C HAPTER 27: N UTRITIONAL T HERAPY AND
A SSISTED F EEDING
Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th
Edition
MULTIPLE CHOICE
1. The nurse who is preparing to give a feeding per a nasogastric (NG) tube
tests the placement of the tube most safely by:
a. checking the lungs for rhonchi.
b. instilling 10 m L of sterile water and checking for cough.
c. aspirating stomach contents.
d. injecting 20 m L of air and listen at the tip of the xiphoid.
ANS: C
The safest and most assured method to test for NG tube placement is to
aspirate stomach contents and check fluid for pH. Using the air method
is not as accurate as the stomach aspiration.
DIF: Cognitive Level: Application REF: p. 497|Skill 27 -2
OBJ: Clinical Practice #3 TOP: NG Tube Insertion
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Physiological Integrit y: Reduction of Risk
2. Stopping the infusion and checking for residual volume, the nurse
aspirates 250 mL of gastric contents. The nurse should next:
, a. replace the aspirate and continue with the feeding.
b. throw the aspi rate away and flush the tubing.
c. replace the aspirate and delay feeding for 1 to 2 hours.
d. throw the aspirate away and delay feeding for 2 hours.
ANS: C
If the residual volume is greater than 250 mL (or per agency policy),
replace the withdrawn fluids, doc ument the residual, and notify the RN
or primary care provider (promotilit y medications may be ordered), and
delay further feeding for 1 to 2 hours if facilit y policy states to do so.
DIF: Cognitive Level: Application REF: p. 500 OBJ:
Clinical Practice #4 TOP: Residual Volume KEY: Nursing
Process Step: Implementation MSC: NCLEX:
Physiological Integrity: Basic Care and Comfort
3. A patient is scheduled to receive an intermittent tube feeding. This
feeding should be allowed to flow in over how many mi nutes?
a. 1 minute
b. 2 minutes
c. 5 minutes
d. 10 minutes
ANS: D
An intermittent feeding should take approximatel y 10 minutes to flow
into the tube.
, DIF: Cognitive Level: Comprehension REF: p. 500
OBJ: Theory #7 TOP: Tube Feeding KEY: Nursing
Process Step: Implementation MSC: NCLEX:
Physiological Integrity: Reduction of Risk
4. When the patient has just finished receiving a tube feeding, the nurse
leaves the head of the patient’s bed elevated for 30 to 60 minutes after
feeding in order to:
a. facilitate stom ach empt ying and prevent aspiration.
b. maintain skin integrity to the buttocks.
c. facilitate lung drainage and promote ventilation.
d. prevent feeding tube from clogging.
ANS: A
The head of the bed should be left elevated at a 30 - to 90-degree angle
for 30 to 60 minutes after the feeding to help reduce the risk of
aspiration.
DIF: Cognitive Level: Comprehension REF: p. 501
OBJ: Clinical Practice #4 TOP: Tube Feeding
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Physiological Integrit y: Reduction of Risk
5. The nurse caring for the patient receiving total parenteral nutrition (TPN)
should monitor the flow rate every:
a. 2 hours.
b. 3 hours.
c. 4 hours.
d. 6 hours.
A SSISTED F EEDING
Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th
Edition
MULTIPLE CHOICE
1. The nurse who is preparing to give a feeding per a nasogastric (NG) tube
tests the placement of the tube most safely by:
a. checking the lungs for rhonchi.
b. instilling 10 m L of sterile water and checking for cough.
c. aspirating stomach contents.
d. injecting 20 m L of air and listen at the tip of the xiphoid.
ANS: C
The safest and most assured method to test for NG tube placement is to
aspirate stomach contents and check fluid for pH. Using the air method
is not as accurate as the stomach aspiration.
DIF: Cognitive Level: Application REF: p. 497|Skill 27 -2
OBJ: Clinical Practice #3 TOP: NG Tube Insertion
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Physiological Integrit y: Reduction of Risk
2. Stopping the infusion and checking for residual volume, the nurse
aspirates 250 mL of gastric contents. The nurse should next:
, a. replace the aspirate and continue with the feeding.
b. throw the aspi rate away and flush the tubing.
c. replace the aspirate and delay feeding for 1 to 2 hours.
d. throw the aspirate away and delay feeding for 2 hours.
ANS: C
If the residual volume is greater than 250 mL (or per agency policy),
replace the withdrawn fluids, doc ument the residual, and notify the RN
or primary care provider (promotilit y medications may be ordered), and
delay further feeding for 1 to 2 hours if facilit y policy states to do so.
DIF: Cognitive Level: Application REF: p. 500 OBJ:
Clinical Practice #4 TOP: Residual Volume KEY: Nursing
Process Step: Implementation MSC: NCLEX:
Physiological Integrity: Basic Care and Comfort
3. A patient is scheduled to receive an intermittent tube feeding. This
feeding should be allowed to flow in over how many mi nutes?
a. 1 minute
b. 2 minutes
c. 5 minutes
d. 10 minutes
ANS: D
An intermittent feeding should take approximatel y 10 minutes to flow
into the tube.
, DIF: Cognitive Level: Comprehension REF: p. 500
OBJ: Theory #7 TOP: Tube Feeding KEY: Nursing
Process Step: Implementation MSC: NCLEX:
Physiological Integrity: Reduction of Risk
4. When the patient has just finished receiving a tube feeding, the nurse
leaves the head of the patient’s bed elevated for 30 to 60 minutes after
feeding in order to:
a. facilitate stom ach empt ying and prevent aspiration.
b. maintain skin integrity to the buttocks.
c. facilitate lung drainage and promote ventilation.
d. prevent feeding tube from clogging.
ANS: A
The head of the bed should be left elevated at a 30 - to 90-degree angle
for 30 to 60 minutes after the feeding to help reduce the risk of
aspiration.
DIF: Cognitive Level: Comprehension REF: p. 501
OBJ: Clinical Practice #4 TOP: Tube Feeding
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Physiological Integrit y: Reduction of Risk
5. The nurse caring for the patient receiving total parenteral nutrition (TPN)
should monitor the flow rate every:
a. 2 hours.
b. 3 hours.
c. 4 hours.
d. 6 hours.
