A nurse is preparing to administer enteral medication to a client who has a gastrostomy tube. Which of the following actions should the nurse take first?
Flush the tube with water.
Measure stomach contents.
Elevate the head of the bed.
Return gastric content into the gastrostomy tube.
The Correct Answer is B
A. Flushing the tube with water is necessary after checking residual stomach contents to clear the tube, but measuring stomach contents comes first to ensure the tube is clear for proper medication administration.
B. Measuring stomach contents is crucial before administering enteral medication to confirm the tube's placement and ensure medication reaches the stomach appropriately, preventing complications such as aspiration.
C. Elevating the head of the bed is important during and after enteral feeding to prevent aspiration, but it is not the first action before medication administration.
D. Returning gastric content into the gastrostomy tube may be necessary after assessing and managing residual stomach contents, but it is not the initial step in medication administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Bringing the dropper from below the client's eye is incorrect as it increases the risk of contamination from the eyelashes.
B. Holding the ophthalmic solution 1 to 2 cm (1/2 to 3/4 in) above the lower conjunctival sac allows for accurate instillation into the eye without touching the dropper tip to the eye or eyelashes.
C. Instilling drops into the inner canthus is incorrect; drops should be placed into the conjunctival sac to ensure proper absorption.
D. Asking the client to look down may help expose the lower conjunctival sac but is not the correct action for administering the drops.
Correct Answer is ["A","B","E"]
Explanation
A. A medical record can indeed be used as evidence in a court of law to support or refute claims related to patient care.
B. Documentation should be organized and timely to ensure accuracy and continuity of care.
C. Documentation should not include the nurse's interpretation but rather objective data and actions taken.
D. Data in a client's medical record should only be shared with those directly involved in the client's care unless otherwise authorized.
E. Information recorded in the client's medical record must be accurate and complete to support safe and effective client care and legal purposes.
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