# A client with a nasogastric tube is receiving continuous enteral nutrition. The nurse must administer immediate-release metoprolol tablets, an enteric-coated aspirin tablet, and phenytoin suspension, which is known to bind with enteral formula and reduce absorption. Which actions should the nurse take? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=558426&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question A client with a nasogastric tube is receiving continuous enteral nutrition. The nurse must administer immediate-release metoprolol tablets, an enteric-coated aspirin tablet, and phenytoin suspension, which is known to bind with enteral formula and reduce absorption. Which actions should the nurse take? Select all that apply. 1 Crush the enteric-coated aspirin tablet and dissolve it in warm water before instilling it through the tube. 2 Interrupt the continuous enteral feeding for the period needed to allow phenytoin absorption, then resume feeding afterward. 3 Crush the metoprolol tablet and mix it with the phenytoin suspension in the same syringe for one instillation. 4 Add the phenytoin suspension directly into the enteral feeding bag so it infuses along with the formula. 5 Flush the nasogastric tube with water before and after administering each medication separately. 6 Contact the prescriber to request a non-enteric-coated or liquid form of the aspirin for tube administration. ## Explanation Safe enteral medication administration requires evaluating each drug individually for compatibility, absorption, and interaction with tube feeding rather than treating all medications the same way. Enteric-coated products cannot be crushed because doing so destroys their protective release mechanism, so the nurse should seek an alternative formulation instead. Phenytoin requires a feeding interruption because the enteral formula binds the drug and reduces absorption, unlike medications without such interactions. Medications should never be combined in one syringe or added directly to a feeding bag, since this risks incompatibility, occlusion, and unpredictable dosing. Flushing the tube before and after each medication, given separately, maintains patency and prevents drug-formula or drug-drug interactions, making it a consistently appropriate nursing action in this scenario. ## In-depth explanation Correct Answer Choices 2, 5, 6 Clinical Reasoning Safe enteral medication administration requires evaluating each drug individually for compatibility, absorption, and interaction with tube feeding rather than treating all medications the same way. Enteric-coated products cannot be crushed because doing so destroys their protective release mechanism, so the nurse should seek an alternative formulation instead. Phenytoin requires a feeding interruption because the enteral formula binds the drug and reduces absorption, unlike medications without such interactions. Medications should never be combined in one syringe or added directly to a feeding bag, since this risks incompatibility, occlusion, and unpredictable dosing. Flushing the tube before and after each medication, given separately, maintains patency and prevents drug-formula or drug-drug interactions, making it a consistently appropriate nursing action in this scenario. Option Review - Incorrect — Enteric-coated tablets are formulated to resist stomach acid and release medication in the intestine, so crushing destroys this protective coating and alters absorption and safety. - Correct — Phenytoin binds with enteral formula components, so holding the feeding before and after the dose protects absorption and ensures the client receives an effective dose. - Incorrect — Combining two different medications in one syringe risks physical incompatibility, tube occlusion, and altered absorption, so each drug should be prepared and given separately. - Incorrect — Instilling medication directly into the feeding bag exposes the drug to prolonged contact with formula, risking degradation, incompatibility, and inaccurate dosing over time. - Correct — Flushing before and after each medication clears the tube, prevents drug-formula interaction, and reduces the risk of occlusion, supporting safe individual administration. - Correct — Because the enteric coating cannot be crushed safely, the prescriber should be consulted to obtain an alternative formulation suitable for enteral tube delivery. Sources 12026 NCLEX-RN Test Plan 2ASPEN Safe Practices for Enteral Nutrition Therapy ## Clinical scenario A client with a nasogastric tube receiving continuous enteral nutrition is due for immediate-release metoprolol, an enteric-coated aspirin tablet, and phenytoin suspension, which is known to bind with enteral formula and reduce absorption. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. 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