A nurse is preparing to administer an enteral feeding via nasogastric tube. Identify the correct sequence the nurse should follow to initiate the feeding. (Move the steps, placing them in the selected order of performance. All steps must be used.)

A. Urinary urgency refers to a sudden, compelling need to urinate, which may or may not be accompanied by frequency (i.e., the need to urinate often). Urgency alone does not necessarily indicate urinary incontinence but rather may suggest conditions like overactive bladder or urge incontinence. This finding is not the most characteristic sign of urinary incontinence but rather a symptom of specific types of incontinence or bladder conditions.
B. Loss of urine when laughing, coughing, or sneezing is indicative of stress urinary incontinence. This type of incontinence occurs when physical activities that increase abdominal pressure (such as coughing, sneezing, or laughing) lead to involuntary leakage of urine. It is a common and classic symptom of stress urinary incontinence.
C. Urinary hesitancy refers to difficulty starting the urine stream or a delay in beginning urination. This symptom is more commonly associated with obstructive urinary conditions or prostatic issues in males rather than incontinence. It does not typically characterize urinary incontinence, which is more related to involuntary leakage rather than difficulties initiating urination.
D. Hematuria is the presence of blood in the urine and can be a sign of various urological issues such as infections, stones, or tumors. It is not a typical finding associated with urinary incontinence, which involves involuntary leakage rather than the presence of blood.

A. The supine position increases the risk of aspiration, where food or liquid could enter the airway and potentially cause aspiration pneumonia. To minimize this risk, the client should be positioned in a semi- Fowler’s position (head of the bed elevated at 30-45 degrees) during feedings.
B. Aspirating gastric residual volumes is a standard practice to check for proper digestion and tolerance of the feeding. Generally, a residual of up to 250-500 mL can be acceptable depending on institutional policy and client condition. This action does not necessarily require intervention unless specific guidelines indicate otherwise.
C. Irrigating the NG tube with tap water is a common practice to ensure the tube remains patent and to help clear any residual feeding material from the tube. Tap water is generally considered acceptable for this purpose, though some facilities may use sterile or distilled water to avoid any potential infections.
D. Administering the feeding through a syringe barrel by gravity is a standard method for intermittent tube feedings. This technique allows the feeding to flow slowly into the stomach without excessive pressure, which can help prevent complications such as nausea or cramping.