A nurse is collecting data from a client who has an NG tube in place for gastric decompression. Which of the following findings should the nurse report to the provider?
Greenish-yellow drainage
Report of hunger
Gastric contents are present in the air vent
Abdominal distention
The Correct Answer is C
Choice A reason: This is not the correct answer because greenish-yellow drainage is a normal color for gastric secretions and does not indicate a problem.
Choice B reason: This is not the correct answer because a report of hunger is common for a client with an NG tube and does not require intervention.
Choice C reason: This is the correct answer because gastric contents in the air vent mean that the NG tube is clogged or kinked and needs to be flushed or replaced. This is the correct answer because it indicates that the NG tube is not functioning properly and could cause aspiration or infection. The other findings are expected or normal for a client with an NG tube.
Choice D reason: This is not the correct answer because abdominal distention is a common reason for placing an NG tube and should improve with gastric decompression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This is incorrect because the client should urinate before the specimen collection to avoid contaminating the stool with urine.
Choice B reason: This is incorrect because the specimen should be kept in a cool area to prevent bacterial growth and decomposition.
Choice C reason: This is incorrect because the client should place at least 2.5 cm (1 in) of formed stool or 15 to 30 mL of liquid stool into a culture tube.
Choice D reason: This is correct because the client should avoid placing toilet tissue in the bedpan after defecation to prevent interfering with the laboratory analysis of the stool.
Correct Answer is D
Explanation
Choice A reason: Turning on loud music in client care areas is not a good action. Loud music can increase noise levels, disrupt sleep, and cause agitation and anxiety for clients. The nurse should keep the noise level low and provide earplugs or headphones for clients who want to listen to music.
Choice B reason: Assigning different nurses to provide care for clients each day is not a good action. Different nurses may have different styles, routines, and expectations, which can confuse and frustrate clients. The nurse should maintain consistency and continuity of care by assigning the same nurses to the same clients as much as possible.
Choice C reason: While offering some choices can empower clients and reduce stress, too many choices might overwhelm them, particularly in an acute care setting. The key is to provide a balance of autonomy while not overwhelming the client.
Choice D reason: Limiting the number of visitors can help create a quieter, more controlled environment, reducing overstimulation and stress for clients. This can be particularly important in an acute care setting where rest and a calm environment are crucial for recovery.
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