ATI Skills 3.0 - Enteral Tube Feeding Pretest / Posttest

A nurse is caring for a client who has a dysfunctional gastrointestinal tract and requires enteral feeding. Which of the following formulas should the nurse administer to the client?

A. Modular

B. Elemental

C. Polymeric

D. Specialty

Correct Answer

B. Elemental

Elemental formulas contain predigested nutrients that are easy for a partially functional gastrointestinal tract to absorb.

Wrong Answer Rational

A. Modular formulas are single-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients.

B. CORRECT

C. Polymeric formulas are whole-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients.

D. Specialty formulas meet specific nutritional needs for clients who have a conditions such as HIV, liver failure, or clients who have pulmonary disease.

A nurse is preparing to administer a continuous enteral tube feeding to a client. The nurse should take which of the following actions to prevent a complication of the tube feeding?

A. Limit the time the formula hangs to 8 hr.

B. Flush the tube every 8 hr.

C. Deliver the formula at a brisk rate.

D. Allow the feeding bag to empty before refilling it.

Correct Answer and Rational:

A. Limit the time the formula hangs to 8 hr.

-Formula that hangs longer than 12 hr for an open system and 48 hr for a closed system is at risk for spoilage of the formula or bacterial contamination, typically manifested as diarrhea.

Wrong answer Rational:

A. CORRECT

B. The nurse should flush the tube every 4 to 6 hr to promote patency and prevent constipation.

C. Administering enteral formula too fast (generally, more than 200 to 300 mL over 10 to 20 min) can cause abdominal cramping, nausea, and vomiting. A lower rate of delivery improves tolerance.

D. Allowing the feeding bag to empty before refilling it can result in an excessive infusion of air.

A client who lives in a long-term care facility is receiving intermittent enteral feedings and is experiencing social isolation. Which of the following interventions should the nurse recommend?

A. Encourage the client to go to the dining room at meal times to talk with other clients.

B. Suggest that the client watch television while feedings are being administered.

C. Remind the client that they can have visitors after feeding administration times.

D. Ask the facility chaplain to speak with the client.

Correct Answer and Rational:

A. Encourage the client to go to the dining room at meal times to talk with other clients.

By encouraging the resident to maintain a normal schedule and social interactions, the nurse is helping to promote socialization and reverse patterns of isolation.

Wrong answer Rational:

A.CORRECT

B. Although television can provide a useful distraction for some clients and might help improve the client's mood, this diversion is not interactive; therefore, it is unlikely to reduce any feelings of isolation the client might have.

C. Although visitation policies vary at every facility, generally visitors are permitted during meal times in long-term care facilities. However, this intervention will not improve the situation if the client does not have a family and social network outside of the facility.

D. The nurse should not contact the chaplain without first consulting with the client.

A nurse is providing teaching about risk for aspiration with a client who is receiving intermittent bolus nasogastric feedings. Which of the following findings should the nurse instruct the client to report?

A. A feeling of fullness

B. Persistent coughing

C. Discomfort in the naris

D. Postfeeding belching

Correct Answer and Rational:

B. Persistent coughing

-A persistent cough can indicate that the distal end of the nasogastric tube has moved into the respiratory tract. The client should report this finding to the nurse immediately because this is a risk for aspiration.

Wrong answer Rational:

A. The nurse should report feelings of fullness; however, this does not indicate the client is as risk for aspiration. The client might benefit from using a prokinetic agent.

B. CORRECT

C. Friction from the presence of the tube can be uncomfortable; however, this does not indicate the client is at risk for aspiration. The nurse should monitor the site closely and move the securing device or talk to the provider about moving the tube.

D. Belching can be expected depending on the composition of the formula and the client's usual response to the nutrients. This finding does not need to be reported.

A nurse is caring for a client who has a significant risk of aspiration and requires nutritional support for about 2 weeks because they are unable to consume adequate nutrients orally. Which of the following types of feeding tubes should the nurse anticipate the provider to prescribe?

A. Nasogastric tube

B. Nasointestinal tube

C. Percutaneous endoscopic gastrostomy tube

D. Percutaneous endoscopic jejunostomy tube

Correct Answer and Rational:

B. Nasointestinal tube

-A nasointestinal tube is recommended for clients at a high risk of aspiration who require short-term feedings of less than 4 weeks.

Wrong answer Rational:

A. Nasogastric tubes are contraindicated for clients at high risk of aspiration. Therefore, another tube should be placed.

B. CORRECT

C. Percutaneous endoscopic gastrostomy (PEG) tubes are indicated for long-term use in clients. Therefore, another tube should be placed.

D. A percutaneous endoscopic jejunostomy tube is indicated for clients who require enteral feedings for more than 4 weeks. Therefore, another tube should be placed.

A nurse is caring for a group of clients. The nurse should identify that which of the following clients requires an enteral tube feeding?

A.A client who has a paralytic ileus

B.A client who has recently experienced facial trauma

C.A client who has dysphagia

D.A client who has a decreased appetite

Correct Answer and Rational:

C. A client who has dysphagia

-The nurse should identify that a client who is unable to swallow oral nutrition can benefit from enteral feedings.

Wrong answer Rational:

A.A client who has a paralytic ileus has an absence of gastrointestinal motility and is unable to tolerate enteral nutrition.

B.Due to the high risk of improper tube placement, a client who has had recent facial or nasal trauma should not have a nasoenteric tube placed. This client requires surgical placement of a gastric or jejunal tube.

C. CORRECT

D.A client who has a decreased appetite might require oral supplements or nutrient-dense foods.

A nurse is inserting a nasogastric tube for a client and asks the client to flex their head toward their chest after the tube passes through the nasopharynx. This action facilitates proper insertion of the tube by achieving which of the following?

A.Closing off the glottis

B.Preventing curling of the tube in the mouth

C.Allowing the client to breathe through the mouth

D.Opening the lower esophageal sphincter

Correct Answer and Rational:

A.Closing off the glottis

Wrong answer Rational:

A.

B.This action does not prevent curling of the tube.

C.This action does not facilitate the client breathing through their mouth.

D.The tube is passing through the nasopharynx; therefore, the esophageal sphincter is not affected.

A nurse is administering an enteral tube feeding to a client. Which of the following actions should the nurse take to prevent aspiration?

A.Flush the feeding tube with 30 mL of water.

B. Add blue food coloring to the enteral formula.

C. Ensure the formula is at room temperature.

D. Place the client in Fowler's position.

Correct Answer and Rational:

C.

Positioning a client in Fowler's position during a tube feeding can reduce the risk of regurgitation, which can lead to aspiration. If Fowler's is uncomfortable or contraindicated for the client, elevate the head of the client's bed to at least 30°.

Wrong answer Rational:

A.Flushing the tube with water before and after administering a tube feeding helps to ensure that the tube is patent and clear of any formula that could obstruct the tube. However, flushing the tube with water will not prevent aspiration.

B.Although this practice was once used to help detect formula aspirated into the lungs by staining airway secretions, it has been associated with clients' deaths and is therefore no longer considered a safe practice.

C.Although administering tube feeding formula at room temperature is preferable, it is done primarily to prevent stomach cramps and does not prevent aspiration.

D.

A nurse is inserting a small-bore feeding tube. Before initiating the feeding, the nurse should take which of the following actions to verify placement?

A.Measure the pH of gastric aspirate.

B. Auscultate the epigastric area while injecting air.

C. Obtain an x-ray.

D. Place the open end of the tube in a cup of water.