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?
Sitting in high-Fowler's position during the feeding.
A history of gastroesophageal reflux disease.
A residual of 65 mL 1 hr postprandial.
Receiving a high-osmolarity formula.
The Correct Answer is B
Choice A rationale:
Sitting in high-Fowler's position during the feeding is actually a preventive measure against aspiration. High-Fowler's position, which involves sitting the patient upright at a 90-degree angle, reduces the risk of aspiration by promoting proper digestion and preventing the regurgitation of gastric contents into the lungs.
Choice B rationale:
A history of gastroesophageal reflux disease (GERD) puts the client at risk for aspiration. GERD is a chronic condition in which stomach acid frequently flows back into the esophagus, potentially reaching the throat and lungs, increasing the risk of aspiration during enteral feedings. Aspiration pneumonia, a serious complication, can develop if stomach contents enter the lungs.
Choice C rationale:
A residual of 65 mL 1 hr postprandial indicates that a significant amount of the feeding solution has not been absorbed, raising concerns about delayed gastric emptying. While this situation might require monitoring and adjustments to the feeding regimen, it does not directly increase the risk of aspiration. Aspiration risk is more related to the reflux of stomach contents into the airways.
Choice D rationale:
Receiving a high-osmolarity formula alone does not directly increase the risk of aspiration. High-osmolarity formulas might require careful administration and monitoring to prevent complications, but aspiration risk is more closely associated with the client's underlying conditions, such as GERD.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) and can increase the risk of bleeding when used with warfarin, which is an anticoagulant medication. Combining these two medications can lead to excessive bleeding and is considered incompatible.
Choice B rationale:
Magnesium hydroxide is an antacid and does not have significant interactions with warfarin. It does not affect the anticoagulant properties of warfarin.
Choice C rationale:
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. It does not have a significant interaction with warfarin.
Choice D rationale:
Propranolol is a beta-blocker used to treat high blood pressure, angina, and other heart conditions. It does not have a significant interaction with warfarin.
Correct Answer is A
No explanation
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