Difficulty: Medium
Average Score: 84%
Simulated
A nurse is caring for a client who is receiving continuous enteral feeding via NG tube. Which of the following is an unexpected finding?
Correct answer
A
Rationale
The correct answer is A: Gastric residual of 300 mL at the end of the shift. This is unexpected because a large gastric residual volume can indicate feeding intolerance, delayed gastric emptying, or an increased risk of aspiration. It may require adjustments in the feeding rate or formulation.
B: Weight gain is expected due to continuous enteral feeding.
C: Blood glucose level within normal range is expected.
D: Diarrhea can be a side effect of enteral feeding but occurring one time in a 24-hr period is not unexpected.
In summary, the unexpected finding of a large gastric residual volume indicates potential issues with the enteral feeding process, while the other choices are within expected parameters.
B: Weight gain is expected due to continuous enteral feeding.
C: Blood glucose level within normal range is expected.
D: Diarrhea can be a side effect of enteral feeding but occurring one time in a 24-hr period is not unexpected.
In summary, the unexpected finding of a large gastric residual volume indicates potential issues with the enteral feeding process, while the other choices are within expected parameters.