A nurse is teaching a client who is receiving enteral nutrition via intermittent tube feedings. Which of the following statements by the client indicates an understanding of the teaching?
I do not need a pump to administer my feedings.
I should administer my feedings over 10 to 20 minutes.
I can administer my feedings while I sleep at night.
I should advance the rate of my feedings slowly.
The Correct Answer is D
Choice A reason: A pump is usually needed to administer intermittent tube feedings, as it can control the flow rate and volume of the formula. A pump can also prevent overfeeding, aspiration, or diarrhea.
Choice B reason: Administering feedings over 10 to 20 minutes is too fast, as it can cause abdominal cramps, nausea, vomiting, or dumping syndrome. Intermittent tube feedings should be administered over 30 to 60 minutes.
Choice C reason: Administering feedings while sleeping at night is not recommended, as it can increase the risk of aspiration, reflux, or infection. Intermittent tube feedings should be administered during waking hours and with the head of the bed elevated at least 30 degrees.
Choice D reason: Advancing the rate of feedings slowly is advisable, as it can help the body adjust to the formula and prevent intolerance or complications. The rate should be increased gradually until the desired goal is reached.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Feedings should not be accompanied by nonnutritive sucking. Nonnutritive sucking is the act of sucking on a pacifier, finger, or other object without getting any nutrition. Nonnutritive sucking can interfere with the establishment of breastfeeding, cause nipple confusion, and reduce milk supply.
Choice B reason: Feedings should be on demand. On demand feeding means feeding the newborn whenever they show signs of hunger, such as rooting, sucking, or crying. On demand feeding helps the newborn regulate their appetite, meet their nutritional needs, and bond with their caregiver.
Choice C reason: Feedings should not begin within 1 hr after birth. This instruction is applicable for breastfeeding, not bottle feeding. Breastfeeding should begin within 1 hr after birth to initiate milk production, stimulate uterine contractions, and transfer colostrum to the newborn. Bottle feeding can be delayed until the newborn is stable and alert.
Choice D reason: Feedings may not occur in clusters. Cluster feeding means feeding the newborn more frequently and for longer periods of time during certain times of the day or night. Cluster feeding is common in breastfed newborns, especially during growth spurts or developmental leaps. Bottle fed newborns may not exhibit cluster feeding, as they tend to have more consistent and predictable feeding patterns.
Correct Answer is C
Explanation
Choice A reason: Using an electronic device is not a reliable method for measuring blood pressure because it may give inaccurate readings due to movement, noise, or battery issues. An electronic device should be calibrated regularly and compared with a manual device.
Choice B reason: Inflating the cuff to 140/90 mmHg is not a correct procedure for measuring blood pressure because it may cause discomfort and false readings. The cuff should be inflated to about 20 to 30 mmHg above the expected systolic pressure or until the pulse disappears.
Choice C reason: Placing the cuff on the upper arm is a correct procedure for measuring blood pressure because it ensures that the cuff is at the same level as the heart and that the brachial artery is compressed. The cuff should be snug and fit around 80% of the arm circumference.
Choice D reason: Measuring blood pressure after exercise is not a good time for measuring blood pressure because it may reflect a temporary increase due to physical activity. Blood pressure should be measured after resting for at least 5 minutes in a quiet and comfortable environment.
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