A nurse is caring for a client who is receiving intermittent bolus enteral feedings through a jejunostomy tube. Which of the following actions should the nurse take?
Elevate the head of the client's bed for 1 hr after the feeding.
Administer the feeding solution at a cold temperature.
Rotate the jejunostomy tube once per day
Flush the tube with 90 mL of sterile water before and after the feeding.
The Correct Answer is A
Elevate the head of the client's bed for 1 hr after the feeding. This is because elevating the head of the client's bed to at least 30 degrees can help prevent aspiration and gastric reflux.
Choice B is incorrect because administering the feeding solution at a cold temperature can cause discomfort and diarrhea.
Choice C is incorrect because rotating the jejunostomy tube once per day can cause irritation and trauma to the stoma site.
Choice D is incorrect because flushing the tube with 90 mL of sterile water before and after the feeding is not necessary as long as the tube is adequately flushed before and after each feeding.
The explanation for why the other choices are not answered: B – Administering the feeding solution at a cold temperature can cause discomfort and diarrhea, so it should not be done. C – Rotating the jejunostomy tube once per day can cause irritation and trauma to the stoma site, so this is not the correct action. D – Flushing the tube with 90 mL of sterile water before and after the feeding is unnecessary to do as long as the tube is adequately flushed before and after each feeding. Thus, this is not the correct answer.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Occupational therapist. Disuse syndrome is a condition that occurs when a person experiences a reduction in physical activity, resulting in a decline in physical function. An occupational therapist can help the client improve their ability to perform daily activities and improve their overall functioning. A social worker can help the client and their family with emotional and social issues related to the condition. An herbalist is not necessary for the management of disuse syndrome. A dietitian can help the client with their nutritional needs but may not address their physical functioning.
Correct Answer is D
Explanation
The correct answer is choice D. Requires nasogastric suction.
Nasogastric suction removes gastric secretions that contain potassium, leading to a loss of potassium from the body.
This can cause hypokalemia, which is a low level of potassium in the blood.
Choice A is wrong because Addison’s disease causes hyperkalemia, which is a high level of potassium in the blood.
Choice B is wrong because tissue damage can release potassium from the cells into the blood, causing hyperkalemia.
Choice C is wrong because uric acid level is not related to potassium level.
Uric acid is a waste product of purine metabolism that can cause gout or kidney stones if elevated.
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