A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes?
To confirm the placement of the NG tube
To determine the client's electrolyte balance
To remove gastric acid that might cause dyspepsia
To identify delayed gastric emptying
The Correct Answer is D
The nurse should measure the gastric residual before administering a feeding to identify delayed gastric emptying. Gastric residual refers to the volume of formula or contents remaining in the stomach from the previous feeding. Measuring gastric residual helps assess how well the client's stomach is emptying and can indicate if there is delayed gastric emptying.
By measuring gastric residual, the nurse can:
● Determine if the stomach has adequately emptied from the previous feeding. ● Assess the client's tolerance to enteral feedings.
● Detect signs of delayed gastric emptying, which can be indicative of gastrointestinal motility issues or other complications.
● Adjust the feeding rate or make other modifications to the enteral feeding plan based on the amount of residual volume.
Confirming the placement of the NG tube is typically done using other methods, such as an X-ray, pH testing, or auscultation of air insufflation. Gastric residual measurement primarily serves the purpose of assessing gastric emptying, rather than confirming tube placement.
While electrolyte imbalances can be monitored in the overall care of a client receiving enteral feedings, measuring gastric residual specifically focuses on assessing gastric emptying and feeding tolerance, rather than determining the client's electrolyte balance.
Removing gastric acid that might cause dyspepsia is not the primary purpose of measuring gastric residual. Gastric residual measurement aims to evaluate the volume of the previous feeding and assess gastric emptying, rather than focusing on dyspepsia specifically.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Hydrochlorothiazide is a thiazide diuretic commonly used to treat hypertension and edema. One of the potential side effects of hydrochlorothiazide is hypokalemia (low potassium levels). To help counteract this effect, it is important for the client to increase their daily intake of foods high in potassium, such as bananas, oranges, spinach, avocados, and potatoes. This helps maintain adequate potassium levels in the body.
The other options mentioned are incorrect:
Take the medication on an empty stomach: Hydrochlorothiazide can be taken with or without food. It does not need to be taken on an empty stomach.
Muscle weakness is an expected adverse effect: Muscle weakness is not a common or expected adverse effect of hydrochlorothiazide. If the client experiences muscle weakness, they should notify their healthcare provider.
Take the medication at bedtime: Hydrochlorothiazide can be taken at any time of the day. There is no specific requirement to take it at bedtime. The dosing schedule should be determined based on the individual's needs and healthcare provider's instructions.
Correct Answer is C,A,D,E,B
Explanation
To pour the sterile solution onto a piece of gauze, the nurse should perform the steps in the following order:
1. Pick up the bottle with the label facing his palm.
2. Remove the bottle cap.
3. Pour 1 to 2 mL into a receptacle.
4. Pour the solution onto the gauze.
5. Place the bottle cap inside up on a clean surface.
It is important to maintain sterility throughout the procedure to prevent contamination. By following this order, the nurse ensures that the solution is poured onto the gauze while minimizing the risk of contamination. Placing the bottle cap inside up on a clean surface after removing it helps maintain the sterility of the cap as well.
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