Deck 20: Enteral Nutrition Support

Question 1

Lora, age 57, is undergoing chemotherapy and radiation for cancer and will soon have surgery. She is in need of oral supplementation to help improve her nutritional status prior to the surgery. What might be done to help her accept oral supplements?

A) Allow her to try several formulations to find one she likes.
B) Warn her that her surgery will have to be delayed if she does not accept them.
C) Give her a trial of tube feeding so that she will prefer the oral supplements.
D) Acknowledge that they taste terrible but tell her they are better than the alternative.

Answer 1

A

Question 2

Mr. Heiman has suffered a stroke and now has dysphagia (difficulty swallowing). He is 5 ft 8 in. tall and weighs 127 lb. The most appropriate method of nutrition support for him would be ____.

A) gastrostomy feedings
B) nasojejunal feedings
C) liquid supplements
D) orogastric feedings

Answer 2

A

Question 3

Which feeding tube placement may require a surgical procedure?

A) nasogastric
B) nasojejunal
C) enterostomy
D) nasoduodenal

Answer 3

C

Question 4

An opening in the abdomen through which a feeding tube can be passed to the stomach is called a(n) ____.

A) ileostomy
B) endoscopic jejunostomy
C) gastrostomy
D) duodenostomy

Question 5

Standard formulas are used for clients who ____.

A) require specific nutrient combinations
B) are able to digest and absorb nutrients without difficulty
C) are severely malnourished
D) require intravenous feedings

Question 6

Alan has been diagnosed with cancer and needs oral supplements to prevent weight loss. What oral supplement that can be purchased over-the-counter should be recommended for Alan?

A) Special K
B) Nutrisystem
C) SlimFast
D) Ensure

Question 7

The type of feeding tube that requires the most difficult insertion procedure is a(n) ____ tube.

A) orogastric
B) nasoduodenal
C) nasojejunal
D) jejunostomy

Question 8

In which patient should gastric feedings be avoided?

A) a pediatric patient
B) a patient at risk of aspiration
C) a patient with extremely high nutrient requirements
D) a patient with severe malnutrition

Question 9

What is a good guideline for serving oral supplements to hospitalized patients?

A) Serve beverages in the can they come in, so that the patient can recognize them.
B) Serve beverages as cold as possible to minimize the often-unpleasant taste.
C) Serve the supplements attractively in a glass on a plate, which may be more appealing to patients.
D) Serve the same flavor every day so that the patient will get used to them.

Question 10

A disadvantage of transnasal tube placement is that ____.

A) it is not an effective means for tube feeding
B) the tube can be easily pulled out
C) the tube is inserted through the skin
D) it requires surgical placement

Question 11

If a patient is going to be tube-fed for longer than ____, a gastrostomy or jejunostomy may be necessary.

A) 1 week
B) 4 weeks
C) 2 months
D) 6 months

Question 12

A(n) ____ feeding tube placement may be preferred for infants because it allows normal breathing.

A) nasoduodenal
B) nasogastric
C) orogastric
D) nasoenteric

Question 13

Standard formulas are also referred to as ____ formulas.

A) polymeric
B) MCT
C) elemental
D) modular

Question 14

Which feature is essential for the administration of enteral nutrition?

A) a functional gastrointestinal tract
B) a good appetite
C) good peripheral venous access
D) minimal nutritional needs

Question 15

Which condition or treatment may indicate the need for tube feedings?

A) obesity
B) mechanical ventilation
C) systemic infection
D) potassium depletion

Question 16

Which tube feeding route is most appropriate for patients requiring long-term nutrition support?

A) enterostomy
B) nasoenteric
C) nasogastric
D) orogastric

Question 17

The fat content of enteral formulas is usually ____ percent of total kcalories.

A) 5 to 10
B) 15 to 30
C) 35 to 50
D) 55 to 60

Question 18

Elemental formulas are also called ____ formulas.

A) polymeric
B) specialty
C) hydrolyzed
D) disease-specific

Question 19

An enteral formula that contains intact proteins and polysaccharides is a(n) ____ formula.

A) standard
B) elemental
C) modular
D) hydrolyzed

Question 20

The protein content of enteral formulas is usually ____ percent of total kcalories.

A) 2 to 10
B) 12 to 20
C) 22 to 30
D) 32 to 40

Question 21

Iris has an order for continuous tube feedings through her nasogastric tube. She is to receive 2500 mL of formula on a continuous basis over 24 hours. At what hourly rate should the health care provider set the infusion pump?

A) 25 mL
B) 58 mL
C) 104 mL
D) 250 mL

Question 22

A respiratory secretion sample typically has a pH of ____.

A) 3 or lower
B) 4
C) 5
D) 6 or higher

Question 23

What can happen when liquid medications are infused along with enteral feedings?

A) The osmolality can increase substantially and may contribute to diarrhea.
B) Fluid overload can occur owing to the additional need for water flushes.
C) Risk of aspiration increases owing to the need for additional water flushes.
D) The medication can more easily reach toxic levels in the body.

Question 24

A health care provider is preparing to administer a tube feeding to a patient with a nasogastric tube. To best reduce the risk of formula contamination, the caregiver should perform which step first?

A) Clean the lid of the can with an alcohol wipe.
B) Warm the can in a pan of hot water.
C) Pour the contents of the can into a clean container.
D) Label the can with the date and time of its opening.

Question 25

A patient with fluid, electrolyte, and protein restrictions would most likely need which type of formula?

A) carbohydrate-modified
B) high-kcalorie
C) renal or hepatic insufficiency
D) standard formula with moderate fiber content

Question 26

A gastric secretion sample typically has a pH of ____.

A) 5 or lower
B) 6 to 7
C) 8 to 9
D) 10 or higher

Question 27

Most enteral formulas have energy density of ____ kcalories per milliliter of fluid.

A) 1.0 to 2.0
B) 2.0 to 3.0
C) 3.0 to 4.0
D) 4.0 to 5.0

Question 28

The vast majority of patients commonly use which type of enteral formula?

A) standard
B) hydrolyzed
C) specialized
D) modular

Question 29

Intermittent feeding using the gravity drip method is suitable for the delivery of no more than how much formula over 30 minutes?

A) 100 mL
B) 200 mL
C) 300 mL
D) 400 mL

Question 30

What is a carbohydrate source used in many standard formulas?

A) aldose
B) maltodextrin
C) amylopectin
D) cellulose

Question 31

The delivery of up to 500 mL of formula within 10 minutes is termed a(n) ____.

A) minimal residual feeding
B) intermittent feeding
C) bolus feeding
D) a continuous drip

Question 32

What is a characteristic of a closed feeding system?

A) The formula can hang for a longer period of time.
B) It is more expensive in the long run.
C) Aseptic technique is not necessary.
D) It requires far more nursing time.

Question 33

Intermittent tube feedings are best tolerated when they are administered over ____.

A) 5 to 10 minutes
B) 30 to 45 minutes
C) 1 to 2 hours
D) 4 to 6 hours

Question 34

Proper sterile techniques should be used during preparation and delivery of formulas to protect patients from ____.

A) receiving the wrong formula
B) exposure to foodborne illness
C) malnutrition
D) dehydration

Question 35

Normal 0
False
False
False
EN-US
X-NONE
X-NONE
A formula with an osmolality greater than that of blood serum is known as a(n) ____ formula.

A) isotonic
B) hypertonic
C) enteral
D) complete

Question 36

Health care facilities have protocols for handling food products and formulas based on the potential hazards and critical control points in food preparation, which are called ____.

A) HACCP systems
B) Joint Commission mandates
C) MSDS requirements
D) AHA standards

Question 37

Open containers of formula that are unused should be disposed of within ____ hours.

A) 6 to 8
B) 8 to 12
C) 12 to 24
D) 24 to 48

Question 38

What is a characteristic of an open feeding system?

A) A greater variety of formulas can be used.
B) The formula must be transferred from its original packaging to a feeding container.
C) An aseptic technique is not necessary.
D) This system costs more initially.

Question 39

When an open feeding system is used, the nurse should hang no more than a(n) ____-hour supply.

A) 6
B) 8
C) 12
D) 16

Question 40

To reduce the risk of aspiration, the patient's upper body is elevated to a ____-degree angle during the feeding.

A) 5 to 10
B) 15 to 30
C) 30 to 45
D) 45 to 60

Question 41

Kristina is a 4-year-old with galactosemia. Her caregivers must ensure adequate intake of ____.

A) vitamin C
B) calcium
C) vitamin E
D) potassium

Question 42

A nurse determines that his patient's jejunostomy tube is clogged. What is a possible cause?

A) using liquid medications
B) using a very viscous energy-dense formula
C) excessive water flushing
D) using a low-fiber formula

Question 43

Which tube feeding delivery method is administered every 3 to 4 hours using a syringe?

A) continuous feedings
B) bolus feedings
C) sustainable feedings
D) cyclic feedings

Question 44

The only current treatment for phenylketonuria (PKU) is a diet that ____.

A) restricts phenylalanine and tyrosine
B) supplies tyrosine and valine
C) supplies valine and restricts phenylalanine
D) supplies tyrosine and restricts phenylalanine

Question 45

Nondietary therapies can treat some inborn errors of metabolism. In some cases, the missing protein is infused, such as in the case of ____.

A) PKU
B) cystic fibrosis
C) hemophilia
D) galactosemia

Question 46

What is a potential metabolic complication of tube feedings?

A) elevated heart rate
B) hyperglycemia
C) increased vitamin C levels
D) redness and irritation at the tube insertion site

Question 47

How often should the feeding tube be flushed if the patient is on continuous feedings?

A) every 4 hours
B) every 8 hours
C) every 12 hours
D) daily

Question 48

A patient who does not tolerate a bolus feeding would most likely develop what symptoms?

A) abdominal discomfort and nausea
B) headache and blurred vision
C) confusion and anxiety
D) constipation and edema

Question 49

Samuel is an 88-year-old patient with a gastrostomy tube. The health care provider knows that Samuel will not always recognize thirst, even though he may need extra water. To evaluate Samuel's hydration status, the provider will check his ____.

A) white blood cell count
B) respiratory rate
C) blood urea nitrogen
D) waist circumference

Question 50

In the United States, phenylketonuria (PKU) affects approximately 1 out of ____ births annually.

A) 5000
B) 12,700
C) 34,500
D) 150,000

Question 51

Tom is a 15-year-old who is eating some food but must also receive enteral feedings for malnutrition associated with Crohn's disease. To help Tom carry on normal activities, the health care team might try ____.

A) continuous feedings
B) intermittent feedings
C) a neon-colored feeding tube
D) brightly colored formulas

Question 52

A patient who requires 3000 kcal per day is receiving a standard formula that provides 1.5 kcal per milliliter continuously over 24 hours. How many milliliters of formula will the patient receive each hour?

A) 50 mL per hour
B) 83 mL per hour
C) 125 mL per hour
D) 150 mL per hour

Question 53

How often should the feeding tube placement be checked if the patient is on intermittent feedings?

A) before each feeding is initiated
B) after each feeding
C) every 6 hours
D) every 12 hours

Question 54

Nausea, vomiting, and cramps in a patient with a feeding tube are most likely caused by ____.

A) an inappropriate size feeding tube
B) inadequate fiber intake
C) a lack of exercise
D) delayed stomach emptying

Question 55

For what purpose would a nurse measure the gastric residual volume in a patient's feeding tube?

A) to check that the stomach is emptying properly
B) to ensure that the patient is receiving adequate water
C) to prevent dumping syndrome and diarrhea
D) to ensure that medications have been digested

Question 56

Why are bolus feedings used only in patients who are not critically ill?

A) Bolus feedings restrict the patient's movements for long periods of time.
B) Risk of aspiration is greater than with other delivery methods.
C) Bolus feedings wouldn't be adequate to meet the patient's nutrition needs in this situation.
D) Bolus feedings require the use of an infusion pump.

Question 57

The main focus of the dietary treatment for galactosemia is the ____.

A) exclusion of galactose
B) provision of galactose
C) exclusion of protein
D) provision of essential fatty acids

Question 58

A patient with a jejunostomy tube has developed an infection around the tube's insertion site. What measure would most likely correct this situation?

A) Using a small-bore tube.
B) Ensuring that medication doses are appropriate.
C) Applying a protective antibiotic dressing.
D) Elevating the head of bed during and after feeding.

Question 59

Typically, adults require ____ mL per kilogram of body weight of water daily.

A) 5 to 8
B) 10 to 12
C) 15 to 20
D) 30 to 40

Question 60

Mr. Simpson is receiving formula intermittently six times a day. He needs 1500 mL every 24 hours. How many milliliters of formula is Mr. Simpson receiving at each feeding?

A) 120
B) 250
C) 333
D) 900

Question 61

A patient requires 1800 kcal per day and is receiving a standard formula that provides 1.2 kcal per milliliter in eight intermittent feedings daily. Calculate the volume of formula required at each feeding.

A) 100 mL
B) 155 mL
C) 188 mL
D) 208 mL

Question 63

Differentiate among standard formulas, elemental formulas, and specialized formulas.

Question 64

66-69. Short Case Study Questions  
Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over 3 years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 lb) in 1 month.
 
What may have caused Maureen to become dehydrated?

A) dysphagia
B) food allergy
C) tube feeding rate
D) diarrhea

Question 65

Discuss medical nutrition therapy for galactosemia and possible long-term complications of this disorder.

Question 66

Describe the factors to consider when selecting a feeding route for a patient who needs tube feedings.

Question 67

Ten days after being admitted to the hospital, Maureen develops gastroparesis and a fistula. What would be a better way to feed Maureen at this point?

A) Orogastric feeding
B) Nasogastric feeding
C) Jejunostomy feeding
D) Nasoduodenal feeding

Question 68

Explain how mechanical complications can develop with tube feedings. How are these complications corrected?

Question 69

Explain how health care professionals select the appropriate enteral formula for an individual patient.

Question 70

What is the diameter (in millimeters) for a 18 French feeding tube?

A) 9 mm
B) 6 mm
C) 3 mm
D) 2 mm

Question 71

While reviewing the nursing home's medical record, the nurse discovers that the doctor has prescribed
Phenytoin for Maureen, a medication that requires the tube feeding to be ____.

A) stopped for an hour before and after medication administration
B) increased by 25 mL every hour following medication administration
C) diluted with 100 mL of water to facilitate medication dissolution
D) administered as a bolus within 2 hours of medication administration

Question 72

Which type of tube feeding did Maureen most likely have when she was in the nursing home?

A) nasogastric
B) orogastric
C) gastrostomy
D) double lumen

Question 73

Which type of enteral feeding should be avoided in patients at high risk of aspiration?

A) Nasogastric feedings
B) Nasojejunal feedings
C) Nasoduodenal feedings
D) Jejunostomy feedings

Question 74

A patient has a procedure in. which an opening into the gastrointestinal tract is made through the abdominal wall for administering enteral feeding. What is this procedure called?

A) Orogastric tube placement
B) Nasogastric tube placement
C) Gastric decompression
D) Enterostomy

Question 75

Elemental enteral formulas provide fat from medium-chain triglycerides (MCTs). Which of the following is false regarding MCTs?

A) They contain fatty acids that are 6 to 12 carbons long.
B) They do not require digestion.
C) They can be absorbed in the absence of lipase or bile.
D) They require pancreatic lipase and bile for digestion and absorption.