A nurse is caring for a client who is receiving intermittent enteral tube feedings. Which of the following factors places the client at risk for aspiration?

A residual of 65 mL 1 hr postprandial.

A history of gastroesophageal reflux disease.

Receiving a high-osmolarity formula.

Sitting in high-Fowler's position during the feeding.

Answer and Explanation

The Correct Answer is B

A.   This amount of residual is generally considered safe; guidelines often cite higher residuals (e.g., >100 mL) as concerning.
B.   Clients with a history of gastroesophageal reflux disease (GERD) are at increased risk for aspiration, particularly when lying flat, because the lower esophageal sphincter may not function properly, allowing stomach contents to move back into the esophagus.
C.   While high-osmolarity formulas can contribute to diarrhea, they are not directly linked to an increased risk of aspiration.
D.   Sitting in a high-Fowler’s position (semi-upright) during feedings is actually recommended to reduce the risk of aspiration.

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Correct Answer is C

Explanation

A. While metronidazole is an antimicrobial medication, it does not pose a significant biohazard risk, and standard precautions for medication spills would suffice.

B. Ampicillin sodium is an antibiotic medication and does not pose a significant biohazard risk, and standard precautions for medication spills would suffice.
C. Doxorubicin hydrochloride is a cytotoxic chemotherapy medication that poses a significant biohazard risk due to its potential carcinogenic and mutagenic properties. Specific facility procedures for handling cytotoxic spills should be followed.
D. Phenytoin is an antiepileptic medication and does not pose a significant biohazard risk, and standard precautions for medication spills would suffice.

A. Suspicious of others B. Preoccupied with aging C. Exhibits separation anxiety D. Ritualistic behavior

Correct Answer is B

Explanation

A. Suspiciousness of others is more characteristic of paranoid personality disorder.

B. Preoccupation with aging is a common characteristic of narcissistic personality disorder. Individuals with this disorder often have an exaggerated sense of self- importance, a need for admiration, and a lack of empathy for others. Concerns about aging may stem from a fear of losing their perceived attractiveness or power.
C. Exhibiting separation anxiety is not typically associated with narcissistic personality disorder.
D. Ritualistic behavior may be seen in obsessive-compulsive personality disorder but is not a defining feature of narcissistic personality disorder.

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