The nurse is preparing to administer a formula feeding by nasogastric tube (NGT) to a 2-month-old. Which intervention should the nurse implement?
Hold the infant with head and shoulders slightly elevated.
Use the syringe plunger to push formula at a rate of 5 ml/minute.
Microwave refrigerated formula to room temperature.
Measure and discard residual gastric contents before feeding.
The Correct Answer is A
Choice A reason: Holding the infant with head and shoulders slightly elevated helps prevent aspiration during feeding.
Choice B reason: Using the syringe plunger to push formula can increase the risk of aspiration and is not recommended.
Choice C reason: Microwaving formula can create hot spots and is not a safe method to warm formula.
Choice D reason: Measuring and discarding residual gastric contents is not typically recommended for routine feeding and can lead to improper assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Nausea and headache are common side effects of many medications, including linezolid, but they are not the most critical findings that need immediate reporting to the healthcare provider.
Choice B reason: Increased fatigue is a concerning symptom but may be related to the underlying infection or other factors. It is important to monitor but is not the most urgent finding in this context.
Choice C reason: Yellow-tinged sputum may indicate an ongoing infection, but it is not uncommon in cases of pneumonia. It should be monitored but does not require immediate reporting unless there are other concerning symptoms.
Choice D reason: Watery diarrhea is the most important finding to report because linezolid can cause Clostridioides difficile-associated diarrhea (CDAD), a potentially serious condition. Early detection and treatment are crucial to prevent complications.
Correct Answer is A
Explanation
Choice A reason: Completing ongoing focused assessments, particularly for a client with wrist restraints, requires the clinical judgment and skills of an RN.
Choice B reason: Supervising a newly hired graduate nurse is important but can also be done by the charge nurse or another experienced RN.
Choice C reason: Transporting a client to the radiology department can be done by a UAP or PN.
Choice D reason: Administering PRN oral analgesics can be delegated to a PN.
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