N/G, Enteral and Parenteral Feedings (from BB) Flashcards
The purpose of a NG tube is for feeding, prevention of nausea, vomiting, and gastric distention following surgery, to remove stomach contents, and to wash (lavage) the stomach.
a. True
b. False
a. True
What information is most important to teach the client going home with a peripherally inserted central catheter (PICC) line?
a. “Avoid carrying your grandchild with the arm that has the IV.”
b. “Be sure to place the arm with the IV in a sling during the day.”
c. “Flush the IV line with normal saline daily.”
d. “You can use the arm with the IV for most of the activities of daily living.”
a. “Avoid carrying your grandchild with the arm that has the IV.”
A properly placed PICC (in the antecubital fossa or the basilic vein) allows the client considerable freedom of movement. Clients can participate in most activities of daily living; however, heavy lifting can dislodge the catheter or occlude the lumen. Although it is important to keep the insertion site and tubing dry, the client can shower. The device is flushed with heparin.
A client is to receive 10 days of antibiotic therapy for urosepsis. The nurse plans to insert which type of intravenous catheter?
a. Hickman
b. Midline
c. Nontunneled central
d. Short peripheral
b. Midline
Midline catheters are used for therapies lasting from 1 to 4 weeks. Short peripheral catheters can be inserted by the nurse for use with antibiotic therapy, but they can stay in only for up to 96 hours. If the length of IV therapy is longer than 6 days, a midline catheter should be chosen. Nontunneled central catheters and Hickman catheters are inserted by a physician.
The home care nurse is about to administer intravenous medication to the client and reads in the chart that the peripherally inserted central catheter (PICC) line in the client’s left arm has been in place for 4 weeks. The IV is patent, with a good blood return. The site is clean and free from manifestations of infiltration, irritation, and infection. Which action by the nurse is most appropriate?
a. Notify the physician.
b. Administer the prescribed medication.
c. Discontinue the PICC line.
d. Switch the medication to the oral route.
b. Administer the prescribed medication.
A PICC line that is functioning well without inflammation or infection may remain in place for months or even years. Because the line shows no signs of complications, it is permissible to administer the IV antibiotic. The physician does not have to be called to have the IV route changed to an oral route.
Which assessment finding for a client with a peripherally inserted central catheter (PICC) line requires immediate attention?
a. Initial dressing over site is 3 days old.
b. Line has been in for 4 weeks.
c. A securement device is absent.
d. Upper extremity swelling is noted.
d. Upper extremity swelling is noted.
Upper extremity swelling could indicate infiltration, and the PICC line will need to be removed. The initial dressing over the PICC site should be changed within 24 hours. This does not require immediate attention, but the swelling does. The dwell time for PICC lines can be months or even years. Securement devices are being used more often now to secure the catheter in place and prevent complications such as phlebitis and infiltration. The IV should have one, but this does not take priority over the client whose arm is swollen.
A nursing student asks why midline catheters need strict sterile dressing changes when short peripheral IVs do not. Which answer by the experienced nurse is most accurate?
a. “Because of the length of time they stay inserted.”
b. “They really don’t need strict sterile technique.”
c. “Because the tip is in the right atrium of the heart.”
d. “The tonicity of the fluids used promotes infection
a. “Because of the length of time they stay inserted.”
Midline catheters can stay in place for as long as 4 weeks, so dressing changes must be done with strict sterile technique to reduce the incidence of infection. The tip does not lie in the right atrium; it resides no farther than the axillary vein. These catheters are used for a wide range of fluids and medications, so tonicity would not be a factor in infection risk.
The nurse is caring for a client with suspected upper GI bleeding. The nurse inserts a nasogastric (NG) tube for gastric lavage and checks placement of the tube in the stomach. When fluid is aspirated from the tube, the pH is found to be 6. Which is the priority action of the nurse?
a. Obtain an order for a stat chest x-ray.
b. Auscultate over the lung fields bilaterally.
c. Assess whether the tube is coiled in the client’s throat.
d. Auscultate over the epigastric area while instilling air.
a. Obtain an order for a stat chest x-ray.
The pH of gastric contents should be below 3.5. A stat chest x-ray should be obtained whenever any doubt arises regarding NG tube placement. The other methods are not appropriate for confirming placement.
A patient receiving parenteral nutrition is administered via the following routes except:
a. Subclavian line.
b. Central Venous Catheter.
c. PICC (Peripherally inserted central catheter) line.
d. PEG tube.
d. PEG tube.
A nurse is monitoring the status of a client’s fat emulsion (lipid) infusion and notes that the infusion is 2 hours delay. The nurse should do which of the following actions?
a. Adjust the infusion rate to catch up over the next hour.
b. Make sure the infusion rate is infusing at the ordered rate.
c. Increase the infusion rate to catch up over the next few hours.
d. Adjust the infusion rate to full blast until the solution is back on time.
b. Make sure the infusion rate is infusing at the ordered rate.
The nurse should maintain the prescribed rate of a fat emulsion even if the infusion’s time consume is behind. Options A, C, and D are incorrect since increasing the rate will potentially cause a fluid overload.
A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensure the availability of which medical equipment before hanging the solution?
a. Glucometer.
b. Dressing tray.
c. Nebulizer.
d. Infusion pump.
d. Infusion pump.
The nurse should prepare an infusion pump prior hanging a parenteral solution. The use of an infusion pump is important to make sure that the solution does not infuse too quickly or delayed since the parenteral nutrition has a high glucose content. Option A: A glucometer is also needed since the client’s glucose level is monitored every 4 to 6 hours, but it is not an essential item needed. Options B and C are not used before hanging a PN solution
A nurse is conducting a follow-up home visit to a client who has been discharged with a parenteral nutrition(PN). Which of the following should the nurse most closely monitor in this kind of therapy?
a. Blood pressure and temperature.
b. Blood pressure and pulse rate.
c. Height and weight.
d. Temperature and weight.
d. Temperature and weight.
The client’s temperature is monitored to identify signs of infection which is one of the complications of this therapy. While the weight is monitored to detect hypervolemia and to determine the effectiveness of this nutritional therapy.
- A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions?
a. Take another bottle of solution.
b. Runs the bottle solution under a warm water.
c. Rolls the bottle solution gently.
d. Shake the bottle solution vigorously.
a. Take another bottle of solution.
Fat emulsions are used as dietary supplements for patients who are unable to get enough fat in their diet, usually because of certain illnesses or recent surgery. The nurse should examine the bottle of fat emulsion for separation of emulsion into layers or fat globules or the accumulation of froth. The nurse should not hang a fat emulsion if any of these observed and should return the solution to the pharmacy.
A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the therapy and assesses the client for which of the following signs of hyperglycemia?
a. High-grade fever, chills, and decreased urination.
b. Fatigue, increased sweating, and heat intolerance.
c. Coarse dry hair, weakness, and fatigue.
d. Thirst, blurred vision, and diuresis.
d. Thirst, blurred vision, and diuresis.
Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision, confusion, weakness, Kussmaul’s respirations, diuresis, and coma when hyperglycemia is severe. Option A are signs of infection. Option B are signs of hyperthyroidism. Option C are signs of hypothyroidism.
A nurse is caring for a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation?
a. On the right side, with head higher than the feet.
b. On the right side, with head lower than the feet.
c. On the left side, with the head higher than the feet.
d. On the left side, with head lower than the feet.
d. On the left side, with head lower than the feet.
Air embolism happens when air enters the catheter system when the IV tubing disconnects. If it is suspected, the client should be placed in a left-side-lying position. The head should be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart.
A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order?
a. Decrease the PN rate to 60ml/hr.
b. Start 0.9% normal saline at 30 ml/hr.
c. Maintain the present infusion rate.
d. Discontinue the PN.
a. Decrease the PN rate to 60ml/hr.
When a client begins eating a regular diet after a period of receiving PN, the PN is decreased slowly. PN that is terminated abruptly will cause hypoglycemia. Gradually decreasing the infusion rate allows the client to remain sufficiently nourished during the transition to a normal diet and prevents an episode of hypoglycemia.
