A nurse is teaching a client who is at 38 weeks of gestation about a contraction stress test. Which of the following statements should the nurse include in the teaching?

Rationale:

A. A liaison negotiates with service providers to obtain accessible cost-effective care: One of the primary roles of a nurse case manager as a liaison is to connect clients with necessary healthcare services. This includes coordinating with service providers, negotiating costs, and ensuring that clients have access to appropriate, cost-effective care to meet their needs.

B. A liaison promotes interprofessional communication: While promoting communication among healthcare team members is an important function of case management, it is more closely aligned with the role of a coordinator rather than the liaison function, which focuses on external connections and access.

C. A liaison monitors the use of clinical practice guidelines for delivery of care: Monitoring adherence to clinical guidelines is part of quality assurance and clinical oversight, which falls under the role of a case manager or quality improvement nurse, not specifically the liaison role.

D. A liaison measures the quality of services being provided: Measuring service quality is a responsibility related to quality management or evaluation within case management, not the primary function of a liaison. The liaison role emphasizes connecting clients to resources rather than evaluating service performance.

Rationale:

A. Check gastric residuals every 4 hr: Monitoring gastric residual volume every 4 hours helps assess tolerance to enteral feeding and reduces the risk of aspiration. High residuals may indicate delayed gastric emptying, requiring adjustment of the feeding regimen or provider notification.

B. Check placement of the feeding tube by x-ray once daily: X-ray is the gold standard for initial confirmation of tube placement, not for routine daily checks. Ongoing verification is typically done by assessing pH of gastric aspirate and observing for signs of misplacement, making daily x-rays unnecessary and impractical.

C. Maintain the head of the client's bed at a 30° angle or higher: Elevating the head of the bed reduces the risk of aspiration during continuous enteral feedings. Proper positioning is a key intervention to promote safety and prevent complications such as pneumonia.

D. Change the feeding container and tubing every 24 hr: Changing the feeding container and tubing every 24 hours helps prevent bacterial contamination and infection. This is a standard infection-control measure in enteral feeding care.

E. Ensure the formula is cold before administration: Formula should be at room temperature before administration. Cold formula can cause gastrointestinal discomfort, cramping, and nausea, so heating it to room temperature improves tolerance and safety.