A nurse is preparing to administer a bolus enteral feeding to a client who has a gastrostomy tube. Which of the following actions should the nurse take first?
Elevate the head of the bed.
Measure stomach contents.
Return gastric content into the gastrostomy tube.
Flush the tube with water
The Correct Answer is A
Elevating the head of the bed to a semi-Fowler's or high Fowler's position helps prevent aspiration during the feeding. This position facilitates proper digestion and reduces the risk of
regurgitation or reflux. It allows gravity to assist in keeping the feeding in the stomach and reduces the likelihood of complications.
The other actions mentioned are also important steps in the process but should be performed after elevating the head of the bed:
Measure stomach contents: This step is usually done before administering any enteral feeding to check for the presence of residual gastric contents. It helps determine if the client is tolerating previous feedings and guides adjustments in the feeding volume or rate if needed.
Return gastric content into the gastrostomy tube: If there is a significant amount of gastric residual, it is recommended to return the contents into the stomach before administering the feeding. This helps ensure that the client receives the full prescribed amount of the enteral feeding.
Flush the tube with water: Flushing the gastrostomy tube with water before and after the feeding helps maintain tube patency, clears any residual feeding or medication, and prevents clogging.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["13"]
Explanation
To calculate the infusion rate in drops per minute (gtt/min), we can use the following formula: Infusion rate (gtt/min) = (Volume to be infused (ml) * Drop factor) / Time (min) Given:
Volume to be infused: 1,200 ml
Drop factor: 15 gtt/ml
Time: 24 hr
First, we need to convert the time from hours to minutes:
24 hr * 60 min/hr = 1,440 min
Now, we can calculate the infusion rate:
Infusion rate (gtt/min) = (1,200 ml * 15 gtt/ml) / 1,440 min
Simplifying the equation:
Infusion rate (gtt/min) = 18,000 gtt / 1,440 min
Dividing both sides:
Infusion rate (gtt/min) ≈ 12.5 gtt/min
Rounding the answer to the nearest whole number, the nurse should set the manual IV infusion to deliver approximately 13 gtt/min.
Correct Answer is D
Explanation
Furosemide is a loop diuretic that helps the body get rid of excess fluid by increasing urine output. However, it also promotes the loss of potassium in the urine, leading to a potential decrease in the body's potassium levels.
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