A nurse is caring for a client who is postoperative following a bowel surgery and has an NG tube connected to low intermittent suction. Which of the following assessment findings should indicate to the nurse that the NG tube might not be functioning properly?
Wall suction set to 60 mm Hg
Drainage fluid is greenish-yellow
Aspirate pH of 3
Abdominal rigidity
The Correct Answer is B
A. The wall suction setting does not directly indicate the functioning of the NG tube.
B. Greenish-yellow drainage fluid may indicate the presence of bile in the stomach, suggesting
that the NG tube is not adequately draining gastric contents, which could indicate a malfunction.
C. An aspirate pH of 3 indicates gastric acidity, which is expected in the stomach and does not necessarily indicate a problem with NG tube function.
D. Abdominal rigidity may suggest intra-abdominal pathology but does not specifically indicate NG tube dysfunction.
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Related Questions
Correct Answer is C
Explanation
A. Encourage the client to ambulate in the hallway 1 hr before bedtime - While light exercise during the day can promote better sleep, exercising close to bedtime can actually disrupt sleep.
B. Tell the client to avoid drinking fluids 1 hr before bedtime - While limiting fluids close to bedtime can reduce nighttime awakenings to urinate, it may not directly address difficulty falling asleep.
C. Schedule routine care tasks during hours when the client is awake - This action ensures that the client can maximize restful sleep during the night by minimizing disruptions from care
activities.
D. Advise the client to leave the television in the room on when trying to fall asleep - Screen
time before bed can interfere with falling asleep due to the stimulating effect of light and content.
Correct Answer is B
Explanation
A. While it's important for the client to empty their bladder before surgery to reduce the risk of complications, administering a preoperative injection typically requires monitoring the client closely for any adverse reactions rather than immediately taking them to the bathroom.
B. Asking the client to verify the surgical site helps prevent wrong-site surgery and ensures proper patient safety protocols are followed.
C. Reviewing deep breathing and coughing exercises is an important preoperative teaching, but it's not typically done immediately after administering a preoperative injection.
D. Raising the side rails on the bed is a safety measure to prevent falls, but it's not directly related to administering a preoperative injection.
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