NUR 3227C Exam 2 - Questions and Answers A client with dementia is discharged home with a percutaneous endoscopic gastrostomy (PEG) tube in place. A
... [Show More] family members receives instructions about how to care for the tube. Which action observed by the home health nurse indicates that the family member is effectively managing the client's care? A. keeps the empty feeding bag attached to the tubing B. flushes the tube with air after medication is given C. replaces the tube on a weekly basis D. elevates the head of the bed after the feeding The nurse is preparing to administer a nasogastric tube feeding. List the steps of the procedure in the order in which they should be performed. A. instill the prescribed solution B. monitor the client's output on a regular basis C. verify the solution to be administered D. document the client's response to the procedure E. aspirate the contents of the stomach C, E, A, D, B The nurse is teaching a student nurse about how to administer percutaneous enterostomal gastrostomy (PEG) tube feeding. Which information would the nurse include? SATA. A. keep the head of the client's bed elevated at least 10 degrees B. connect the tube feeding bag to the client and feeding pump C. flush with warm water before feeding D. check the prescription for the correct formula E. set the correct rate and initiate the pump F. check for diarrhea A client is being prepared for surgery to have placement of a percutaneous endoscopic gastrostomy (PEG) tube. The client asks why the PEG tube is preferred over the existing nasogastric tube that is being used for feedings. Which explanation would the nurse give for why a PEG tube is preferred for administering a tube feeding? A. there is less chance of aspiration with a PEG tube B. the PEG tube does not require a pump C. self-administration of the tube feeding is possible D. more tube feeding mixture can be given each time The nurse is preparing to insert a nasogastric (NG) tube for a client to allow continuous suction. Which tube would the nurse select? A. levin B. dobhoff C. salem sump D. gastrostomy The nurse provides education to a client who is learning how to self-administer gastrostomy tube feedings and would include which instruction? A. administering water after the feeding is completed B. maintaining the supine position during the feeding C. heating the feeding solution to slightly above body temperature D. determining tube placement by instilling water before the feeding A health care provider prescribes an intermittent enteral tube feeding for a client with a nasogastric tube. Place the nursing interventions in the order in which they should be implemented. A. elevate the head of the bed to at least 30 degrees B. verify the health care provider's prescription C. administer the volume of feeding as per the prescription D. flush the tube with 30 mL of water after the feeding E. check the volume of residual against the parameters prescribed B, A, E, C, D A client is receiving intermittent nasogastric (NG) tube feedings to supplement oral nutritional intake. The nurse administers the feeding over 30 to 60 minutes to reduce which hazard? A. distention B. flatulence C. indigestion D. regurgitation Which statement by a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery indicates effective teaching? A. "TPN provides supplemental nutrition" B. "TPN provides short-term nutrition after surgery" C. "TPN provides total nutrition when gastrointestinal function is questionable" D. "TPN assists people who are unable to eat but have active gastrointestinal function" Three days after admission to the hospital for a cerebrovascular accident (CVA), a client has a nasogastric tube inserted and is receiving continuous tube feedings. Which action would the nurse take to evaluate whether the feeding is being absorbed? A. aspirate for a residual volume B. evaluate the intake in relation to the output C. instill air into the client's stomach while auscultating D. comparer the client's body weight with the baseline data Which process would the nurse use to determine the length of tube needed to reach a client's stomach for nasogastric feeding? A. the tube is advanced until resistance is met B. the tube is advanced until gastric contents are aspirated C. a measurement is made from nose to earlobe and then to the epigastric area D. a measurement is made from mouth to umbilicus and then half that distance is added During a change of shift report, the night nurse indicates that a client cannot tolerate prescribed intermittent tube feedings. Which action should the receiving nurse take? A. suggest that an antiemetic be prescribed B. change the feeding schedule to omit nights C. request that the type of solution be changed D. gather more data from the night nurse about the technique used A client has a nasogastric feeding tube inserted, and the health care provider prescribes the feeding to be instituted immediately. Which action would the nurse take first? A. instill normal saline into the tube to maintain patency B. obtain an x-ray to verify that the tube is in the stomach C. auscultate the epigastric area while instilling 30 mL of air D. withdraw stomach contents to observe color and consistency After a resection of the colon, a client returns to the surgical unit from the postanesthesia care unit with a nasogastric tube attached to negative pressure. Which would the nurse explain is the purpose of this tube? A. monitors the acidity of gastric secretions B. provides a route for liquid tube feedings when possible C. permits continuous decompression of the large intestine D. removes fluids and gas from the upper gastrointestinal tract The nurse is providing care to a client who is receiving enteral feedings via a nasogastric (NG) tube. Which serious complication would the nurse take measures to prevent? A. skin breakdown B. aspiration pneumonia C. retention ileus D. profuse diarrhea Place the following nursing statement reflecting Kubler-Ross' five stages of dying/grief in the correct order. A. "Have you and your oncologist talked about how radiation therapy might prolong your life?" B. "You do understand that your child experienced a fatal head trauma in the accident?" C. "Being angry at your partner for dying and leaving you alone is a natural grief reaction." D. "I've collected the information you requested concerning end-of-life planning." E. "Can we talk about the benefits of agreeing to take an antidepressant medication?" B, C, A, E, D Which action is appropriate for the registered nurse regarding assisted suicide? A. nurses may have an open attitude toward the client's end of life B. nurses' participation in assisted suicide violates the code of ethics C. nurses may listen to the client's expressions of fear and attempt to control the client's pain D. nurses can participate in assisted suicide only if the individual could make an oral and written request An older client states, "I've lived a good life. I don't want to die, but I accept it as a part of life." Which developmental task has the client achieved according to Erikson's psychosocial stages of development? A. identity B. integrity C. despair D. generativity A client who had been receiving palliative care for cancer has deteriorated and now needs end-of-life care. The nurse identifies that which type of care will now be removed from the treatment plan? SATA. A. chemotherapy B. repositioning C. regular oral care D. blood transfusion E. radiation therapy Which nursing intervention would be the priority for a client in hospice care with symptoms of dyspnea? A. administer benzodiazepines B. apply wet cloths on the client's face C. encourage imagery and deep breathing D. provide prescribed oxygen by nasal cannula The nurse is assisting with the end-of-life care of a client. Which activity is performed when the nurse views family as context? A. assess the resources available to the family B. meet the client's family's comfort and nutritional needs C. meet the client's comfort, hygiene, and nutritional needs D. determine the family's need for rest and their stage of coping The nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun to care for the client. Which is the best nursing intervention in preparing for the client's discharge? A. contact the client's health care provider to ask to substitute a liquid form of medications for the pill form B. teach the client and family members to crush the pills and administer them with applesauce C. contact the client's health care provider to discuss use of transdermal medications for pain control D. teach the client and family members about addiction that may occur as a result of regular opioid use The student nurse is describing palliative care to a client's family. Which statement made by the student nurse indicates a need for correction by the registered nurse (RN)? A. 'Palliative care is the same as hospice care.' B. 'Palliative care focuses on the care of the client.' C. 'Palliative care includes symptom management in the client.' D. 'Palliative care is an interprofessional approach to the delivery of care.' Which problems would the nurse plan to address when dealing with ethical issues specifically related to end-of-life care? SATA. A. clients may be unable to communicate effectively B. all interventions for helping the clients seem futile C. clients are often unfamiliar with the concept of autonomy D. multiple medications affect the cognitive ability of the clients E. predictions regarding health outcomes are not always accurate A client suffering from cancer is near the end of life. Which action(s) would be performed by the nurse to support the client's family members? SATA. [Show Less]