The client experiencing abdominal distention and severe vomiting has just had a nasogastric (NG) tube inserted. When teaching this client, which rationale for the use of the NG tube should the nurse include?

Decompressing the stomach

Administering medications

Determining the pH of the gastric secretions

Supplying nutrients via tube feedings

Answer and Explanation

The Correct Answer is A

A. One of the primary purposes of inserting an NG tube is to decompress the stomach by removing gastric contents. In the case of abdominal distention and severe vomiting, excess gas and fluid accumulation in the stomach can contribute to discomfort and further vomiting. The NG tube provides a way to suction out these contents, relieving pressure and reducing symptoms.
B. NG tubes can also be used to administer medications directly into the stomach. This route is particularly useful when a client is unable to take medications orally due to vomiting or other gastrointestinal issues. Medications can be crushed and dissolved in liquid form before being administered through the NG tube.
C. In some situations, such as when assessing for gastrointestinal bleeding or checking for tube placement, it may be necessary to determine the pH of gastric secretions. Gastric aspirate obtained through the NG tube can be tested for acidity, which can help confirm that the tube is correctly positioned in the stomach and provide information about the client's digestive function.
D. While NG tubes can be used to supply nutrients via tube feedings, this is not typically the primary rationale for their use in the acute situation described (abdominal distention and severe vomiting). However, in cases where a client is unable to tolerate oral intake due to their condition, tube feedings can be administered through the NG tube to provide essential nutrients and maintain nutritional status.

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Correct Answer is D

Explanation

D. fluids and medications that may be irritating to peripheral veins can be given through a central venous access device (CVAD). CVADs are beneficial because they allow for the administration of vesicants, irritant solutions, or large volumes of fluid that could damage smaller, peripheral veins. They also provide reliable venous access for patients who are critically ill, have poor venous access, or require long-term medication treatment, such as for pain, infection, cancer, or to supply nutrition.
A. While central lines do have a risk of sepsis, it is not necessarily lower than peripheral sites
B. Patency confirmation methods are not exclusive to CVADs and are also applicable to peripheral IV catheters.
C. Both placement and maintenance require strict aseptic techniques to minimize the risk of infection.

A. Administer an intravenous sedative B. Assess the client for seizure activity C. Assist the client in slowed breathing techniques D. Check the client's blood pressure

Correct Answer is C

Explanation

C. Assisting the client in slowed breathing techniques is the most appropriate initial intervention for a client experiencing hyperventilation due to acute psychological stress. Slowed breathing techniques, such as pursed-lip breathing or diaphragmatic breathing, can help normalize respiratory rate and depth, thereby correcting the respiratory alkalosis. Encouraging the client to breathe slowly and deeply can help reduce the respiratory rate and restore a more balanced acid-base status.
A. Administering a sedative may not be the initial intervention for a client experiencing hyperventilation due to acute psychological stress. Sedatives can depress the respiratory drive further and may exacerbate respiratory alkalosis. Additionally, administering sedatives should be based on a comprehensive assessment and medical prescription, rather than as a first-line intervention for hyperventilation.
B. While hyperventilation can sometimes lead to symptoms resembling seizure activity (such as muscle twitching or numbness), assessing for seizure activity is not typically the initial intervention for respiratory alkalosis. In the context of acute psychological stress causing hyperventilation, addressing the hyperventilation itself is the priority.
D. While monitoring vital signs, including blood pressure, is important in assessing the client's overall condition, it is not the initial intervention specifically for addressing respiratory alkalosis due to hyperventilation. The priority in this situation is to address the hyperventilation itself through appropriate breathing techniques.

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The client experiencing abdominal distention and severe vomiting has just had a nasogastric (NG) tube inserted. When teaching this client, which rationale for the use of the NG tube should the nurse include?

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Naxlex Comprehensive Predictor Exams

The nurse knows that an advantage of using a central venous access device is that:

Correct Answer is D

Explanation

A client is hyperventilating due to an acute psychologic stressor. The arterial blood gas results show that the client is in respiratory alkalosis. What is the nurse's initial intervention?

Correct Answer is C

Explanation

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