A nurse in a long-term care facility is caring for a client who dies during the nurse's shift. Identify the sequence in which the nurse should perform the following steps. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

A. Have the client wear a mask when receiving visitors: Mask use is primarily indicated for airborne or droplet precautions to prevent respiratory transmission of pathogens. Shigella is transmitted via the fecal-oral route, not through respiratory droplets, so a mask is not required for visitors or staff in this case.

B. Wear a gown when caring for the client: Contact precautions are appropriate for clients with diarrhea caused by Shigella because the bacteria can be transmitted through direct or indirect contact with fecal matter. Wearing a gown protects the nurse’s clothing from contamination and helps prevent the spread of infection to other clients or surfaces.

C. Assign the client to a room with negative-pressure airflow exchange: Negative-pressure rooms are used for airborne pathogens such as tuberculosis, not for enteric infections like Shigella. Shigella does not remain suspended in the air and therefore does not require special airflow control.

D. Limit the client's time with visitors to no more than 30 min per day: Restricting visitation time is not a standard precaution for fecal-oral infections. Infection control relies on proper hand hygiene, use of personal protective equipment, and environmental cleaning rather than strictly limiting visitor duration.

A. The tube aspirate has a pH of 7 (less than 5): Gastric aspirate typically has an acidic pH ranging from about 1 to 5 due to the presence of hydrochloric acid in the stomach. A pH of 7 is neutral and more consistent with respiratory or intestinal secretions rather than gastric contents. Therefore, this finding does not reliably confirm that the NG tube is correctly positioned in the stomach.

B. An x-ray shows the end of the tube above the pylorus: Radiographic confirmation is considered the gold standard for verifying nasogastric tube placement. An x-ray showing the tube tip located within the stomach, above the pylorus, confirms that the tube has not entered the respiratory tract and is positioned appropriately for gastric decompression or feeding. This method provides the most accurate and reliable confirmation of placement.

C. Bowel sounds are present on auscultation: The presence of bowel sounds only indicates intestinal motility and does not provide information about the position of the NG tube. Historically, auscultating for air insufflation (“whooshing” sound) was used to check placement, but this practice is unreliable because similar sounds can occur even when the tube is misplaced in the lungs.

D. The client reports relief of nausea: Symptom relief may occur after gastric decompression but does not confirm correct placement of the tube. A client might experience temporary relief even if the tube is partially misplaced. Objective verification methods such as radiographic confirmation are necessary to ensure safe and correct tube positioning.