Progressive Care Nursing Certification (PCCN) Practice Exam

A newly admitted patient sustained a stroke and is now receiving enteral feedings. What should the nurse anticipate based on gastric residual volumes?

1. Dilution of the enteral feeds by 50% with water

2. Administration of a prokinetic agent

3. Decreasing the rate of enteral feedings by 50%

4. Initiation of parenteral nutrition

The correct answer is: Administration of a prokinetic agent

The anticipation of administering a prokinetic agent is based on the management of gastric residual volumes, particularly in patients who have sustained a stroke and may have impaired gastric motility. In such cases, decreased gastric emptying can lead to increased residual volumes, which can not only hinder effective nutrition but also elevate the risk for complications, including aspiration. A prokinetic agent promotes gastric motility, facilitating the movement of contents through the stomach into the small intestine. This is particularly important in patients with neurologic deficits who might experience slower gastric emptying due to altered gastrointestinal function. By enhancing gastric motility, the nurse can help ensure that the enteral feeding is utilized effectively, nutritional therapy is optimized, and the risk for associated complications is minimized. Addressing the other options: Dilution of enteral feeds or decreasing the rate may not address the underlying problem of delayed gastric emptying effectively. Initiating parenteral nutrition would typically be reserved for cases of prolonged enteral feeding intolerance or where enteral feeding cannot be achieved, rather than as a first-line response to increased residual volumes. Thus, the use of a prokinetic agent is the most appropriate and proactive approach in this scenario.