A nurse is preparing to remove an NG tube for a client who is postoperative following colon surgery. In which order should the nurse perform the following steps? (Move the steps, placing them in the order of performance. Use all the steps.)

Pinch and withdraw the tube.

Disconnect the tube from the suction device.

Instill 50 mL of air into the tube.

Ask the client to take a deep breath.

Apply clean gloves.

Answer and Explanation

The Correct Answer is E,B,C,D,A

First, the nurse should apply clean gloves (E) to maintain sterility and safety. Next, the nurse should disconnect the tube from the suction device (B), ensuring that the device is no longer actively working on the tube.

Before removing the tube, it is important to instill air into it (C); this helps clear any residual contents and minimizes the risk of aspiration. The nurse should then ask the client to take a deep breath (D), which helps close the epiglottis to prevent aspiration during the removal of the tube. Finally, the nurse can pinch and withdraw the tube (A), completing the process in a swift, steady motion to ensure comfort and safety for the client.

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Correct Answer is A

Explanation

A) Play music in the client's room. - Music therapy can be a beneficial nonpharmacological intervention for managing pain and promoting relaxation.
B) Keep the client's room well lit. - Bright lighting may exacerbate pain for some clients; dim lighting or allowing the client to control the lighting can be more helpful.
C) Ensure that the client's room is kept at a cool temperature. - Temperature preferences can vary among individuals; the nurse should adjust the room temperature according to the client's comfort.

D) Encourage the client to abstain from distracting activities. - Engaging in distracting activities can help divert the client's attention from pain, so encouraging them may be appropriate.

A. Return the medication to the medication cabinet. B. Notify the provider of the client's refusal. C. Document the refusal in the client's medical record. D. Inform the client of the potential consequences of their refusal

Correct Answer is D

Explanation

A. Return the medication to the medication cabinet- Returning the medication without addressing the client's concerns does not promote understanding or collaboration.
B. Notify the provider of the client's refusal- Notifying the provider is important but should come after attempting to address the client's concerns.
C. Document the refusal in the client's medical record- Documentation is necessary but should follow a discussion with the client.
D. Inform the client of the potential consequences of their refusal- The nurse should first educate the client about the risks associated with not taking their antihypertensive medication to ensure they are making an informed decision.

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A nurse is preparing to remove an NG tube for a client who is postoperative following colon surgery. In which order should the nurse perform the following steps? (Move the steps, placing them in the order of performance. Use all the steps.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing nonpharmacological interventions for a client who is experiencing pain. Which of the following actions should the nurse take

Correct Answer is A

Explanation

A nurse is caring for a client who refuses their morning dose of antihypertensive medication. The client tells the nurse, "I'm not going to take this medication because it makes me sick and dizzy." Which of the following actions should the nurse take first?

Correct Answer is D

Explanation

A nurse is reinforcing teaching about end-of-life care with the partner of a client. Which of the following statements should the nurse make?

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