The nurse is preparing to administer enteral nutrition to a patient. Which assessment finding would prompt the nurse to hold the nutrition and notify the patient's provider?
a. Blood pressure of 90/60 mm Hg
b. Decreased bowel sounds
c. A productive cough
d. A temperature of 37.8° C
ANS: B
Enteral nutrition requires adequate small bowel function with digestion, absorption, and gastrointestinal motility. The nurse should assess for abdominal distension and a decrease or absence of bowel sounds. Patients may still receive enteral feedings if hypotension, cough, or elevated temperature are present.
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