A nurse is caring for an infant who receives intermittent enteral feedings through a gastrostomy tube.
Which of the following actions should the nurse take when administering a feeding? (Select all that apply.).
Offer the infant a pacifier during feedings.
Check for residual volumes by aspirating stomach contents.
Place the infant in supine position.
Instill the formula over a period of 30 to 45 min.
Heat the formula to 39° C (102° F) prior to administration.
Correct Answer : A,B,D
A. Offer the infant a pacifier during feedings.
B. Check for residual volumes by aspirating stomach contents.
D. Instill the formula over a period of 30 to 45 min.
Offering the infant a pacifier during feedings can help promote non-nutritive sucking and provide comfort to the infant.
Checking for residual volumes by aspirating stomach contents can help monitor gastric emptying and tolerance to enteral feeding.
Instilling the formula over a period of 30 to 45 min can help prevent overfeeding and reduce the risk of aspiration.
Choice C is wrong because placing the infant in a supine position during feedings increases the risk of aspiration.
The infant should be placed in an upright or semi-upright position during feedings.
Choice E is wrong because heating the formula to 39° C (102° F) prior to administration is not necessary and may even be harmful if the formula is overheated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
According to the normal pediatric vital signs chart provided by Cleveland Clinic, the normal blood pressure range for a 2-year-old child should be between 90- 105/55-70 mm Hg. The blood pressure of 118/74 mm Hg is higher than the normal range for a 2- year-old child and should be reported to the provider.
Choice B is wrong because a respiratory rate of 26/min falls within the normal range of 20-30 breaths per minute for a child between ages 1 and.
Choice C is wrong because a pulse rate of 98/min falls within the normal range of 80-125 beats per minute for a child between ages 1 and.
Choice D is wrong because a temperature of 37.2° C (99° F) falls within the normal range for children which is around 98.6 degrees.
Correct Answer is D
Explanation
Provide for periods of rest.
Children with heart failure may have trouble breathing, especially with activity, and may feel tired.
It is important for them to have periods of rest to help manage their symptoms.
Choice A is wrong because increasing the child’s oxygen flow rate should be done under the guidance of a healthcare provider.
Choice B is wrong because it is important to monitor the child’s weight more frequently than once a month.
Choice C is wrong because digoxin is a medication that can help the heart beat stronger with a more regular rhythm and should not be withheld based on pulse rate alone.
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