable to flush, contact health care provider for replacement of tube and potential need to reroute medication. F) Have the patient place the chin to the chest and swallow.
A, C, E
Which of the following are accurate statements related to the use of water and administering medication through a feeding tube? (Select all that apply.) A) Cold water should be avoided as it may cause abdominal cramping. B) Tap water as hot as possible should be used to enable the medications to dissolve. C) The feeding tube should be flushed with 10 mL of water after each medication is administered. D) Patients who receive tube feedings do not require water. E) The feeding tube should be flushed with 30 to 60 mL of water after the last medication. F) Any time water is administered through the feeding tube, the amount should be documented on the intake and output record.
A, C, E, F
A patient has a nasogastric feeding tube. The nurse is aware of the need to monitor the patient for potential complications. Which of the following symptoms, if demonstrated by the patient, would potentially indicate the greatest risk related to tube feedings? A) Diarrhea B) Dyspnea C) Abdominal distention D) Throat irritation
B
If the nurse suspects the NG feeding tube has migrated, the nurse should: A) Instill 10 mL of water into the feeding tube, reinsert the stylet, and reposition the tube. B) Stop any enteral feedings and obtain an order for a chest x-ray to determine placement. C) Irrigate the tube with tap water. D) Reposition the patient from side to side.
B
The health care provider has ordered an enteral feeding tube for an elderly patient. Which statement if made by the patient's family member indicates further instruction is needed? A) "The enteral feedings will help provide additional calories." B) "The tube feedings are used to improve digestion." C) "This will help prevent her from getting pneumonia again from choking." D) "Tube feedings are less likely to cause infection than getting nutrients by IV infusion."
B
The nurse attempts to aspirate gastric contents from an established NG feeding tube and obtains no return. What action should the nurse take? A) Document the finding. B) Reposition the patient. C) Assume that the tube is in the appropriate place and start the tube feeding. D) Get an order for a chest x-ray to verify placement before administering the tube feeding.
B
The nurse is inserting an NG feeding tube for the first time. Which action, if made by the nurse, indicates further instruction is needed? A) The nurse dips the end of the tube into a glass of water to activate the lubricant. B) The nurse has the patient flex the head as the tube is inserted into the naris. C) The nurse aims back and down toward the ear. D) The nurse advances the tube as the patient swallows.
B
The nurses are discussing feeding tube migration and prevention. Which of the following statements indicates correct understanding? A) As long as the external portion of a feeding tube is taped in place, the tube will be unable to migrate out of position. B) A feeding tube can enter the airway without causing obvious respiratory symptoms. C) The nurse should have the patient deep breathe and cough and suction the patient frequently. D) The nurse should keep the head of the bed flat to reduce the risk of tube migration.
B
The patient begins to cough and choke as the nurse is inserting the NG tube. What is the best action for the nurse to take at this time? A) Pull the feeding tube out and start over in the opposite naris. B) Pull the tube back and attempt to reinsert. C) Instruct the patient to take small sips of water and swallow. D) Auscultate over the carina.
B
Which of the following may be delegated to NAP? A) Administering medication through a feeding tube B) Administering a tube feeding C) Verifying feeding tube placement D) Inserting an NG feeding tube
B
A patient is receiving a continuous enteral feeding by infusion pump. The nurse enters the patient's room to verify tube placement and measure residual. The nurse notices the patient's respirations are shallow and rapid and that the patient's color is ashen. The nurse notes rhonchi upon auscultation, and the patient appears to be coughing up sputum of a color similar to the formula feeding. What action(s) should the nurse take? (Select all that apply.) A) Administer oxygen. B) Turn off the tube feeding. C) Have the patient deep breathe and cough. D) Position the patient in Fowler's position and suction the patient. E) Position patient on the left side and suction the patient. F) Notify the health care provider. G) Prepare for chest x-ray examination.
B) Turn off the tube feeding D) Position the patient in Fowler's position and suction the patient F) Notify the healthcare provider G) Prepare for chest xray examination
a client who has recently been started on enteral feedings begins to complain of abdominal cramping, followed by passage of two liquid stools.the nurse notes that the client has abdominal distention as well.the nurse reviews the nutritional content on the label of the can to see if it contains which ingredient? A) maltose B) lactose C) sucrose D) fructose
B) lactose rationale: several tube feeding formulas contain lactose.a client with an unreported history of lactose intolerance would develop symptoms such as these in response to nutritional therapy with these formulas.if the client is diagnosed as lactose intolerant, a lactose-free formula should be prescribed by the health care provider.this will resolve the client's symptoms and promote adequate nutrition for the client
a caregiver states that the client eats only about 25% of the food that is offered and seems to be losing weight.the caregiver asks the nurse about feeding the client by a tube into the stomach.which initial response by the nurse would be appropriate? A) tube feedings are only for long-term feeding problems B) tube feedings can provide adequate amounts of required nutrients C) tube feedings often result in complications such as aspiration pneumonia. D) tube feedings are not helpful in cases of intractable vomiting or severe diarrhea
B) tube feedings can provide adequate amounts of required nutrients rationale: weight loss and a dietary intake of only 25% indicate that alternative sources of nutritional intake should be soughttube feeding is an alternative for temporary or permanent nutritional maintenance.enteral tube feedings are generally safer and significantly less costly than peripheral or parenteral nutritionoption A is incorrect because tube feedings are often temporary measures.option C may be correct; however, it is not the best response to a caregiver seeking initial informationoption D is unrelated to the situation of this question
The nurse is inserting an NG feeding tube. Which of the following supplies will the nurse need to perform the procedure? (Select all that apply.) A) Saline nasal spray B) 8 to 12 Fr feeding tube C) 60 mL syringe D) Stethoscope E) Tube fixation device F) Tincture of benzoin G) Sterile specimen cup H) Cup of water/straw
B, C, D, E, F, H
The health care provider just left the patient's room after explaining the options of NG or NI feeding tube placement. A student asks a nurse about the differences between nasogastric and nasointestinal feedings. Which of the following are accurate statements made by the nurse? (Select all that apply.) A) Insertion of an NG tube requires clean gloves, whereas insertion of an NI tube requires sterile gloves. B) Gastric aspirate is expected to have a lower pH than intestinal aspirate. C) The advantage to an NI tube is that there is less risk for aspiration. D) NI tubes are used for patients with nasal problems such as nosebleeds or deviated septums. NG tubes are used for patients without nasal problems. E) Both NG and NI tubes are usually used for less than 30 days.
B, C, E
The nurse aspirates stomach contents from a newly inserted feeding tube. The nurse is aware the patient has been on the proton-pump inhibitor omeprazole (Pepcid). The pH strip reads "3." Where should the nurse expect the x-ray to determine placement of the feeding tube? A) In the lungs B) In the esophagus C) In the stomach D) In the small intestine
C
The nurse is going to administer an intermittent tube feeding. Since the patient's feeding tube has been in place for 3 days, which action is best for the nurse to take at this time? A) Obtain an order for x-ray verification of tube location. B) Auscultate over the gastric area while instilling 30 mL of air into the feeding tube. C) Aspirate gastric contents and test on a pH strip. D) Verify the indelible ink mark on the tube is at the nares.
C
The nurse is going to irrigate the patient's established feeding tube with 30 mL of tap water before instilling the tube feeding. The nurse attempts to do so without success. What should action should the nurse take? A) Notify the health care provider. B) Irrigate the tubing with soda, such as Coca-Cola. C) Reposition the patient. D) Use a smaller-sized syringe with the plunger to push the fluid through the feeding tube.
C
The nurse is reading the health care provider's orders to increase the rate of the patient's NG feeding. Which of the following orders should the nurse question? A) Isocal 150 mL per feeding tube every 4 hours, increase by 50 mL per feeding per day until total volume is achieved to meet patient's caloric needs according to dietician's referral. B) Finger-stick blood glucose every 6 hours until maximum administration rate is achieved and maintained for 24 hours. C) Advance tube feeding rate by 100 mL/hr every 8 to 12 hours to target rate of 250 mL/hr over 12 hours. D) Weigh patient daily until maximum administration rate is reached and maintained for 24 hours, then weigh patient 3 times per week.
C
The nurse just inserted an NG feeding tube. The health care provider's order states to administer all meds per tube and a continuous feeding of Isocal at 30 mL per hour. The order also states to check the patient's blood glucose every 6 hours. When can the nurse begin to instill feedings, water, or medications through the feeding tube? A) Immediately after placement is verified by pH testing B) When the patient's blood glucose is verified to be within normal limits C) When tube placement has been verified by x-ray film D) After administering 30 mL of water, the medications may be given, followed by another 30 mL of water, and then the continuous feeding may be initiated.
C
Why is it important to have the tube feeding at room temperature? A) It is unnecessary to keep the tube feeding cold because it will be hanging at room temperature anyway. B) It aids the speed of digestion. C) Cold formula can cause gastric cramping. D) Cold formula may lower the patient's body temperature.
C
the nurse is preparing to administer an intermittent tube feeding to a client.the nurse aspirates 90 mL of residual tube feeding.which action should the nurse take with the aspirated residual? A) contact the health care provider B) flush it down the toilet and hold the feeding C) reinstill the residual and administer the feeding D) deduct the amount of the residual from the new feeding and administer that amount to the client
C) reinstill the residual and administer the feedingrationaleunless otherwise instructed (or per agency policy) a residual amount of less than 100 mL may be reinstilled and the prescribed amount of tube feeding administered.it is important to return the contents to the stomach to prevent electrolyte imbalances.therefore the other options are incorrect
Which of the following, if exhibited by the patient, may increase the risk for spontaneous enteral tube dislocation? (Select all that apply.) A) Nausea B) Ambulation C) Vomiting D) Frequent nasotracheal suctioning E) Severe bouts of coughing H2 antagonists
C, D, E
Which of the following medications should never be given through a feeding tube? (Select all that apply.) A) Liquid medications B) Elixirs C) Sublingual tablets D) Enteric-coated (EC) E) Sustained release (SR) F) Extended release (XR) G) Long acting (LA) H) Large tablets or pills
C, D, E, F, G
A patient is receiving a continuous enteral feeding by infusion pump. The nurse enters the patient's room to verify tube placement and measure residual. The nurse notices the patient's respirations are shallow and rapid and that the patient's color is ashen. The nurse notes rhonchi upon auscultation, and the patient appears to be coughing up sputum of a color similar to the formula feeding. What action(s) should the nurse take? (Select all that apply.) A) Ask if the patient feels short of breath. B) Administer oxygen. C) Turn off the tube feeding. D) Have the patient deep breathe and cough. E) Position the patient in Fowler's position and suction the patient. F) Position patient on the left side and suction the patient. G) Notify the health care provider. H) Prepare for chest x-ray examination.
C, E, G, H
The nurse is going to administer a bolus enteral tube feeding of 240 mL. The nurse has obtained a pH of 4 and 50 mL of gastric aspirate. Based on these findings, what action should the nurse take? A) Stop the feeding and recheck the residual in one hour. B) Reposition the feeding tube under fluoroscopy. C) Discard the aspirate and continue with the bolus feeding as prescribed. D) Return the aspirate to the patient's stomach and administer the feeding.
D
The patient's wife is watching as the nurse prepares to insert a small bore feeding tube. She asks the nurse, "What is the purpose of the guide wire?" The nurse correctly responds: A) "Because placement must be verified by a chest x-ray, the guide wire is used to determine correct placement when it shows up on radiography." B) "To keep the patient from pulling the tube out as readily." C) "To serve as a guide to determine when the correct length of tubing has been inserted." D) "Because feeding tubes are flexible, a guide wire or stylet is used to provide rigidity that facilitates positioning."
D
The student nurse is preparing to administer medication through a feeding tube. Which of the following statements if made by the student nurse indicates correct understanding? A) "I will perform hand hygiene. Gloves are only necessary for tube insertion, not medication administration." B) "The head of the bed should be kept flat during medication administration." C) "I will aspirate gastric contents to check placement of the feeding tube and residual volume and then I will dispose of the aspirate properly." D) "I will flush with 10 mL of tap water after each medicine and with 30-60 mL of water after the last medication."
D
Which of the following accurately describes the greatest risk related to having a feeding tube? A) Electrolyte imbalance B) Fluid volume overload C) Infection D) Aspiration
D
a client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia.the health care provider inserts a nasogastric tube and prescribes a tube feeding of a standard formula feeding to run at 50 ml/hrthe nurse plans care, knowing that which is true regarding enteral feedings? A) enteral feedings are a frequent cause of sepsis B) tube feedings should be refrigerated until just before use C) the caloric value of enteral feedings is generally 5 to 10 kcal/ml D) enteral feedings require the normal digestive capabilities of the GI tract
D) enteral feedings require the normal digestive capabilities of the GI tract rationale: enteral nutrition can include providing nutrients by mouth, nasogastric tube, gastrostomy tubes or a percutaneous endoscopic gastrostromy tube (PEG tube)the common element in each of these methods of delivery is that the client must have normal GI digestive capabilitiesif the client does not have a normal GI tract, other methods of nutrient delivery must be sought, such as parenteral nutrition.enteral feedings may cause aspiration pneumonia because of regurgitation of formula into the lungs; however, they are not generally associated with sepsis.tube feedings should be given at room temperature to avoid problems with diarrhea.the caloric value of most standard enteral feeding formulas is 1 to 2 kcal/ml
a client receiving enteral feedings develops abdominal distention and diarrhea shortly after initiation of the feedings. in review of the nursing history for this client, which of these notations indicates the need to notify the health care provider? A) difficulty swallowing B) history of hemorrhoids C) history of enteral feedings D) lactose intolerance since childhood
D) lactose intolerance since childhood rationale: lactose intolerance would require the client to be placed on a lactose-free formula.the primary health care provider would be notified to change the prescribed enteral solution.the other options are unrelated to the client's problem.
a client in a long-term care facility is being prepared to be discharged to home in 2 days. the client has been eating a regular diet for a week, yet is still receiving intermittent enteral tube feedings and will need to receive these feedings at home.the client states concern about not being able to continue the tube feedings at home. which nursing response would be appropriate at this time? A) do you want to stay in the nursing home a few more days? B) have you discussed your feelings with your health care provider? C) you need to talk to your health care provider about these feelings D) tell me more about your concerns with your feelings after going home.
D) tell me more about your concerns with your feelings after going home. rationale: a client often has fears about leaving the secure, cared-for environment of the health care facility.this client has a fear about not being able to provide self-care at home and not being able to handle the tube feedings at home.an open communication statement such as "tell me more about...." often leads to valuable information and the client's concerns.the other options are nontherapeutic statements
Match the type of feeding with the patient condition: Parenteral nutrition Jejunostomy tube NG feeding tube 1) Patient with burns who cannot consume enough calories orally 2) Patient with difficulty swallowing after having a CVA and will need long-term nutritional support. 3) Patient with malabsorption syndrome.
Parenteral nutrition - 3 Jejunostomy tube - 2 NG feeding tube - 1
