A patient with a nasogastric (NG) tube in place is experiencing respiratory distress. What is the most appropriate initial nursing intervention?
Elevate the head of the bed to 90 degrees
Administer a bronchodilator as prescribed.
Check the placement of the NG tube to ensure it has not dislodged into the lungs.
Increase the flow rate of the patient’s oxygen therapy.
The Correct Answer is C
A. Elevate the head of the bed to 90 degrees: While elevating the head of the bed may help ease breathing, it does not address the potential issue of NG tube misplacement.
B. Administer a bronchodilator as prescribed: This would only be appropriate if the patient’s respiratory distress were related to bronchospasm or asthma, not NG tube displacement.
C. Check the placement of the NG tube to ensure it has not dislodged into the lungs. When a patient with an NG tube experiences respiratory distress, the tube may have dislodged and entered the respiratory tract, which could obstruct breathing. Verifying the placement of the NG tube is critical to preventing aspiration or further complications.
D. Increase the flow rate of the patient’s oxygen therapy: This may provide temporary relief but does not resolve the underlying cause of the distress if the NG tube has entered the respiratory tract.
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Related Questions
Correct Answer is D
Explanation
A. The gallbladder became infected by a virus and needs to be removed: Gallstones are not caused by a viral infection.
B. The gallbladder has become inflamed due to a build-up of gallstones that are blocking the common bile duct: While gallstones can obstruct the bile duct, leading to inflammation, the best explanation relates to cholesterol as the main cause of stone formation.
C. The gallbladder has become blocked by a tumor and is no longer working: Tumors are not a common cause of gallstones or cholecystitis.
D. The gallbladder has become inflamed due to the cholesterol in the gallstones. Gallstones are typically formed from cholesterol and bile salts. When there is too much cholesterol in the bile, it can form stones that may lead to inflammation of the gallbladder (cholecystitis).
Correct Answer is B
Explanation
A. "Vomiting blood or material that looks like coffee grounds is a serious sign that I need to go to the emergency room." This is a correct understanding. Vomiting blood or coffee-ground material is a sign of gastrointestinal bleeding and requires immediate medical attention.
B. "If I experience severe abdominal pain, I should take an over-the-counter antacid and rest."
Taking an over-the-counter antacid without contacting a healthcare provider for severe pain could mask serious complications, such as recurrent bleeding or perforation, that need immediate medical attention. This statement indicates a need for further teaching.
C. "I should avoid taking NSAIDs like ibuprofen as they can increase my risk of bleeding." This is a correct understanding, as NSAIDs can cause or worsen gastric ulcers and increase the risk of bleeding.
D. "I should immediately report any black, tarry stools to my healthcare provider."This is a correct understanding. Black, tarry stools (melena) indicate upper gastrointestinal bleeding.
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