A nurse is providing teaching about the administration of gastrostomy tube feedings to the parents of an infant. Which of the following instructions should the nurse include?

Provide a pacifier for nonnutritive sucking.

Warm the formula in the microwave prior to administration.

Change the gastrostomy tube every 3 days.

Place the infant in a supine position after the feeding.

Answer and Explanation

The Correct Answer is A

Rationale:
A. Provide a pacifier for nonnutritive sucking: Offering a pacifier promotes nonnutritive sucking, which supports oral motor development and provides comfort for the infant during gastrostomy tube feedings. This practice can help the infant transition more easily to oral feeding later.

B. Warm the formula in the microwave prior to administration: Warming formula in the microwave is unsafe because it can create hot spots that may burn the infant’s mouth or esophagus. Formula should be warmed using a bottle warmer or by placing the container in warm water.

C. Change the gastrostomy tube every 3 days: Routine gastrostomy tube replacement every 3 days is unnecessary and can cause trauma. Tubes are generally changed according to manufacturer recommendations or when malfunction or blockage occurs.

D. Place the infant in a supine position after the feeding: Infants should be kept in an upright or semi-upright position during and after feedings to reduce the risk of aspiration. Supine positioning increases the likelihood of reflux and respiratory complications.

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Correct Answer is A

Explanation

Rationale:
A. "I will ask your provider to discuss options for discontinuing treatment with you.": This response supports the client’s autonomy and right to refuse treatment while ensuring that the provider is informed to discuss the medical and ethical aspects of stopping therapy. It reflects respect for the client’s wishes and promotes shared decision-making.

B. "You cannot legally discontinue treatment unless you have a living will.": A living will is not required for a client to refuse or discontinue treatment. Competent clients have the legal and ethical right to make decisions about their own care, including the choice to stop therapy, regardless of advance directives.

C. "You must continue with these treatments because they are lifesaving.": This statement disregards the client’s autonomy and imposes the nurse’s opinion on the client’s decision. Even if the treatment is potentially lifesaving, the client has the right to decline it based on their personal values and quality-of-life considerations.

D. "I know your provider thinks these treatments are necessary for you.": This response shifts focus away from the client’s preferences and reinforces the provider’s opinion instead. It fails to acknowledge the client’s emotional and ethical right to choose.

A. Creatinine B. Alkaline phosphatase C. Bilirubin D. Amylase

Correct Answer is A

Explanation

Rationale:
A. Creatinine: Serum creatinine is a key indicator of renal function. Cyclosporine is nephrotoxic, so monitoring both BUN and creatinine helps detect early signs of kidney impairment or transplant rejection.

B. Alkaline phosphatase: This enzyme primarily reflects liver and bone activity, not renal function. It is not routinely used to evaluate kidney status.

C. Bilirubin: Bilirubin levels are used to assess liver function and hemolytic disorders, not kidney function.

D. Amylase: Amylase is an enzyme related to pancreatic function and used to diagnose pancreatitis, not renal impairment.

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A nurse is providing teaching about the administration of gastrostomy tube feedings to the parents of an infant. Which of the following instructions should the nurse include?

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