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Basic Exam 3: Chapters 44, 46, 47, 51, 52, 53, 54, 55, 58 & 59
Exam 3 Review
Chapter 44: Digestive and Gastrointestinal Treatment Modalities
QUESTION
1. A nurse is preparing to place a patient ordered nasogastric tube. How should the nurse
best determine the correct length of the nasogastric tube?
A) Place distal tip to nose, then ear tip and end of xiphoid process.
B) Instruct the patient to lie prone and measure tip of nose to umbilical area.
C) Insert the tube into the patients nose until secretions can be aspirated.
D) Obtain an order from the physician for the length of tube to insert.
QUESTION
2. A patient is concerned about leakage of gastric contents out of the gastric sump tube the
nurse has just inserted. What would the nurse do to prevent reflux gastric contents from
coming through the blue vent of a gastric sump tube?
A) Prime the tubing with 20 mL of normal saline.
B) Keep the vent lumen above the patients waist.
C) Maintain the patient in a high Fowlers position.
D) Have the patient pin the tube to the thigh.
Feedback:
The blue vent lumen should be kept above the patients waist to prevent reflux of gastric
contents through it; otherwise it acts as a siphon. A one-way anti-reflux valve seated in the
blue pigtail can prevent the reflux of gastric contents out the vent lumen. To prevent reflux,
the nurse does not prime the tubing, maintain the patient in a high Fowlers position, or
,have the patient pin the tube to the thigh.
,QUESTION
3. A patient receiving tube feedings is experiencing diarrhea. The nurse and the physician
suspect that the patient is experiencing dumping syndrome. What intervention is most
appropriate?
A) Stop the tube feed and aspirate stomach contents.
B) Increase the hourly feed rate so it finishes earlier.
C) Dilute the concentration of the feeding solution.
D) Administer fluid replacement
by IV.
Feedback:
Dumping syndrome can generally be alleviated by starting with a dilute solution and then
increasing the concentration of the solution over several days. Fluid replacement may be
necessary but does not prevent or treat dumping syndrome. There is no need to aspirate
stomach contents. Increasing the rate will exacerbate the problem.
QUESTION
4. A nurse is admitting a patient to the postsurgical unit following a gastrostomy. When
planning assessments, the nurse should be aware of what potential postoperative
complication of a gastrostomy?
A) Premature removal of the G tube
B) Bowel perforation
C) Constipation
D) Development of peptic ulcer disease
Feedback:
A significant postoperative complication of a gastrostomy is premature removal of the G
tube. Constipation is a less immediate threat and bowel perforation and PUD are not noted
to be likely complications.
,QUESTION
,5. A nursing educator is reviewing the care of patients with feeding tubes and endotracheal
tubes (ET). The educator has emphasized the need to check for tube placement in the
stomach as well as residual volume. What is the main purpose of this nursing action?
A) Prevent gastric ulcers
B) Prevent aspiration
C) Prevent abdominal distention
D) Prevent diarrhea
Feedback:
Protecting the client from aspirating is essential because aspiration can cause pneumonia,
a potentially life-threatening disorder. Gastric ulcers are not a common complication of
tube feeding in clients with ET tubes. Abdominal distention and diarrhea can both be
associated with tube feeding, but prevention of these problems is not the primary
rationale for confirming placement.
QUESTION
6. The nurse is administering total parenteral nutrition (TPN) to a client who underwent
surgery for gastric cancer. Which of the nurses assessments most directly addresses a
major complication of TPN?
A) Checking the patients capillary blood glucose levels regularly
B) Having the patient frequently rate his or her hunger on a 10-point scale
,C) Measuring the patients heart rhythm at least every 6 hours
,D) Monitoring the patients level of consciousness
each shift Ans: A
Feedback:
The solution, used as a base for most TPN, consists of a high dextrose concentration and
may raise blood glucose levels significantly, resulting in hyperglycemia. This is a more
salient threat than hunger, though this should be addressed. Dysrhythmias and decreased
LOC are not among the most common complications.
QUESTION
7. A critical care nurse is caring for a patient diagnosed with acute pancreatitis. The nurse
knows that the indications for starting parenteral nutrition (PN) for this patient are
what?
A) 5% deficit in body weight compared to preillness weight and increased caloric need
B) Calorie deficit and muscle wasting combined with low electrolyte levels
C) Inability to take in adequate oral food or fluids within 7 days
D) Significant risk of aspiration coupled with decreased level of consciousness
Ans: C
Feedback:
,The indications for PN include an inability to ingest adequate oral food or fluids within 7
, days. Weight loss, muscle wasting combined with electrolyte imbalances, and aspiration
indicate a need for nutritional support, but this does not necessary have to be parenteral.
QUESTION
8. A nurse is preparing to administer a patients intravenous fat emulsion simultaneously
with parenteral nutrition (PN). Which of the following principles should guide the
nurses action?
A) Intravenous fat emulsions may be infused simultaneously with PN through a Y-
connector close to the infusion site and should not be filtered.
B) The nurse should prepare for placement of another intravenous line, as intravenous
fat emulsions may not be infused simultaneously through the line used for PN.
C) Intravenous fat emulsions may be infused simultaneously with PN through a Y-
connector close to the infusion site after running the emulsion through a filter.
D) The intravenous fat emulsions can be piggy-backed into any existing IV solution that
is infusing.
Ans: A
Feedback:
Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector
close to the infusion site and should not be filtered. The patient does not need another
, intravenous line for the fat emulsion. The IVFE cannot be piggy-backed into any existing
Basic Exam 3: Chapters 44, 46, 47, 51, 52, 53, 54, 55, 58 & 59
Exam 3 Review
Chapter 44: Digestive and Gastrointestinal Treatment Modalities
QUESTION
1. A nurse is preparing to place a patient ordered nasogastric tube. How should the nurse
best determine the correct length of the nasogastric tube?
A) Place distal tip to nose, then ear tip and end of xiphoid process.
B) Instruct the patient to lie prone and measure tip of nose to umbilical area.
C) Insert the tube into the patients nose until secretions can be aspirated.
D) Obtain an order from the physician for the length of tube to insert.
QUESTION
2. A patient is concerned about leakage of gastric contents out of the gastric sump tube the
nurse has just inserted. What would the nurse do to prevent reflux gastric contents from
coming through the blue vent of a gastric sump tube?
A) Prime the tubing with 20 mL of normal saline.
B) Keep the vent lumen above the patients waist.
C) Maintain the patient in a high Fowlers position.
D) Have the patient pin the tube to the thigh.
Feedback:
The blue vent lumen should be kept above the patients waist to prevent reflux of gastric
contents through it; otherwise it acts as a siphon. A one-way anti-reflux valve seated in the
blue pigtail can prevent the reflux of gastric contents out the vent lumen. To prevent reflux,
the nurse does not prime the tubing, maintain the patient in a high Fowlers position, or
,have the patient pin the tube to the thigh.
,QUESTION
3. A patient receiving tube feedings is experiencing diarrhea. The nurse and the physician
suspect that the patient is experiencing dumping syndrome. What intervention is most
appropriate?
A) Stop the tube feed and aspirate stomach contents.
B) Increase the hourly feed rate so it finishes earlier.
C) Dilute the concentration of the feeding solution.
D) Administer fluid replacement
by IV.
Feedback:
Dumping syndrome can generally be alleviated by starting with a dilute solution and then
increasing the concentration of the solution over several days. Fluid replacement may be
necessary but does not prevent or treat dumping syndrome. There is no need to aspirate
stomach contents. Increasing the rate will exacerbate the problem.
QUESTION
4. A nurse is admitting a patient to the postsurgical unit following a gastrostomy. When
planning assessments, the nurse should be aware of what potential postoperative
complication of a gastrostomy?
A) Premature removal of the G tube
B) Bowel perforation
C) Constipation
D) Development of peptic ulcer disease
Feedback:
A significant postoperative complication of a gastrostomy is premature removal of the G
tube. Constipation is a less immediate threat and bowel perforation and PUD are not noted
to be likely complications.
,QUESTION
,5. A nursing educator is reviewing the care of patients with feeding tubes and endotracheal
tubes (ET). The educator has emphasized the need to check for tube placement in the
stomach as well as residual volume. What is the main purpose of this nursing action?
A) Prevent gastric ulcers
B) Prevent aspiration
C) Prevent abdominal distention
D) Prevent diarrhea
Feedback:
Protecting the client from aspirating is essential because aspiration can cause pneumonia,
a potentially life-threatening disorder. Gastric ulcers are not a common complication of
tube feeding in clients with ET tubes. Abdominal distention and diarrhea can both be
associated with tube feeding, but prevention of these problems is not the primary
rationale for confirming placement.
QUESTION
6. The nurse is administering total parenteral nutrition (TPN) to a client who underwent
surgery for gastric cancer. Which of the nurses assessments most directly addresses a
major complication of TPN?
A) Checking the patients capillary blood glucose levels regularly
B) Having the patient frequently rate his or her hunger on a 10-point scale
,C) Measuring the patients heart rhythm at least every 6 hours
,D) Monitoring the patients level of consciousness
each shift Ans: A
Feedback:
The solution, used as a base for most TPN, consists of a high dextrose concentration and
may raise blood glucose levels significantly, resulting in hyperglycemia. This is a more
salient threat than hunger, though this should be addressed. Dysrhythmias and decreased
LOC are not among the most common complications.
QUESTION
7. A critical care nurse is caring for a patient diagnosed with acute pancreatitis. The nurse
knows that the indications for starting parenteral nutrition (PN) for this patient are
what?
A) 5% deficit in body weight compared to preillness weight and increased caloric need
B) Calorie deficit and muscle wasting combined with low electrolyte levels
C) Inability to take in adequate oral food or fluids within 7 days
D) Significant risk of aspiration coupled with decreased level of consciousness
Ans: C
Feedback:
,The indications for PN include an inability to ingest adequate oral food or fluids within 7
, days. Weight loss, muscle wasting combined with electrolyte imbalances, and aspiration
indicate a need for nutritional support, but this does not necessary have to be parenteral.
QUESTION
8. A nurse is preparing to administer a patients intravenous fat emulsion simultaneously
with parenteral nutrition (PN). Which of the following principles should guide the
nurses action?
A) Intravenous fat emulsions may be infused simultaneously with PN through a Y-
connector close to the infusion site and should not be filtered.
B) The nurse should prepare for placement of another intravenous line, as intravenous
fat emulsions may not be infused simultaneously through the line used for PN.
C) Intravenous fat emulsions may be infused simultaneously with PN through a Y-
connector close to the infusion site after running the emulsion through a filter.
D) The intravenous fat emulsions can be piggy-backed into any existing IV solution that
is infusing.
Ans: A
Feedback:
Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector
close to the infusion site and should not be filtered. The patient does not need another
, intravenous line for the fat emulsion. The IVFE cannot be piggy-backed into any existing
