A nurse is caring for a client who is postoperative and has an NG tube that has drained 2,500 ml. In the past 6 hr. The nurse should monitor the client for which of the following electrolyte Imbalances?

Decreased potassium level

Decreased calcium level

Elevated magnesium level

Elevated sodium level

Answer and Explanation

The Correct Answer is A

A. Decreased potassium level
NG tube drainage can lead to hypokalemia (low potassium levels) due to the loss of gastric fluids, which contain significant amounts of potassium. This choice is correct.

B. Decreased calcium level
Calcium levels are not directly affected by NG tube drainage.

C. Elevated magnesium level
NG tube drainage does not typically lead to elevated magnesium levels.

D. Elevated sodium level
NG tube drainage can result in hyponatremia (low sodium levels) due to the loss of gastric fluids. Elevated sodium levels are not expected in this situation.

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Correct Answer is C

Explanation

A. Keep the head of the bed elevated at 15 degrees.

This is not sufficient for preventing aspiration and ensuring proper digestion. The head of the bed should be elevated at least 30 degrees to reduce the risk of aspiration and promote better digestion of enteral feedings.

B. Place enough formula in the feeding bag to last for 8 hr of continuous feeding: It is recommended to change the feeding formula and bag every 24 hours. Placing formula for an extended period can increase the risk of bacterial growth.

C. Flush the tube with 30 ml of water every 4 hr: Regular flushing of the tube helps maintain patency, prevents clogging, and ensures proper hydration. Flushing every 4 hours is a standard practice for continuous feeding.

D. Change the feeding bag and tubing every 72 hr: Feeding bags and tubing should be changed more frequently, typically every 24 hours, to reduce the risk of infection.

A. Bradycardia B. Report of epigastric fullness C. Severe upper abdominal pain D. Hyperactive bowel sounds

Correct Answer is C

Explanation

A. Bradycardia
Bradycardia is not a direct symptom of gastrointestinal perforation. When a perforation occurs, the body's response is often to increase the heart rate (tachycardia) due to the stress and shock.

B. Report of epigastric fullness
Epigastric fullness might be a symptom of peptic ulcer disease but is not specific to gastrointestinal perforation.

C. Severe upper abdominal pain
Correct choice. Severe upper abdominal pain, particularly sudden and intense pain, can be indicative of gastrointestinal perforation. This is a medical emergency and requires immediate attention.

D. Hyperactive bowel sounds
Gastrointestinal perforation can lead to absent or hypoactive bowel sounds due to inflammation and irritation of the abdominal cavity, not hyperactive bowel sounds.

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A nurse is caring for a client who is postoperative and has an NG tube that has drained 2,500 ml. In the past 6 hr. The nurse should monitor the client for which of the following electrolyte Imbalances?

Nursing Test Bank

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