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Nursing:
doi: 10.1097/01.NURSE.0000440608.12040.13
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Nursing2013 survey results: Drug administration by enteral feeding tube

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INSTRUCTIONS Drug administration by enteral feeding tube

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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.

1. Which of the following is a risk factor for enteral tube occlusion?

a. short tube length

b. large tube caliber

c. infrequent medication delivery

d. inadequate water flushing

2. Before publication of the A.S.P.E.Enteral Nutrition Practice Recommendations in 2009, surveys revealed that most nurses

a. avoided crushing modified-release oral dosage forms.

b. flushed the tube between medications administered.

c. administered drugs separately from one another.

d. diluted liquid medications.

3. Most nurses responding to the Nursing2013 survey worked in

a. hospitals.

b. subacute care.

c. home healthcare.

d. long-term care.

4. According to the most current Nationwide Inpatient Sample data, which statement concerning EN is true?

a. Most hospitalized patients receive only enteral formula through the tube.

b. About 25% of long-term care residents receive EN.

c. Long-term care residents with cognitive impairment are more likely to receive EN.

d. More than half a million hospitalized patients receive EN annually.

5. Nurses responding to this survey identified which of the following as the medication most frequently added directly to EN formula?

a. antibiotics

b. electrolytes

c. GI medications

d. corticosteroids

6. Which factor doesn't influence the compatibility of a drug mixed with EN?

a. the drug's pH

b. the EN formula's fiber content

c. the drug's viscosity

d. the volume of water used to flush the tube

7. Before administering medication through an enteral tube, the nurse should first

a. flush the tube with tap water.

b. stop the feeding.

c. check for EN residue adhering to the lumen.

d. measure gastric residual volume.

8. For most adult patients, what's the minimum amount of water used to flush the tube before drug administration?

a. 10 mL

b. 15 mL

c. 20 mL

d. 30 mL

9. What's the primary reason for using sterile water instead of tap water for flushing?

a. Sterile water removes residue better than tap water.

b. Sterile water is easier to keep at the bedside.

c. Sterile water is more cost-effective.

d. Tap water is frequently contaminated.

10. What's the best practice when more than one drug is scheduled for administration at the same time via an enteral tube?

a. Give each drug separately.

b. Mix at least two liquid medications together.

c. Crush at least two immediate-release medications together.

d. Mix one immediate-release medication and one liquid medication together.

11. Based on results from this survey, what percentage of nurses mix medications for enteral administration at least some of the time?

a. 2%

b. 13%

c. 47%

d. 62%

12. Which type of oral tablet can be crushed and given via an EN tube?

a. extended-release

b. immediate-release

c. enteric-coated

d. sustained-release

13. To administer the contents of hard gelatin capsules via enteral tube,

a. dissolve the capsule in 15 mL of warm water.

b. grind the capsule into a fine powder and mix with sterile water.

c. open the capsule and mix powder with tap water.

d. open the capsule and mix powder with sterile water.

14. Which drug dosage form is classified as modified release?

a. suspension

b. enteric-coated tablet

c. solution

d. compressed tablet

15. Crushing enteric-coated tablets increases the risk of all of the following except

a. inadequate dosing.

b. tube occlusion.

c. rapid release of large drug amounts.

d. altered drug bioavailability.

16. Administer medications given via EN tube with

a. any appropriately sized syringe.

b. any 50 mL syringe.

c. a clean oral syringe at least 30 mL in size.

d. a sterile oral syringe at least 30 mL in size.

17. Why is it important to dilute liquid medications before administering via EN tube?

a. Dilution prevents medication delivery through the distal end of the feeding tube.

b. Dilution increases drug viscosity.

c. Dilution increases drug osmolality.

d. Dilution improves drug delivery.

18. Liquid medications with high osmolality

a. are less effective when diluted.

b. contribute to slower GI motility.

c. may require significantly more dilution than other drugs.

d. are less effective than crushed tablets.

19. In this survey, what percentage of nurses reported that they don't dilute liquid medications before administration?

a. 48%

b. 32%

c. 27%

d. 12%

20. Based on U.Pharmacopeia standards, the preferred diluents for most drugs are sterile 0.9% sodium chloride and

a. tap water.

b. sterile water.

c. cranberry juice.

d. ginger ale.

21. Hold continuous EN for at least 60 minutes before and after phenytoin administration to prevent

a. gastric distension.

b. too rapid absorption.

c. decreased bioavailability.

d. diarrhea.

22. 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?

a. 8%

b. 24%

c. 32%

d. 36%

23. Which of the following has led to sentinel event medication errors?

a. providing oral drugs in an I.syringe

b. failing to measure gastric residual volumes before giving medications

c. causing fluid volume overload with flushing practices

d. failing to document tube placement by ultrasound

24. According to this survey, most nurses obtain information about medication administration from

a. the Internet.

b. nursing colleagues.

c. product inserts.

d. institutional policies and procedures.

25. In this survey, what percentage of nurses refer to product inserts/prescribing information for information on drug administration?

a. 70%

b. 57%

c. 43%

d. 31%

26. 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?

a. 7%

b. 17%

c. 56%

d. 76%

27. In this survey, what percentage of nurses often or always consult with a pharmacist when uncertain about medication delivery?

a. 85%

b. 56%

c. 11%

d. 3%

28. Which circumstance often results in an occluded feeding tube?

a. The tip of EN tube is in the jejunum.

b. The tube is regularly flushed with sterile water.

c. Protein-based formulas come in contact with gastric acid.

d. The tube is regularly flushed with purified water.

29. To clear an occluded EN tube, the nurse's first step should be to

a. attempt to flush it.

b. attempt to aspirate with a syringe.

c. assess for kinks in the tube.

d. call the pharmacist.

30. Which action should a nurse take to clear an occluded feeding tube?

a. follow institutional nursing protocol

b. flush with cold water

c. flush with sodium bicarbonate solution

d. flush with a carbonated beverage

31. Research has shown the superiority of which liquid for declogging an EN tube?

a. water

b. cranberry juice

c. hydrogen peroxide

d. carbonated beverage

32. Which is an acceptable method for verifying enteral tube tip placement?

a. auscultating over the stomach

b. aspirating stomach contents

c. estimating length of tube inside patient

d. flushing with sterile water

33. Which of the following is a key finding of this survey?

a. Most nurses crush modified-release medications for administration via enteral tube.

b. Over 50% of nurses don't dilute liquid medications before administration.

c. Most nurses use tap water for tube flushing.

d. Less than 50% of nurses flush the tube before and between administration of medications.

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