Chapter 29: Gastrointestinal Intubation
Fundamental Nursing Skills and Concepts 12th Edition, Timby
MULTIPLE CHOICE
1. A patient recently started on enteral tube feedings starts complaining of nausea and
having diarrhea. The best nursing action is to:
a. check the enteral tube for placement.
b. slow down the feedings and monitor.
c. perform a fingerstick blood glucose test.
d. stop the feedings and inform the physician.
ANS: D
Nausea, constipation, and diarrhea are concerns following institution of tube feedings.
DIF: Cognitive Level: Application REF: m 497, Box 27-3 OBJ:
Clinical Practice #4 TOP: Enteral Nutrition KEY: Nursing Process
Step: Implementation MSC: NCLEX: Physiological Integrity:
basic care and comfort
2. A patient has a new order to have an NG tube removed. The nurse should initially:
a. wash her hands and apply clean gloves.
b. encourage mouth care as needed.
c. explain the procedure to the patient.
d. pinch the tube while removing it.
ANS: C
Explaining the procedure to the patient before starting helps in gaining the patients
confidence.
DIF: Cognitive Level: Application REF: m 492, Steps 27-2 OBJ:
Clinical Practice #3 TOP: NG Tube Removal KEY: Nursing Process
Step: Implementation MSC: NCLEX: Safe Effective Care
Environment
3. A nurse is instructing a family member who will be caring for a patient receiving enteral
feedings after discharge to home. The nurse would emphasize:
a. taping the gastrostomy tube so that it does not hang lower than the stomach.
b. discarding unused opened refrigerated formula after 3 to 4 days.
c. administering tube feedings while they are still cold from the refrigerator.
d. mixing all medications together for administration at the same time.
ANS: A
The tube should be taped so that it is higher than the entry point into the body.
DIF: Cognitive Level: Application REF: m 498, Patient Teaching
OBJ: Clinical Practice #2 TOP: Health Teaching KEY:
Nursing Process Step: Implementation MSC: NCLEX:
Physiological Integrity: basic care and comfort
4. The nurse inserting an NG tube through the nostril into the back of the throat of a patient
would instruct the patient to:
, a. hyperextend the head.
b. cough forcefully.
c. drop head forward and begin to swallow.
d. open mouth and extend tongue.
ANS: C
The patient should be instructed to tip the head forward and begin to swallow to help
advance the tube through the esophagus.
DIF: Cognitive Level: Application REF: m 490, Skill 27-2 OBJ:
Clinical Practice #3 TOP: NG Tube Insertion KEY: Nursing Process
Step: Implementation MSC: NCLEX: Safe Effective Care
Environment
5. The nurse caring for a patient receiving enteral feedings would assess for tolerance of the
feeding by monitoring:
a. for gastric tube patency.
b. for duodenal tube patency.
c. for abdominal distention.
d. the rate of the feeding.
ANS: C
Assessing the abdomen for distention helps the nurse identify intolerance of tube
feedings.
DIF: Cognitive Level: Application REF: m 494, Skill 27-3 OBJ:
Clinical Practice #4 TOP: Enteral Nutrition KEY: Nursing Process
Step: Assessment MSC: NCLEX: Physiological Integrity: basic
care and comfort
6. While the nurse is explaining the procedure for inserting a tube for enteral feedings, the
patient interrupts and asks why there is a need for this tube. The nurses best response is:
a. Your physician has ordered this to help your condition.
b. Tell me what your doctor told you about this procedure.
c. Are you telling me you dont want this tube inserted?
d. This tube placement will only be temporary.
ANS: B
In assessing the patients understanding, the nurse should assess the level of the
patients understanding and knowledge about the procedure.
DIF: Cognitive Level: Application REF: m 497 OBJ: Clinical Practice #3
TOP: NG Tube Insertion KEY: Nursing Process Step:
Assessment MSC: NCLEX: Psychosocial Integrity: basic care and comfort
7. When caring for a patient receiving total parenteral nutrition, the nurse knows that it is
essential to:
a. check for flow rate every shift.
b. order electrolytes daily.
c. monitor IV site every shift.
d. monitor for blood glucose.
ANS: D
Fundamental Nursing Skills and Concepts 12th Edition, Timby
MULTIPLE CHOICE
1. A patient recently started on enteral tube feedings starts complaining of nausea and
having diarrhea. The best nursing action is to:
a. check the enteral tube for placement.
b. slow down the feedings and monitor.
c. perform a fingerstick blood glucose test.
d. stop the feedings and inform the physician.
ANS: D
Nausea, constipation, and diarrhea are concerns following institution of tube feedings.
DIF: Cognitive Level: Application REF: m 497, Box 27-3 OBJ:
Clinical Practice #4 TOP: Enteral Nutrition KEY: Nursing Process
Step: Implementation MSC: NCLEX: Physiological Integrity:
basic care and comfort
2. A patient has a new order to have an NG tube removed. The nurse should initially:
a. wash her hands and apply clean gloves.
b. encourage mouth care as needed.
c. explain the procedure to the patient.
d. pinch the tube while removing it.
ANS: C
Explaining the procedure to the patient before starting helps in gaining the patients
confidence.
DIF: Cognitive Level: Application REF: m 492, Steps 27-2 OBJ:
Clinical Practice #3 TOP: NG Tube Removal KEY: Nursing Process
Step: Implementation MSC: NCLEX: Safe Effective Care
Environment
3. A nurse is instructing a family member who will be caring for a patient receiving enteral
feedings after discharge to home. The nurse would emphasize:
a. taping the gastrostomy tube so that it does not hang lower than the stomach.
b. discarding unused opened refrigerated formula after 3 to 4 days.
c. administering tube feedings while they are still cold from the refrigerator.
d. mixing all medications together for administration at the same time.
ANS: A
The tube should be taped so that it is higher than the entry point into the body.
DIF: Cognitive Level: Application REF: m 498, Patient Teaching
OBJ: Clinical Practice #2 TOP: Health Teaching KEY:
Nursing Process Step: Implementation MSC: NCLEX:
Physiological Integrity: basic care and comfort
4. The nurse inserting an NG tube through the nostril into the back of the throat of a patient
would instruct the patient to:
, a. hyperextend the head.
b. cough forcefully.
c. drop head forward and begin to swallow.
d. open mouth and extend tongue.
ANS: C
The patient should be instructed to tip the head forward and begin to swallow to help
advance the tube through the esophagus.
DIF: Cognitive Level: Application REF: m 490, Skill 27-2 OBJ:
Clinical Practice #3 TOP: NG Tube Insertion KEY: Nursing Process
Step: Implementation MSC: NCLEX: Safe Effective Care
Environment
5. The nurse caring for a patient receiving enteral feedings would assess for tolerance of the
feeding by monitoring:
a. for gastric tube patency.
b. for duodenal tube patency.
c. for abdominal distention.
d. the rate of the feeding.
ANS: C
Assessing the abdomen for distention helps the nurse identify intolerance of tube
feedings.
DIF: Cognitive Level: Application REF: m 494, Skill 27-3 OBJ:
Clinical Practice #4 TOP: Enteral Nutrition KEY: Nursing Process
Step: Assessment MSC: NCLEX: Physiological Integrity: basic
care and comfort
6. While the nurse is explaining the procedure for inserting a tube for enteral feedings, the
patient interrupts and asks why there is a need for this tube. The nurses best response is:
a. Your physician has ordered this to help your condition.
b. Tell me what your doctor told you about this procedure.
c. Are you telling me you dont want this tube inserted?
d. This tube placement will only be temporary.
ANS: B
In assessing the patients understanding, the nurse should assess the level of the
patients understanding and knowledge about the procedure.
DIF: Cognitive Level: Application REF: m 497 OBJ: Clinical Practice #3
TOP: NG Tube Insertion KEY: Nursing Process Step:
Assessment MSC: NCLEX: Psychosocial Integrity: basic care and comfort
7. When caring for a patient receiving total parenteral nutrition, the nurse knows that it is
essential to:
a. check for flow rate every shift.
b. order electrolytes daily.
c. monitor IV site every shift.
d. monitor for blood glucose.
ANS: D
