he nurse is caring for a client who has a bowel obstruction and a new prescription for the insertion of a nasogastric tube. Which of the following interventions should the nurse take when inserting the nasogastric tube?
Instruct the client to place his chin to his chest and swallow.
Withdraw the tube if the client gags during insertion.
Place the client in a supine position.
Measure the tube for insertion from the tip of the nose to the umbilicus.
The Correct Answer is A
a. Instruct the client to place his chin to his chest and swallow: This technique helps facilitate the passage of the nasogastric tube through the pharynx and into the esophagus.
b. Withdraw the tube if the client gags during insertion: Gagging is a normal response, and
withdrawing the tube may lead to repeated attempts and discomfort for the client. Encouraging the client to swallow can help overcome the gag reflex.
c. Place the client in a supine position: The client is usually positioned in a semi-Fowler's position or upright to ease tube insertion and minimize the risk of aspiration.
d. Measure the tube for insertion from the tip of the nose to the umbilicus: The proper
measurement for nasogastric tube insertion is typically from the tip of the nose to the earlobe and then down to the xiphoid process, not the umbilicus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale for A: Taking enteric-coated pills with meals is generally acceptable as food does not affect the integrity of the enteric coating. The coating is designed to withstand the acidic environment of the stomach and dissolve in the more neutral pH of the intestine.
Rationale for B: Enteric-coated tablets should not be crushed as this destroys the coating designed to protect the stomach lining from the medication's potentially irritating effects, ensuring the medication is released in the intestine.
Rationale for C: This statement is correct; enteric-coated medications are formulated to bypass the stomach and dissolve in the intestine, which can help minimize gastric side effects and irritation.
Rationale for D: It is common for anti-inflammatory medications like naproxen to take several weeks to reach full efficacy. This statement reflects a correct understanding of the medication's expected onset of action.
Correct Answer is A
Explanation
a. Determine the patency of the tubing: The first action should be to assess for any obstruction or kinks in the tubing. A blockage may be preventing the flow of urine.
b. Notify the provider: While notifying the provider may be necessary, assessing the tubing for patency is a more immediate action.
c. Offer oral fluids: While hydration is important, the priority is to ensure that the urinary catheter is functioning properly.
d. Administer a prescribed analgesic: Pain management is important postoperatively, but the
immediate concern is the lack of urinary output, which requires assessment and intervention to rule out catheter obstruction.
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