Fundamentals Nursing Skills 10th Edition Timby Test Bank

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Fundamentals Nursing Skills 10th Edition Timby Test Bank

ISBN-13: 978-1608317875

ISBN-10: 1608317870



Fundamentals Nursing Skills 10th Edition Timby Test Bank

ISBN-13: 978-1608317875

ISBN-10: 1608317870




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Chapter 29

1. A nurse is caring for a client who has taken an overdose of ibuprofen. Which of the following tubes is most suitable for removing the toxic substances?
  A) Orogastric tube
  B) Nasointestinal tube
  C) Sump tube
  D) Nasogastric tube
  Ans: A
  An orogastric tube inserted at the mouth into the stomach is used in an emergency to remove toxic substances that have been ingested. The diameter of the tube is large enough to remove pill fragments and stomach debris. A nasointestinal tube is used to provide nourishment to the client. Sump tubes are used almost exclusively to remove fluid and gas from the stomach. A nasogastric tube is placed through the nose and advanced to the stomach. It is smaller in diameter than an orogastric tube; hence, it is not suitable for removing pill fragments and stomach debris quickly.



2. A nurse is caring for a client who is experiencing dumping syndrome following a nasointestinal intubation. Which of the following signs or symptoms is seen in a client with dumping syndrome?
  A) Pallor
  B) Wheezing
  C) Headache
  D) Dizziness
  Ans: D
  The client will show symptoms of dizziness, sweating, and nausea caused by fluid shifts from the circulating blood to the intestine and low blood glucose level in case it is due to a surge of insulin. Pallor, headaches, and wheezing are not symptoms of dumping syndrome.



3. A nurse needs to insert a gastrointestinal tube for a client with peptic ulcers. Which of the following is the clearest indication for the use of gastrointestinal intubation?
  A) Controlling gastric bleeding
  B) Examining the peptic ulcers
  C) Measuring gastric residual volume
  D) Reducing risk of reflux
  Ans: A
  A gastric or intestinal tube is used for a variety of reasons, including controlling gastric bleeding, a process called compression or tamponade. An endoscope is used for examining peptic ulcers. Gastric residual and gastric reflux are caused by gastrointestinal intubationRemember, it would be incorrect to say that gastrointestinal intubation measures gastric residual or reduces the risk of reflux.



4. A nurse notices that a client’s nasogastric tube is draining poorly. Which of the following is a possible cause of a poorly draining nasogastric tube?
  A) A vent has been left unplugged by the nurse.
  B) The drainage container is empty.
  C) The tube is displaced above the cardiac sphincter.
  D) The suction level (mm Hg) is higher than it should be.
  Ans: C
  Displacement above the cardiac sphincter is a possible cause of a poorly draining nasogastric tube. An unplugged vent will not cause poor drainage because often nurses remove the cap and restore the port to atmospheric pressure. A drainage container that is filled beyond capacity causes poor draining. Excessive suction does not cause poor drainage.



5. A nurse is caring for a client who is being tube-fed. Which of the following actions should the nurse perform when assessing a client’s gastric residual volume?
  A) Aspirate fluid from the tube using a 5 ml syringe.
  B) Clamp the tube and wait for 15 minutes.
  C) Stop the infusion of the tube-feeding formula.
  D) Aspirate or flush the tube with water.
  Ans: C
  The nurse should stop the infusion of the tube-feeding formula to facilitate measurement. Next, the nurse should aspirate the fluid from the feeding tube using a 50 ml syringe, not a 5 ml syringe. Clamping the tube and waiting for 15 minutes or flushing the tube with water is done to clear an obstructed feeding tube, not to assess the gastric residual volume of a client.



6. A nurse is writing instructions on the discharge sheet of a client with a nasointestinal tube inserted for temporary feedings after discharge. Which of the following instruction should the nurse provide?
  A) Internet resources for answering questions
  B) Guidelines for delaying a feed
  C) Technique for removing the tube for cleaning
  D) Method of assessing gastric residual
  Ans: B
  The nurse provides a written instruction sheet that includes guidelines for delaying a feed and the names and contact numbers of people to call if questions arise. The tube is not removed for cleaning purposes and gastric residuals are normally assessed by the nurse.



7. A nurse is assessing the volume of liquid nutrition that has been tube-fed to a client. What will happen if the volume of feeding exceeds the client’s physiologic capacity?
  A) Constipation
  B) Pallor
  C) Obesity
  D) Gastric reflux
  Ans: D
  Overfilling the client’s stomach can cause gastric reflux, regurgitation, vomiting, aspiration, and pneumonia. Exceeding the volume of feeding beyond a client’s physiologic capacity does not as commonly lead to constipation, pallor, or obesity.



8. A nurse is administering prescribed medication through an intestinal decompression tube to a client with a complete bowel obstruction. Which of the following is a feature of the tube used for intestinal decompression?
  A) The tube is situated in the stomach.
  B) The tube is weighted with tungsten.
  C) Two lumens are used for suctioning.
  D) Mercury-weighted tubes are used.
  Ans: B
  Intestinal tubes used in intestinal decompression are now weighted with tungsten, not with mercury, because mercury is hazardous to both the client and the environment. One lumen is used to suction the intestinal contents and the other acts as a vent to reduce suction-induced trauma to the intestinal tissue. The weighted tip and peristalsis, if present, propel the tube beyond the stomach and into the intestine.



9. A nurse is providing liquid nourishment four to six times a day in feedings of less than 30 minutes duration to a client who is being tube-fed. Which of the following tube-feeding schedules is the nurse adhering to?
  A) Cyclic
  B) Intermittent
  C) Continuous
  D) Bolus
  Ans: D
  A bolus feeding is the instillation of liquid nourishment four to six times a day in less than 30 minutes, usually 250 to 400 ml of formula per administration. An intermittent feeding is administered over 30 to 60 minutes. Cyclic feeding (over a period of 8 to 12 hours) is followed by a 16- to 12-hour pause. Continuous feeding is administered at a rate of ~1.5 ml/minute.



10. A nurse is assisting a physician in placing a tube inside a client with the help of an endoscope to provide access to various parts of the GI tract. Which of the following tubes is being inserted inside the client?
  A) Nasointestinal
  B) Myringotomy
  C) Transabdominal
  D) Colon
  Ans: C
  A transabdominal tube provides access to various parts of the GI tract. A transabdominal gastrostomy tube is inserted with the use of an endoscope. Myringotomy tubes are small tubes that are surgically placed into a child’s eardrum to help drain the fluid out of the middle ear in order to reduce the risk of ear infections. A nasointestinal tube is inserted through the nose for distal placement below the stomach. Colon tubes are inserted in the rectum for an enema.



11. A nurse is unable to clear an obstruction in a client’s feeding tube. Which of the following is most suitable if the nurse is unable to remove the obstruction?
  A) Instill a large volume of very hot tap water.
  B) Remove the tube.
  C) Attempt to instill a crushed ASA tablet.
  D) Delay nutrition for 24 hours.
  Ans: B
  When an obstruction cannot be cleared, the tube should be removed and another inserted rather than compromising nutrition by the delay. Instilling a large volume of very hot tap water is a safety risk. ASA is not used to clear tube obstructions.



12. A nurse is assessing the nasal passages of a client before inserting a nasointestinal tube. Which of the following excludes a nostril for tube insertion?
  A) Wide nasal passage
  B) Presence of nasal polyps
  C) Nasal hair growth
  D) Undeviated nasal septum
  Ans: B
  A nostril is excluded from intubation if there is the presence of nasal polyps (small growths of tissue), a deviated septum, or a narrow nasal passage. Nasal hair does not preclude the insertion of a tube.



13. A nurse needs to determine whether a nasogastric tube is correctly placed. Which of the following techniques should the nurse perform?
  A) Check placement using a stethoscope over the chest.
  B) Obtain repeated x-rays.
  C) Secure the tube to avoid migration.
  D) Check the color of aspirated fluid.
  Ans: D
  The nurse should check the color of the aspirated fluid. If the aspirated fluid appears clear, brownish-yellow, or green, the nurse can presume that its source is the stomach. The nurse should place the stethoscope over the abdomen, not the chest, and listen to the abdominal sounds. An abdominal x-ray is obtained to check the placement of the tube, but obtaining repeated x-rays is harmful to the client and unnecessary. Securing the tube to avoid migration does not confirm if it is in the stomach.



14. A nurse is determining the length of a nasogastric sump tube before inserting it inside a client. The nurse is placing the distal tip of the tube at the client’s nose. To which of the following places should the nurse measure the tube distance for proper placement?
  A) The jaw and then midway to the sternum
  B) The mouth and then between the nipples
  C) The midsternum and then to the umbilicus
  D) The ear and then to the xiphoid process
  Ans: D
  The nurse obtains the length from the nose to earlobe to the xiphoid process and marks the tube appropriately. The first mark on the tube is made at the measured distance from the nose to the earlobe. It indicates the distance to the nasal pharynx, a location that places the tip at the back of the throat but above where the gag reflex is stimulated. The nurse need not measure the distance from jaw to sternum, from mouth to nipples, and from midsternum to umbilicus as these are incorrect procedures.



15. A nurse notices that, even with intermittent suctioning, an NPO client’s nasogastric tube is becoming obstructed. Which of the following interventions will promote tube patency?
  A) Give liberal amounts of water to the client.
  B) Inspect the tube carefully.
  C) Give ice chips to the client.
  D) Remove and wash the tube.
  Ans: C
  Giving ice chips or occasional sips of water to a client promotes tube patency. The fluid helps to dilute the gastric secretions. However, both must be given sparingly because water is hypotonic and draws electrolytes into the gastric fluid. Because the diluted fluid is ultimately removed, giving the client liberal amounts of water can deplete serum electrolytes. Removing and washing the tube is not recommended unless patency cannot be restored.



16. An elderly client’s small-bowel obstruction has resolved and her intestinal decompression tube has been ordered to be removed. When performing this nursing action, what should the nurse prioritize?
  A) Instill a small amount of water to provide lubrication while withdrawing the tube.
  B) Remove the tube slowly to avoid injuring the client.
  C) Change from continuous to intermittent suction during removal.
  D) Aspirate the tube while removing it in order to normalize pressure.
  Ans: B
  An intestinal decompression tube is removed slowly because removal is in a reverse direction through the curves of the intestine and the valves of the lower and upper ends of the stomach. The tube is withdrawn 6 to 10 in. (15 to 25 cm) at 10-minute intervals. It is incorrect to aspirate or instill water during removal and the suction should be turned off, not merely changed to intermittent suction.



17. A client has been receiving tube feeds for the past several days. The client’s plan of care identifies the nursing diagnosis Risk for Fluid Imbalance. How should this risk be best mitigated?
  A) Ensure the client adheres to the correct fluid restriction while receiving feeds.
  B) Use the smallest amount of water necessary to flush the tube after feeds or medications.
  C) Administer supplementary water after considering the quantity of feeds and flushes.
  D) Aspirate the stomach contents if the client develops peripheral edema.
  Ans: C
  Clients on tube feeds are generally susceptible to dehydration, not fluid volume overload. As such, fluid restrictions and minimal flushes are unnecessary. Stomach contents are not aspirated to maintain fluid balance.



18. A nurse is providing care for a client who has dysphagia secondary to a stroke. The client has recently begun continuous tube feedings in order to meet his nutritional needs. The nurse has assessed the client’s gastric residual as ordered and identified a gastric residual volume of 210 ml. How should the nurse follow up this finding?
  A) Administer an additional 90 to 140 ml of feeding formula.
  B) Instill 60 to 120 ml of sterile water to dilute the stomach contents.
  C) Dilute the feedings by 50% with tap water for the next 6 hours.
  D) Stop the feed until the client’s gastric residual is less than 100 ml.
  Ans: D
  As a rule of thumb, the gastric residual should be no more than 100 ml or no more than 20% of the previous hour’s tube-feeding volume. If the gastric residual is high, the feeding is stopped and gastric residual is rechecked again every 30 minutes until it is within a safe volume for resuming the feeding. Adding more formula or water would exacerbate the problem.



19. A client has recently been changed from intermittent tube feedings to a cyclic feeding schedule, in which the client receives feedings for 8 to 12 hours followed by several hours without feedings. What is the most likely rationale for this change in the client’s feeding schedule?
  A) The client’s nutritional needs are lower than they previously were.
  B) The client is transitioning from tube feedings to oral food intake.
  C) The client has experienced a fluid imbalance or electrolyte imbalance.
  D) The client’s activity level and mobility have increased.
  Ans: B
  Cyclic feedings are often used to wean clients from tube feedings while continuing to maintain adequate nutrition. This change would not likely be prompted by increased nutritional needs, fluid and electrolyte imbalances, or increased activity.



20. A nurse has replaced the bag and tubing set that are being used to administer intermittent tube feedings to an elderly client with modest nutritional needs. How often should the nurse change the tubing and bag that are used to administer this client’s tube feedings?
  A) After each intermittent feed
  B) After 24 hours
  C) Every five to seven days
  D) Immediately after each time that the tube is flushed
  Ans: B
  Tube-feeding administration sets are replaced every 24 hours regardless of the feeding schedule.







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