A nurse is monitoring an infant who is receiving opioids for pain.
Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect?

Choice A rationale:

"Consume 1,500 to 1,700 calories per day." This statement provides a specific calorie range suitable for most adolescents. It ensures they receive adequate energy to support their growth and daily activities. Adequate caloric intake is essential during adolescence to support proper physical and mental development.

Choice B rationale:

"Decrease your vitamin D intake once you start to menstruate." Menstruation does not affect the need for vitamin D intake. In fact, vitamin D is crucial for bone health, especially during adolescence when bones are still developing. Adolescents, including females, should maintain an appropriate level of vitamin D intake to support bone health and overall well-being.

Choice C rationale:

"Increase the amount of your dietary iron intake." During adolescence, especially for females, iron requirements increase due to menstrual losses. Iron is essential for the production of red blood cells and to prevent anemia. Adolescents, particularly females, should be educated about the importance of including iron-rich foods in their diet to meet their increased nutritional needs.

Choice D rationale:

"Limit your sodium intake to 3,000 milligrams per day." While limiting sodium intake is generally advisable for overall health, this statement does not specifically address the nutritional needs of adolescents. Adolescents need guidance on various aspects of nutrition, but limiting sodium intake should be part of a broader discussion about a balanced diet, rather than a singular focus during this educational session.

Choice A rationale:

Attaching the feeding bag tubing to the end of the NG tube is a step in the enteral feeding process, but it is not the first action the nurse should take. First, the nurse needs to assess the pH of the gastric secretions to confirm the NG tube placement in the stomach. If the pH is acidic (usually below 5.5), it indicates that the NG tube is in the stomach. If the pH is alkaline, it may suggest the tube is in the respiratory tract, and feeding should not be initiated. Therefore, this choice is not the correct first action.

Choice B rationale:

Flushing the tube with water is important to ensure it is clear and not clogged. However, it is not the first action the nurse should take. Checking the pH of the gastric secretions is crucial to confirm the NG tube placement before any other interventions. If the nurse encounters resistance while flushing the tube, it could indicate a misplaced tube, emphasizing the importance of checking the pH first.

Choice C rationale:

Checking the pH of the gastric secretions is the correct first action before administering enteral feeding. Gastric secretions are acidic (usually below 5.5), confirming the tube's placement in the stomach. This step ensures the safety of the feeding process and prevents complications such as aspiration pneumonia. Once the placement is confirmed, the nurse can proceed with other steps, such as attaching the feeding bag tubing and setting the administration rate on the feeding pump.

Choice D rationale:

Setting the administration rate on the feeding pump is a necessary step in enteral feeding but should only be done after confirming the tube placement by checking the pH of the gastric secretions. If the nurse administers the feeding without confirming the tube placement, there is a risk of aspiration, which can be life-threatening.