A nurse is caring for a client who has diarrhea and is receiving intermittent enteral feedings. Which of the following actions should the nurse take?
Flush the tube with 10 mL of water after feedings.
Discard the open can of formula after 36 hr.
Administer feedings at a slower rate.
Provide chilled formula.
The Correct Answer is C
A. Flushing the tube with water after feedings helps to prevent tube clogging and ensures adequate delivery of enteral feedings. However, it does not address the diarrhea.
B. While it's important to discard open cans of formula within a specified timeframe to prevent bacterial growth, diarrhea in the client is not directly addressed by discarding formula after 36 hours.
C. The nurse should consider administering feedings at a slower rate to manage diarrhea. This approach can help reduce the incidence of diarrhea as it allows for better absorption of the nutrients.
D. Providing chilled formula is not typically indicated for clients with diarrhea and may not be well-tolerated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A: A client who is scheduled for a colonoscopy and is taking sodium phosphate requires follow-up care because sodium phosphate can cause colonic mucosal damage and electrolyte imbalances that may affect the safety and accuracy of the colonoscopy. Sodium phosphate is a bowel preparation agent that empties the colon before the procedure, but it can also cause dehydration, kidney injury, and cardiac arrhythmias.
B: Induration following a Mantoux test indicates a reaction that may suggest tuberculosis exposure, but this is an expected result that requires assessment rather than immediate follow-up.
C: Bumetanide is a diuretic, and an increase in urination is an expected effect of this medication.
D: Warfarin is considered safe during lactation since it is not excreted in breastmilk to any measurable degree.
Correct Answer is B
Explanation
A. While maintaining eye contact during feedings can foster bonding and comfort, it is not specifically beneficial for managing symptoms of neonatal abstinence syndrome (NAS).
B. Minimizing noise in the newborn's environment is crucial for a baby with NAS. These infants often have increased sensitivity to stimulation and can become easily agitated. A quiet, calming environment can help soothe them.
C. Administering naloxone to a newborn with NAS is not recommended. Naloxone is an opioid antagonist and, while it can reverse opioid effects acutely, it is not a treatment for the withdrawal symptoms associated with NAS.
D. Swaddling the newborn is beneficial, but the legs should not be extended.
Swaddling should allow for some movement of the legs and hips to prevent the development of hip dysplasia. Swaddling in a way that allows the legs to bend and move is generally recommended.
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