A nurse is preparing to insert an NG tube for a client who requires enteral feedings. Which of the following instructions should the nurse give the client before beginning the procedure?

"Raise the index finger if gagging occurs during insertion."

"Bear down during insertion."

Say "stop" if a burning sensation is felt inside the nose."

Inhale forcefully during insertion."

Answer and Explanation

The Correct Answer is C

A.   Raising the index finger is not a typical response for managing gagging during NG tube insertion.

B.   Bearing down during insertion is not an appropriate instruction and may increase the risk of complications.
C.   Instructing the client to say "stop" if a burning sensation is felt inside the nose allows for communication and prompt action to ensure the client's comfort and safety.
D.   Inhaling forcefully during insertion is not a recommended action and may interfere with the procedure.

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Correct Answer is C

Explanation

A. 1+ pitting edema is mild, with a slight indentation.

B. 4+ pitting edema is severe, with a deep indentation that lasts a long time.

C. 3+ pitting edema is moderate, with a deeper indentation that takes some time to rebound.
D. 2+ pitting edema is moderate, with a slight indentation that rebounds fairly quickly.

A. Granulex B. Hydrocolloid C. Proteolytic enzyme D. Cortisone cream

Correct Answer is B

Explanation

A. Granulex is a topical medication used for wound care, but it may not be the first choice for a stage II pressure ulcer.
B. Hydrocolloid dressings are appropriate for stage II pressure ulcers, providing a moist environment to support healing and protecting the wound from contamination.
C. Proteolytic enzymes are used for debridement of necrotic tissue and may not be the primary choice for a stage II pressure ulcer.

D. Cortisone cream is a topical steroid that may be used for certain skin conditions but is not typically the first-line treatment for pressure ulcers.

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A nurse is preparing to insert an NG tube for a client who requires enteral feedings. Which of the following instructions should the nurse give the client before beginning the procedure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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