Nokea
A patient with dysphagia is scheduled for PEG tube insertion and asks the nurse how the tube will stay in place. What is the nurses best response?
- A. Adhesive holds a flange in place against the abdominal skin.
- B. A stitch holds the tube in place externally.
- C. The tube is stitched to the abdominal skin externally and the stomach wall internally.
- D. An internal retention disc secures the tube against the stomach wall.
Correct Answer: D
Rationale: A PEG tube is held in place by an internal retention disc (flange) that holds it against the stomach wall. It is not held in place by stitches or adhesives.
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A patients enteral feedings have been determined to be too concentrated based on the patients development of dumping syndrome. What physiologic phenomenon caused this patients complication of enteral feeding?
- A. Increased gastric secretion of HCl and gastrin because of high osmolality of feeds
- B. Entry of large amounts of water into the small intestine because of osmotic pressure
- C. Mucosal irritation of the stomach and small intestine by the high concentration of the feed
- D. Acid-base imbalance resulting from the high volume of solutes in the feed
Correct Answer: B
Rationale: When a concentrated solution of high osmolality entering the intestines is taken in quickly or in large amounts, water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment. This results in dumping syndrome. Dumping syndrome is not the result of changes in HCl or gastrin levels. It is not caused by an acid-base imbalance or direct irritation of the GI mucosa.
A nurse is caring for a patient with a nasogastric tube for feeding. During shift assessment, the nurse auscultates a new onset of bilateral lung crackles and notes a respiratory rate of 30 breaths per minute. The patients oxygen saturation is 89% by pulse oximetry. After ensuring the patients immediate safety, what is the nurses most appropriate action?
- A. Perform chest physiotherapy.
- B. Reduce the height of the patients bed and remove the NG tube.
- C. Liaise with the dietitian to obtain a feeding solution with lower osmolarity.
- D. Report possible signs of aspiration pneumonia to the primary care provider.
Correct Answer: D
Rationale: The patient should be assessed for further signs of aspiration pneumonia. It is unnecessary to remove the NG tube and chest physiotherapy is not indicated. A different feeding solution will not resolve this complication.
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 nurse is caring for a patient who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the patient?
- A. Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN.
- B. Administer a hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN.
- C. Administer 3 ampules of dextrose 50% immediately prior to discontinuing the PN.
- D. Administer 3 ampules of dextrose 50% 1 hour after discontinuing the PN.
Correct Answer: A
Rationale: After administration of the PN solution is gradually discontinued, an isotonic dextrose solution is administered for 1 to 2 hours to protect against rebound hypoglycemia. The other listed actions would likely cause hyperglycemia.
A patient who suffered a stroke had an NG tube inserted to facilitate feeding shortly after admission. The patient has since become comatose and the patients family asks the nurse why the physician is recommending the removal of the patients NG tube and the insertion of a gastrostomy tube. What is the nurses best response?
- A. It eliminates the risk for infection.
- B. Feeds can be infused at a faster rate.
- C. Regurgitation and aspiration are less likely.
- D. It allows caregivers to provide personal hygiene more easily.
Correct Answer: C
Rationale: Gastrostomy is preferred over NG feedings in the patient who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely than with NG feedings. Both tubes carry a risk for infection; this change in care is not motivated by the possibility of faster infusion or easier personal care.