A nurse is caring for a client who has diarrhea and is receiving intermittent enteral feedings. Which of the following actions should the nurse take?

Provide chilled formula.

Administer feedings at a slower rate.

Discard the open can of formula after 36 hr.

Flush the tube with 10 mL of water after feedings.

Answer and Explanation

The Correct Answer is B

A. Provide chilled formula: Chilled formula can be less palatable and may cause gastrointestinal discomfort, potentially worsening diarrhea. Room temperature or slightly warmed formula is generally recommended for enteral feedings to enhance tolerance and digestion.

B. Administer feedings at a slower rate: Slowing the rate of enteral feedings can help reduce gastrointestinal irritation and improve absorption, which may be particularly beneficial for a client experiencing diarrhea. This approach allows the intestines more time to process the nutrients, potentially alleviating symptoms.

C. Discard the open can of formula after 36 hr: While proper storage is important, many enteral formulas can be stored for up to 48 hours once opened. The key is to ensure the formula is stored correctly to prevent bacterial growth, but the 36-hour guideline may not be strictly necessary in all cases.

D. Flush the tube with 10 mL of water after feedings: Flushing the tube is a good practice to maintain tube patency, but the volume may not be adequate depending on the tube size and the specific protocol. Adequate flushing is essential, but it does not directly address the issue of diarrhea, which is the priority concern in this scenario.

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Correct Answer is D

Explanation

A) Amputation does not automatically disqualify someone from being a kidney donor, as the donor's overall health and kidney function are the primary concerns.

B) Osteoarthritis is not a contraindication for kidney donation, as this condition generally does not affect kidney function or the ability to undergo surgery.

C) Primary glaucoma is an eye condition that does not typically impact the decision to donate a kidney. The focus is primarily on the donor's renal function and overall health.

D) Hypertension can be a significant contraindication for kidney donation, especially if it is poorly controlled. Elevated blood pressure can increase the risk of complications during and after surgery and may affect the donor's long-term health, as they would have only one kidney. Therefore, this condition should be carefully evaluated before considering kidney donation.

A. Plans for a check of the client's fingerstick glucose level every 6 hr B. Schedules a bag and tubing change for 24 hr after the start of the infusion C. Uses the TPN IV tubing to administer the client's next dose of antibiotics D. Gradually increases the TPN infusion rate each hour until the prescribed rate is achieved

Correct Answer is C

Explanation

A. Plans for a check of the client's fingerstick glucose level every 6 hr: Monitoring blood glucose levels is essential for clients receiving TPN due to the risk of hyperglycemia. Checking glucose every 6 hours is a standard practice that helps ensure appropriate glycemic control, so this action is appropriate.

B. Schedules a bag and tubing change for 24 hr after the start of the infusion: It is standard practice to change the TPN bag and tubing every 24 hours to reduce the risk of infection and maintain sterility. This timing aligns with best practices for TPN administration, indicating no need for intervention.

C. Uses the TPN IV tubing to administer the client's next dose of antibiotics: Using the TPN line for additional medications, such as antibiotics, can lead to complications like incompatible drug interactions or infection. TPN should ideally be delivered through a dedicated line to prevent these risks, which necessitates intervention from the supervising nurse.

D. Gradually increases the TPN infusion rate each hour until the prescribed rate is achieved: Gradual escalation of the TPN infusion rate is important to prevent complications such as hyperglycemia. This action is appropriate, as it allows the body to adapt to the increased caloric intake safely.

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A nurse is caring for a client who has diarrhea and is receiving intermittent enteral feedings. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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