WEEK 11 NSE211 EXAM QUESTIONS
WITH COMPLETE SLUTIONS
Check Tube location - Answer-Aspiration (withdrawal) of stomach contents - check pH
of gastric juice Listening to gastric pop is not considered an accurate location of tube
Most accurate assessment: X-ray visualization
Check gastric residual volumes - ↑ retained volume ↑ risk of aspiration
See facility policy re starting feeds when pt. has high residuals
Providing Enteral Feedings Video - Answer-Administration of nutritionally balanced
liquefied food (e.g., Resource, Isosource, 2cal) directly into the stomach or small bowel
through NG/OG (short term) or PEG, Gtube, J-tube (longer term)
Reasons for enteral feed - Answer-Pt cannot ingest food but is still able to digest food &
absorb nutrients
Pts with impaired level of consciousness, aspiration, esophageal obstruction
Early feeding & adequate nutrition is important to patient recovery
Pts who are ill have high nutritional requirements & can become malnourished very
quickly
Types of Enteral Formulas
Standard Intact Nutrients - Answer-Whole protein nitrogen source, for use in pts with
normal or near normal GI function, protein content varies
Most products contain ~ 1.0 kcal/mL
Most are lactose-free
Products are fibre containing or fibre free
Types of Enteral feeds: Elemental - Answer-Pre-digested nutrients; most have low fat
content or high % of medium chain triglycerides; for use in pts with severely impaired GI
absorption
Types of enteral feeds: Fluid Restricted - Answer-Intact nutrients, calorically dense (2.0
kcal/mL)
Renal-intact nutrients, low phosphorus & low K+
Other types disease specific - Intact nutrients designed for feeding pts with diabetes,
liver & renal failure etc.
Types of feed & rate will be determined by dietician based on pt's clinical needs
Examine various types of feed & nutrients.
Enteral Feeding Methods
Continuous - Answer-Run at a slower, consistent rate over 24 hours
Residual volumes checked q4h - volume over 200ml means feed should be held **see
hospital policy at institution**
, Flush enteral tube with water q 1-4h or as ordered by MD / dietician
Maintain HOB elevation for 30-60 minutes after feed is completed
MUST flush with H2O if feed is stopped, tube will block if feed is left sitting in tube
Only 4h of feeds should be hung at a time to prevent bacterial growth
Enteral feeding methods: Intermittent - Answer-Also known as bolus feeds, runs at a
faster rate intermittently
Used when pts are being weaned off enteral & could begin eating
Flush with 30ml H2O after each feed to ensure tube is clear
Nursing Management of Enteral Feeding
Assessments include: - Answer-check tube placement
assess bowel sounds
daily weights
accurate I&O
blood glucose levels
Feeding Protocol - Answer-Rate of Administration - Goal rate is calculated based on pt
age, size, health status & nutritional needs; feeds may be started slowly (e.g.,
10ml/hour) & be increased incrementally until the target rate is achieved
Complications of Enteral Feeding - Answer-High gastric residuals - d/t poor absorption.
Fluid & Electrolyte imbalance
Aspiration
Tube displacement & occlusion
Altered absorption of medications
Interventions of enteral feeds - Answer-Keep HOB > 30°
Assess, monitor, document & inform physician
May need prokinetic medications
Complications of Enteral Feeding
Vomiting - Answer-Assess, position pt to minimize aspiration risk, consider antiemetics,
inform physician & document
Hold feeds or place NG to suction if ordered
Complications of Enteral Feeding: Abdominal distension &/or cramping - Answer-Mild -
check for constipation, inform physician if moderate or severe & document
Moderate - check for bowel obstruction
Severe - place NG to suction if ordered
Complications of Enteral Feeding: Diarrhea - Answer-Diarrhea:
Mild - 1-2 x/shift - maintain & determine if any other causes
Moderate - 3-4 x/shift - maintain - re-evaluate in 6 hr
Severe - >4 x/shift - inform & document physician
May need to decrease rate by 50% & monitor* check agency policy*
WITH COMPLETE SLUTIONS
Check Tube location - Answer-Aspiration (withdrawal) of stomach contents - check pH
of gastric juice Listening to gastric pop is not considered an accurate location of tube
Most accurate assessment: X-ray visualization
Check gastric residual volumes - ↑ retained volume ↑ risk of aspiration
See facility policy re starting feeds when pt. has high residuals
Providing Enteral Feedings Video - Answer-Administration of nutritionally balanced
liquefied food (e.g., Resource, Isosource, 2cal) directly into the stomach or small bowel
through NG/OG (short term) or PEG, Gtube, J-tube (longer term)
Reasons for enteral feed - Answer-Pt cannot ingest food but is still able to digest food &
absorb nutrients
Pts with impaired level of consciousness, aspiration, esophageal obstruction
Early feeding & adequate nutrition is important to patient recovery
Pts who are ill have high nutritional requirements & can become malnourished very
quickly
Types of Enteral Formulas
Standard Intact Nutrients - Answer-Whole protein nitrogen source, for use in pts with
normal or near normal GI function, protein content varies
Most products contain ~ 1.0 kcal/mL
Most are lactose-free
Products are fibre containing or fibre free
Types of Enteral feeds: Elemental - Answer-Pre-digested nutrients; most have low fat
content or high % of medium chain triglycerides; for use in pts with severely impaired GI
absorption
Types of enteral feeds: Fluid Restricted - Answer-Intact nutrients, calorically dense (2.0
kcal/mL)
Renal-intact nutrients, low phosphorus & low K+
Other types disease specific - Intact nutrients designed for feeding pts with diabetes,
liver & renal failure etc.
Types of feed & rate will be determined by dietician based on pt's clinical needs
Examine various types of feed & nutrients.
Enteral Feeding Methods
Continuous - Answer-Run at a slower, consistent rate over 24 hours
Residual volumes checked q4h - volume over 200ml means feed should be held **see
hospital policy at institution**
, Flush enteral tube with water q 1-4h or as ordered by MD / dietician
Maintain HOB elevation for 30-60 minutes after feed is completed
MUST flush with H2O if feed is stopped, tube will block if feed is left sitting in tube
Only 4h of feeds should be hung at a time to prevent bacterial growth
Enteral feeding methods: Intermittent - Answer-Also known as bolus feeds, runs at a
faster rate intermittently
Used when pts are being weaned off enteral & could begin eating
Flush with 30ml H2O after each feed to ensure tube is clear
Nursing Management of Enteral Feeding
Assessments include: - Answer-check tube placement
assess bowel sounds
daily weights
accurate I&O
blood glucose levels
Feeding Protocol - Answer-Rate of Administration - Goal rate is calculated based on pt
age, size, health status & nutritional needs; feeds may be started slowly (e.g.,
10ml/hour) & be increased incrementally until the target rate is achieved
Complications of Enteral Feeding - Answer-High gastric residuals - d/t poor absorption.
Fluid & Electrolyte imbalance
Aspiration
Tube displacement & occlusion
Altered absorption of medications
Interventions of enteral feeds - Answer-Keep HOB > 30°
Assess, monitor, document & inform physician
May need prokinetic medications
Complications of Enteral Feeding
Vomiting - Answer-Assess, position pt to minimize aspiration risk, consider antiemetics,
inform physician & document
Hold feeds or place NG to suction if ordered
Complications of Enteral Feeding: Abdominal distension &/or cramping - Answer-Mild -
check for constipation, inform physician if moderate or severe & document
Moderate - check for bowel obstruction
Severe - place NG to suction if ordered
Complications of Enteral Feeding: Diarrhea - Answer-Diarrhea:
Mild - 1-2 x/shift - maintain & determine if any other causes
Moderate - 3-4 x/shift - maintain - re-evaluate in 6 hr
Severe - >4 x/shift - inform & document physician
May need to decrease rate by 50% & monitor* check agency policy*
