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The nurse is caring for a patient who is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the following actions should the nurse include in the plan of care?
- A. Keep the patient positioned on the left side.
- B. Obtain a daily x-ray to verify tube placement.
- C. Check the gastric residual volume every 4-6 hours.
- D. Avoid giving bolus tube feedings through the PEG tube.
Correct Answer: C
Rationale: The gastric residual volume is assessed every 4-6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily x-rays are not needed. Bolus feedings can be administered through a PEG tube.
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The nurse is caring for a patient who is receiving continuous enteral nutrition through a small-bore silicone feeding tube, has a computed tomography (CT) scan ordered, and will have to be placed in a flat position for the scan. Which of the following actions by the nurse is best?
- A. Shut the feeding off 30-60 minutes before the scan.
- B. Ask the health care provider to reschedule the CT scan.
- C. Connect the feeding tube to continuous suction during the scan.
- D. Send the patient to CT scan with oral suction in case of aspiration.
Correct Answer: A
Rationale: The tube feeding should be shut off 30-60 minutes before any procedure requiring the patient to lie flat. Because the CT scan is ordered for diagnosis of patient problems, rescheduling is not usually an option. Prevention, rather than treatment, of aspiration is needed. Small-bore feeding tubes are soft and collapse easily with aspiration or suction, making nasogastric suction of gastric contents unreliable.
Which of the following actions should the nurse take first in order to improve calorie and protein intake for a patient who eats only about 50% of each meal because of 'feeling too tired to eat much'?
- A. Teach the patient about the importance of good nutrition
- B. Serve multiple small feedings of high-calorie, high-protein foods.
- C. Obtain an order for enteral feedings of liquid nutritional supplements.
- D. Consult with the health care provider about providing parenteral nutrition (PN).
Correct Answer: B
Rationale: Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patient's inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.
The nurse is teaching a patient about a high calorie, high protein diet. Which of the following menu choices indicates that the teaching has been effective?
- A. Baked fish with applesauce
- B. Beef noodle soup and canned corn
- C. Fresh vegetables with yogurt topping
- D. Fried chicken with potatoes and gravy
Correct Answer: D
Rationale: Foods that are high in calories include fried foods and those covered with sauces. High protein foods include meat and dairy products. The other choices are lower in calories and protein.
The nurse is caring for a patient who is to have a bolus tube feeding. Which of the following actions should the nurse implement?
- A. Deliver the feeding via a syringe over 15 minutes.
- B. Increase the rate of the tube feeding to deliver the bolus over 5 minutes.
- C. Withhold water by mouth for 30 minutes prior to the bolus feeding.
- D. Question the order as tube feedings are not to be delivered as a bolus.
Correct Answer: A
Rationale: Bolus feedings are typically delivered by gravity via a syringe over approximately 15 minutes when the feeding tube is placed in the stomach. The tube feeding rate would not be increased as the bolus should be delivered by gravity via a syringe. It's important to remember that the patient still needs water (1 mL/cal formula received), and this may be administered at any time that the patient can tolerate it.
The nurse is caring for a patient who is malnourished and is receiving parenteral nutrition (PN) containing amino acids and dextrose for the past 24 hours. The nurse observes that about 50 mL remain in the PN container. Which of the following actions is best for the nurse to take?
- A. Ask the health care provider to clarify the written PN order.
- B. Add a new container of PN using the current tubing and filter.
- C. Hang a new container of PN and change the IV tubing and filter.
- D. Infuse the remaining 50 mL and then hang a new container of PN.
Correct Answer: B
Rationale: All PN solutions are changed at 24 hours. PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily. Infusion of the additional 50 mL will increase patient risk for infection. Changing the IV tubing and filter more frequently than required will unnecessarily increase costs. The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes.