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 C
Explanation
Choice A reason: Limiting high-calorie supplements to between meals is not a good strategy for managing anorexia while receiving radiation therapy because it can reduce the appetite and intake of regular meals, which are more nutritious and balanced. High-calorie supplements should be used as an addition to, not a replacement for, regular meals.
Choice B reason: Avoiding overeating during 'good' days is not a good strategy for managing anorexia while receiving radiation therapy because it can cause discomfort, nausea, or vomiting, which can worsen anorexia and affect the tolerance of radiation therapy. Eating should be based on hunger and satiety cues, not on good or bad days.
Choice C reason: Consuming nutrition-dense foods first is a good strategy for managing anorexia while receiving radiation therapy because it can ensure adequate intake of calories, protein, vitamins, and minerals, which are essential for healing and recovery. Nutrition-dense foods are those that provide high amounts of nutrients per serving, such as eggs, cheese, nuts, beans, and meat.
Choice D reason: Eating hot foods rather than cold foods is not a good strategy for managing anorexia while receiving radiation therapy because it can irritate the mouth and throat, which may be inflamed or sore due to radiation therapy. Cold foods are more soothing and refreshing for the mouth and throat, such as ice cream, yogurt, smoothies, and popsicles.
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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