NURS 107 PM – EXAM #6 STUDY GUIDE Spring 2026

NURS 107 PM – EXAM #6 STUDY GUIDE Spring 2026

PRIORITY & CLINICAL JUDGMENT

  • Priority nursing assessments with enteral feedings

    • Assessments are critical to ensure patient safety and effective nutrition.

  • Identifying urgent vs non-urgent findings

    • Differentiate signs that require immediate attention from those that can be monitored.

  • When to stop a feeding vs continue monitoring

    • Assess patient tolerance and symptoms before making decisions regarding feedings.

  • Application of ABCs (Airway, Breathing, Circulation)

    • Ensure that foundational life-sustaining measures (ABCs) are stable before initiating or continuing enteral feeding.

  • Recognizing complications that require immediate action

    • Essential to identify complications such as aspiration pneumonia and tube displacement swiftly.

NG TUBES: PURPOSE & INDICATIONS

  • Indications for NG tube placement

    • Used for decompression (removal of gastric content) or feeding (providing nutrition).

  • Differences between NG tubes, Salem sump tubes, and G-tubes

    • NG Tubes: Inserted through the nose into the stomach; primarily for short-term use.

    • Salem Sump Tubes: Used for gastric decompression and drainage, has a double lumen for venting air.

    • G-tubes (Gastric Tubes): Surgically placed directly into the stomach; utilized for long-term enteral feeding.

  • Short-term vs long-term enteral access

    • Short-term: NG tubes suitable for up to 4-6 weeks.

    • Long-term: G-tubes or PEG (Percutaneous Endoscopic Gastrostomy) tubes recommended for use beyond 6 weeks.

CONTRAINDICATIONS & PRE-INSERTION ASSESSMENT

  • Conditions where NG tubes should NOT be placed

    • Basal skull fracture, esophageal varices, severe facial trauma.

  • Common NG tube and G-tube indications (when they SHOULD be placed)

    • NG tube for patients unable to swallow or who need gastric decompression.

    • G-tube for long-term nutritional support.

  • Required nursing assessments before insertion

    • Assess swallowing ability, bowel sounds, and previous surgical history related to the upper gastrointestinal tract.

  • Patient safety considerations prior to procedure

    • Ensure informed consent, confirm patient identity, and provide emotional support.

TUBE PLACEMENT VERIFICATION

  • Methods used to confirm placement

    • Radiographic confirmation (most reliable), aspirate pH testing, and auscultation (least reliable).

  • Which methods are reliable vs unreliable (and which one is most reliable?)

    • Most reliable: Radiographic confirmation.

    • Reliable: Aspirate pH testing indicating gastric contents (pH < 5.5).

    • Unreliable: Auscultation for air insufflation.

  • Interpretation of:

    • Gastric pH values: Normal gastric fluid should have a pH < 5.5, indicating the presence of gastric acid.

    • Aspirate characteristics: Color and consistency provide clues; yellowish-green (bile) may indicate non-gastric placement, while clear or cloudy green (gastric fluid) suggests proper placement.

ONGOING VERIFICATION DURING CARE

  • Continuous assessments during feeding to ensure tube integrity and patency.

COMPLICATIONS & SAFETY RISKS

  • Signs and symptoms of:

    • Aspiration: Coughing, choking, dyspnea, low oxygen saturation.

    • Feeding intolerance: Bloating, reflux, abdominal pain, diarrhea.

    • Tube displacement: Visible length change of the tube outside the nostril, respiratory distress.

  • Risk factors for aspiration

    • Decreased level of consciousness, poor swallowing ability, supine positioning.

  • Electrolyte imbalances related to suction

    • Monitor electrolytes; losses can occur from gastric drainage.

ENTERAL FEEDING MANAGEMENT

  • Types of feedings:

    • Continuous: Provides a steady infusion of formula, usually via a pump.

    • Intermittent/Bolus: Administered at set intervals in larger volumes.

  • Nursing responsibilities during feedings

    • Monitor tolerance (observing for symptoms of intolerance), administer feedings correctly according to protocol.

  • Proper patient positioning and rationale

    • Patients should be positioned at a 30–45 degree angle during feedings to reduce aspiration risk.

  • Gastric residuals:

    • When to check: Before each feeding or at regular intervals based on protocol.

    • What to do after checking gastric residual: Retract if residual > 500 mL or as per institutional policy.

    • Nursing considerations: Assess for symptoms and adjust feeding accordingly.

MEDICATION ADMINISTRATION VIA TUBE

  • Types of medications that should NOT be crushed

    • Enteric-coated, sustained-release, or extended-release medications; these formulations should be administered in their original form.

  • Safe medication administration practices

    • Follow guidelines, flush tubes before and after medication administration to maintain patency.

  • Flushing protocols and rationale

    • Usually 30 mL of water before and after medication to ensure proper delivery and avoid blockage.

  • Medication administration when suction or feedings are running

    • Discuss with prescriber whether to hold suction/feeding during medication administration based on drug characteristics.

TUBE CARE & MAINTENANCE

  • Preventing tube clogging

    • Regular flushing with water, avoiding high-viscosity formulas.

  • Infection prevention practices

    • Maintain sterile techniques during care and avoid contamination during feeding setup.

  • Care of feeding systems (open vs closed)

    • Open systems require more frequent checks and care to prevent contamination; closed systems reduce infection risks.

  • Special considerations for Salem sump tubes

    • Must maintain venting to prevent pressure build-up during decompression.

  • Tube irrigation process

    • Irrigate with sterile water to maintain patency and prevent clogging.

INSERTION & REMOVAL

  • Patient education prior to NG tube insertion

    • Explain the procedure, justify necessity, and discuss potential discomforts and complications.

  • Expected vs. Non-expected (concerning) patient responses during insertion

    • Expected: Mild discomfort, gag reflex.

    • Non-expected: Severe pain or respiratory distress.

  • Nursing actions if complications occur during insertion

    • Withdraw tube if resistance is met or if patient exhibits severe distress; provide supplemental oxygen as needed.

  • Proper technique and safety considerations for removal

    • Verifying correct position and following procedure for safe and gentle removal to avoid causing trauma or discomfort.

DELEGATION & SCOPE OF PRACTICE

  • Tasks appropriate for UAP vs RN (nutrition and/or tube feedings)

    • UAP may assist with feeding only when tube placement is already confirmed; RNs must oversee complex assessments.

  • Nursing responsibilities requiring clinical judgment

    • Assessments that evaluate patient response, adjustments to feeding and medication protocols, and tube integrity checks.

  • Safety considerations when delegating care

    • Confirm UAP's understanding and training regarding feeding protocols and monitoring responsibilities.

SPECIAL PATIENT CONSIDERATIONS

  • Patients with:

    • Dysphagia: Requires careful assessment of swallowing capability; possible altered diet.

    • Decreased level of consciousness: May necessitate enteral feeding to ensure adequate nutrition.

    • Cognitive impairment: Increased risk for aspiration; monitoring necessary.

  • Long-term vs short-term feeding needs

    • Assess each patient's prognosis and dietary needs to determine appropriate tube choice.

NUTRITION FUNDAMENTALS

  • Classes of nutrients

    • Carbohydrates, proteins, fats, vitamins, minerals, and water.

  • Which nutrients provide energy?

    • Carbohydrates, proteins, and fats are primary energy sources for the body.

  • BMI:

    • How it is calculated?: BMI = rac{weight(kg)}{height(m)^2}

    • Categories and implications?:

      • Underweight (BMI < 18.5)

      • Normal weight (BMI 18.5–24.9)

      • Overweight (BMI 25–29.9)

      • Obesity (BMI ≥ 30)

      • Each category correlates with health risks.

  • BMR:

    • Factors that increase or decrease Basal Metabolic Rate: Age, gender, body composition, hormonal levels, and temperature.

PATIENT EDUCATION

  • Teaching for NG tube insertion and care

    • Provide complete guidance on hygiene, maintenance, and symptom monitoring.

  • Feeding safety at home or in hospital

    • Educate on feeding protocols and monitoring techniques.

  • Prevention of complications

    • Discuss signs to watch for, such as aspiration or tube dislodgment.

  • When patients can refuse treatment

    • Educate on patient rights and the ability to refuse feeding or treatment as informed participants in their care.

SAFETY & ERROR PREVENTION

  • Preventing wrong-route medication errors

    • Implement checks and balances, including confirming patient identity and double-checking medication administration routes.

  • Equipment safety (tubing, pumps, labeling)

    • Regular inspection and maintenance of feeding machinery and equipment.

  • Infection control practices

    • Hygiene protocols strictly followed by all personnel involved in care.

  • Monitoring for complications during NG tube and G-tube care

    • Continuous assessment necessary to rapidly identify and address complications.