Chapter 31: Enteral Nutrition

Chapter 31: Enteral Nutrition

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Of the patients listed below, which would be a candidate for nasoenteric feeding tube placement?

a.	Post–motor vehicle accident victim with a broken nose and jaw
b.	Patient with a bleeding ulcer and possible esophageal varices
c.	Elderly patient with a diagnosis of failure to thrive and an inability to chew
d.	Patient with an esophageal tumor

 

 

ANS:  C

Enteral nutrition, 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. Nasoenteric tubes are contraindicated in patients with facial trauma, prolonged bleeding, and upper gastrointestinal (GI) blockage (as is seen in cases of solid cancer).

 

DIF:    Cognitive Level: Analysis                REF:   Text reference: p. 775

OBJ:   Assess the patient who is to receive enteral tube feedings.

TOP:   Indications/Contraindications for Nasoenteric Tube Insertion

KEY:  Nursing Process Step: Assessment   MSC:  NCLEX: Physiological Integrity

 

2. 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?

a.	Test the pH of the contents.
b.	Use a carbon dioxide sensor.
c.	Lower the head of the bed to 15 degrees.
d.	Obtain an order for a chest radiograph.

 

 

ANS:  D

The most reliable method of feeding tube verification is a chest radiograph (chest x-ray). Gastric and intestinal pH measurements have 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. Elevation of the head of the bed to a minimum of 30 degrees is a simple method used 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.

 

DIF:    Cognitive Level: Application           REF:   Text reference: p. 776 |Text reference: p. 781

OBJ:   Demonstrate ability to correctly insert a small-bore feeding tube.

TOP:   Determining Position of NG Tubes

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity

 

3. The nurse is checking gastric residual on a patient who has a continuously running tube feeding. She finds that the patient has a 600-mL residual volume. How should the nurse respond?

a.	Stop the tube feeding.
b.	Slow the tube feeding.
c.	Continue the tube feeding at the same rate.
d.	Increase the rate of the tube feeding.

 

 

ANS:  A

Tube feedings are stopped if the patient has high gastric residual (more than 500 mL).

 

DIF:    Cognitive Level: Application           REF:   Text reference: p. 776 |Text reference: p. 790

OBJ:   Assess the patient who is to receive enteral tube feedings.

TOP:   Residual Volume                             KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity

 

4. Before insertion of a nasogastric (NG) tube, of which finding should the physician be notified?

a.	Patent nares
b.	Absent bowel sounds
c.	Evident gag reflex
d.	Impaired swallowing

 

 

ANS:  B

Absent bowel sounds may indicate decreased or absent peristalsis and increased risk for aspiration. A finding of patent nares rules out obstruction or irritated nares, septal defect, or facial fracture and does not need to be reported to the physician because it is a “normal” finding. The nurse should assess the patient for a gag reflex to determine the patient’s ability to swallow and to discern whether a greater risk for 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.

 

DIF:    Cognitive Level: Application           REF:   Text reference: p. 777 |Text reference: p. 789

OBJ:   Demonstrate ability to correctly insert a small-bore feeding tube.

TOP:   Absent Bowel Sounds KEY:             Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity

 

5. An appropriate technique for nasogastric (NG) tube insertion is for the nurse to:

a.	position the patient supine.
b.	apply oil-based lubricant to the plastic tube.
c.	advance the tube while the patient swallows.
d.	measure the tube length from the nose to the sternum.

 

 

ANS:  C

Encourage the patient to swallow by giving small sips of water or ice chips. Advance the tube as the patient swallows. Rotate the tube 180 degrees while inserting. Swallowing facilitates passage of the tube past the oropharynx. Position the patient sitting with the head of the bed elevated at least 30 degrees. If the patient is comatose, place him in semi-Fowler’s position with the head propped forward using a pillow. If the patient is forced to lie supine, place him in reverse Trendelenburg’s position. This reduces the risk for pulmonary aspiration in the event that the patient should vomit. Apply water-soluble lubricant. The tip of the tube must reach the stomach. Measure the distance from the tip of the nose to the earlobe to the xiphoid process of the sternum. Add 20 to 30 cm (8 to 12 inches) for a nasoenteric tube.

 

DIF:    Cognitive Level: Application           REF:   Text reference: p. 779

OBJ:   Demonstrate ability to correctly insert a small-bore feeding tube.

TOP:   NG Tube Insertion                          KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity