1. An older adult patient is discharged after an inpatient stay for weight loss because of lung
cancer. A nasoenteric tube was placed for enteral feedings to improve the patient’s nutrition until
surgery next month. The nurse teaches the patient and family that aspiration is a risk with EN
when the patient is placed in which position?
A. Reverse Trendelenburg position
B. Supine position
C. Sitting up in a chair
D. In bed with the head of the bed elevated 30 to 45 degrees
Rationale: To decrease the risk for aspiration, a patient receiving tube feedings should have the
head elevated and not be in a supine position. Elevating the patient’s head―whether raising the
head of the bed 30 to 45 degrees, placing the patient in reverse Trendelenburg position, or having
the patient sit up in a chair—decreases the risk for aspiration.
2. A patient with a pancreatic pseudocyst will require nasojejunal feeding for about 6 weeks. The
patient will need assistance to administer the feeding. Preparations for discharge should involve
which nursing intervention?
A. Instructing the patient on what must and must not occur at home based on what is being
currently done in the acute care facility
B. Ordering supplies for the patient from a home supply vendor, including a backpack for
24-hour-a-day feeding because that is what is infusing now
C. Telling the patient not to worry about the feeding because a home health nurse will take care
of it
D. Discussing a plan that best fits the patient’s lifestyle and including the patient and family in
administering the feeding and related care as soon as possible
Rationale: Adapting a plan that best fits the patient’s lifestyle and needs and including the
patient in decision-making and hands-on education will enhance success and satisfaction; the
family may be very helpful, so they should be included in the education. Explaining what must
and must not occur may decrease the patient’s involvement in treatment. Regimens used in the
acute care setting may not be the most appropriate ones for the home setting, so ordering
supplies at this time is inappropriate. Along with the family, the nurse determines the patient’s
ability to handle the feeding and related care and whether a home health nurse is needed.
3. Which action should the nurse take to help a patient confirm that the nasoenteric tube has not
become displaced before administering a feeding?
A. Mark the tube where it exits the naris; measure and record the external length in the discharge
instructions for comparison.
B. Teach the patient to assess the quality and quantity of aspirated return and assess the pH of the
return every 8 hours.
C. Teach the patient to instill air into the tube via a syringe while listening for the air bolus over
the abdomen.
D. Pin the tube to the patient’s clothing and stress that it must always be pinned in the same place
on clothing.
Rationale: The nurse should mark the tube where it exits the naris and measure and record the
external length in the discharge instructions for comparison. The nurse should then instruct the
patient with a nasoenteric tube to monitor the external tube length on a regular basis and compare
it with the measurement provided in the discharge instructions. The patient should not use the
tube and should notify the home health nurse or practitioner if placement is questionable.
Returns are typically small from a tube that terminates in the small bowel, and pH assessment
may not be practical or realistic for a patient in the home setting. Listening for injected air could
be misleading because air may be heard if the tube tip is anywhere in the thorax. Pinning the tube
to the patient’s clothing may cause pulling on it as the clothing is changed. Securing the tube to
the neck should be more stable.
4. A patient who is undergoing radiation treatments for head and neck cancer is to begin feeding
via a G tube because the patient’s mouth is very sore and adequate fluid and nutrition is difficult
to obtain orally. The practitioner wants the patient to continue to eat and drink by mouth, if able.
The nurse establishes a plan with the patient and suggests that which action take place?
A. Use a syringe to administer feedings quickly so that the patient has plenty of time for other
activities.
B. Continue to try eating meals and administer feeding after each meal, adjusting the feeding
amount to how much the patient has eaten.
C. Try to eat after the enteral feedings to make sure the patient gets every feeding as ordered.
D. Administer feedings five times per day, according to a schedule the nurse provides, to ensure
success.
Rationale: Eating meals and administering feeding immediately afterward lets the patient eat
while there is an appetite, because enteral feeding reduces appetite; this allows for adjusting the
amount of feeding the patient needs based on how much is eaten. The patient will probably
tolerate feedings at a rate similar to the duration of the current meals as opposed to the quick
ingestion that may be administered with a syringe feeding; however, very slow feedings should
not be needed, which may tax the patient’s lifestyle. The patient should be able to determine the
best schedule for feedings with the understanding of how much nutrition and fluid is needed each
day.
5. A patient who is receiving chemotherapy has been getting enteral feedings at home. After 2
weeks, the patient has lost 2.75 kg (6 lb) and reports feeling very weak and tired. While
discussing the regimen with the nurse, the patient indicates that getting enough feeding and fluid
during the day is difficult. What suggestion for the patient is appropriate?
A. Waiting to administer the feeding until after the patient receives chemotherapy to help prevent
feeding-related problems
B. Administering feedings faster to be able to get more in the course of a day
C. Comparing the amount of recommended feeding to the amounts of previous usual meals and
daily fluid intake
D. Finding a way to get more calories and feeding than originally ordered
Rationale: The nurse should help the patient understand the amounts of feeding and fluid
ordered according to usual household terms, such as cups of water and food needed each day.
Although a syringeful of water may seem like a large amount, comparison with usual household
amounts may indicate otherwise. Feeding faster may cause discomfort for the patient; the nurse
should help plan feedings as comfortable, relaxed meals. Waiting to administer feedings until
later in the day may cause the patient to miss feedings and fluid; the nurse can encourage the
patient to administer feeding while the chemotherapy infuses. Typically, weight loss initially
reflects fluid loss, which is also manifested as weakness and fatigue; the nurse should explore
with the patient the amount of water being ingested because the patient may be becoming
dehydrated. The nurse should advise the patient to consult a registered dietitian if there are
questions about the adequacy of nutrition and fluid.
6. What nursing consideration should be included in the plan of care for a patient who is to begin
enteral feeding?
A. Advising the patient to avoid social situations that may be uncomfortable
B. Writing a schedule for the patient and advising strict adherence for best results
C. Involving the patient in feeding on the morning of discharge
D. Using directions and examples that are as simple and practical as possible
Rationale: Practical and simple education about tube feeding and related care helps alleviate the
patient’s anxiety about this new method of receiving nutrition while keeping safety in mind. To
maximize the amount of education, the nurse should involve the patient and others who may help
administer enteral feeding and perform related care as soon as it is determined that home feeding
may be needed and not wait until the morning of discharge. The nurse should help the patient
and family establish a schedule that best fits the patient’s lifestyle, ensuring that they understand
the necessary daily amounts of nutrition and fluid. The nurse should also encourage the patient
and family to keep life as normal as possible, including attending social events even if the patient
cannot eat by mouth.
7. Which outcomes should be monitored to assess the adequacy of nutrition in a patient receiving
enteral nutrition at home?
A. Daily weights, healing, and hunger satisfaction
B. Weight trend, energy level, healing, and hunger satisfaction
C. Albumin or prealbumin levels weekly
D. Intake and output and weights daily
Rationale: With adequate nutrition and fluid, the patient receiving enteral feeding should be able
to heal wounds, maintain a stable weight, have a good energy level, and have a general sense of
well-being with hunger satisfied. Although albumin and prealbumin levels may reflect nutritional
status, weekly levels are generally not indicated for the patient receiving enteral feeding because
many other factors affect these levels. Monitoring intake and output may be helpful for a patient
with excessive losses or complex problems, but it is not necessary in general. Daily weights may
not be necessary; monitoring the patient’s weight trend and assessing the fit of clothing are
practical ways to monitor the adequacy of fluid and nutrition.
8. The patient and family should be taught to reconstitute powdered formula with which fluid?
A. Purified water
B. Sterile water
C. Tap water
D. Milk
Rationale: The patient and family should be taught to use sterile water for reconstituting
powdered formula to decrease the risk of contamination. Tap water, milk, and purified water
should not be used.
9. A nonverbal patient is receiving enteral feedings at home. The family reports that the patient is
writhing while enteral feeds are being administered and that the GRV is 550 ml. What should the
nurse tell the family member to do?
A. Stop the feeding for 8 hours and then recheck the GRV.
B. Reinstill the gastric returns and resume feedings.
C. Withhold EN for 2 hours and then resume feedings.
D. Withhold EN for 2 hours and then recheck the GRV.
Rationale: Because the GRV is greater than 500 ml, the nurse should tell the family member to
withhold EN for 2 hours and then recheck the GRV. The family member should not be told to
stop the feeding for 8 hours. Telling the family member to return the residual and resume
feedings would not be appropriate because returning more than 500 ml of GRV could cause
further discomfort or emesis. The nurse would not tell the family member to resume EN after 2
hours without first rechecking the GRV.
10. A patient is being discharged from the hospital on enteral feedings. The nurse teaches the
family member to add formula to the bag and allow it to hang for what period of time?
A. 2 hours
B. 4 hours
C. 12 hours
D. 24 hours
Rationale: The nurse teaches the patient and family to add enough formula to a bag so that it
does not hang for longer than 4 hours. Reconstituted formulas should not be exposed to room
temperature for longer than 4 hours. Hanging formula for 2 hours would create too much
additional work for the family member given that the formula is safe to hang for up to 4 hours.
Allowing the formula to hang for 12 to 24 hours would contribute to microbial growth.