Question 1

MO: Enteral Nutrition Inserting a Nasogastric Tube  1. What would the nurse do if he or she were not able to insert a nasogastric tube in either of a patient\'s nares?  a. Ask another nurse to attempt the insertion.  b. Document the attempts in the patient\'s medical record.  c. Notify the physician that the attempts were unsuccessful.  d. Allow the patient to rest for 30 minutes before resuming the process.

Accepted Answer

C. Notify the physician that the attempts were unsuccessful.  R: The nurse would notify the physician because he or she will need to attempt to insert the tube or determine another treatment option.

Question 2

MO: Enteral Nutrition Inserting a Nasogastric Tube  2. What would the nurse do if he or she encountered resistance when inserting a nasogastric tube?  a. Ask the patient to cough.   b. Withdraw the tube to the nasopharynx.  c. Encourage the patient to swallow.  d. Instruct the patient to hyperextend the neck.

Accepted Answer

c. Encourage the patient to swallow.  CORRECT. If the patient starts to cough, experiences a drop in oxygen saturation, or shows other signs of respiratory distress, withdraw the tube into the posterior nasopharynx until normal breathing resumes. Do not force the tube or push it against resistance.

Question 3

MO: Enteral Nutrition Inserting a Nasogastric Tube  3. Which patient does not have a medical condition that contraindicates placement of a nasogastric tube?  a. A 28-year-old patient who fractured a femur after heavy drinking  b. A 73-year-old patient who is on anticoagulation therapy.  c. A 54-year-old patient who broke a cheekbone in a fall  d. A 67-year-old patient with a history of unexplained nosebleeds

Accepted Answer

a. A 28-year-old patient who fractured a femur after heavy drinking  CORRECT. Neither the patient\'s broken femur nor the patient\'s alcohol consumption would contraindicate placement of a nasogastric tube.

Question 4

MO: Enteral Nutrition Inserting a Nasogastric Tube  4. What might the nurse do to reduce the patient\'s discomfort before inserting a nasogastric tube?  a. Examine each naris for patency and skin breakdown.  b. Place the patient in the high-Fowler\'s position.  c. Anesthetize the throat.  d. Have the patient take a few sips of water.

Accepted Answer

a. Examine each naris for patency and skin breakdown.  CORRECT. Examining each naris for patency and signs of skin breakdown will help the nurse determine which naris will accommodate a nasogastric tube with less discomfort.

Question 5

MO: Enteral Nutrition Inserting a Nasogastric Tube  5. Which intervention might the nurse delegate to nursing assistive personnel (NAP) when inserting a nasogastric tube?  a. Positioning the patient in a high-Fowler\'s position  b. Assessing the patient\'s abdomen for bowel sounds  c. Determining any history of unexplained nosebleeds  d. Educating the patient about the need for the intervention

Accepted Answer

a. Positioning the patient in a high-Fowler\'s position  CORRECT. Positioning the patient is within NAP scope of practice.

Question 6

MO: Enteral Nutrition Providing Enteral Feedings  1. Why does the nurse elevate the head of the bed to 30 degrees for a patient receiving an intermittent tube feeding?  a. Elevating the head of the bed reduces the risk for aspiration.  b. Proper elevation of the head of the bed promotes the patient\'s digestion.  c. Acid reflux is reduced when the head of the bed is elevated at least 30 degrees.  d. Nutrients are absorbed more efficiently when the head of the bed is elevated.

Accepted Answer

a. Elevating the head of the bed reduces the risk for aspiration.  CORRECT. Elevating the head of the bed reduces the risk for aspiration.

Question 7

MO: Enteral Nutrition Providing Enteral Feedings  2. What is the proper response to the nurse\'s observation that the patient\'s closed-system enteral feeding has 150 mL of formula remaining and that the infusion order rate is for 50 mL/hr?  a. Recalculate the present drip factor for accuracy.  b. Terminate the fluid, and prepare to hang a new bag of formula.  c. Plan to check the feeding for completion within the next 3 hours.  d. Check with the pharmacy to see if the formula has been hanging too long.

Accepted Answer

c. Plan to check the feeding for completion within the next 3 hours.  CORRECT. Because the ordered dose is 50 mL/hr, checking for completion within 3 hours is the right choice.

Question 8

MO: Enteral Nutrition Providing Enteral Feedings  3. After unsuccessfully attempting to flush a nasogastric (NG) tube with water, what is the most appropriate action for the nurse to take?  a. Flush the tube with ginger ale.  b. Use apple juice to flush the tube.  c. Obtain a product designed to unclog NG tubes.  d. Force-flush the system with sterile normal saline.

Accepted Answer

c. Obtain a product designed to unclog NG tubes.  CORRECT. If the feeding tube becomes clogged, the nurse should obtain and use an unclogging product for feeding tubes.

Question 9

MO: Enteral Nutrition Providing Enteral Feedings  4. How could the nurse assess the patency of a nasogastric (NG) tube being used for enteral nutrition?  a. Elevate the head of the patient\'s bed to at least 30 degrees.  b. Use an intravenous fluid infusion set.  c. Check the gastric residual volume.  d. Monitor the amount of intake the patient tolerates in an 8-hour period.

Accepted Answer

c. Check the gastric residual volume.  CORRECT. The nurse would check gastric residual volume. Doing so could determine the patency of the feeding tube.

Question 10

MO: Enteral Nutrition Providing Enteral Feedings  5. Which nursing action is appropriate when feeding gastric residual is 50 mL?  a. Return it to the stomach via the feeding tube.  b. Dispose of the residual contents down the commode.  c. Discard the stomach contents as a liquid biohazard.  d. Return half of the volume to the stomach, and discard the rest.

Accepted Answer

a. Return it to the stomach via the feeding tube.  CORRECT. If the volume of the residual stomach contents is less than 250 mL, it can be returned to the stomach via the feeding tube.

Question 11

MO: Enteral Nutrition Removing a Feeding Tube  1. How might the nurse minimize the patient\'s anxiety when removing a nasogastric tube?  a. Administer a mild sedative prescribed by the patient\'s health care provider.  b. Ask the patient\'s caregiver to emotionally support the patient during the removal.  c. Provide reassurance of what will happen during the procedure and talk the patient through the process.  d. Instruct the patient to take deep, calming breaths while revisiting a pleasant memory.

Accepted Answer

c. Provide reassurance of what will happen during the procedure and talk the patient through the process.  CORRECT. Letting the patient know what to expect during an intervention usually reduces anxiety.

Question 12

MO: Enteral Nutrition Removing a Feeding Tube  2. What would minimize the nurse\'s risk for contamination during the removal of a nasogastric tube?  a. Wearing treatment gloves  b. Providing the patient with an emesis basin  c. Protecting the patient\'s chest with an absorbent towel  d. Discarding any soiled tissues in the biohazard receptacle

Accepted Answer

a. Wearing treatment gloves  CORRECT. Wearing gloves will protect the nurse from contamination.

Question 13

MO: Enteral Nutrition Removing a Feeding Tube  3. What will the nurse need before removing a patient\'s nasogastric tube?  a. Evidence of hypoactive bowel sounds in all quadrants  b. Absence of abdominal pain and distention  c. Assurance that the patient can pass flatus   d. A health care provider\'s order

Accepted Answer

d. A health care provider\'s order  CORRECT. The nasogastric tube may be removed only with a health care provider\'s order.

Question 14

MO: Enteral Nutrition Removing a Feeding Tube  4. What patient care might the nurse delegate to nursing assistive personnel (NAP) when a patient\'s nasogastric tube is removed?  a. Assessing the patient for abdominal distention  b. Providing the patient with mouth care  c. Documenting tube removal  d. Checking for bowel sounds

Accepted Answer

b. Providing the patient with mouth care  CORRECT. The skill of mouth care may be delegated to NAP.

Question 15

MO: Enteral Nutrition Removing a Feeding Tube  5. Why does the nurse kink the nasogastric tube before removing it from a patient?  a. To suppress the cough reflex  b. To keep any fluid from flowing out  c. To hinder the gag reflex  d. To prevent transmission of microorganisms

Accepted Answer

b. To keep any fluid from flowing out  CORRECT. Kinking the tube keeps any residual fluid in the tube from flowing out.

Question 16

MO: Respiratory Care and Suctioning Providing Tracheostomy Care  1. How can the nurse best minimize a patient\'s risk for infection during tracheostomy care?  a. Adhere to sterile technique when appropriate.  b. Frequently assess for signs of local or systemic infection.  c. Monitor for indications that tracheostomy care is needed.  d. Instruct nursing assistive personnel (NAP) to report any changes in color or odor of tracheal drainage.

Accepted Answer

a. Adhere to sterile technique when appropriate.  CORRECT. Adherence to sterile technique is the most important factor in minimizing the patient\'s risk for infection during tracheostomy care.

Question 17

MO: Respiratory Care and Suctioning Providing Tracheostomy Care  2. Which nursing action shows the most effective planning for emergency care of a patient with a tracheostomy?  a. Having a spare oxygen mask at the patient\'s bedside  b. Keeping an obturator and a tracheostomy tube at the patient\'s bedside  c. Reviewing the agency\'s policy regarding tracheostomy care  d. Instructing the family to call immediately if the patient has difficulty breathing

Accepted Answer

b. Keeping an obturator and a tracheostomy tube at the patient\'s bedside  CORRECT. Keeping an obturator and a tracheostomy tube of the correct size at the patient\'s bedside is the best way to plan for an emergency involving a tracheostomy, such as tube dislodgement.

Question 18

MO: Respiratory Care and Suctioning Providing Tracheostomy Care  3. Which intervention reduces the risk for skin breakdown in a patient with a new tracheostomy?  a. Cleaning the stoma with hydrogen peroxide and drying thoroughly  b. Cleaning and assessing the skin around the stoma  c. Assessing temperature and reporting skin breakdown immediately  d. Allowing the patient to re-oxygenate after each tracheal suctioning

Accepted Answer

b. Cleaning and assessing the skin around the stoma  CORRECT. Frequently cleaning and assessing the skin in the tracheostomy area will reduce the patient\'s risk for skin breakdown.

Question 19

MO: Respiratory Care and Suctioning Providing Tracheostomy Care  4. Which action may be delegated to nursing assistive personnel (NAP) regarding the care of a patient with a tracheostomy?  a. Performing tracheostomy care for a patient whose tracheostomy was placed 1 week ago  b. Removing the outer cannula and placing the obturator   c. Holding the tracheostomy tube while the nurse changes the neck ties  d. Monitoring oxygen saturation levels and placing oxygen if needed

Accepted Answer

c. Holding the tracheostomy tube while the nurse changes the neck ties  CORRECT. NAP may hold the tube while the nurse changes the ties during tracheostomy care.

Question 20

MO: Respiratory Care and Suctioning Providing Tracheostomy Care  5. Which technique would the nurse use to change a patient\'s tracheostomy ties?  a. Use a slipknot.  b. Ensure that two fingers fit snugly under the tie.  c. Knot the ends of the tie in the eyelets on the faceplate.  d. Ask the patient to hold his or her breath while the ties are changed.

Accepted Answer

b. Ensure that two fingers fit snugly under the tie.  CORRECT. When the tie is secure, two fingers should fit snugly under it.

Question 21

MO: Respiratory Care and Suctioning Performing Oropharyngeal Suctioning  1. Which action would the nurse perform when preparing to suction a patient\'s oropharynx?  a. Apply sterile gloves.  b. Place the patient in a semi-Fowler\'s or sitting position.  c. Remove the nasal cannula.  d. Flush the suction catheter with 200 mL of warm tap water.

Accepted Answer

b. Place the patient in a semi-Fowler\'s or sitting position.  CORRECT. A semi-Fowler\'s or sitting position would facilitate this intervention.

Question 22

MO: Respiratory Care and Suctioning Performing Oropharyngeal Suctioning  2. After oropharyngeal suctioning, what does the nurse do with the supplies?  a. Place the Yankauer catheter in a clean, dry area.  b. Place all disposable equipment into the wrapper of the suction catheter before discarding it in a trash receptacle.  c. Fold the paper drape with the outer surface inward, and dispose of it in a biohazard receptacle.  d. Place dirty gloves in the biohazard receptacle in the patient\'s room.

Accepted Answer

a. Place the Yankauer catheter in a clean, dry area.  CORRECT. Placing the Yankauer catheter in a clean, dry area will protect it until it is needed again.

Question 23

MO: Respiratory Care and Suctioning Performing Oropharyngeal Suctioning  3. When preparing to suction a patient\'s oral cavity, why would the nurse first suction a small amount of water through the catheter?  a. To moisten the exterior of the plastic catheter  b. To ensure that the catheter\'s suction is functioning properly  c. To minimize friction as the catheter moves within the oral cavity  d. To avoid startling the patient with the sound created by the suction

Accepted Answer

b. To ensure that the catheter\'s suction is functioning properly  CORRECT. A small amount of water is suctioned through the catheter to ensure that the suction equipment is working properly.

Question 24

MO: Respiratory Care and Suctioning Performing Oropharyngeal Suctioning  4. What is a priority intervention when performing oropharyngeal suctioning for a patient who is receiving oxygen by face mask?  a. Complete the suctioning process in 20 seconds or less.  b. Keep the oxygen mask near the patient\'s face during the suctioning procedure.  c. Encourage the patient to take several deep breaths before suctioning begins.  d. Increase the oxygen flow rate by 1 L/min for 3 minutes before suctioning.

Accepted Answer

b. Keep the oxygen mask near the patient\'s face during the suctioning procedure.  CORRECT. Keeping the oxygen mask near the patient\'s face during the intervention ensures that oxygen therapy will not be interrupted.

Question 25

MO: Respiratory Care and Suctioning Performing Oropharyngeal Suctioning  5. Which action is most useful in evaluating the effectiveness of oropharyngeal suctioning?  a. Comparing presuctioning and postsuctioning respiratory assessment data  b. Confirming that the patient\'s pulse oximetry value is >90%  c. Asking the patient to report any symptoms of dyspnea  d. Assessing the patient\'s skin for signs of cyanosis

Accepted Answer

a. Comparing presuctioning and postsuctioning respiratory assessment data  CORRECT. Comparing presuctioning and postsuctioning assessment data allows the nurse to compare the patient\'s postintervention respiratory status against his or her baseline to see if it has improved.

Question 26

MO: Respiratory Care and Suctioning Performing Nasotracheal and Nasopharyngeal Suctioning  1. Which action is part of the preparation for nasotracheal suctioning?  a. Place the patient in a supine position.  b. Preoxygenate the patient with 100% oxygen.  c. Suction 100 mL of warm tap water to flush the suction catheter.  d. Place water-soluble lubricant onto the open sterile catheter package.

Accepted Answer

d. Place water-soluble lubricant onto the open sterile catheter package.  CORRECT. Lubricant facilitates the insertion of the catheter

Question 27

MO: Respiratory Care and Suctioning Performing Nasotracheal and Nasopharyngeal Suctioning  2. Which response would the nurse report immediately if it occurred in association with nasotracheal suctioning?  a. Patient complains of discomfort during the procedure  b. Patient has a severe bout of nonproductive coughing and complains of sore throat  c. After oxygen delivery device has been reapplied on completion of the procedure, patient\'s pulse oximetry reading falls to 88%  d. Patient\'s pulse rate increases by 10 beats/min

Accepted Answer

c. After oxygen delivery device has been reapplied on completion of the procedure, patient\'s pulse oximetry reading falls to 88%  CORRECT. This decline in peripheral blood oxygen saturation must be reported. It represents a decline in the patient\'s condition following a procedure that should have improved his or her SpO2 reading.

Question 28

Respiratory Care and Suctioning Performing Nasotracheal and Nasopharyngeal Suctioning  3. While suctioning the nasotracheal airway, the nurse notes that a patient\'s pulse rate has fallen from 102 beats/min to 80 beats/min. What is the best course of action?  a. Encourage the patient to take several deep breaths.  b. Interrupt suction to the catheter for at least 10 seconds.  c. Discontinue suctioning by removing the suction catheter.  d. Assess the patient\'s pulse oximetry reading to see if oxygenation is adequate.

Accepted Answer

c. Discontinue suctioning by removing the suction catheter.  CORRECT. A drop in pulse of 20 beats/min or more necessitates discontinuation of suctioning and removal of the catheter.

Question 29

Respiratory Care and Suctioning Performing Nasotracheal and Nasopharyngeal Suctioning  4. As a nasotracheal catheter is inserted to suction the airway, a patient begins to gag and says, \"I feel like I\'m going to throw up.\" What is the nurse\'s best response?  a. Complete the catheter insertion in 5 seconds or less.  b. Remove the catheter.  c. Encourage the patient to take several deep breaths to minimize the nausea.  d. Stop advancing the catheter, and allow the patient to rest for several minutes.

Accepted Answer

b. Remove the catheter.  CORRECT. Gagging and nausea indicate that the catheter has probably entered the esophagus and must be removed.

Question 30

Respiratory Care and Suctioning Performing Nasotracheal and Nasopharyngeal Suctioning  5. How does the nurse evaluate the effect of nasotracheal suctioning on a patient\'s respiratory status?  a. Asking the patient about symptoms of respiratory difficulty  b. Comparing respiratory assessment data from before and after the suctioning procedure.  c. Confirming that the patient\'s pulse oximetry value is >90%  d. Auscultating the patient\'s chest after suctioning

Accepted Answer

b. Comparing respiratory assessment data from before and after the suctioning procedure.  CORRECT. Comparing presuctioning and postsuctioning assessment data will provide the best measure of the procedure\'s efficacy.

Question 31

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   1. With established exit sites, use gauze or a clean cloth to clean the tube with ______________ daily.  a. a cleaning device   b. alcohol  c. soap and water   d. feeding solution

Accepted Answer

c. soap and water

Question 32

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   2.) Rotate the bolster _______________ every day to relieve pressure on the skin and allow for aeration.  a.) a quarter turn b.) a half turn c.) a full turn d.) two full turns

Accepted Answer

a.) a quarter turn

Question 33

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   3.) Tube flushing helps to prevent the tube from clogging and is done __________________ every feeding.  a.) during b.) before and after c.) before but not after d.) after but not before

Accepted Answer

c.) before but not after

Question 34

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   4. The balloon in balloon gastrostomy tubes requires ____________ maintenance.  a.) daily b.) every other day c.) every shift d.) weekly

Accepted Answer

d.) weekly

Question 35

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   5. Refill the balloon with the recommended amount of ______________.   a.) sterile water  b.) saline  c.) alcohol  d.) water

Accepted Answer

a.) sterile water

Question 36

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   6. Check the height of the external bolster with the patient in both the sitting and ___________ positions.  a.) standing b.) supine c.) prone d.) side-lying

Accepted Answer

b.) supine

Question 37

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   7. If a gastrostomy tube is pulled out, the tube tract begins to close within ________________.  a.) 30 minutes b.) 1 hour c.) 2 to 4 hours d.) 12 hours

Accepted Answer

c.) 2 to 4 hours

Question 38

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting  8. If the tube cannot be rotated easily and moved freely in and out of the stoma, it may be __________________.  a.) infected b.)collapsed c.) imbedded in the gastric wall d.) in use

Accepted Answer

c.) imbedded in the gastric wall

Question 39

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   9. If a gastrostomy tube is unintentionally removed, ________________.  a. cover the stoma with gauze and contact a physician immediately  b. replace it immediately  c. wash and replace it as soon as you can   d. leave it out

Accepted Answer

a. cover the stoma with gauze and contact a physician immediately

Question 40

ME: Enteral Feeding Tubes: A Guide for Nurses, Part 3: Daily Care and Troubleshooting   10. In the event that the tube does become clogged, _______________.  a. use a piston syringe to flush the tube with alcohol   b. rotate it until it clears   c. remove it and replace with a new tube   d. use a 50 mL syringe to flush the tube with warm water

Accepted Answer

d. use a 50 mL syringe to flush the tube with warm water

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