A nurse positions a patient for the insertion of a nasogastric (NGT) tube by:

Side-lying with head of bed (HOB) at 30 degrees.

In the tripod position; leaning over the over the bed table on the left side with chin-to-chest.

Sitting the patient in an upright position.

Sitting the patient in an upright position and hyperextending the patient's head.

Answer and Explanation

The Correct Answer is C

Choice A rationale

The side-lying position with the head of bed at 30 degrees does not optimally align the nasal passages with the esophagus, increasing the risk of the NGT entering the trachea. Proper alignment facilitates easier and safer insertion into the stomach.

Choice B rationale

The tripod position is typically used for patients experiencing respiratory distress to maximize lung expansion. It does not provide the necessary head and neck alignment for safe nasogastric tube insertion.

Choice C rationale

Sitting the patient in an upright position, ideally between 45 to 90 degrees, uses gravity to aid the passage of the NGT down the esophagus. This position also allows the patient to cough effectively if the tube inadvertently enters the trachea.

Choice D rationale

Hyperextending the patient's head during NGT insertion can close off the esophagus and open the trachea, significantly increasing the risk of misplacement of the tube into the respiratory tract. The neck should be flexed forward with the chin to the chest during insertion.

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Correct Answer is ["A","D"]

Explanation

Choice A rationale

Vanilla pudding is often restricted in dysphagia diets due to its smooth, slippery texture, which can be difficult to control in the oral cavity and increases the risk of aspiration into the airway. Individuals with dysphagia may have impaired swallowing mechanisms, making thin, liquid-like consistencies particularly hazardous.

Choice B rationale

Cranberry juice is a thin liquid and poses a significant aspiration risk for a patient with dysphagia. Thin liquids are difficult to manage in the mouth and throat, increasing the likelihood of the liquid entering the trachea instead of the esophagus. Patients with swallowing difficulties often require thickened liquids to improve bolus control.

Choice C rationale

Beef broth is a clear liquid and, similar to cranberry juice, presents a high risk of aspiration for a patient with dysphagia. Its thin consistency makes it challenging for individuals with impaired swallowing to control its movement, potentially leading to it entering the airway and causing respiratory complications.

Choice D rationale

Orange gelatin, while seemingly semi-solid, often melts into a thin liquid in the mouth due to body temperature. This change in consistency makes it difficult to control and increases the risk of aspiration in patients with dysphagia. Gelatin's slippery texture further compounds this risk.

A. Secure the tube and retest the pH in one hour. B. Insert the tube an additional 1-2 inches and retest the pH. C. Auscultate for the "swoosh" of air. D. Obtain an x-ray to confirm placement.

Correct Answer is D

Explanation

Choice A rationale

Securing the tube and retesting the pH in one hour is insufficient to confirm correct placement. While a pH of 3 suggests gastric placement (normal gastric pH is typically 1.5 to 3.5), it doesn't definitively rule out placement in the respiratory tract or intestines, as these can occasionally have acidic pH levels. Delaying definitive confirmation could lead to serious complications if the tube is misplaced.

Choice B rationale

Inserting the tube an additional 1-2 inches and retesting the pH is not a reliable method for confirming placement. Advancing the tube further without radiographic confirmation could increase the risk of trauma to the gastrointestinal tract or even pulmonary aspiration if the initial placement was incorrect. pH testing alone is not conclusive.

Choice C rationale

Auscultating for the "swoosh" of air while injecting air into the NG tube is an outdated and unreliable method for confirming placement. The sound can be misleading and may be heard even if the tube is incorrectly positioned in the esophagus or lungs. This method does not provide definitive proof of gastric placement and poses a risk of aspiration.

Choice D rationale

Obtaining an x-ray is the gold standard for confirming nasogastric tube placement. Radiographic imaging allows for direct visualization of the tube's trajectory and ensures that the distal tip is correctly positioned in the stomach or duodenum. This method provides the most accurate and reliable confirmation, minimizing the risk of complications such as aspiration or misadministration of feedings and medications.

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A nurse positions a patient for the insertion of a nasogastric (NGT) tube by:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following items on the tray should the nurse remove?

Correct Answer is ["A","D"]

Explanation

The nurse places a nasogastric tube (NGT) as ordered by the physician.When confirming placement, the nurse aspirates stomach contents and measures the gastric pH at 3. What should the nurse do next?

Correct Answer is D

Explanation

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