Module 5: Enteral Nutrition

When should placement of a feeding tube be verified? (Select all that apply.) a. before administering formula through the tube b. before administering medication through the tube c. before administering water through the tube d. only when the health care provider orders it e. if the patient is complaining of a sore throat f. at least once every 6 hours when continuous feeding are given

a, b, c, f

A patient has a medical history of cerebrovascular accident with impaired swallowing, stomach cancer with gastric resection, anemia, and hypertension. What route of feeding would you expect the patient to have? a. oral b. NG c. NI d. Parenteral

c. NI Rationale: NG is contraindicated due to stomach cancer; parenteral is not preferred over enteral feeding b/c enteral feeding is usually safer for the patients

A nurse is reviewing the policy for irrigating a feeding tube. What information should the nurse include that would address accurate principles of infection control when performing this procedure? (Select all that apply.) a. Sterile water may be required for patients who are critically ill. b. Perform hand hygiene and apply clean gloves to irrigate a feeding tube. c. Use only sterile water for irrigation. d. Tap water should not be used for feeding tube irrigation with neonates. e. Change irrigation bottle every 24 hours.

a, b, d, e

The nurse understands that irrigating a feeding tube helps prevent it from becoming clogged and clears the tubing of fluid. At what times is it appropriate to flush a feeding tube? (Select all that apply.) a. Before an intermittent feeding. b. After medication administration. c. Once a shift. d. Between medications. e. Before medication administration.

a, b, d, e

What are some factors that, if present, could place the patient at risk for tube dislodgement? a. retching and/or vomiting b. harsh coughing c. continuous tube feeding d. aspirating gastric contents e. frequent nasotracheal suctioning

a, b, e

The nurse inserted an NG feeding tube. Which of the following actions should be included in the nurse's evaluation of the procedure? (select all that apply.) a. auscultation of lung sounds b. determining patient's temperature and WBC count c. confirming x-ray results with PCP d. inspecting nasal mucosa e. observing patient for persistent gagging or coughing

a, c, d, e

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) Stop any enteral feedings and obtain an order for a chest x-ray to determine placement. Rationale: If the nurse observes signs of respiratory impairment, the feeding tube may have migrated from the stomach to the airway, or if the nurse obtains a larger amount of gastric residual, the tube may have migrated from the intestine to the stomach. The nurse should stop any enteral feedings, notify the health care provider, and prepare to obtain a chest x-ray film as ordered. A stylet should never be reinserted in a patient because this can cause perforation of the tube and injure the patient. Irrigating the tube with water would be appropriate if the tube were clogged. Turning the patient from side to side may help in obtaining aspirate.

TRUE/FALSE A health care provider's order is necessary to verify tube placement by pH testing.

FALSE Rationale: Although a health care provider's order is required for insertion and radiological verification of placement, it is unnecessary for routine verification of tube placement by pH testing. Testing the pH of aspirate is an expectation of competent nursing care of the patient with an enteral tube.

TRUE/FALSE As long as the patient does not demonstrate respiratory symptoms (choking, coughing, cyanosis), pH testing of aspirate is unnecessary.

FALSE Rationale: The absence of signs and symptoms of respiratory difficulty does not ensure nonrespiratory placement, especially in patients with decreased level of consciousness or altered cough and gag reflex.

Identify the patients who might benefit from enteral nutrition. Select all that apply. a. a patient with a massive bowel resection b. a patient who experienced a stroke and has difficulty swallowing c. A patient with muscular dystrophy d. a patient with paralytic ileus e. a patient with malabsorption syndrome f. A patient with cancer of the head and neck

b, c, f

TRUE/FALSE The nurse documented in the patient's medical record that the feeding tube was patent. This is reflected by the ability to easily instill fluid during tube irrigation.

TRUE Rationale: Tube patency means that it is open and flushes easily when fluid is instilled

Enteral feedings may be administered by (Select all that apply.) a. Continuous feeding pump. b. Intermittent gravity drip. c. Through a large vein. d. Intravenously. e. Through a central vascular access device.

a, b Rationale: Enteral feedings may be administered continuously using a feeding pump or intermittently by gravity drip. Enteral feedings should never be administered intravenously. Parenteral nutrition is administered through a large vein as with a central vascular access device.

Which of the following patients may benefit from enteral nutrition? (Select all that apply.) Select all that apply. a. A patient with oral cancer. b. A patient with paralytic ileus. c. A patient with burns of the lower extremities. d. A patient who had a CVA (stroke) and has dysphagia (difficulty swallowing). e. A patient who has a brain injury.

a, c, d, e Rationale: Patients with brain injury or an altered or reduced level of consciousness and patients with neuromuscular diseases who have a high incidence of aspiration may benefit from long-term enteral therapy. Patients with head or neck cancer may be candidates for enteral nutrition. A patient with paralytic ileus has a nonfunctional GI tract, and enteral nutrition is inappropriate. Some patients have an increased metabolism as a result of sepsis or burns and are unable to ingest enough calories to meet their bodies' metabolic needs. These patients may also benefit from enteral nutrition.

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. Thirst. c. Abdominal distention and discomfort. d. Nausea. e. Residual volume greater than 500 mL. f. Flatulence.

a, c, d, e Rationale: If the patient develops diarrhea 3 or more times in 24 hours, this indicates intolerance. Notify the health care provider and confer with the dietitian to determine the need to modify the type of formula, concentration, or rate of infusion. Tolerance is indicated by absence of nausea and diarrhea and by low gastric residuals. Residual volume indicates whether gastric emptying is delayed; 500 mL or more remaining in the patient's stomach may reflect delayed gastric emptying. Abdominal discomfort and distention may indicate intolerance to the tube feeding, possibly from too rapid an infusion. Flatulence and thirst do not indicate an intolerance to tube feeding.

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. tincture of benzoin b. saline nasal spray c. cup of water/straw d. 8-12 Fr feeding tube e. tube fixation device f. stethoscope g. 60-mL ENFit syringe h. sterile specimen cup

a, c, d, e, f, g

A patient is receiving 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 crackles on 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. Notify the health care provider. b. Ask if the patient feels short of breath. c. Have the patient deep breathe and cough. d. Suction the patient. e. Position patient on side. f. Turn off the tube feeding.

a, d, e, f Rationale: The patient has aspirated formula. The nurse should turn off the tube feeding immediately, position the patient in in a side-lying position, suction, and notify the health care provider. It is unnecessary to ask the patient about feeling short of breath because it is apparent. Having the patient deep breathe and cough will fail to help at this time.

A nurse is assessing a patient before irrigating a nasogastric tube and initiating enteral feeding. Which of the following, if noted, would be cause for concern? (Select all that apply.) a. Absent bowel sounds. b. Patient complaints of feeling hungry. c. Green-tinged gastric aspirate. d. Gastric residual volume 25 mL. e. "Coffee ground" appearance of gastric aspirate.

a, e Rationale: "coffee ground" appearance may be old blood, indicating GI bleeding

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. Restrain the patient's hands before leaving the room. c. Remove the tube. d. Pull back on the tube. e. Secure the tape on the patient's nose well with the tube in the current location.

a. Advance the tube until the mark is even with the naris and verify correct tube placement. Rationale: An increased external length of tube may indicate that the distal tip is incorrectly positioned. Using the tube in its current location could place the patient at greater risk for aspiration. The nurse needs to advance the tube until the mark reaches the patient's naris and then verify correct tube placement. It is unnecessary to remove the tube unless the nurse is unable to advance the tube the desired length. Pulling back on the tube will only increase the external length of the tube, thus preventing the tube from being inserted the desired depth.

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. Absence of bowel sounds. c. Inability to flush the feeding tube. d. Pain and gastric aspirate hemoccult positive.

a. Dyspnea and decreased oxygen saturation. Rationale: The risk for aspiration of regurgitated gastric contents into the respiratory tract is increased when the tip of a nasointestinal (NI) tube accidentally dislocates upward into the stomach or when the tip of either a nasogastric (NG) or NI tube dislocates upward into the esophagus. When a tube migrates to the lung, complications such as aspiration, pneumonia, pneumothorax, and peritonitis can develop if feedings are subsequently administered. Pain and gastric aspirate hemoccult positive would be symptoms indicating perforation and subsequent bleeding. The absence of bowel sounds is indicative of paralytic ileus. The inability to flush the feeding tube is indicative of clogging of the tube.

Which of the following is an appropriate nursing action to prevent a complication of nasogastric (NG) tube feedings? a. Keep the head of the patient's bed elevated at least 30 degrees. b. Change the feeding tube bag and tubing every 72 hours for a continuous feeding. c. Leave the feeding tube unclamped and unplugged between feedings. d. Allow the syringe to empty of feeding before adding more to the syringe.

a. Keep the head of the patient's bed elevated at least 30 degrees.

You are reviewing the patient's medical record. Which of the medications may alter the pH test results? a. Pepcid (famotidine) b. Levaquin (levofloxacin) c. feosol (ferrous sulfate)

a. Pepcid (famotidine) Rationale: H2 receptor antagonists reduce the volume of gastric acid secretion and the acid concentration of secretions

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. Reposition the patient. b. Use a smaller syringe with the plunger to push the fluid through the feeding tube. c. Irrigate the tubing with soda, such as Coca-Cola. d. Notify the health care provider.

a. Reposition the patient.

After a feeding tube is placed, all patients remain at risk for __________ and need careful nursing management to avoid this complication. a. aspiration b. parenteral c. jejunostomy d. enteral e. jejunal f. gastrostomy g. dehydration

a. aspiration

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 guidewire?" The nurse correctly responds: a. because feeding tubes are flexible, a guidewire or stylet is used to provide rigidity that facilitates positioning b. to keep the patient from pulling the tube out as readily c. because placement must be verified by a chest x-ray, the guidewire is used to determine correct placement when it shows up on radiography. d. to serve as a guide to determine when the correct length of tubing has been inserted

a. because feeding tubes are flexible, a guide wire or stylet is used to provide rigidity that facilitates positioning Rationale: The guide wire or stylet provides rigidity that facilitates positioning and is removed once correct placement is verified via a chest x-ray. The tip of the feeding tube contains a radiopaque material that will show up on the x-ray of the chest/abdomen to verify feeding tube placement. Once measured, tape or indelible ink is placed on the tube to indicate the length at which the nurse should stop inserting the tube.

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 1-5 b. pH of 1-11 c. pH of 6 or greater d. pH greater than 5

a. pH of 1-5

Confirmation of correct tube placement by x-ray examination is done _______________. a. upon insertion b. inappropriate c. appropriate d. aspiration e. bleeding

a. upon insertion

The nurse is gathering supplies to perform irrigation of a feeding tube. The nurse has a stethoscope and the patient has a towel. What other supplies are needed to perform the procedure? (Select all that apply.) a. Small-bore feeding tube. b. Clean gloves. c. Tap water or sterile water. d. Sterile gloves. e. Feeding pump. f. 60-mL ENFit syringe.

b, c, f

The health care provider's orders say to advance the intermittent tube feedings to 240 mL every 4 hours "as tolerated." Which of the following findings by you, the nurse, demonstrate that the tube feedings are being "tolerated" to increase the rate of infusion? a. Gastric residual of 400 mL b. Gastric residual of 30 mL c. Absence of constipation d. Absence of nausea e. Absence of diarrhea f. Increased abdominal girth

b, c, d Rationale: Tolerance is indicated by the absence of nausea and diarrhea and by low gastric residuals

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.) Select all that apply. a. Have patient sip ice water. b. Position patient on side. c. Contact health care provider for possible chest x-ray. d. Place patient in high-Fowler's position. e. Suction airway as needed.

b, c, e Rationale: Persistent gagging leads to vomiting with aspiration of GI contents. You should position the patient on the side, and suction the airway as needed. The health care provider should be contacted and consideration made of the need for an immediate chest x-ray film.

Identify signs and symptoms of accidental respiratory migration of a feeding tube. (Select all that apply.) a. Distention. b. Decreased pulse oximetry. c. Choking. d. Sore throat. e. Coughing.

b, c, e Rationale: Signs of respiratory distress such as paroxysms of coughing, choking, or persistent gagging; decreased pulse oximetry; cyanosis; or change in respiratory patterns (e.g., increase in rate) are symptomatic of accidental feeding tube migration into the airway. A sore throat may occur because of irritation by the feeding tube. Distention of the abdomen is not a symptom of accidental respiratory migration of a feeding tube.

A nursing instructor is reviewing the skill of irrigating a feeding tube with a group of nursing students. Which statement(s), if made by the nursing student, is(are) accurate, indicating learning has occurred? (Select all that apply.) a. "It is unnecessary to irrigate a feeding tube if the patient's medications are in liquid form." b. "Curdled enteral formula and improperly crushed medications are the most common causes of feeding tube occlusion." c. "Bowel sounds should be present if the patient is receiving tube feedings." d. "It is acceptable to delegate routine irrigation of a feeding tube to NAP." e. "It is unnecessary to irrigate nasoenteric feeding tubes; only nasogastric tubes require irrigation." f. "The patient should be placed in a high Fowler's or semi-Fowler's position for feeding tube irrigation."

b, c, f

A group of nursing students is 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. "An example of the parenteral route is subcutaneous or IM injections or the IV route." b. "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." c. "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." d. "Enteral nutrition is preferred because it is less expensive than parenteral nutrition and maintains functioning of the gut."

b. "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." Rationale: Enteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube. Parenteral nutrition is a form of specialized nutrition support in which nutrients are provided intravenously.

The nurse should verify tube placement and check for residual volume every ________ hours in patients who have a continuous enteral tube feeding. a. 72 b. 4 to 6 c. 24-48 d. 8 e. 12

b. 4 to 6

If a patient's gastric feeding tube has migrated to the lung, what would be the expected pH test result? a. 5 b. 6 c. 4 d. 0

b. 6 Rationale: Gastric contents of a patient who has been fasting for at least 4 hours would be expected to test at a pH of 1 to 4. Pleural fluid is at a pH of 6 or greater.

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. Cold formula can cause gastric cramping. c. It aids the speed of digestion. d. Cold formula may lower the patient's body temperature.

b. Cold formula can cause gastric cramping.

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. In a left lateral position b. On the patient's right side c. Lying flat d. In a high-Fowler's position

b. On the patient's right side Rationale: Placing the patient on the right side promotes passage of the tube into the small intestine (duodenum or jejunum).

The nurse is inserting an NG feeding tube. Which step in the procedure is inaccurate, indicating further instruction is needed? a. When tip of tube reaches carina, stop and listen for air exchange from distal portion of tube. Continue to advance tube until desired length has been passed. Check back of throat with a penlight and tongue blade. Check placement of tube. b. Perform hand hygiene and place patient in left lateral position. Determine length of tube from the xyphoid process to the tip of the patient's nose. Insert stylet into feeding tube. Inspect nares. Dip end of tube in ice water. c. Hand patient a cup of water with a straw. Gently insert the tube through the nostril to back of throat. Have patient flex head toward chest. Give small sips of water and advance the tube as patient swallows. Rotate tube 180 degrees while inserting. d. Mark exit site on tube with indelible ink. Apply tincture of benzoin to nose and allow to become "tacky." Remove gloves and apply stabilization device. Obtain an x-ray film to verify tube placement.

b. Perform hand hygiene and place patient in left lateral position. Determine length of tube from the xyphoid process to the tip of the patient's nose. Insert stylet into feeding tube. Inspect nares. Dip end of tube in ice water. Rationale: The patient should be placed in a high Fowler's or sitting position to reduce the risk of pulmonary aspiration in the event the patient vomits. If the patient is comatose, place in semi-Fowler's position. The nurse should first explain the procedure to the patient to gain cooperation and check the feeding tube for flaws that could injure the patient. The length of the tube to be inserted is determined by measuring the distance from the tip of the nose to the earlobe to the xiphoid process. Ten milliliters of water should be injected into the feeding tube to aid stylet insertion, and the stylet should be securely positioned against the weighted tip. The tube may be dipped in water, but not ice water because this would only make the tube less pliable for insertion.

The nurse is irrigating a nasogastric feeding tube after having verified tube placement by pH testing. The nurse draws up 30 mL of tap water into an ENFit syringe, removes the plug at the end of the tube, attaches the ENFit syringe, and slowly instills the irrigation solution. The nurse removes the syringe and plugs the end of the tube. What error occurred in the performance of this skill? a. There was no error; the nurse performed the skill correctly. b. The nurse failed to kink the tubing before connecting and removing the syringe from the end of the feeding tube. c. The nurse should have used sterile water from a container marked with the date and nurse's initials. d. The nurse instilled the irrigation solution at an incorrect rate.

b. The nurse failed to kink the tubing before connecting and removing the syringe from the end of the feeding tube.

The nurse is irrigating a patient's feeding tube and is unable to instill the fluid. What is an appropriate nursing action? a. Reattempt irrigating the tube with a carbonated beverage. b. Turn the patient onto left side and reattempt irrigation. c. Ask the patient to cough and reattempt irrigation. d. Use a smaller size syringe for flushing.

b. Turn the patient onto left side and reattempt irrigation.

Which of the following nursing actions helps reduce the risk of aspiration? a. performing nasotracheal suctioning before instilling a tube feeding. b. elevating the head of the patient's bed c. keeping the patient well hydrated d. encouraging the patient to deep breathe and cough

b. elevating the head of the patient's bed Rationale: Keeping the head elevated above the stomach helps reduce the risk of aspiration. Risk factors for tube dislodgement include frequent nasotracheal suctioning and severe coughing. Dislodgement of the tube places the patient at high risk for aspiration. Keeping the patient well hydrated does not reduce the risk of aspiration.

It is ________________ to delegate verification of tube placement to NAP. a. upon insertion b. inappropriate c. appropriate d. aspiration e. bleeding

b. inappropriate

You determine the patient's residual volume is 300 mL. The patient denies any abdominal discomfort or nausea. What should you do? a. shut off the feeding and notify the health care provider b. institute measures to reduce the risk of aspiration such as requesting an order for an agent to increase gastric motility c. do not return gastric aspirate to stomach; continue feeding, rechecking gastric residual volume in 1 hour d. change the type of formula being used

b. institute measures to reduce risk of aspiration such as requesting order for an agent to increase gastric motility Rationale: GRVs in range of 200-500 mL should raise concern and lead to implementation of measures to reduce risk of aspiration. Automatic cessation of feeding shouldn't occur for GRV less than 500 mL in the absence of other signs of intolerance

________ nutrition is a method of delivering nutrition through a catheter placed in a large central vein. a. aspiration b. parenteral c. jejunostomy d. enteral e. jejunal f. gastrostomy g. dehydration

b. parenteral

Identify the appropriate times to verify enteral tube placement by pH testing. (Select all that apply.) a. Immediately after administration of medications through the feeding tube. b. Upon discontinuing the feeding tube. c. Before administration of medications through the tube. d. Before each intermittent feeding. e. At least once every 6 hours during continuous feedings.

c, d, e Rationale: Verification of correct tube placement is performed before each intermittent feeding, at least once every 6 hours when continuous feedings are given, and before medications are administered through the tube. The nurse should wait at least 1 hour after medication administration before aspirating gastric contents. Premature aspiration of gastric fluid will remove medication, reducing the dose delivered to the patient. Medication may also interfere with pH testing. It is unnecessary to verify placement upon discontinuing the feeding tube.

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. NI tubes are used for patients with nasal problems such as nosebleeds or deviated septums. NG tubes are used for patients without nasal problems. b. Insertion of an NG tube requires clean gloves, whereas insertion of an NI tube requires sterile gloves. c. The advantage to an NI tube is that there is less risk for aspiration. d. Both NG and NI tubes are usually used for less than 30 days. e. Gastric aspirate is expected to have a lower pH than intestinal aspirate.

c, d, e Rationale: Gastric aspirate is expected to have a pH less than 5 in a fasting patient, whereas intestinal pH is expected to be 6 or higher. There is believed to be less risk of aspiration with a nasoenteric tube because it is placed beyond the pylorus. Both NG and NI tubes are used for less than 30 days. Patients needing tube feedings for a longer period are candidates for a more permanent solution, such as a gastrostomy or jejunostomy tube.

You are preparing to administer an intermittent tube feeding. For effective time management, you enlist the help of NAP. What instructions should you give the NAP to complete this task? a. to assess for bowel sounds before administering feeding b. how to verify tube placement by pH testing c. to place the patient in an upright position d. allow the feeding to infuse per ordered rate e. report any difficulty with the feeding infusion f. to report any distress experienced by the patient immediately

c, d, e, f Rationale: NAP can assist nurse with tube feeding but can not assess

The patient is to have his feeding tube irrigated. The patient asks why this is necessary. The nurse would be correct to state which of the following? (Select all that apply.) a. "This helps us to determine when your feeding tube can be discontinued." b. "Performing regular feeding tube irrigations helps to maintain the tube in your stomach where it is supposed to be." c. "Sometimes crushed medications can block the tube; doing this helps keep it open." d. "The purpose of irrigating the feeding tube is to give you additional water so you won't become dehydrated." e. "Irrigating your feeding tube keeps it open for your feeding to be administered easily."

c, e

You have received an order to insert an NG feeding tube and to begin tube feedings once placement has been verified. Which of the following may contraindicate NG tube insertion and feeding at this time? (Select all that apply.) a. The patient is on oxygen. b. The patient's gag reflex is present. c. Absence of bowel sounds in all four quadrants d. Patent right naris; slight edema of mucosa of left naris e. On anticoagulant therapy with recent nosebleed

c, e

Which of the following, if exhibited by the patient, may increase the risk for spontaneous enteral tube dislocation? (Select all that apply.) Select all that apply. a. Nausea. b. Ambulation. c. Altered level of consciousness, agitation. d. H2 antagonists. e. Nasotracheal suctioning. f. Vomiting.

c, e, f Rationale: Conditions that increase the risk of spontaneous tube dislocation from the intended position include vomiting or retching, nasotracheal suctioning, altered level of consciousness, and agitation. Nausea, ambulation, and H2 antagonists are not risk factors for spontaneous dislocation of an enteral feeding tube.

A nurse is caring for a patient with a nasogastric feeding tube who is receiving a continuous enteral feeding. The nurse informs the patient the feeding will be stopped temporarily so water can be instilled through the feeding tube. The patient asks, "Why don't you add the water to the bag containing the feeding?" What would be the best response by the nurse? a. "That would increase the length of hang time of your feeding increasing the risk of spoiling of the nutritional formula." b. "Because your health care provider ordered additional water every 6 hours." c. "Flushing the tubing with water helps keep it from becoming clogged." d. "Adding water to the feeding would alter the gastric residual volume, making it more difficult to determine feeding tolerance."

c. "Flushing the tubing with water helps keep it from becoming clogged."

For continuous enteral feeding, the maximum amount of time formula should remain hanging in a closed, ready-to-hang system is ________ hours. a. 72 b. 4 to 6 c. 24-48 d. 8 e. 12

c. 24-48

The nurse is going to irrigate a nasogastric feeding tube. The nurse would be correct to draw up how much water into the ENFit syringe? a. The same amount as the gastric residual volume. b. 60 mL. c. 30 mL. d. 15 mL.

c. 30 mL

The nurses are discussing feeding tube migration and prevention. Which of the following statements indicates correct understanding? a. The nurse should have the patient deep breathe and cough and suction the patient frequently. b. The nurse should keep the head of the bed flat to reduce the risk of tube migration. c. A feeding tube can enter the airway without causing obvious respiratory symptoms. d. As long as the external portion of a feeding tube is taped in place, the tube will be unable to migrate out of position.

c. A feeding tube can enter the airway without causing obvious respiratory symptoms. rationale: Absence of signs and symptoms does not ensure nonrespiratory placement, especially in patients with decreased level of consciousness or altered cough and gag reflex. The nurse is responsible for ensuring that the tube has remained in the intended position before administering formula or medications through the tube. Coughing and frequent suctioning may increase the risk of feeding tube migration. A tube's distal tip can migrate upward or downward from its original correct position, even when the external portion of the tube is taped in place. The nurse should keep the head of the bed elevated 30 degrees at all times to reduce the risk of aspiration.

The nurse is going to administer an intermittent tube feeding. Because 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. Verify the indelible ink mark on the tube is at the nares. 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. Obtain an order for x-ray film verification of tube location.

c. Aspirate gastric contents and test on a pH strip. Rationale: Ongoing verification of tube placement is made by pH testing of aspirate. Verification by x-ray film is necessary on feeding tube insertion and if tube migration is suspected. Auscultation is no longer considered a reliable method for determining feeding tube placement. The tube can migrate without moving at its externally taped location.

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. Discard the aspirate and continue with the bolus feeding as prescribed. b. Reposition the feeding tube under fluoroscopy. c. Return the aspirate to the patient's stomach and administer the feeding. d. Stop the feeding and recheck the residual in 1 hour.

c. Return the aspirate to the patient's stomach and administer the feeding.

The nurse just inserted an NG feeding tube. The health care provider's order states to administer all meds per tube and 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. After administering 30 mL of water, the medications may be given, followed by another 30 mL of water, and then continuous feeding may be initiated. c. when tube placement has been verified by x-ray film d. when the patient's blood glucose is verified to be within normal limits

c. When tube placement has been verified by x-ray film. Rationale: Proper position is essential before instilling anything through the feeding tube. Upon insertion, placement of tube is verified by x-ray examination. Blood glucose readings aid in monitoring the patient's tolerance of the feeding.

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. abdominal distention b. throat irritation c. dyspnea d. diarrhea

c. dyspnea

The NAP reports to you that the patient seems to be having difficulty breathing and appears "a little blue." The feeding tube remains secured with tape, and the infusion pump is not alarming. What action should you take at this time? a. tell the NAP to turn the feeding tube down to a slower rate b. nothing, since the tube remains taped and the infusion pump is operating without alarming c. go and assess the patient, turn the feeding off, and notify the health care provider d. ask the NAP if the patient has been coughing or retching

c. go and assess the patient, turn the feeding off, and notify the health care provider Rationale: You should assess the patient and, if the patient is displaying respiratory symptoms, turn the feeding off and notify the health care provider. You should be prepared to initiate oxygen therapy and obtain a chest x-ray film.

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. The pH strip reads "3." Where should the nurse expect the x-ray film to identify placement of the feeding tube? a. In the small intestine. b. In the lungs. c. In the stomach. d. In the esophagus.

c. in the stomach

A patient has been receiving ranitidine hydrochloride, an H2 receptor antagonist, for treatment of a duodenal ulcer. How may this affect pH testing? a. it will not affect pH testing b. it will decrease the gastric pH reading c. it will increase the gastric pH reading

c. it will increase the gastric pH reading Rationale: H2 receptor antagonists, such as ranitidine hydrochloride, reduce the volume of gastric acid secretion and the acid concentration of secretions thus increasing gastric pH

The nurse attempts to aspirate gastric contents from an established NG feeding tube and obtains no return. What action should the nurse take? a. get an order for a chest x-ray film to verify placement before administering the tube feeding b. remove the tube and insert a new one c. reposition the patient, flush tube with 30 mL air, and reattempt to aspirate. d. document finding

c. reposition the patient, flush tube with 30 mL air, and reattempt to aspirate.

You aspirate gastric contents to check the residual volume. Fifty milliliters are obtained. You return the gastric contents to the patient's stomach. The patient asks you why you did this. Your best response is: a. "to clear the tubing in preparation for starting the feeding" b. to prevent air from entering the stomach c. returning the aspirate prevents fluid and electrolyte imbalance d. the risk of abdominal discomfort is lessened if the aspirate is returned to the stomach

c. returning the aspirate prevents fluid and electrolyte imbalance

A nursing student asks the staff nurse why auscultation is not used for verifying feeding tube placement. The nurse's best response is: a. "it creates gaseous distention and discomfort in the patient when performed repeatedly b. "the air entering the enteral tube can introduce bacteria also." c. "Additional oxygen can alter the patient's acid-base balance, thus altering pH test results d. "A tube placed in the lungs/pharynx/esophagus sounds like air entering the stomach."

d. "A tube placed in the lungs/pharynx/esophagus sounds like air entering the stomach Rationale: the sound created when air is inserted through the feeding tube can be mistaken for correct tube placement, when in reality the tube may be inadvertently placed in the lungs, pharynx, or esophagus

A nurse is telling a coworker that she is unable to flush a feeding tube. Which suggestion offered by the coworker would be accurate, useful information? a. "Try using Coca-Cola to flush the tubing; the carbonation will break up any blockage." b. "Call the health care provider; the tube is going to have to be replaced." c. "Cranberry juice works well because the acidity dissolves occlusions from medication." d. "Reposition the patient and see if you are able to flush the tubing with water."

d. "Reposition the patient and see if you are able to flush the tubing with water."

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. "Tube feedings are less likely to cause infection than getting nutrients by IV infusion." b. "This will help prevent her from getting pneumonia again from choking." c. "The enteral feedings will help provide additional calories." d. "The tube feedings are used to improve digestion."

d. "The tube feedings are used to improve digestion." Rationale: Enteral feedings will not improve digestion. Enteral feedings are used with patients who have adequate digestion and absorption but cannot ingest, chew, or swallow food safely or in adequate amounts. Advantages of enteral feedings over parenteral feedings are that they are less expensive, maintain functioning of the gut, and are less likely to cause infection.

The patient is receiving a continuous enteral feeding. Which of the following assessment findings would require follow-up? a. Less than 10 mL of aspirate from nasoenteric tube. b. Bowel sounds present in all four quadrants. c. pH of gastric contents 5.0. d. Gastric residual of 375 mL.

d. Gastric residual of 375 mL. Rationale: GRVs in range of 200 to 500 mL should raise concern and lead to implementation of measures to reduce risk of aspiration. Normal residual for a nasoenteric tube is in the 10 mL or less range. Bowel sounds in all four quadrants and pH of 5.0 in gastric contents is normal for a patient who is receiving continuous enteral feeding.

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. Auscultate over the carina. b. Pull the feeding tube out and start over in the opposite naris. c. Instruct the patient to take small sips of water and swallow. d. Pull the tube back into the posterior nasopharynx and attempt to reinsert.

d. Pull the tube back into the posterior nasopharynx and attempt to reinsert. Rationale: The nurse should first pull the tube back without removing completely and attempt to reinsert. If the patient is already choking drinking water will not help. If the patient is coughing or choking, the tube has most likely entered the airway.

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. Then use dips the end of the tube into a glass of water to activate the lubricant b. the nurse aims back and down towards the ear. c. The nurse advances the tube as the patient swallows d. The nurse has the patient flex the head as the tube is inserted into the naris

d. The nurse has the patient flex the head as the tube is inserted into the naris Rationale: The nurse should have the patient flex the head toward the chest after the tube has passed the nasopharynx because this closes off the glottis and reduces the risk of the tube entering the trachea. Flexion of the head as the tube is inserted into the naris is unnecessary and may make the passage of the tube through the nasopharynx more difficult. Dipping the tube into a glass of water activates the surface lubricant to facilitate passage of the tube into the naris to the GI tract. The nurse should aim back and down toward the ear. Natural contour facilitates passage of the tube into the GI tract. Swallowing facilitates passage of the tube past the oropharynx.

Which of the following may be delegated to nursing assistive personnel (NAP)? a. inserting NG tube b. verifying feeding tube placement c. assessing for peristalsis d. administering a tube feeding e. administering medication through a feeding tube

d. administering a tube feeding

The risk of ___________ is increased when the tip of an NI tube accidentally dislocates upward into the stomach. a. upon insertion b. inappropriate c. appropriate d. aspiration e. bleeding

d. aspiration

Which of the following accurately describes the greatest risk related to having a feeding tube? a. Electrolyte imbalance b. infection c. fluid volume overload d. aspiration

d. aspiration Rationale: Although the risk of aspiration is lessened with a jejunal feeding tube, once a feeding tube is placed, all patients remain at risk for aspiration and need careful nursing management to avoid this complication.

___________ nutritions refers to nutrients given via the GI tract. a. aspiration b. parenteral c. jejunostomy d. enteral e. jejunal f. gastrostomy g. dehydration

d. enteral

For continuous enteral feeding, the maximum amount of time formula should remain hanging is ________ hours in an open system. a. 72 b. 4 to 6 c. 24-48 d. 8 e. 12

e. 12

Gastric feedings may be given to patients with a low risk of aspiration; however, if there is a risk of aspiration, ________ feeding is preferred. a. aspiration b. parenteral c. jejunostomy d. enteral e. jejunal f. gastrostomy g. dehydration

e. jejunal

As you are inserting the feeding tube, resistance is felt and the patient beings to cough. What action should you take? a. withdraw the tube completely and insert in other naris b. push the tube in harder past the area of resistance c. instill 30 mL of water in the tube to aid insertion d. continue with insertion as this is to be expected; encourage the patient to swallow e. stop advancing the tube and pull the tube back into the posterior nasopharynx until normal breathing resumes

e. stop advancing the tube and pull the tube back into the posterior nasopharynx until normal breathing resumes

Patients who require long-term nutritional support may have a tube placed endoscopically or surgically through the abdominal wall as a ________ (into the stomach). a. aspiration b. parenteral c. jejunostomy d. enteral e. jejunal f. gastrostomy g. dehydration

f. gastrostomy