Feeding Tubes (20 Questions)

1.1 Mr. Antoine Desrosiers, a 64-year-old patient, has undergone a total gastrectomy due to gastric cancer. The surgery was completed without complications, and he is now in the immediate postoperative recovery phase. A nasogastric (NG) tube is in place for gastric decompression and drainage.

Four hours postoperatively, the nurse notes that the NG tube is draining a moderate amount of bloody fluid. Mr. Desrosiers is stable, with no abdominal distension, and vital signs are within normal limits.

Question:
Which of the following is the appropriate nursing intervention? *
1.2 During your routine assessment, you notice the NG tube has migrated outward by approximately 3 cm from the marked position documented in the operating room report. Mr. Desrosiers is resting but reports mild nausea.

Question:
What is your priority nursing action before notifying the surgeon? *
1.3 Mr. Desrosiers, now one week post–total gastrectomy, continues to receive enteral nutrition via a nasogastric (NG) feeding tube. During your morning assessment, you observe that his right nostril—the side where the tube is inserted—appears red and inflamed, and Mr. Desrosiers complains of soreness and irritation at the site. The left nostril is patent with intact skin and no signs of breakdown.

Question:
What is the best action to take at this time? *
1.4 Although his condition is stable, he now begins to complain of dry mouth and nasal irritation, especially around the new insertion site. He asks the nurse, “Is there anything you can do to help me feel less dry?”

Question:
Which of the following actions should the nurse take to help prevent dry mucous membranes? *
2.1 You are caring for Mrs. Clara Gendron, a 79-year-old patient who had a nasogastric (NG) tube inserted 24 hours agofollowing a stroke. A chest X-ray was previously completed to confirm correct placement. This morning, as you prepare to administer her enteral feeding, you notice that the tape securing the NG tube is missing and the tube appears to have shifted slightly.

There is no documentation of the insertion length, and the patient has been moving frequently in bed. You must now verify that the tube is still correctly placed before proceeding.

Question:
How should the nurse confirm NG tube placement at the bedside before administering the feeding? *
2.2 After confirming the correct placement of Mrs. Gendron’s nasogastric (NG) tube, you proceed to initiate her enteral feeding. Two hours later, you return to assess her tolerance. You note that the feeding appears to be pooling in the syringe, and the tube seems to have poor flow.

Question:
Which of the following findings most likely indicates that the NG tube has become occluded? *
3.1 Mme. Dubois, a 68-year-old woman, has been admitted to the hospital with severe dehydration and gastrointestinal obstruction. The doctor has ordered the insertion of a nasogastric (NG) tube to help decompress her stomach and relieve her symptoms. During the procedure, as the nurse is advancing the NG tube, Mme. Dubois suddenly begins to cough and exhibits difficulty breathing.

Question:
What is the most appropriate action for the nurse to take? *
3.2 You have just inserted a nasogastric tube (NGT) to Mme. Dubois. Before starting enteral feeding, you want to ensure that the NGT is correctly positioned.

Question
What should you do next? *
3.3 Mme. Dubois medical record indicates diagnoses of angina and hypertension controlled with a long-acting medication: dilTIAZem CD (Cardizem CDTM) 120 mg PO daily for the past five years.

The following is an excerpt from her medication administration record:
Acetaminophen (TylenolTM) 500 mg/tab, 1 000 mg (2 tabs) PO qid via the nasogastric tube – 08:00 12:00 16:00 22:00
DilTIAZem (CardizemTM) 30 mg/tab, 30 mg (1 tab) PO qid via the nasogastric tube – 08:00 12:00 16:00 22:00
Dimenhydrinate (GravolTM) 50 mg/mL, 50 mg (1 mL) intravenously q 6 h PRN for nausea or vomiting

At 08:00, you administer Mme. Dubois's medications through the NG tube and she says: "This is not the same medication that I take for my blood pressure at home."

Question:
What is your most appropriate response to the patient? *
4. Marie Dupont, a 45-year-old French national, is admitted to the hospital with severe nausea and vomiting. The registered nurse is preparing to insert a nasogastric (NG) tube to provide relief and facilitate treatment. To ensure the correct placement of the NG tube, the nurse needs to determine the accurate measurement of the length of the tube to be inserted.

Question:
What action should the nurse take? *
5. Mme. Lavoie, 58, is ordered to receive an NG tube for gastric decompression following bowel obstruction. As you advance the tube, she suddenly begins coughing violently, her oxygen saturation drops from 97% to 90%, and she appears distressed with watery eyes and difficulty speaking.

Question:
What is the nurse’s priority action? *
6. Mr. Gauthier, 71, has a gastrostomy (PEG) tube for long-term enteral feeding. During your assessment, you observe redness, moisture, and leakage of gastric contents around the insertion site. He reports mild burning pain and a sour odor from the area. His vitals are stable.

Question:
What is the most appropriate nursing action? *
7. Mme. Roy, 64, is receiving continuous tube feeding through an NG tube at 50 mL/hr. When checking her gastric residual, you withdraw 420 mL of formula. She has mild nausea but no vomiting. Respirations are 16 and oxygen saturation is 98%.

Question:
What should the nurse do first? *
8. Mr. Nadeau, 50, tells you that his NG tube “feels loose.” When you inspect it, the marking at the naris has shifted from 55 cm to 45 cm. He reports mild nausea but no respiratory trouble.

Question:
What is the nurse’s best action? *
9. Mme. Martel, 81, on long-term tube feeding via PEG, develops frequent watery diarrhea over the past 24 hours. The feeding rate is unchanged. Her abdomen is soft, and she denies pain. She has not received antibiotics recently.

Question:
Which intervention is most appropriate? *
10. Mr. Bélanger, 76, receiving intermittent bolus tube feedings, suddenly begins coughing during the feeding. He becomes short of breath, O₂ saturation falls to 90%, and his respiratory rate increases to 24. He is lying in a semi-supine position.

Question:
What is the priority nursing action? *
11. Ms. Pelletier, 36, has a nasojejunal tube for continuous feeding. When preparing her morning medications, you notice the tube is completely blocked, and no flushing is possible. Her feeding has also stopped flowing.

Question:
What should the nurse do first? *
13. Mme. Cloutier, 72, has an NG tube connected to low intermittent suction for a small bowel obstruction. Over the past two hours, you observe 700 mL of green bile in the canister. She feels weak and complains of dry lips. Her BP is 100/62 and HR 106.

Question:
What should the nurse do first? *
14. Ms. Denis, 29, is admitted with hyperemesis gravidarum and requires an NG tube for feeding. After insertion, you confirm the marking and the pH is 5.5. She is comfortable and has no respiratory symptoms. The physician orders feeding to start immediately.

Question:
What is the nurse’s safest action? *