Question 1

Which of these nursing actions included in the plan of care for a patient who is receiving intermittent tube feedings through a PEG tube may be delegated to an LPN/LVN?

Accepted Answer

LPN/LVN education and scope of practice include actions such as dressing changes and wound care. Patient teaching and complex assessments (such as patient nutrition and hydration status) require RN-level education and scope of practice.

Question 2

While caring for a comatose patient who is receiving continuous tube feedings through a soft nasogastric tube, the nurse notes the presence of new crackles in the patient's lungs. In which order will the nurse take the following actions?

Accepted Answer

The assessment data indicate that aspiration may have occurred, and the nurse's first action should be to turn off the tube feeding to avoid further aspiration. The next action should be to check the oxygen saturation because this may indicate the need for immediate respiratory suctioning or oxygen administration. The residual volume should be obtained because it provides data about possible causes of aspiration. Finally, the health care provider should be notified and informed of all the assessment data the nurse has just obtained.

Question 3

During a busy day, the nurse admits all of these patients to the medical-surgical unit. Which patients are most important to refer to the dietician for a complete nutritional assessment? (Select all that apply.)

Accepted Answer

Multiple fractures, diabetes, and poor wound healing are diagnoses that place the patient at nutritional risk. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.

Question 4

The nurse notes that the peripheral PN bag is almost empty and a new PN bag has not yet arrived from the pharmacy. Which action is appropriate?

Accepted Answer

To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurse's scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose is appropriate but is not an adequate response because monitoring

Question 5

A patient who is receiving a continuous tube feeding 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. The nurse will plan to

Accepted Answer

The tube feeding should be shut off 30 to 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.

Question 6

When using a soft, silicone nasogastric tube for enteral feedings, the nurse will need to

Accepted Answer

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.

Quiz 40: Nursing Management: Nutritional Problems