Question 1

Which technique is appropriate when providing intermittent tube feeding once the placement of the tube has been checked?&#10;A) Cool the formula&#10;B) Lower the head of the bed&#10;C) Allow bag to empty gradually over 30 to 60 minutes&#10;D) Add food coloring to detect aspiration

Accepted Answer

Allow bag to empty gradually over 30 to 60 minutes.Gradual emptying of tube feeding by gravity from feeding bag reduces risk of abdominal discomfort,vomiting,or diarrhea induced by bolus or too-rapid infusion of tube feedings.
Cold formula causes gastric cramping.Place client in high-Fowler's position or elevate head of bed at least 30 degrees to prevent aspiration.Do not add food coloring or dye to formula to assist in detecting aspiration,presumably by staining tracheobronchial secretions.This is associated with increased risk for contamination and may cause patient deaths.

Question 2

Which technique is appropriate for the nurse to implement during nasogastric (NG)tube insertion?&#10;A) Use sterile gloves&#10;B) Have the client mouth-breathe&#10;C) Advance the tube quickly when the client coughs&#10;D) Bend the client's head backward after the tube is through the nasopharynx

Accepted Answer

Emphasize need to mouth-breathe and swallow during the procedure.Helps facilitate passage of tube and alleviates patient's fears during the procedure.
Put on clean gloves.Do not force tube.If resistance is met or client starts to cough,choke,or become cyanotic,stop advancing the tube and pull tube back and start over.Have client flex head toward chest after tube has passed through nasopharynx.Closes off glottis and reduces risk of tube entering trachea.

Question 3

The patient has an enteral feeding tube in place.Pulmonary aspiration is the main complication related to feeding tubes.Other complications include which of the following? (Select all that apply.)&#10;A) Infection&#10;B) Diarrhea&#10;C) Tube clogging&#10;D) Tube dislodgement&#10;E)  None of above

Accepted Answer

The main complication related to feeding tubes is pulmonary aspiration with possible lung compromise.Other complications include misplaced tubes,infection,diarrhea,tube clogging,and tube dislodgement.

Question 4

The nurse has just inserted a nasogastric (NG)feeding tube into a patient.What should the nurse do to definitely ascertain that the tube is in the stomach or in the intestine?&#10;A) Test the pH of the contents&#10;B) Utilize a carbon dioxide sensor&#10;C) Lower the head of the bed to 15 degrees&#10;D) Obtain an order for a chest radiograph

Accepted Answer

Current evidence-based practice indicates that the most reliable method of feeding tube verification is chest radiograph (chest x-ray).
The use of gastric and intestinal pH measurements has been shown to differentiate tube placement,with the stomach having a lower pH than the intestines.This helps to ensure that the tube is beyond the pylorus,theoretically reducing the risk for aspiration.This method is helpful before and after radiological confirmation.Carbon dioxide sensors are helpful in determining tube placement between the stomach and the lung.A small plastic piece with an embedded yellow sensor is attached to the end of the feeding tube; the sensor changes color when carbon dioxide is present.Investigators have shown that this reduces the incidence of inadvertent pulmonary placement.This method is helpful before and after radiological confirmation.Head of bed elevation to a minimum of 30 degrees is a simple method to keep the risk for aspiration at a minimum.The nurse is instrumental in achieving this goal.This method does not ascertain placement but may be useful in preventing aspiration.

Question 5

Which evaluation indicates that the placement of a nasogastric or enteric tube is correct?&#10;A) Nasointestinal aspirate with a pH of less than 6&#10;B) Pleural fluid pH of less than 6&#10;C) Gastric aspirate with a pH of 2 after client fasting&#10;D) Gastric aspirate with a pH of 4 and continuous tube feedings

Accepted Answer

Gastric fluid from client who has fasted for at least 4 hours usually has pH range of 1 to 4.
Fluid from enteric tube of fasting client usually has pH greater than 6.pH of pleural fluid from the tracheobronchial tree is generally greater than 6.Client with continuous tube feeding may have pH of 5 or higher.

Question 6

The nurse has inserted a nasogastric (NG)feeding tube.The feeding tube has a stylet in place to aid in insertion.What should the nurse do once the tube is in place?&#10;A) Remove the stylet immediately&#10;B) Reinsert the stylet if radiograph determines incorrect placement&#10;C) Fasten the end of the NG tube to the patient's gown using tape and a safety pin&#10;D) Leave the stylet in place and obtain a chest/abdomen radiography

Accepted Answer

Leave stylet in place (if used)until correct position is verified by x-ray film.
Never attempt to reinsert a partially or fully removed stylet while feeding tube is in place.This can cause perforation of the tube and can injure the patient.Do not use safety pins to pin the tube to the patient's gown.Safety pins become unfastened and can cause injury to the patient.

Question 7

Conditions that increase the risk for spontaneous tube dislocation include which of the following? (Select all that apply.)&#10;A) Retching/vomiting&#10;B) Nasotracheal suction&#10;C) Coughing&#10;D) Cyanosis

Accepted Answer

Conditions that increase the risk for spontaneous tube dislocation include retching/vomiting,nasotracheal suction,and severe bouts of coughing.Cyanosis may be an indicator of displacement but is not a cause.

Question 8

The nurse is caring for a patient who has continuous tube feedings.What must the nurse do to care for this patient?&#10;A) Verify tube position every 4 to 12 hours&#10;B) Obtain a radiograph every 4 to 12 hours&#10;C) Instill air into the stomach via the tube and listen for bubbles&#10;D) Do not worry about tube placement since it has already been determined to be in the right place

Accepted Answer

Following initial radiographic verification that a tube is positioned in the desired site (either the stomach or the small intestine),the nurse is responsible for ensuring that the tube has remained in the intended position before administering formula or medications through the tube.Therefore,the nurse must verify tube position every 4 to 12 hours and as needed.
Because it is not practical to do radiographic checks at this frequency,other methods of determining placement have been investigated.Insufflation of air into tube while auscultating abdomen is not a reliable means to determine position of feeding tube tip.It is possible for the tip of a feeding tube to move into a different location (from the stomach to the intestine or from the intestine into the stomach)without any external evidence that the tube has moved.The risk for aspiration of regurgitated gastric contents into the respiratory tract increases when the tip of the tube accidentally dislocates upward into the esophagus.

Question 9

Before the insertion of a nasogastric (NG)tube,the physician should be notified of:&#10;A) Patent nares&#10;B) Absent bowel sounds&#10;C) Evident gag reflex&#10;D) Impaired swallowing

Accepted Answer

Absent bowel sounds may indicate decreased or absent peristalsis and increased risk of aspiration.
A patent nares rules out obstruction or irritated nares,septal defect,or facial fractures and does not need to be reported to the physician since it is a "normal" finding.The nurse should assess client for gag reflex to assess client's ability to swallow and determine if a greater risk of aspiration exists.An evident gag reflex is a normal finding and does not need to be reported to the physician.Impaired swallowing is the probable reason for insertion of the NG tube.

Question 10

The nurse is initiating a continuous tube feeding for a patient who has a gastrostomy tube.Which of the following procedures indicates proper practice?&#10;A) Allow the container to empty gradually over 60 minutes&#10;B) Change the bag every 24 hours&#10;C) Do not use water to flush the tube&#10;D) Increase the rate of administration quickly

Accepted Answer

Rinse bag and tubing with warm water whenever feedings are interrupted.Use a new administration set every 24 hours.
Allowing the container to empty over 30 to 60 minutes is the method used for intermittent administration of tube feeding.Administer water via feeding tube as ordered or between feedings.Provides patient with source of water to help maintain fluid and electrolyte balance.Clears tubing of formula.Advance rate of concentration of tube feeding gradually.
Helps to prevent diarrhea and gastric intolerance to formula.

Question 11

The nurse determines that a nasogastric (NG)tube needs irrigation when she:&#10;A) Obtains more than 200 mL of residual volume&#10;B) Obtains a small amount of thin watery residual&#10;C) Does not encounter resistance when aspirating the residual&#10;D) Obtains a reduced volume of thick secretions

Accepted Answer

The answer of The nurse determines that a nasogastric (NG)tube...

Question 12

Of the patients listed below,which would be a candidate for nasoenteric feeding tube placement?&#10;A) A post-motor-vehicle-accident victim with a broken nose and jaw&#10;B) A patient with a bleeding ulcer and possible esophageal varices&#10;C) An elderly patient with a diagnosis of failure to thrive and an inability to chew&#10;D) A patient with an esophageal tumor

Accepted Answer

The answer of Of the patients listed below,which would be...

Question 13

An appropriate technique for the nurse to implement for enteral feeding is:&#10;A) Weighing the client weekly&#10;B) Measuring gastric residual every hour&#10;C) Changing the formula every 8 hours in an open system&#10;D) Leaving formula in place in an open system for up to 24 hours

Accepted Answer

The answer of An appropriate technique for the nurse to...

Question 14

What is an appropriate amount of nasogastric irrigant for an adult client?&#10;A) 1 or 2 mL&#10;B) 30 mL&#10;C) 5 to 15 mL&#10;D) 250 mL

Accepted Answer

The answer of What is an appropriate amount of nasogastric...

Question 15

The nurse is checking gastric residual on a patient who has a continuously running tube feeding.She finds that the patient has a 300-mL residual volume.How should the nurse respond?&#10;A) Stop the tube feeding&#10;B) Slow the tube feeding&#10;C) Continue the tube feeding at the same rate&#10;D) Increase the rate of the tube feeding

Accepted Answer

The answer of The nurse is checking gastric residual on...

Question 16

Complications related to long-term placement of nasogastric (NG)tubes include which of the following? (Select all that apply.)&#10;A) Otitis&#10;B) Sinusitis&#10;C) Nasal septum erosion&#10;D) Patient discomfort&#10;E)  None of above

Accepted Answer

The answer of Complications related to long-term placement of nasogastric...

Question 17

An appropriate technique for nasogastric (NG)tube insertion is for the nurse to:&#10;A) Position the client supine&#10;B) Apply oil-based lubricant to the plastic tube&#10;C) Advance the tube while the client swallows&#10;D) Measure the tube length from the nose to the sternum

Accepted Answer

The answer of An appropriate technique for nasogastric (NG)tube insertion...

Question 18

The nurse is checking the residual volume on a patient who is getting intermittent tube feedings via his NG tube.Which of the following observations may indicate that the patient has started to bleed again?

A) Obtains brown aspirate
B) Notices that the abdomen is distended
C) Obtains red aspirate
D) Notices severe respiratory distress

Accepted Answer

The answer of The nurse is checking the residual volume...

Question 19

The nurse,physician,and dietitian collaborate to select an enteral feeding formula for the patient.Their decision should be based on which of the following? (Select all that apply.)&#10;A) Protein requirements of the patient&#10;B) Digestive ability of the patient&#10;C) Amount of lactose required&#10;D) The patient's disease process

Accepted Answer

The answer of The nurse,physician,and dietitian collaborate to select an...

Question 20

Additional teaching is required when the nurse evaluates the provision of the intermittent tube feeding and the family member:&#10;A) Keeps the formula refrigerated between feedings&#10;B) Keeps the feeding tube capped between feedings&#10;C) Begins the feeding before checking tube placement&#10;D) Irrigates the tube with 30 to 60 mL of water before and after feedings

Accepted Answer

The answer of Additional teaching is required when the nurse...

Question 21

Nasoenteric tubes,once placed into the small bowel,are thought to reduce the risk for ___________________.

Accepted Answer

The answer of Nasoenteric tubes,once placed into the small bowel,are...

Question 22

______________,commonly called tube feeding,is the administration of nutrients through the gastrointestinal tract when a patient cannot ingest,chew,or swallow,but can digest and absorb nutrients.

Accepted Answer

The answer of ______________,commonly called tube feeding,is the administration of...

Question 23

Gastrostomy feeding tubes require that the patient has normal _____________.

Accepted Answer

The answer of Gastrostomy feeding tubes require that the patient...

Question 24

A tube passed through the nose or mouth with the end terminating in the stomach or the small bowel,and used for feeding the patient for short periods of time is known as a _________________.

Accepted Answer

The answer of A tube passed through the nose or...

Deck 31: Enteral Nutrition