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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Document assessment findings and interventions after providing care for a group of clients:Delaying documentation until after providing care for a group of clients can lead to incomplete or inaccurate records. Timely documentation is essential for maintaining accurate client records and ensuring continuity of care.
B) Delay cleaning personal work area until the end of the shift:Delaying the cleaning of the personal work area can lead to disorganization and potential safety hazards. Maintaining a clean and organized work area throughout the shift helps improve efficiency and safety.
C) Gather supplies for a client’s dressing change after removing the old dressing:Gathering supplies after removing the old dressing can lead to delays and increased risk of infection. It is more efficient to gather all necessary supplies before starting the procedure to ensure a smooth and timely dressing change.
D) Complete activities for one client before moving to the next client:Completing activities for one client before moving to the next client helps ensure that each client receives focused and uninterrupted care. This approach minimizes the risk of errors and enhances time management by reducing the need to switch tasks frequently.
Correct Answer is A
Explanation
A) This statement demonstrates an understanding of infection prevention related to chickenpox. The contagious period for chickenpox is typically considered to end once the sores have crusted over, making it safe to visit a person who has had chickenpox after this time. This reflects appropriate awareness of infectious disease protocols.
B) This statement reflects a misunderstanding about antibiotic use, as antibiotics are ineffective against viral infections. Taking antibiotics when they are not needed can lead to antibiotic resistance and other complications, highlighting the importance of understanding when to use these medications.
C) Washing hands for only 10 seconds, even with hot water, is insufficient for effective hand hygiene. The Centers for Disease Control and Prevention (CDC) recommends washing hands for at least 20 seconds to effectively remove pathogens, especially after gardening, which can introduce soilborne pathogens.
D) Cleaning a cat's litter box during pregnancy poses a risk for toxoplasmosis, a parasitic infection that can have serious consequences for the fetus. Pregnant women are advised to avoid this task or take precautions if they must do it, demonstrating a lack of understanding of specific infection risks associated with pregnancy.
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