A nurse is administering continuous enteral feedings for a client through a percutaneous esophageal gastrostomy (PEG) tube. Which of the following actions should the nurse take?
Check gastric residuals every 8 hr.
Return gastric contents if residual is less than 250 mL.
Measure the pH of gastric residual every 24 hr.
Flush the tube with 15 mL of water every 4 hr.
The Correct Answer is D
Choice A reason: Checking gastric residuals every 8 hr is not frequent enough, as it can miss signs of delayed gastric emptying, which can cause aspiration, nausea, vomiting, or abdominal distension. Gastric residuals should be checked every 4 hr.
Choice B reason: Returning gastric contents if residual is less than 250 mL is not advisable, as it can increase the risk of infection, contamination, or electrolyte imbalance. Gastric contents should be discarded if residual is more than 100 mL.
Choice C reason: Measuring the pH of gastric residual every 24 hr is not necessary, as it does not reflect the effectiveness or tolerance of the feeding. The pH of gastric residual should be checked before each feeding or every 6 to 8 hr to confirm tube placement and prevent misconnection.
Choice D reason: Flushing the tube with 15 mL of water every 4 hr is a correct action, as it can prevent clogging, maintain patency, and clear the tube of formula residue. Water should also be used to flush the tube before and after each medication administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Avocado dip is high in fat and calories, even though it is mostly unsaturated fat. It is not a good choice for a low-fat diet.
Choice B reason: Fish is a good source of protein and omega-3 fatty acids, which can lower blood cholesterol and triglycerides. The American Heart Association recommends eating at least two servings of fish per week, especially fatty fish like salmon, tuna, and mackerel.
Choice C reason: Margarine is made from vegetable oils and may contain trans fats, which can raise LDL (baD. cholesterol and lower HDL (gooD. cholesterol. It is better to use a small amount of butter or a non-fat spread on waffles.
Choice D reason: The skin on poultry is high in fat and cholesterol, and should be removed before cooking or eating. Broiling does not reduce the fat content of the skin.
Correct Answer is C
Explanation
Choice A reason: 1 cup green grapes has about 15 mg of calcium, which is low compared to other foods. Green grapes are also a good source of vitamin C, potassium, and antioxidants.
Choice B reason: One medium banana has about 6 mg of calcium, which is very low compared to other foods. Banana is also a good source of potassium, fiber, and vitamin B6.
Choice C reason: 1 cup broccoli has about 180 mg of calcium, which is high compared to other foods. Broccoli is also a good source of vitamin C, folate, and antioxidants.
Choice D reason: One large tomato has about 18 mg of calcium, which is low compared to other foods. Tomato is also a good source of vitamin C, lycopene, and potassium.
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