The nurse is ready to begin a tube feeding via an NG feeding tube for a patient who is comatose. What action should the nurse take before starting the feeding?
a. Listen to bowel sounds.
b. Check the pH of gastric aspirate.
c. Secure the NG tube with additional tape.
d. Irrigate the tube with 10 mL of sterile water.
ANS: B
Prior to instilling anything into the NG tube, it is essential to verify placement of the NG tube; after x-ray is performed, the preferred method of verification is to check the pH of the gastric aspirate. A. Bowel sounds can be auscultated at any time. C. The NG tube should have been secured after insertion. D. The tube is irrigated with normal saline and not sterile water.
You might also like to view...
As the LPN/LVN collects data about a client, she uses critical thinking skills to: Standard Text: Select all that apply
1. Organize data. 2. Use subjective data to develop nursing diagnoses. 3. Use objective data to develop nursing diagnoses. 4. Use irrelevant data to develop nursing diagnoses. 5. Report information.
A patient is brought to the emergency department after being bitten by a rattlesnake. The nurse asks the patient to describe the snake that bit him. Why would the nurse ask this question?
A) Antivenin is very specific for antigens to which they can respond. B) Antivenin can only respond to cells that have not been attacked by the venom. C) Antivenin only responds to a specific group of spiders or snakes. D) Antivenin is very non-specific about a class of snakes or spiders.
The nurse, planning care for a client with Parkinson disease (PD), identifies which intervention as supporting mobility while providing the spouse with an activity that is beneficial for the client?
A) Suggest that the spouse use a blender to make foods easier for the client to swallow. B) Review the medication administration schedule with the spouse. C) Instruct the spouse to ambulate the client at least four times a day. D) Instruct the spouse on proper turning and repositioning techniques.
The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. This result is:
a. within therapeutic limits. b. below therapeutic limits. c. above therapeutic limits. d. invalid because of the time lapse since the last dose.