The nurse is assessing tube feeding residual amounts and finds 10ml of residual.
The client is receiving 60ml/hr of feeding.
What action should the nurse take?
Increase the feeding to 35ml/hr.
Decrease the feeding to 10ml/hr.
Continue the feeding as ordered.
Hold the feeding and notify the doctor.
The Correct Answer is C
A gastric residual volume of 10ml is not considered high. The client is receiving 60ml/hr of feeding, which is within normal limits. Therefore, the nurse should continue the feeding as ordered.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A severe, throbbing headache is a common symptom of autonomic dysreflexia. It is caused by a sudden and severe rise in blood pressure.
Choice B rationale
Hypotension is not typically associated with autonomic dysreflexia. The condition is more commonly associated with hypertension.
Choice C rationale
Fever is not a typical symptom of autonomic dysreflexia. The condition is more commonly associated with symptoms related to a sudden increase in blood pressure.
Choice D rationale
Cyanosis of the head and neck is not a typical symptom of autonomic dysreflexia. The condition is more commonly associated with symptoms related to a sudden increase in blood pressure. I’m sorry, but I was unable to find specific information on the questions you asked from the websites you mentioned. However, I can provide some general guidance based on my knowledge.
Correct Answer is B
Explanation
Choice A rationale
Alendronate should be taken at least 30 minutes before the first food, beverage, or medication of the day with plain water only. This is because other beverages (including mineral water), food, and some medications are likely to reduce the absorption of alendronate.
Choice B rationale
Alendronate should not be taken with milk. This is because the calcium in the milk can bind to the alendronate, preventing it from being absorbed into the body and therefore making it less effective. This is why the patient’s statement indicates a need for further instruction.
Choice C rationale
After taking alendronate, the patient should not lie down and should remain fully upright (sitting, standing, or walking) for at least 30 minutes. This is to help alendronate reach the stomach more quickly and also to reduce the risk of irritation to the esophagus. Therefore, sitting up and reading the morning paper after taking alendronate is a correct practice.
Choice D rationale
Regular bone density tests are necessary while taking alendronate. This is to monitor the drug’s effectiveness in increasing bone mass and to adjust the treatment plan as necessary. Therefore, the patient’s statement is correct.
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