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A nurse has obtained an order to remove a patients NG tube and has prepared the patient accordingly. After flushing the tube and removing the nasal tape, the nurse attempts removal but is met with resistance. Because the nurse is unable to overcome this resistance, what is the most appropriate action?
- A. Gently twist the tube before pulling.
- B. Instill a digestive enzyme solution and reattempt removal in 10 to 15 minutes.
- C. Flush the tube with hot tap water and reattempt removal.
- D. Report this finding to the patients primary care provider.
Correct Answer: D
Rationale: If the tube does not come out easily, force should not be used, and the problem should be reported to the primary provider. Enzymes are used to resolve obstructions, not to aid removal. For safety reasons, hot water is never instilled into a tube. Twisting could cause damage to the mucosa.
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A nurse is participating in a patients care conference and the team is deciding between parenteral nutrition (PN) and a total nutritional admixture (TNA). What advantages are associated with providing TNA rather than PN?
- A. TNA can be mixed by a certified registered nurse.
- B. TNA can be administered over 8 hours, while PN requires 24-hour administration.
- C. TNA is less costly than PN.
- D. TNA does not require the use of a micron filter.
Correct Answer: C
Rationale: TNA is mixed in one container and administered to the patient over a 24-hour period. A 1.5-micron filter is used with the TNA solution. Advantages of the TNA over PN include cost savings. Pharmacy staff must prepare both solutions.
A patient receiving tube feedings is experiencing diarrhea. The nurse and the physician suspect that the patient is experiencing dumping syndrome. What intervention is most appropriate?
- A. Stop the tube feed and aspirate stomach contents.
- B. Increase the hourly feed rate so it finishes earlier.
- C. Dilute the concentration of the feeding solution.
- D. Administer fluid replacement by IV.
Correct Answer: C
Rationale: Dumping syndrome can generally be alleviated by starting with a dilute solution and then increasing the concentration of the solution over several days. Fluid replacement may be necessary but does not prevent or treat dumping syndrome. There is no need to aspirate stomach contents. Increasing the rate will exacerbate the problem.
A patient has a gastrostomy tube that has been placed to drain stomach contents by low intermittent suction. What is the nurses priority during this aspect of the patients care?
- A. Measure and record drainage.
- B. Monitor drainage for change in color.
- C. Titrate the suction every hour.
- D. Feed the patient via the G tube as ordered.
Correct Answer: A
Rationale: This drainage should be measured and recorded because it is a significant indicator of GI function. The nurse should indeed monitor the color of the output, but fluid balance is normally the priority. Frequent titration of the suction should not be necessary and feeding is contraindicated if the G tube is in place for drainage.
The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurses assessments most directly addresses a major complication of TPN?
- A. Checking the patients capillary blood glucose levels regularly
- B. Having the patient frequently rate his or her hunger on a 10-point scale
- C. Measuring the patients heart rhythm at least every 6 hours
- D. Monitoring the patients level of consciousness each shift
Correct Answer: A
Rationale: The solution, used as a base for most TPN, consists of a high dextrose concentration and may raise blood glucose levels significantly, resulting in hyperglycemia. This is a more salient threat than hunger, though this should be addressed. Dysrhythmias and decreased LOC are not among the most common complications.
A nurse is initiating parenteral nutrition (PN) to a postoperative patient who has developed complications. The nurse should initiate therapy by performing which of the following actions?
- A. Starting with a rapid infusion rate to meet the patients nutritional needs as quickly as possible
- B. Initiating the infusion slowly and monitoring the patients fluid and glucose tolerance
- C. Changing the rate of administration every 2 hours based on serum electrolyte values
- D. Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body
Correct Answer: B
Rationale: PN solutions are initiated slowly and advanced gradually each day to the desired rate as the patients fluid and glucose tolerance permits. The formulation of the PN solutions is calculated carefully each day to meet the complete nutritional needs of the individual patient based on clinical findings and laboratory data. It is not infused more quickly at mealtimes.