A nurse is preparing to administer an enteral feeding via an established NG tube. Identify the sequence the nurse should follow to initiate the feeding.

(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Verify tube placement.

Check the residual feeding contents.

Administer the feeding.

Evaluate tolerance to the feeding.

Answer and Explanation

The Correct Answer is A,B,C,D

Choice A rationale

Verifying tube placement is the initial critical step to ensure the feeding is delivered into the gastrointestinal tract and not the respiratory system, thereby preventing aspiration. Methods for verification include pH testing of aspirate (target pH ≤ 5.5), and radiographic confirmation is the gold standard, especially after initial placement.

Choice B rationale

Checking the residual feeding contents before administering a new feeding is essential to assess the client's tolerance to the previous feeding and prevent overfeeding, which can lead to complications like abdominal distension, nausea, vomiting, and aspiration. A high residual volume may indicate delayed gastric emptying.

Choice C rationale

Administering the feeding follows confirmation of tube placement and assessment of residual volume. The feeding should be administered at the prescribed rate and volume, ensuring the client receives adequate nutrition and hydration. The client should be positioned with the head of the bed elevated at least 30-45 degrees during and for at least 30-60 minutes after feeding to minimize aspiration risk.

Choice D rationale

Evaluating the client's tolerance to the feeding is an ongoing process that involves monitoring for signs and symptoms such as abdominal distension, pain, nausea, vomiting, diarrhea, or aspiration. This evaluation helps determine if the feeding regimen needs adjustment in terms of rate, volume, or formula.

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Correct Answer is C

Explanation

Choice A rationale

NPO (nothing by mouth) might be a temporary measure immediately following a stroke if aspiration risk is very high. However, prolonged NPO can lead to malnutrition and dehydration, hindering recovery. Nutritional support is crucial for stroke patients, so alternative feeding methods should be explored.

Choice B rationale

Total parenteral nutrition (TPN) is a method of providing nutrients intravenously, bypassing the gastrointestinal tract. It is usually reserved for patients with severe gastrointestinal dysfunction or when enteral feeding is not feasible or tolerated. While it provides nutrition, it carries risks of infection and metabolic complications and is not the first-line treatment for dysphagia.

Choice C rationale

A mechanical soft diet consists of foods that are easy to chew and swallow, reducing the risk of choking and aspiration in patients with mild to moderate dysphagia. This diet provides necessary nutrients while minimizing the effort required for safe oral intake, promoting better nutrition and hydration compared to NPO.

Choice D rationale

Supplements via NG tube provide enteral nutrition directly into the stomach or small intestine, bypassing the oral cavity and pharynx. This is an appropriate nutritional therapy for patients with severe dysphagia who cannot safely swallow even modified textures, ensuring adequate caloric and nutrient intake to support recovery and prevent malnutrition.

A. Speech therapist. B. Respiratory therapist. C. Dentist. D. Physical therapist.

Correct Answer is A

Explanation

Choice A rationale

A speech therapist specializes in diagnosing and treating swallowing disorders, such as dysphagia. They assess the client’s ability to swallow safely and provide interventions to improve swallowing techniques, including exercises and modifications to diet. Referral to a speech therapist is essential for managing dysphagia and preventing complications like aspiration pneumonia.

Choice B rationale

A respiratory therapist primarily deals with breathing problems and airway management, not swallowing difficulties. While respiratory therapists play a role in managing clients with respiratory distress, they do not specialize in dysphagia.

Choice C rationale

A dentist focuses on oral health, which is important for overall health, but they are not the appropriate specialist for managing dysphagia. While they may address oral conditions that could impact swallowing, dysphagia management requires the expertise of a speech therapist.

Choice D rationale

A physical therapist focuses on physical movement and rehabilitation. While physical therapy may assist in mobility and motor coordination, dysphagia management falls within the domain of a speech therapist, not a physical therapist.

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A nurse is preparing to administer an enteral feeding via an established NG tube. Identify the sequence the nurse should follow to initiate the feeding. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Nursing Test Bank

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Correct Answer is C

Explanation

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Correct Answer is A

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A nurse is preparing to administer an enteral feeding via an established NG tube. Identify the sequence the nurse should follow to initiate the feeding.

(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)