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?

Choice A rationale

NPO (nothing by mouth) until dysphagia subsides might be a temporary measure immediately following a stroke to prevent aspiration. However, prolonged NPO status can lead to malnutrition and dehydration. The plan of care should aim for the safest and most effective route for nutritional support as soon as feasible, considering the patient's swallowing ability.

Choice B rationale

Initiation of total parenteral nutrition (TPN) is a method of providing nutrition intravenously, bypassing the gastrointestinal tract. TPN is typically reserved for patients with a non-functional or severely impaired digestive system. For a patient with dysphagia after a stroke, if the gastrointestinal tract is functional, enteral feeding (via a feeding tube) is often preferred over TPN due to its physiological benefits and lower risk of complications.

Choice C rationale

A mechanical soft diet consists of foods that are easy to chew and swallow. The texture of the food is altered (e.g., pureed, mashed, ground) to reduce the effort required for mastication and swallowing, thereby decreasing the risk of aspiration in patients with dysphagia. This type of diet is a common nutritional therapy for individuals with mild to moderate swallowing difficulties following a stroke.

Choice D rationale

Supplements via NG tube (nasogastric tube) involve delivering liquid nutritional formulas directly into the stomach through a tube inserted into the nose and down the esophagus. While an NG tube can provide necessary nutrition for patients with dysphagia, a gastrostomy tube (G-tube or PEG tube), placed directly into the stomach through the abdominal wall, is often preferred for long-term enteral feeding as it is generally more comfortable and less likely to cause irritation than an NG tube.

Choice A rationale

While mammography is a crucial tool for detecting breast cancer, particularly in women over 40, it is not a replacement for breast self-examination (BSE). Mammograms are radiographic images that can detect abnormalities, but BSE helps women become familiar with their own breasts and identify changes that may occur between mammograms.

Choice B rationale

Although annual clinical breast exams by a physician are important, they are not a substitute for monthly BSE. BSE allows women to regularly assess their breasts for any new lumps, changes in size or shape, skin thickening, or nipple discharge. These changes might occur between annual physician visits.

Choice C rationale

Mammograms are indeed effective in detecting breast cancer, often before a lump can be felt. However, BSE plays a vital role in increasing a woman's awareness of her breasts' normal texture and appearance. This familiarity enables her to notice subtle changes that may warrant further medical evaluation, complementing the benefits of mammography.

Choice D rationale

Mammograms are a highly reliable method for detecting breast cancer, especially in early stages. However, BSE is not unnecessary. It empowers women to take an active role in their breast health by promoting early detection of changes that might be indicative of cancer and can occur between scheduled mammograms.