A nurse is caring for a client who is receiving intermittent enteral feedings through an NG tube

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A nurse is caring for a client who is receiving intermittent enteral feedings through an NG tube. The specific gravity of the client's urine is 1.035. Which of the following actions should the nurse take?
A. Deliver the formula at a slower rate
B. Request a lower-fat formula
C. Provide more water with feedings D. Instill a lactose-free formula

C. Provide more water with feedings

Explanation: The elevation in the client's specific gravity indicates dehydration. The nurse should provide more fluids either by adding free water to feedings or by instilling water between feedings. Another strategy is to request a formula that contains less protein.

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following disorders should the nurse identify as increasing the client's metabolic needs? (Select all that apply.)
A. COPD
B. Hypothyroidism
C. Cancer
D. Parkinson's disease
E. Major burns

A. COPD
C. Cancer
D. Parkinson's disease
E. Major burns

Explanation:
Clients who have COPD develop hypermetabolism as a result of the increased amount of energy used to breathe. Cancer can cause a number of metabolic changes, including hypermetabolism as a result of the tumor growth. Clients who have Parkinson's disease develop hypermetabolism because they burn calories due to muscular rigidity. Finally, clients who have major burns develop severe metabolic stress, which includes hypermetabolism and hypercatabolism.

A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the client's meal tray?
A. Canned fruit
B. White bread
C. Broiled hamburger
D. Coleslaw

D. Coleslaw

Explanation: Coleslaw contains raw cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables.

A nurse is reviewing a client's 24 hr dietary recall. The client reports eating a slice of toasted white bread with butter, a banana, a glass of milk, and a cup of coffee for breakfast; grilled chicken, a baked potato, and a glass of milk for lunch; an apple and cheddar cheese for a snack; and 2 servings of chicken, 2 cups of steamed broccoli, and a glass of milk for dinner. This client's diet is deficient in which of the following food groups?
A. Dairy
B. Vegetables
C. Fruits
D. Grains

D. Grains

Explanation: This client only consumed 1 serving of grains on the day of the 24-hour dietary recall. USDA dietary guidelines recommend 3 or more ounce-equivalents of whole-grain products per day. Additionally, the choice of white bread is low in fiber, which can lead to constipation and an increased risk of developing hyperlipidemia. The USDA guidelines recommend that at least half of the grains consumed should be whole grain.

A nurse is planning an in-service training session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes plays a role in the digestion of protein?
A. Amylase
B. Lipase
C. Steapsin
D. Pepsin

D. Pepsin

Explanation: Pepsin is an enzyme secreted by the gastric mucosa that breaks down protein into polypeptides. Other enzymes such as trypsin and aminopeptidase further break down the polypeptides into amino acids, which can be used by the body.

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When working with patients receiving intermittent enteral feedings via a gastrostomy tube which position does the patient have to be in?

-place the patient in Fowler's position. *The Fowler's position is recommended during tube feeding to reduce the risk of regurgitation, which can lead to aspiration. If Fowler's is uncomfortable for the patient, an acceptable alternative is elevating the head of the bed at least 30º.

When caring for a client who is receiving enteral feeding the nurse would take which measure to prevent aspiration?

If you find tube feeding contents in the patient's mouth during oral care, assume the presence of reflux, which increases aspiration risk. To help prevent this problem, keep the head of the bed elevated 30 degrees or higher when possible.

Which of the following actions should the nurse take before administering an enteral feeding?

Which of the following actions should the nurse take to verify tube placement before administering the initial feeding? Obtain a radiography. Verification for tube placement with radiography is the gold standard for tube placement before any secretions are aspirated or feedings are initiated.

When a patient is receiving continuous enteral feedings at what degree of elevation should you keep the head of the bed?

If unable to sit up for a bolus feed or if receiving continuous feeding, the head of the bed should be elevated 30-45 degrees during feeding and for at least 30 minutes after the feed to reduce the risk of aspiration.