A nurse is caring for a client who is receiving enteral feedings via NG tube. Which of the following actions should the nurse take prior to administering the formula?

Check for gastric residual volume.

Flush the tube with sterile 0.9% sodium chloride irrigation.

Encourage the client to take sips of water.

Encourage the client to breathe deeply and cough.

Answer and Explanation

The Correct Answer is A

A. Before administering enteral feeding, it is important to check the gastric residual volume to ensure that the previous feeding has been adequately digested and to reduce the risk of aspiration. High residual volumes can indicate delayed gastric emptying and may require holding the feeding.

B. While it is important to flush the tube, this is typically done with water (sterile or tap) rather than sterile 0.9% sodium chloride, unless specifically ordered for medical reasons. The primary step before feeding is to check the residual volume.

C. Encouraging the client to take sips of water is not applicable in the context of enteral feeding via NG tube, as the feeding is delivered directly into the stomach or intestines.

D. Encouraging deep breathing and coughing is not relevant to the administration of enteral feedings via an NG tube. These actions are more related to respiratory care.

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Correct Answer is A

Explanation

The rationale for this answer is that a back massage is a non-pharmacological intervention that can help reduce pain by promoting relaxation and increasing blood circulation. It also shows respect for the client's preference and offers a choice of alternative therapy.

A. Faxing medical information to the client's provider's office B. Teaching the client discharge instructions with his partner present C. Giving a telephone report to a surgical nurse when sending the client to the surgical suite D. Discussing the client's transfer to a long-term care facility with a nurse from another unit

Correct Answer is D

Explanation

The nurse should identify that discussing the client's transfer to a long-term care facility with a nurse from another unit is a violation of HIPAA because it is not related to the client's care or treatment. The nurse should only share information with health care team members who are directly involved in the client's care or have a legitimate need to know.

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A nurse is caring for a client who is receiving enteral feedings via NG tube. Which of the following actions should the nurse take prior to administering the formula?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is D

Explanation

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