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 ["C","D","E"]
Explanation
C. Sleep plays a crucial role in stress management and resilience. Adequate sleep helps regulate stress hormones such as cortisol, promotes emotional regulation, and enhances coping mechanisms. Chronic sleep deprivation can lead to increased stress levels and reduced ability to cope with stressors.
D. Sleep is essential for the restoration and repair of both the mind and body. During sleep, the body undergoes processes such as tissue repair, muscle growth, and memory consolidation. Sleep also allows the brain to clear toxins and waste products accumulated during wakefulness, promoting cognitive function and overall well-being.
E. One of the functions of sleep is to conserve energy. During sleep, metabolic rate and energy expenditure decrease, allowing the body to conserve resources for essential physiological processes. Sleep helps replenish energy stores, repair cellular damage, and prepare the body for the next day's activities.
A. Sleep has been shown to have analgesic effects and can improve pain tolerance. Adequate sleep helps reduce the perception of pain and promotes the release of endogenous pain-relieving substances in the body.
B. During sleep, blood pressure typically decreases as part of the normal sleep-wake cycle. However, certain sleep disorders, such as sleep apnea, may lead to fluctuations in blood pressure during sleep. Overall, quality sleep is important for maintaining cardiovascular health and regulating blood pressure.
Correct Answer is D
Explanation
D. Impaired immunity is a serious complication of prolonged stress that can have significant implications for overall health and susceptibility to illness. Chronic stress has been linked to dysregulation of the immune system, leading to decreased immune function and increased susceptibility to infections, autoimmune disorders, and other illnesses. Impaired immunity can compromise the body's ability to fight off pathogens and may contribute to the development or exacerbation of various health conditions.
A. Increased muscle tension is a common physiological response to stress but it is not typically considered a serious complication. Prolonged muscle tension can lead to discomfort, headaches, and musculoskeletal issues, but it is not usually life-threatening or associated with severe complications.
B. Altered sleep patterns, such as insomnia or disrupted sleep, can be significant consequences of prolonged stress. Chronic sleep disturbances can negatively impact physical health, cognitive function, and emotional well-being. While altered sleep patterns can have serious implications for overall health and quality of life, they are not typically considered life-threatening in the short term.
C. Increased peristalsis refers to heightened movement of the gastrointestinal tract, which can result in symptoms such as diarrhea or gastrointestinal discomfort. While gastrointestinal disturbances are common manifestations of stress, they are generally not considered the most serious complication of prolonged stress. However, severe or persistent gastrointestinal symptoms may warrant medical evaluation and management.
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