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16 Cards in this Set
- Front
- Back
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The most accurate method of determining initial NG feeding tube placement is:
A. auscultating for air over the gastric region B. aspirating secretions and checking the pH. C. abdominal radiography D. Both A and B |
C. Abdominal radiography
Although checking air over the gastric region and apirating secretions are helpful, an abdominal x-ray is the gold standard for feeding tube placment |
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Immediately after an open cholecystectomy, a pt is stated on enteral tube feeding at goal rate. 12 hrs after surgery, the pt has had 4 episodes of diarrhea, approximately 475mL. Bowel sounds are present. The most appropriate and initial nursing action would be to:
A. request that the pt be changed to parenteral nutrition. B. request that the pt be changed to maintenance intravenous IV fluids only. C. reduce the rate of the enteral feeding infusion D. send stool for C.Diff cultures |
C. Reduce the rate of enteral feeding infusion
Enteral nutrition may be initiated immediately after surgery, with or without the presence of bowel sounds; however, the rate should be started and advanced at a slower rate (which is often significantly less volume than goal rates.) Parenteral nutrition is inappropriate at this point as there is no contraindication to enteral nutrition and that is the perferred physiological route. Maintenance IV fluids provide no nutritional value to the patient, other than minimal calories. C.Diff cultures may be an appropriate intervention if the pt is concurrently receiving antibiotics and the initial intervention of slowing the enteral infusion rate does not correct the diarrhea. |
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A pt has a duodenal feeding tube placed endoscopically past the pylorus. The nurse giving you the report tells you that the pt is receiving enteral nutrition at goal rate of infusion of 60 mL/hr; however, he is concerned that the residual 1 hr ago was 125 mL. An abdominal film confirms correct placement. The most appropriate nursing action is to:
A. hold tube feedings for 2 hrs and restart at lower rate. B. resume TF as ordered adn monitor for N/V; residuals postpyloric may be misleading. C. DC enteral feedings and request parenteral nutrition be initiated. D. hold TF for 4 hrs and restart after diluting with water. |
B. resume TF as ordered and monitor for N/V; residuals postpyloric may be misleading.
Postpyloric residuals are inaccurate often due to the fact that the intestinal lumen is not a reservoir and the narrow feeding tubes tend to collapse upon themselves during aspiration. It is best to monitor the pt for N/V as a sign of intolerance. Small intestinal infusion rates should be no faster than 150 cc/hr. Holding tube feedings and diluting them with water will place the pt at risk for inadequate nutrition, especially if this is done frequently and adjustments are not made on supplement the pt. Patenteral nutrition is not indicated. |
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Which of the following macronutrients in parenteral nutrition may need to be increased in a pt who has large, nonhealing wounds?
A. Carbs B. Lipids C. Trace elements D. Protein |
D. Protein
Protein, or amino acids, is the building blocks for tissue maintenance and repair, and hence wound healing. All the other nutrients are important for metabolic functioning, but protein would be increased in order to promote wound healing. |
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The nervous system stores glucose for fuel.
A. True B. False |
B. False
The nervous system cannot store or synthesize glucose as a fuel source. |
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Excess glucose is converted and stored as glycogen and fatty acids.
a. True b. False |
A. True
Excess glucose is converted and stored as glycogen and fatty acids. |
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The malnourished patient is at greater risk for illness and infection.
a. True b. False |
A. True
The most important reason to properly nourish pts is to prevent the immunosuppression and impairment of physiological organ function that can result from malnutrition. |
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When delivering gastric tube feedings to a critically ill patient, the nurse should evaluate gastric tube placement:
A. every 2hrs and prn B. before every feeding or medication administration C. every shift D. PRN only |
B. before every feeding or medication administration
Recheck tube placement initiating intermittent feedings or medication administration, and at least once each shift. |
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A patient's tolerance to tube feedings depends on the:
A. flow rate B. osmolarity of the formula C. gastric residuals D. both A and B are correct |
D. both A and D are correct.
A pts tolerance to enteral feedings depend on the rate of flow and osmolarity of the formula. |
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The most frequent problem encountered when a patient cannot tolerate tube feedings is:
A. hypoactive bowel sounds B. diarrhea C. tarry stools D. coffee ground emesis |
B. Diarrhea
Diarrhea is the most common complication of enteral feeding. |
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The patient's order is to start total parenteral nutrition (TPN) containing a concentration of 15% glucose and 3.5% amino acids. The nurse realizes the solution must be:
A. initially started in a peripheral line. B. given in a central line C. checked, since glucose concentration is dangerouly high. D. held until renal function studies are done |
B. given in a central line
Central parenteral nutrition, also known as TPN, is infused through a large central vein. |
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When administering TPN, the nurse must monitor for:
A. hyperglycemia B. hypoglycemia C. hyponatremia D. hypokalemia |
A. hypoglycemia
Hyperglycemia, or a blood sugar elevated over 200 mg/dL, can occur if the pancreas does not respond to the increased glucose level. |
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Your patient is receiving continuous full strength tube feedings at the rate of 100 cc/hr. The aspirated residual is 260 cc. The best action to take would be to:
A. hold the feeding for an hr and recheck the residual. B. decrease the rate of 50 cc/hr C. change the concentration of one-half strength D. lower the HOB until the residual is less than 20 cc. |
A. hold the feeding for an hr and recheck the residual.
If cessation of TF for high residual is necessary, a common intervention holding the feeding for 1-2 hrs and rechecking the residual every 1-2 hrs until the residual is less than 200 mL form a NG tube or less than 100 mL from a gastronomy tube, at which point feedings can be resumed. |
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Mr. Kaye has become septic following a perforated diverticulum. In order to meet his nutritional needs, he should receive:
A. a low residue diet with high protein and calorie suppletments B. intermittent enteral feedings C. Continuous enteral feedings D. TPN |
D. TPN
Parenteral nutrition is indicated when oral or enteral nutrition is not possible or when absorption or function of the GI tract is not sufficient to meet the nutritional needs of the pt. |
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Which of the following can the pharmacist add directly to the TPN solution?
A. insulin B. potassium C. lipids D. All of the above |
D. all of the above
IV lipids provide a concentrated source of calories. Most electrolyte solutions contain potassium. Insulin is commonly added to the solutions because fo the increased incidence of hyperglycemia during TPN insulin. |
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Mrs. Simmons is receiving TPN at 100 cc/hr. Upon return from the radiology department, her nurse notices that the infusion pump is off and the TPN is now 200 cc behind schedule. The nurse should:
A. restart the infusion at 150 cc/hr in order to make up the lost volume. B. check the pt's blood glucose level C. bolus the pt with 200 cc and then restart the infusion at 100 cc/hr D. administer a 5% dextrose solution |
B. check the pt's blood glucose level
Checking blood sugars within 30 to 60 minute window after discontinuation helps the nruse identify and manage immediate glucose abnormalities. |
