A nurse is caring for a client who has an NG tube for decompression. The nurse notes the tubing is clogged. Which of the following actions should the nurse take?

Increase continuous wall suctioning.

Instruct the client to cough forcefully.

Slightly withdraw the tube.

Check the tubing for kinks.

Answer and Explanation

The Correct Answer is D

A. Increasing suction can damage the gastric mucosa and will not resolve a mechanical clog.
B. Having the client cough forcefully will not help clear a clogged NG tube and could cause discomfort.
C. Withdrawing the tube without assessing the issue may cause incorrect placement and further complications.
D. Checking the tubing for kinks is the first and most appropriate action to resolve a clog, as kinks or bends can impede suction flow.

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Correct Answer is B

Explanation

A. Decreased urinary output may occur with reduced cardiac output but is more commonly associated with left-sided heart failure due to poor perfusion to the kidneys.
B. Peripheral edema is a hallmark sign of right-sided heart failure, as blood backs up into the systemic venous circulation, leading to fluid accumulation in the extremities.
C. Cool extremities are more indicative of left-sided heart failure, where decreased cardiac output leads to poor perfusion.
D. Crackles in the lung fields are associated with left-sided heart failure, due to pulmonary congestion and fluid buildup in the alveoli.

A. Offer the client oral fluids when awake B. Discontinue IV fluid infusion on arrival to the PACU C. Check the client's vital signs once every hour until awake D. Maintain the client in a supine position.

Correct Answer is A

Explanation

A. Offering oral fluids once the client is awake and has a gag reflex is appropriate to prevent dehydration and ensure the client can safely swallow.
B. Discontinuing IV fluids immediately upon arrival to the PACU is inappropriate, as the client may still need fluid support until they are fully stable and able to tolerate oral intake.
C. Checking vital signs only once every hour is too infrequent in the immediate postoperative phase. Vital signs should be monitored every 15 minutes initially.
D. Maintaining a supine position is not ideal after general anesthesia due to the risk of airway obstruction. A lateral or semi-Fowler's position is safer to promote airway patency.

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A nurse is caring for a client who has an NG tube for decompression. The nurse notes the tubing is clogged. Which of the following actions should the nurse take?

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