Enteral nutrition giving nutrients into the gastro-intestinal tract through a feeding tube
Parenteral nutrition giving nutrients through a catheter inserted into a vein
Check residuals in which tube? g-tube
How much residual is too much? 500 or 250 x2
What to do if residual is too much? put it ...
Nurs 321 Exam 1 Questions and
Solutions
Enteral nutrition ✅giving nutrients into the gastro-intestinal tract through a feeding tube
Parenteral nutrition ✅giving nutrients through a catheter inserted into a vein
Check residuals in which tube? ✅g-tube
How much residual is too much? ✅500 or 250 x2
What to do if residual is too much? ✅put it back, hold the next feeding, tell the provider
When do we flush tube feedings? ✅before AND after feedings and medication
administration
How long is everything for enteral tube feedings good for? ✅24 hours; change if its
been longer
TPN risks ✅infection (bacterial or fungal)
Air emboli
Wrong spot
Electrolyte imbalances
Hyper/hypoglycemia
TPN runs out and next bag isnt ready; what do you do? ✅hypoglycemia!! Start D10!!
Its been 24 hours and there is still food in TPN; what do you do? ✅change it
Who is at highest risk for re-feeding syndrome ✅elderly
Malnourished
Re-feeding syndrome: four things to look out for ✅fluid overload, hypomagnesium,
hypophosphotemia, hypokalemia
How to check if TPN is in the right place ✅x-ray!!!!
Ph in metabolic alkalosis ✅greater than 7.45
Bicarbonate in metabolic alkalosis ✅above 26, high.
,A patient has been admitted to the hospital due to experiencing vomiting for several
days. The cause of the patient's vomiting is unknown. Which of the following
interventions should be considered the nurse's priority in providing care for this patient?
A. Administration of parental antiemetics.
B. Insertion of an NG tube for suction.
C. IV replacement of fluid and electrolytes.
D. Oral administration of broth & tea. ✅c. IV replacement of fluid and electrolytes.
D
What increases a patient's risk for candidiasis? ✅antibiotics and corticosteroids
Which mouth concern can result from chemotherapy, renal disease or liver disease?
✅mucositis
When caring for a patient in the initial postoperative period after a partial glossectomy
with a radial neck dissection, which of the following is the nurse's primary concern?
Select an answer and submit. For keyboard navigation, use the up/down arrow keys to
select an answer.
A. Assessing the patient's coping.
B. Maintaining a patent airway.
C. Providing adequate nutrition
D. Relieving the patient's pain. ✅b. Maintaining a patent airway.
The nurse provides education to a patient who has a hiatal hernia and experiences
GERD after eating. Which activity should the nurse instruct this patient to avoid?
A. Lying flat after meals
B. Eating small, frequent meals that are not spicy
C. Sleeping with the HOB elevated 30 degrees
D. Taking ranitidine on an empty stomach ✅A. Lying flat after meals
The nurse has requested a dietary consult for a patient with GERD. What statements
provide useful dietary information for this patient to manage the GERD symptoms?
(Select all that apply.)
A. Maintain an ideal body weight.
B. Avoid spicy foods.
C. Avoid fatty foods.
D. A glass of wine after dinner will help you relax.
E. A cup of peppermint will help improve digestion. ✅A. Maintain an ideal body weight.
B. Avoid spicy foods.
C. Avoid fatty foods.
The nurse is caring for a patient who encountered a minor esophageal injury after
accidently swallowing a piece of a chicken bone. The patient will receive medications
and nutrition for 4 to 6 days by nasogastric tube to control mucosal damage and
promote healing. Which of the following actions should the nurse plan to take first when
administering medications through the nasogastric tube?
,A. Verify the patient's identification and explain the procedure to the patient.
B. Flush the nasogastric tube with 30 to 50 ml per hospital policy prior to administering
the medication.
C. Check the provider's order.
D. Prepare the medication for administration. ✅C. Check the provider's order.
The nurse always checks the physician's order before administering a medication. After
verification of the order, the RN determines that the medication is appropriate to be
given though a nasogastric tube. Certain medications have a delayed action or enteric
coating. Check the approved drug reference or agency pharmacy to verify that these
medications can be given through a nasogastric tube. If a medication is not available in
an elixir form, the nurse prepares the medication by crushing pills or opening capsules
and mixing each medication in 15 to 30 ml of water. Confirmation of patient
identification, tube placement, residual volume, and presence of bowel sounds are
checked. Medication is drawn up with the appropriate catheter-tip syringe and
administered to the patient and then flushed with 15 to 30 ml of water. Documentation of
medication administration and any pertinent information is completed.
A nurse working in an endoscopy clinic is screening patients for the risk of developing
Barrett's esophagus. The nurse should consider which patient at greatest risk?
A. The patient with a 20-year history of alcohol abuse
B. The patient with a 30-pack-per-year smoking history
C. The patient who ingested lye as a child and is now 47 years old
D. The patient who has had untreated GERD for 30 years ✅D. The patient who has
had untreated GERD for 30 years
The patient with untreated GERD is at greatest risk. Barrett's esophagus is found in the
lower one third of the esophagus, mainly at the gastroesophageal junction (GEJ) and
cardiac (first part of the stomach) of the stomach. Long-term exposure to gastric acid
reflux causes metaplastic transformation (Barrett's esophagus) that leads to esophageal
adenocarcinoma. Alcohol abuse,cigarette smoking, and lye ingestion are risk factors of
squamous cell carcinoma of the upper portions of the esophagus.
Which clinical manifestations will the nurse expect to find when taking care of a patient
diagnosed with oral cancer? (Select all that apply.)
A. Pain radiating to the ear
B. Otitis media
C. Leukoplakia
D. Presence of HPV E. Nasal polyposis ✅A. Pain radiating to the ear
C. Leukoplakia
D. Presence of HPV E. Nasal polyposis
The nurse completed teaching for the client who will be receiving TPN while at home.
Which client statement indicates that further teaching is needed?
•A. "My refrigerator is big enough to store several bags of parenteral solution."
•B. "I will keep my cellular phone with me at all times to use in an emergency."
•C. "I plan to use the main floor bedroom; it'll be best with the infusion pump."
, •D. "i'll sit at the table to remove the IV catheter cap to attach the IV tubing." ✅D. "i'll sit
at the table to remove the IV catheter cap to attach the IV tubing."
. The IV infusion tubing is connected to the insertion site cap and not removed to
administer the TPN solution. Caps are changed every 3 to 7 days during dressing
changes, with the client in a flat position. An air embolus can occur if the cap is removed
while the client is in a sitting position. (Some hospital policies say to change caps daily
when hanging a new bag of TPN)
The nurse is initiating an IV infusion of lactated Ringer's (LR) for the client in shock.
What is the purpose of LR for this client?
•A. Increase fluid volume and urinary output.
•B. Draw water from the cells into the blood vessels.
•C. Provide dextrose and nutrients to prevent cellular death.
•D. Replace potassium and magnesium for cardiac stabilization. ✅A. Increase fluid
volume and urinary output.
•The client with a BMI of 30 is attending a health promotion program at a clinic. Which
outcome is best for the nurse to document in the client's plan of care?
•A. The client will lose 2 lb per week for the next 4 weeks.
•B. The client will gain 2 lb per week for the next 4 weeks.
•C. Teach the client to increase intake of fruits and vegetables.
D. Inform the client to call the clinic weekly with weight results ✅A. The client will lose
2 lb per week for the next 4 weeks.
The client prescribed a high-protein, high-calorie diet is not meeting protein or caloric
intake goals. The client states, "I feel full quickly after eating three meals daily." Which
interventions should the nurse recommend? Select all that apply.
•A. Include more fresh fruits and vegetables in the diet.
•B. Eat six smaller meals instead of three meals daily.
•C. Include protein bars and whole milk yogurt as snacks.
•D. Drink regular instead of diet carbonated beverages.
•E. Add protein supplements to cooked cereals. ✅Eat six smaller meals instead of
three meals daily.
Include protein bars and whole milk yogurt as snacks.
Add protein supplements to cooked cereals.
An experienced nurse is observing a new nurse teaching the client about TPN. Which
statement indicates that the new nurse needs additional orientation regarding the
administration of TPN?
•A. "A gastrostomy tube will be inserted through the abdominal wall into your stomach to
administer your TPN."
•B. "Your blood glucose will be monitored frequently because the TPN has a high
concentration of dextrose."
•C. "Although an infusion pump will be used to administer the TPN solution, you can still
ambulate with assistance."
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