A nurse is about to administer a bolus enteral feeding to a client who is on bedrest. How does the nurse position the client during the feeding?
On left side, with the knees bent
With the head of the bed elevated 30-45 degrees
On the right side, with a pillow behind the back
With the head of the bed elevated 15 degree
The Correct Answer is B
B. Elevating the head of the bed to 30-45 degrees is the recommended position for administering enteral feeding to reduce the risk of aspiration. This semi-upright position helps promote gastric emptying and reduces the likelihood of reflux or regurgitation of the feed into the lungs. It also allows for better tolerance of the feeding and minimizes the risk of complications.
A. Positioning the client on the left side with the knees bent is not typically recommended for enteral feeding. This position may increase the risk of aspiration, especially if the client has impaired swallowing or if there are issues with gastric emptying. It may also not be the most comfortable or practical position for administering enteral feeding.
C. Positioning the client on the right side with a pillow behind the back is not a standard practice for administering enteral feeding. This position may not provide optimal access for administering the feed, and it does not offer the benefits of head elevation to reduce the risk of aspiration.
D. Elevating the head of the bed to only 15 degrees may not provide sufficient upright positioning to reduce the risk of aspiration during enteral feeding. While it is better than lying completely flat, a higher degree of elevation (30-45 degrees) is generally recommended for optimal safety and effectiveness of enteral feeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This approach involves providing medication education to the client as each medication is administered. While this ensures that the client receives information about each medication in a timely manner, it may not allow for comprehensive education or adequate time for the client to ask questions or clarify information. Additionally, the client may feel overwhelmed by receiving information about multiple medications at once.
B. Incorporating medication education into another activity, such as assisting the client with his bath, can be an efficient use of time. However, it may not provide an optimal environment for focused learning and discussion. The client may be distracted or uncomfortable during the bath, limiting their ability to absorb and retain information effectively.
C. This approach involves providing medication education to the client after discharge via a follow-up phone call. While this allows for more time and flexibility in providing education, it may not address the client's immediate needs or questions prior to discharge. Additionally, the client may have already started taking the medications by the time of the follow-up call, potentially leading to missed opportunities for clarification or adjustment of the medication regimen.
D. Providing written instructions for the client to read at home is an efficient way to ensure that the client has access to information about their medications. This allows the client to review the information at their own pace and refer back to it as needed. However, written instructions alone may not be sufficient for addressing all aspects of medication education, such as potential side effects, drug interactions, or administration techniques.
Correct Answer is B
Explanation
B. Adapting to a stressor involves adjusting one's thoughts, feelings, or behaviors in response to the stressor. The nursing instructor's advice to the student to think of each clinical day as an opportunity to learn new things is an example of adapting to the stressor of clinical anxiety. By reframing the clinical experience as an opportunity for growth and learning, the student can change their perspective and better cope with their anxiety.
A. Eliminating a stressor involves completely removing the source of stress from the situation. In this scenario, the nursing instructor is not removing the clinical experience itself, which may be causing the student's anxiety, but rather providing a coping strategy to help the student manage their anxiety and view the clinical day in a more positive light.
C. Altering a stressor involves making changes to the stressor itself to reduce its impact or eliminate it altogether. In this scenario, the nursing instructor is not directly altering the clinical experience but rather providing a cognitive coping strategy to help the student manage their anxiety. While altering the clinical experience itself may not be feasible, altering one's perception of the experience can be an effective way to cope with stress.
D. Avoiding a stressor involves deliberately avoiding or withdrawing from the situation or activity that is causing stress. In this scenario, the nursing instructor is not advising the student to avoid clinical altogether but rather providing guidance on how to approach and cope with the clinical experience in a more positive and constructive manner.
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