The nurse is changing the PN tubing. What action should the nurse take to prevent an air embolus?
Have the patient turn on the left side and perform a Valsalva maneuver.
Have the patient cough vigorously when tubing is disconnected.
Have the patient take a deep breath and hold it.
Place patient in supine position with head of bed elevated 90 degrees.
The Correct Answer is A
Changing parenteral nutrition (PN) tubing involves central venous access in many patients. Any open central line connection can allow air to be entrained into the venous system; increasing intrathoracic/central venous pressure during the change and positioning the patient appropriately reduces that risk.
Rationale for correct answer:
1. Have the patient turn on the left side and perform a Valsalva maneuver: The Valsalva increases intrathoracic and central venous pressure so air is less likely to be sucked into the central venous catheter during disconnection. Placing the patient on the left side helps trap any entrained air in the right atrium/ventricle and away from the pulmonary outflow.
Rationale for incorrect answers:
2. Have the patient cough vigorously when tubing is disconnected: Coughing can transiently raise intrathoracic pressure but is uncontrolled and may dislodge lines or cause complications.
3. Have the patient take a deep breath and hold it: Holding a deep breath raises intrathoracic pressure somewhat, but a true Valsalva (forced expiration against a closed glottis or “bear down”) is more effective.
4. Place patient in supine position with head of bed elevated 90 degrees: Head-up positioning lowers central venous pressure and increases the risk of air being entrained.
Take home points:
When manipulating central lines or changing PN tubing:
- clamp the catheter when possible
- prime tubing carefully to remove air
- have the patient perform a Valsalva or exhale-and-hold during disconnection to raise central venous pressure
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Enteral nutrition through nasogastric (NG) tubes is a common nursing intervention for patients who cannot eat orally. The stomach acts as a natural reservoir, allowing gradual delivery of nutrients. Understanding the physiologic advantage of gastric feeding helps nurses prevent complications such as dumping syndrome and metabolic imbalances.
Rationale for correct answer:
1. Dumping syndrome: The stomach regulates the flow of food into the small intestine, reducing the risk of rapid emptying that causes diarrhea, cramping, and hypoglycemia.
Rationale for incorrect answers:
2. Duodenal ulcers: NG feeding does not prevent ulcer formation. Ulcers are primarily linked to H. pylori infection, NSAID use, or acid imbalance.
3. Hyperglycemia: Hyperglycemia is more related to the composition of feedings and metabolic regulation, not the site of feeding.
4. Gastric ulcers: Feeding into the stomach does not specifically prevent gastric ulcers.
Take home points:
- The stomach acts as a reservoir that prevents dumping syndrome by regulating nutrient flow.
- NG feeding must be monitored carefully for tolerance, aspiration, and correct placement.
Correct Answer is B
Explanation
Safe placement of a small-bore nasally placed feeding tube (Dobhoff tube or similar) is crucial for effective nutrition delivery and to prevent complications such as aspiration pneumonia.
Rationale for correct answer:
2. The stomach is the most common site for small-bore nasogastric feeding tube placement. It allows for bolus or continuous feeding, easy monitoring, and is the safest initial site. Placement is verified by X-ray before feeding begins.
Rationale for incorrect answers:
1. The esophagus is the passageway from the throat to the stomach. If a feeding tube tip remains here, formula could easily reflux into the airway and cause aspiration.
3. Feeding tubes are not advanced into the large intestine. The large bowel’s function is fluid absorption and stool formation, not nutrient absorption.
4. In some cases, feeding tubes are advanced past the stomach into the duodenum or jejunum, especially for patients at high risk of aspiration (e.g., impaired gastric emptying, severe reflux). While this is appropriate, it requires specialized placement.
Take home points:
- Small-bore nasogastric feeding tubes are most commonly placed in the stomach.
- Placement in the small intestine (jejunum/duodenum) is used for patients at high aspiration risk, but never in the esophagus or large intestine.
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