A nurse is caring for a patient 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 determine the patient’s electrolyte balance
To confirm the placement of the NG tube
To remove gastric acid that might cause dyspepsia
To identify delayed gastric emptying
The Correct Answer is D
Choice A rationale
While electrolyte balance is important in patient care, it is not the primary reason for measuring gastric residual before administering a feeding through an NG tube.
Choice B rationale
Confirming the placement of the NG tube is crucial before administering a feeding. However, measuring the gastric residual is not the primary method used to confirm tube placement.
Choice C rationale
Removing gastric acid that might cause dyspepsia is not the main purpose of measuring gastric residual. Dyspepsia, or indigestion, is typically managed with medications and dietary modifications.
Choice D rationale
The primary purpose of measuring gastric residual is to identify delayed gastric emptying. Gastric residual refers to the volume of formula or contents remaining in the stomach from the previous feeding. If gastric emptying is delayed, the nurse should avoid overfeeding the patient and causing gastric distention.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Skin pallor and cool-to-touch skin are common signs of severe dehydration. When the body is severely dehydrated, blood flow to the skin decreases, causing the skin to feel cool and look pale.
Choice B rationale
Pitting edema is not a clinical finding of severe dehydration. In fact, it’s quite the opposite. Pitting edema is a condition that causes swelling due to fluid accumulation, often due to conditions like heart failure, liver disease, or kidney disease.
Choice C rationale
Tachycardia with a thready pulse is a common sign of severe dehydration. The heart rate increases in an attempt to maintain blood flow to the organs, and the pulse may feel weak or thready due to low blood volume.
Choice D rationale
Lung sounds diminished with crackles upon auscultation is not typically associated with dehydration. This is more commonly seen in conditions affecting the lungs such as pneumonia or heart failure.
Correct Answer is A
Explanation
Choice A rationale
An elevated white blood cell (WBC) count in a urinalysis can indicate an infection or inflammation in the body. A count of 10 is higher than the normal range, which is typically 0 to 5 WBCs per high power field.
Choice B rationale
Occasional casts in the urine are not typically a cause for concern. Casts are tiny tube-shaped particles that can form due to kidney conditions, but occasional casts can be normal.
Choice C rationale
A pH of 5.0 is within the normal range for urine pH, which is typically between 4.6 and 8.0.
Therefore, this result would not typically need to be communicated to the provider.
Choice D rationale
Dark amber color of the urine can be a sign of dehydration, but it can also be influenced by certain foods, medications, and health conditions. It is not typically a result that needs to be communicated to the provider.
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