Enteral Nutrition Administration, Monitoring, and Clinical Issues

Question 1

What is the maximum hang time for human breast milk?

Answer 1

4 hours

Question 2

In critically ill patients receiving early EN, what is most likely to increase success in achieving goal feeding rate?

Answer 2

Use of a volume base EN feeding protocol

Question 3

What is the optimal solution concentration of an oral rehydration solution (ORS) for patients with short bowel syndrome?

Answer 3

90-120 mmol/L

Question 4

A patient with short bowel and end-jejunostomy requires the use of ORS to help prevent dehydration. What best describes the preferred composition of ORS?

Answer 4

An iso-osmolar solution such as juice diluted with 50% water

Question 5

What is the best practice recommendation in EN formula safety?

Answer 5

Change the enteral feeding administration set every 24 hours

Question 6

What is a benefit of closed enteral feeding systems?

Answer 6

Decreased risk for microbial contamination

Question 7

What method of EN delivery is preferred for critically ill patients?

Answer 7

Continuous infusion

Question 8

What type of feeding delivery method is most appropriate for patients with jejunostomy?

Answer 8

Continuous pump

Question 9

Which enteral feeding method provides 240 ml of formula via a syringe over as few as 4-10 minutes, three to six times daily?

Answer 9

Bolus feeding

Question 10

Most enteral formulas designed for oral consumptions are composed primarily of:

Answer 10

Carbohydrates

Question 11

Which individuals would benefit from cyclic tube feedings?

Answer 11

Status post CVA who has initiated oral foods during the day

Question 12

What tube feeding orders best reflects the use of intermittent schedule?

Answer 12

240 ml administered over 45 min, five times a day

Question 13

Which feeding schedule would be most appropriate for a critically ill patient with poorly controlled blood glucose?

Answer 13

Continuous

Question 14

What should always appear on the label of EN formula given to a patient in the hospital?

Answer 14

Patient ID, product name, administration method, route, access device, date and time of the formula was prepared and hung

Question 15

When transitioning from EN to oral feeding, tube feeding my be discontinued when adequacy of oral intake meets at least:

Answer 15

66% of nutrient needs

Question 16

Which type of insulin should be used when initiating EN on a hospitalized diabetic patient?

Answer 16

Regular (short acting) insulin

Question 17

Which patient is at a lowest risk of pulmonary injury from small bore feeding tube misplacement?

Answer 17

A patient who is alert and cooperative

Question 18

The initiation of EN should be delayed when the patient is:

Answer 18

Hemodynamically unstable

Question 19

When initiating and advancing EN in hospitalized patient, what order is the most appropriate?

Answer 19

Full strength formula at 10-40 ml/hr and advancing to goal rate in 1-2 days.

Question 20

One method of minimizing the complications associated with refeeding syndrome is to initiate electrolyte replacement before nutrition therapy begins. What is true regarding this plan?

Answer 20

Patients even considered not at risk should be included in protocol

Question 21

Your patient is showing outwards signs of tube feeding intolerance including nausea and abdominal distention. The nurse checks gastric residuals and the last three measurements are 265 ml, 250 ml, and 330 ml. What is the most appropriate recommendation?

Answer 21

Consider adding a motility agent

Question 22

When a patient is receiving a protein modulator, what is important to discuss with the family to prevent tube feeding syndrome?

Answer 22

The importance of providing adequate free water each day

Question 23

What is true regarding infectious complications associated with EN?

Answer 23

Bacterial contamination may originate from the patients throat, lung, and stomach

Question 24

An EN patient is experiencing abdominal distention but his residuals were 100 ml, what is appropriate strategy to alleviate symptoms?

Answer 24

Determine last bowel movement and initiate a bowel regimen if constipation is suspected?

Question 25

A terminally ill patient at home on hospice complains of nausea during enteral feeds. A decision is made to discontinue EN. What is true regarding the dying patient?

Answer 25

The most common symptom when nutrition and hydration are held is dry mouth.

Question 26

What is a benefit of electromagnetic placement device for NGT placement?

Answer 26

Provides a 3-D location

Question 27

In a patient with a newly placed g or j tube, observation of which condition at the tube exit site would signal concern for infection?

Answer 27

Foul smelling drainage

Question 28

What is a major risk factor for aspiration in critically ill patients?

Answer 28

Decreased level of consciousness

Question 29

What is considered appropriate management of hypergranulation around the PEG site?

Answer 29

Cauterization with silver nitrite

Question 30

A patient with oral cancer, who has gained 10 pounds since starting home bolus feeds via g tube complains of pain and pressure on the “inside of his stomach” but no redness or drainage at the exterior site. What is the most appropriate response for the clinician?

Answer 30

Refer the patient to the gastroenterologist or enterostomal nurse

Question 31

Constipation in the enterally fed patient may be associated with many thing with the exception of?

Answer 31

Rapid or bolus infusion

Question 32

What is the most likely cause of watery diarrhea and bloating in the EN fed adult patient?

Answer 32

Sorbitol content of liquid administration

Question 33

AN EN patient reports nausea and vomiting. If delayed gastric emptying is suspected as the causative factor, what is least likely to improve the patient’s symptoms?

Answer 33

Use a more concentrated formula

Question 34

What best describes the addition of blue dye to EN?

Answer 34

It is no longer recommended for detection of aspiration of enteral formula

Question 35

When administering multiple medications via enteral feeding tubes, medications should be:

Answer 35

Administered separately, followed by a 15-30 ml water flush

Question 36

Which tube requires immediate replacement if it becomes dislodged?

Answer 36

Jejunostomy tube

Question 37

Which formula is likely to cause an occluded feeding tube?

Answer 37

Calorie dense formula

Question 38

What intervention assists with maintaining feeding tube patency in adult patient?

Answer 38

Flush feeding tube with 30 ml of water every four hours during continuous feeds

Question 39

What is not a research based method for restoring feeding tube patency when tubes are clogged?

Answer 39

Cranberry juice flush

Question 40

Monitoring GRV have been ordered as part of a treatment plan. What intervention can be utilized to prevent occlusion associated with GRV assessment?

Answer 40

Feeding tube should be flushed with 30 ml of water following GRV assessment

Question 41

What interventions has not been proven effective in reducing the risk of aspiration associated with EN in adult patients?

Answer 41

Check gastric residuals every shift

Question 42

What is most likely to improve tolerance of EN in a post operative patient with documented high GRV receiving bolus feeds?

Answer 42

Provide continuous feeds

Question 43

What is the primary source of oozing stools in a tube fed patient?

Answer 43

Fecal impaction