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Drug administration by enteral feeding tube
INSTRUCTIONS Drug administration by enteral feeding tube
TEST INSTRUCTIONS
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Drug administration by enteral feeding tube
GENERAL PURPOSE: To provide nurses with information about best practices for medication administration by enteral feeding tube. LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to: 1. Explain complications of medication administration via enteral tube. 2. Describe best practices for administering medications via enteral tube. 3. Discuss opportunities for improving practice.
- Which of the following is a risk factor for enteral tube occlusion?
- short tube length
- large tube caliber
- infrequent medication delivery
- inadequate water flushing
- Before publication of the A.S.P.E.Enteral Nutrition Practice Recommendations in 2009, surveys revealed that most nurses
- avoided crushing modified-release oral dosage forms.
- flushed the tube between medications administered.
- administered drugs separately from one another.
- diluted liquid medications.
- Most nurses responding to theNursing2013 survey worked in
- hospitals.
- subacute care.
- home healthcare.
- long-term care.
- According to the most current Nationwide Inpatient Sample data, which statement concerning EN is true?
- Most hospitalized patients receive only enteral formula through the tube.
- About 25% of long-term care residents receive EN.
- Long-term care residents with cognitive impairment are more likely to receive EN.
- More than half a million hospitalized patients receive EN annually.
- Nurses responding to this survey identified which of the following as the medication most frequently added directly to EN formula?
- antibiotics
- electrolytes
- GI medications
- corticosteroids
- Which factordoesn't influence the compatibility of a drug mixed with EN?
- the drug's pH
- the EN formula's fiber content
- the drug's viscosity
- the volume of water used to flush the tube
- Before administering medication through an enteral tube, the nurse should first
- flush the tube with tap water.
- stop the feeding.
- check for EN residue adhering to the lumen.
- measure gastric residual volume.
- For most adult patients, what's the minimum amount of water used to flush the tube before drug administration?
- 10 mL
- 15 mL
- 20 mL
- 30 mL
- What's theprimaryreason for using sterile water instead of tap water for flushing?
- Sterile water removes residue better than tap water.
- Sterile water is easier to keep at the bedside.
- Sterile water is more cost-effective.
- Tap water is frequently contaminated.
- What's the best practice when more than one drug is scheduled for administration at the same time via an enteral tube?
- Give each drug separately.
- Mix at least two liquid medications together.
- Crush at least two immediate-release medications together.
- Mix one immediate-release medication and one liquid medication together.
- Based on results from this survey, what percentage of nurses mix medications for enteral administration at least some of the time?
- 2%
- 13%
- 47%
- 62%
- Which type of oral tablet can be crushed and given via an EN tube?
- extended-release
- immediate-release
- enteric-coated
- sustained-release
- To administer the contents of hard gelatin capsules via enteral tube,
- dissolve the capsule in 15 mL of warm water.
- grind the capsule into a fine powder and mix with sterile water.
- open the capsule and mix powder with tap water.
- open the capsule and mix powder with sterile water.
- Which drug dosage form is classified as modified release?
- suspension
- enteric-coated tablet
- solution
- compressed tablet
- Crushing enteric-coated tablets increases the risk of all of the followingexcept
- inadequate dosing.
- tube occlusion.
- rapid release of large drug amounts.
- altered drug bioavailability.
- Administer medications given via EN tube with
- any appropriately sized syringe.
- any 50 mL syringe.
- a clean oral syringe at least 30 mL in size.
- a sterile oral syringe at least 30 mL in size.
- Why is it important to dilute liquid medications before administering via EN tube?
- Dilution prevents medication delivery through the distal end of the feeding tube.
- Dilution increases drug viscosity.
- Dilution increases drug osmolality.
- Dilution improves drug delivery.
- Liquid medications with high osmolality
- are less effective when diluted.
- contribute to slower GI motility.
- may require significantly more dilution than other drugs.
- are less effective than crushed tablets.
- In this survey, what percentage of nurses reported that they don't dilute liquid medications before administration?
- 48%
- 32%
- 27%
- 12%
- Based on U.Pharmacopeia standards, the preferred diluents for most drugs are sterile 0.9% sodium chloride and
- tap water.
- sterile water.
- cranberry juice.
- ginger ale.
- Hold continuous EN for at least 60 minutes before and after phenytoin administration to prevent
- gastric distension.
- too rapid absorption.
- decreased bioavailability.
- diarrhea.
- In this survey, what percentage of nurses responded that pharmacists always provide ready-to-administer enteral drug products in an oral syringe labeled for the patient?
- 8%
- 24%
- 32%
- 36%
- Which of the following has led to sentinel event medication errors?
- providing oral drugs in an I.syringe
- failing to measure gastric residual volumes before giving medications
- causing fluid volume overload with flushing practices
- failing to document tube placement by ultrasound
- According to this survey, most nurses obtain information about medication administration from
- the Internet.
- nursing colleagues.
- product inserts.
- institutional policies and procedures.
- In this survey, what percentage of nurses refer to product inserts/prescribing information for information on drug administration?
- 70%
- 57%
- 43%
- 31%
- In this survey, what percentage of nurses don't know if their institution has a policy and procedure for medication delivery via enteral feeding tube?
- 7%
- 17%
- 56%
- 76%
- In this survey, what percentage of nurses often or always consult with a pharmacist when uncertain about medication delivery?
- 85%
- 56%
- 11%
- 3%
- Which circumstance often results in an occluded feeding tube?
- The tip of EN tube is in the jejunum.
- The tube is regularly flushed with sterile water.
- Protein-based formulas come in contact with gastric acid.
- The tube is regularly flushed with purified water.
- To clear an occluded EN tube, the nurse's first step should be to
- attempt to flush it.
- attempt to aspirate with a syringe.
- assess for kinks in the tube.
- call the pharmacist.
- Which action should a nurse take to clear an occluded feeding tube?
- follow institutional nursing protocol
- flush with cold water
- flush with sodium bicarbonate solution
- flush with a carbonated beverage
- Research has shown the superiority of which liquid for declogging an EN tube?
- water
- cranberry juice
- hydrogen peroxide
- carbonated beverage
- Which is an acceptable method for verifying enteral tube tip placement?
- auscultating over the stomach
- aspirating stomach contents
- estimating length of tube inside patient
- flushing with sterile water
- Which of the following is a key finding of this survey?
- Most nurses crush modified-release medications for administration via enteral tube.
- Over 50% of nurses don't dilute liquid medications before administration.
- Most nurses use tap water for tube flushing.
- Less than 50% of nurses flush the tube before and between administration of medications.