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Which of the following actions should the nurse implement when using a soft, silicone nasogastric tube for enteral feedings?
- A. Avoid giving medications through the feeding tube.
- B. Flush the tubing after checking for residual volumes.
- C. Administer continuous feedings using an infusion pump.
- D. Replace the tube every 3-5 days to avoid mucosal damage.
Correct Answer: B
Rationale: The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals. Medications can be given through these tubes, but flushing after medication administration is important to avoid clogging.
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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.
The student nurse is caring for a patient who is receiving intermittent tube feedings. Which of the following actions by the student nurse should cause the RN to intervene in the patient's care?
- A. Positions the head of the bed at 30 degrees.
- B. Flushes the tube before and after the feeding.
- C. Checks residual volume every hour.
- D. Maintains the elevated bed position one hour after the feeding.
Correct Answer: C
Rationale: The residual volume should be checked every 4 hours, not every hour. Elevating the head of the bed to a minimum of 30 degrees, but preferably 45 degrees, prevents aspiration. With intermittent delivery, the head should remain elevated for 30-60 minutes after feeding. The tube is to be flushed before and after the feeding.
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 caring for a patient with protein calorie malnutrition who has had abdominal surgery and is receiving parenteral nutrition (PN). Which of the following findings is the best indicator that the patient is receiving adequate nutrition?
- A. Blood glucose is 6.1 mmol/L.
- B. Serum albumin level is 35 g/L.
- C. Fluid intake and output are balanced.
- D. Surgical incision is healing normally.
Correct Answer: D
Rationale: Because poor wound healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia, but it does not indicate that the patient's nutrition is adequate. The intake and output will be monitored but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient.
The nurse is admitting a patient for electrolyte disorders of unknown etiology. Which of the following findings is most important to report to the health care provider?
- A. The patient's knuckles are macerated.
- B. The patient uses laxatives on a daily basis.
- C. The patient has a history of weight fluctuations.
- D. The patient's serum potassium level is 2.2 mmol/L.
Correct Answer: D
Rationale: The low serum potassium level may cause life-threatening cardiac dysrhythmias and potassium supplementation is needed rapidly. The other information also will be reported because it suggests that bulimia may be the etiology of the patient's electrolyte disturbances, but it does not suggest imminent life-threatening complications.