A nurse is checking for proper placement of a feeding tube.
Which of the following methods is the most reliable for verification of tube placement?

Choice A rationale

Documenting the refusal in the client's medical record is important for legal and clinical reasons, ensuring there's a record of the client's decision and the nurse's response. However, it doesn't address the client's immediate concerns or needs.

Choice B rationale

Returning the medication to the medication cabinet is a necessary step to ensure medication safety and avoid accidental administration. Yet, it does not address the client's reasons for refusal or the potential risks involved.

Choice C rationale

The nurse’s first action should be to provide client education about the importance of taking the medication and the potential consequences of refusal (e.g., increased blood pressure, risk of stroke or heart attack). Addressing the client’s concerns about side effects can encourage adherence or lead to an alternative treatment plan.Client autonomy is respected, but ensuring informed refusal is part of the nurse’s role.

Choice D rationale

The provider should be informed, but only after the nurse has attempted to educate and address the client’s concerns. The provider may adjust the prescription if side effects are problematic.

Choice A rationale

Avoid placing toilet tissue in the bedpan after defecation to prevent contamination of the stool specimen. Toilet tissue can introduce foreign substances that may interfere with lab results.

Choice B rationale

Urinate after the specimen collection is incorrect because urine can contaminate the stool sample. The client should urinate before collecting the stool specimen to avoid mixing the two.

Choice C rationale

Placing 1.3 cm (0.5 in) of formed stool into a culture tube is insufficient for a proper stool sample. Typically, a larger sample is needed to ensure enough material is available for testing.

Choice D rationale

Keeping the specimen in a warm area is incorrect because stool samples should be kept in a cool environment to preserve the integrity of the specimen until it can be analyzed.