A nurse is teaching the partner of a client about administering intermittent enteral feedings. Which of the following instructions should the nurse include?
Wear sterile gloves during a feeding.
Chill the feeding prior to administering.
Flush the tubing with 15 mL of water after each feeding.
Position the client upright prior to a feeding.
The Correct Answer is C
Choice C reason: Flushing the tubing with water after each feeding is important to prevent clogging, maintain patency, and clear any residual formula from the tube. It also helps to prevent bacterial growth and infection.
Choice A reason: Wearing sterile gloves during a feeding is not necessary, as enteral feedings are not considered sterile procedures. Clean gloves are sufficient to prevent contamination and protect the nurse and the client.
Choice B reason: Chilling the feeding prior to administering is not recommended, as cold formula can cause abdominal cramping, discomfort, and diarrhea. The formula should be at room temperature or slightly warmed before giving it to the client.
Choice D reason: Positioning the client upright prior to a feeding is correct, but it is not enough. The client should remain upright for at least 30 minutes after the feeding as well, to prevent aspiration, reflux, and nausea.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Weight gain of 0.45 kg (1 lb) per week is not within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended weight gain for this client is 0.35 to 0.5 kg (0.8 to 1 lb) per week.
Choice B reason: Intake of 200 extra calories per day is within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended caloric intake for this client is 2200 to 2900 calories per day, which is about 340 to 450 calories more than the pre-pregnancy intake.
Choice C reason: Intake of 100 extra calories per day is not within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended caloric intake for this client is 2200 to 2900 calories per day, which is about 340 to 450 calories more than the pre-pregnancy intake.
Choice D reason: Weight gain of 0.91 kg (2 lb) per week is not within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended weight gain for this client is 0.35 to 0.5 kg (0.8 to 1 lb) per week.
Correct Answer is A
Explanation
Choice A reason: Fried chicken is an acceptable choice for a client who is taking tranylcypromine, a monoamine oxidase inhibitor (MAOI). MAOIs can cause a hypertensive crisis if the client consumes foods that are high in tyramine, such as aged cheeses, cured meats, smoked fish, and fermented products. Fried chicken does not contain tyramine and is safe to eat.
Choice B reason: Salami is not an acceptable choice for a client who is taking tranylcypromine, as it is a cured meat that is high in tyramine. The nurse should advise the client to avoid salami and other similar foods, such as pepperoni, ham, bacon, and sausage.
Choice C reason: Smoked salmon is not an acceptable choice for a client who is taking tranylcypromine, as it is a smoked fish that is high in tyramine. The nurse should advise the client to avoid smoked salmon and other similar foods, such as herring, anchovies, and caviar.
Choice D reason: Cheddar cheese is not an acceptable choice for a client who is taking tranylcypromine, as it is an aged cheese that is high in tyramine. The nurse should advise the client to avoid cheddar cheese and other similar foods, such as blue cheese, Swiss cheese, and Parmesan cheese.
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