A nurse is preparing to initiate a continuous enteral feeding through an open system to a client. Which of the following actions should the nurse take?
Administer 200 mL of formula during the initial infusion
Give the initial feeding over 15 min.
Reconstitute the formula with tap water
Discard unused formula after 8 hr.
The Correct Answer is D
A) Administer 200 mL of formula during the initial infusion:
The initial infusion rate for continuous enteral feeding is typically started at a slower rate, often lower than 200 mL, to assess the client's tolerance and prevent complications such as aspiration or dumping syndrome.
B) Give the initial feeding over 15 min:
Continuous enteral feeding is administered slowly over an extended period, usually 24 hours, to ensure gradual delivery of nutrients and minimize the risk of complications such as aspiration or gastrointestinal intolerance. Giving the initial feeding over 15 minutes is too rapid and can lead to adverse events.
C) Reconstitute the formula with tap water:
Reconstituting enteral formula with tap water is not recommended due to the potential risk of contamination with bacteria or other pathogens. It's essential to use sterile water or water that has been specifically purified for enteral feeding to minimize the risk of infection.
D) Discard unused formula after 8 hr:
Unused formula should be discarded after 4 hours, not 8 hours, to reduce the risk of bacterial contamination and ensure the integrity of the enteral nutrition. This practice aligns with guidelines for safe enteral feeding administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Tuna: Tuna is a major source of magnesium. It is a type of fish that contains a significant amount of this mineral. Magnesium plays a crucial role in various physiological functions, including muscle and nerve function, blood sugar regulation, and bone health. Including tuna in the diet can help maintain adequate magnesium levels.
B) Tomatoes: While tomatoes are nutritious and provide various vitamins and minerals, including potassium and vitamin C, they are not considered a major source of magnesium. Magnesium-rich foods are typically those that are high in seeds, nuts, whole grains, and leafy green vegetables.
C) Eggs: Eggs are a good source of several nutrients, including protein, vitamins, and minerals like vitamin D and choline. However, they are not particularly high in magnesium compared to other foods like nuts, seeds, and leafy greens.
D) Oranges: Oranges are well-known for their vitamin C content and are a good source of dietary fiber. However, they are not considered a major source of magnesium. Magnesium-rich foods are typically those that are more plant-based, such as nuts, seeds, and green leafy vegetables.
Correct Answer is A
Explanation
A. "It sounds like you are exhausted."
This response demonstrates empathy and acknowledges the client's emotional state. The "E" in the NURSE mnemonic stands for "empathize," which involves recognizing and validating the client's feelings. By acknowledging that the client may be exhausted, the nurse shows understanding and empathy towards the client's experience of feeling overwhelmed.
B. "Tell me more about how you are feeling."
This response demonstrates active listening and encourages the client to express their emotions further. While important for therapeutic communication, it does not specifically address the client's feeling of being overwhelmed as directly as option A.
C. "You have so much to deal with. How can I be of help to you?"
This response demonstrates support and willingness to assist the client but does not directly address the client's reported feeling of being overwhelmed.
D. "It is impressive how you have managed to deal with the situation."
This response offers praise but does not directly address the client's reported feeling of being overwhelmed. It may also inadvertently minimize the client's feelings by focusing on their ability to cope rather than acknowledging their current emotional state.
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