Enteral Tube Feedings

Chapter 14

1. Which action by the student nurse would cause the nursing instructor to intervene when administering medications through a feeding tube?
2. Dissolving a patient’s crushed medication in sterile water or saline
3. Crushing a patient’s medications together to facilitate administration
4. Pouring the dissolved fluid/medication mixture into the feeding syringe to infuse by gravity
5. Elevating the head of the patient’s bed 35 to 45 degrees to prevent aspiration
6. Which statement is false regarding open tube feeding systems?
7. They may be administered by syringe or feeding bag.
8. A feeding bag may hang 24 hours, but should be rinsed well between feedings.
9. The syringe used to administer bolus feedings must be replaced every 24 hours.
10. A ready-to-hang bottle may be used to administer feedings through an open system.
11. A feeding tube that is placed directly into the stomach with the aid of an endoscope is called:
12. A nasogastric tube
13. An orogastric tube
14. A percutaneous endoscopic gastrostomy (PEG) tube
15. A percutaneous endoscopic jejunostomy (PEJ) tube
16. A provider orders a bolus feeding for a patient. How should the nurse implement this order?
17. At regular intervals in large quantities
18. At a constant, continuous rate
19. At a constant rate over 8 to 12 hours
20. Intermittently in small, equal amounts
21. Which of the following is the most reliable method of verifying the correct placement of a feeding tube?
22. Aspirating stomach contents
23. Checking the pH of stomach contents
24. Instilling air into the stomach while listening with a stethoscope
25. Through radiography (x-ray)
26. After initially verifying placement of a patient’s feeding tube by x-ray, which methods should the nurse use to verify placement routinely at the bedside? Select all that apply.
27. Checking the tube for carbon monoxide using a capnometer at least once per shift
28. Aspiration of stomach contents for greenish-brown fluid
29. Injecting a small volume of air while auscultating over the stomach area
30. Placing the end of the feeding tube into a cup of distilled water to check for bubbling
31. Repeating an x-ray prior to each feeding or at least daily to document placement
32. The nurse is checking the residual volume of tube feeding on a patient who is receiving continuous feeding at 40 mL/hr. After aspirating and noting that the patient has 120 mL residual feeding in the stomach, what should the nurse do? Select all that apply.
33. Discard the aspirated feeding into the client’s toilet using Standard Precautions.
34. Document the procedure and the amount of aspirate obtained.
35. Place the feeding infusion on hold.
36. Flush the feeding tube with tap water.
37. Return the aspirate to the stomach through the feeding tube.
38. Which of the following are disadvantages of gastrostomy tubes? Select all that apply.
39. Requires smaller volumes of feeding due to small size of jejunum
40. Requires surgical procedure and incision
41. Highest risk of aspiration of any feeding system
42. Risk of infection at insertion site
43. May become dislodged
44. Which types of tube feeding delivery systems have lower risk of aspiration into the lungs? Select all that apply.
45. Jejunostomy
46. Gastrostomy
47. Nasogastric
48. Gastrojejunostomy
49. Nasoduodenal

Calculate the daily amount of formula (in mL/ day) needed for the following patients. Assume the patient requires normal amounts of protein (0.8 g/kg/day) and calories (25 cal/kg/day). Round to the nearest whole number.

1. Patient weight: 45 kg. The formula provides 120 calories per 100 mL. _____ mL/day
2. Patient weight: 62 kg. The formula provides 48 g protein per 1,000 mL. _____ mL/day
3. Patient weight: 87 kg. The formula provides 2,500 calories per 1 L. _____ mL/day
4. Patient weight: 59 kg. The formula provides 12 g protein per 240 mL. _____ mL/day
5. Patient weight: 70 kg. The formula provides 620 calories per 480 mL. _____ mL/day

Calculate the flow rate (mL/hr) for the following feedings. Round the final answer to the nearest whole number.

1. The provider orders a feeding of 240 mL of formula to be given over 20 minutes via enteral feeding pump. _____ mL/hr
2. The provider orders a feeding of 480 mL of formula to be given over 1 hour via enteral feeding pump. _____ mL/hr
3. The provider orders a feeding of 1 L of formula to be given over 12 hours via enteral feeding pump. _____ mL/hr
4. The provider orders a feeding of 1,500 mL of formula to be given over 24 hours via enteral feeding pump. _____ mL/hr

Calculate the amount of water to add to the formula to obtain the feeding strength in the question. Round to the nearest whole number.

1. A provider orders a formula to be diluted to 1/4-strength; 240 mL of formula are available.

_____ mL of water

1. A provider orders a formula to be diluted to 1/2-strength; 480 mL of formula are available.

_____ mL of water

1. A provider orders a formula to be diluted to 1/3-strength; 100 mL of formula are available.

_____ mL of water

1. A provider orders a formula to be diluted to 3/4-strength; 240 mL of formula are available.

_____ mL of water

1. A provider orders a formula to be diluted to 2/3-strength; 180 mL of formula are available.

_____ mL of water