A nurse is caring for a client who has a nasogastric (NG) tube in place for gastric decompression and notes that the tube is not draining. Which of the following steps should the nurse take first?

Reposition the NG tube.

Inject 20 mL of air and aspirate in the NG tube.

Instill an irrigation solution slowly.

Check the functioning of the suction equipment.

Answer and Explanation

The Correct Answer is D

Choice A reason: Repositioning the NG tube is a later step; checking suction function is first, as equipment failure is a common cause of no drainage. Assuming repositioning is initial risks delaying simple fixes, potentially prolonging discomfort, critical to avoid in ensuring effective gastric decompression.

Choice B reason: Injecting air and aspirating is a troubleshooting step but follows checking suction equipment, which may resolve no drainage. Assuming air injection is first risks unnecessary intervention, potentially causing discomfort, critical to prevent in ensuring efficient NG tube management for gastric decompression.

Choice C reason: Instilling irrigation solution is a later step after confirming suction function, as equipment issues are more common. Assuming irrigation is first risks clogging or discomfort, critical to avoid in ensuring proper NG tube function and effective gastric decompression in clients with non-draining tubes.

Choice D reason: Checking suction equipment function is the first step for a non-draining NG tube, as equipment failure is a common issue, easily corrected. This ensures effective decompression, critical for preventing gastric distention, supporting client comfort, and guiding further troubleshooting in managing NG tube care.

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Correct Answer is B

Explanation

Choice A reason: Elevating the bed to 45° increases bleeding risk at the femoral site post-catheterization; flat positioning is preferred. Assessing pulses is priority. Elevating risks hematoma, critical to avoid in ensuring vascular safety, monitoring for complications, and supporting recovery in immediate postoperative cardiac catheterization care.

Choice B reason: Assessing peripheral pulses every 15 minutes post-femoral catheterization monitors for arterial occlusion or bleeding, critical for detecting complications like hematoma or thrombosis. This ensures timely intervention, essential for vascular integrity, preventing limb ischemia, and supporting safe recovery in the immediate postoperative period.

Choice C reason: Changing the dressing 4 hours post-catheterization is premature unless soiled; initial monitoring of pulses is priority. Assuming dressing change is urgent risks disrupting the site, increasing bleeding, critical to avoid in ensuring site stability and vascular safety in immediate post-catheterization care.

Choice D reason: Flexing the right knee is contraindicated post-femoral catheterization, risking site disruption or bleeding; leg immobility is required. Assessing pulses is key. Instructing flexion risks hematoma, critical to prevent in ensuring vascular safety, monitoring complications, and supporting recovery in postoperative cardiac catheterization clients.

A. Use an electric razor when shaving while taking this medication. B. Avoid taking this medication with milk products. C. This medication can cause back pain. D. Avoid prolonged exposure to sunlight while taking this medication.

Correct Answer is A

Explanation

Choice A reason: Using an eight electric razor reduces bleeding risk in clients on warfarin, an anticoagulant that increases bleeding tendency, critical for safety. This instruction prevents cuts, essential for minimizing hemorrhage, supporting adherence, and ensuring safe daily activities in clients managing anticoagulation therapy.

Choice B reason: Milk products do not interact with warfarin; consistent vitamin K intake is key. Assuming milk avoidance is needed risks unnecessary dietary restriction, potentially affecting nutrition, critical to avoid in ensuring accurate dietary education for clients on warfarin therapy.

Choice C reason: Back pain is not a common warfarin side effect; bleeding is the primary concern. Assuming back pain is related risks misinforming the client, potentially causing unnecessary worry, critical to prevent in ensuring accurate education and safety for clients on anticoagulation therapy.

Choice D reason: Sunlight exposure does not significantly affect warfarin; photosensitivity is unrelated. Assuming sunlight avoidance is needed risks unnecessary lifestyle restrictions, critical to avoid in ensuring accurate teaching, focusing on bleeding precautions, and supporting safe warfarin use in clients requiring anticoagulation.

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A nurse is caring for a client who has a nasogastric (NG) tube in place for gastric decompression and notes that the tube is not draining. Which of the following steps should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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