A nurse is collecting data from a client who has an NG tube in place for gastric decompression. Which of the following findings should the nurse report to the provider?
Greenish-yellow drainage
Report of hunger
Gastric contents are present in the air vent
Abdominal distention
The Correct Answer is C
Choice A reason: This is not the correct answer because greenish-yellow drainage is a normal color for gastric secretions and does not indicate a problem.
Choice B reason: This is not the correct answer because a report of hunger is common for a client with an NG tube and does not require intervention.
Choice C reason: This is the correct answer because gastric contents in the air vent mean that the NG tube is clogged or kinked and needs to be flushed or replaced. This is the correct answer because it indicates that the NG tube is not functioning properly and could cause aspiration or infection. The other findings are expected or normal for a client with an NG tube.
Choice D reason: This is not the correct answer because abdominal distention is a common reason for placing an NG tube and should improve with gastric decompression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not the correct answer because the FLACC scale is designed for infants and children who are unable to verbalize their pain, not for adults who speak a different language.
Choice B reason: This is not the correct answer because asking an assistive personnel to interpret is not a reliable or ethical way of communicating with the client. The nurse should use a professional interpreter or a certified bilingual staff member.
Choice C reason: This is the correct answer because a communication board is a simple and effective way of assessing the client's pain level and location.
Choice D reason: This is not the correct answer because the FACES pain scale is based on facial expressions that may vary across cultures and languages. The client may not understand or relate to the pictures on the scale.
Correct Answer is C
Explanation
Choice A reason: You do not need to have advance directives in place in order to refuse recommended treatment. Advance directives are legal documents that allow you to express your wishes for your health care in case you are unable to communicate or make decisions for yourself. You have the right to accept or refuse any treatment at any time, as long as you are competent and informed.
Choice B reason: An attorney is not needed in order for you to name a designee in your health care proxy. A health care proxy is a type of advance directive that allows you to appoint a person to make health care decisions for you if you are unable to do so. You can choose anyone you trust, such as a family member or a friend, as your designee. You do not need a lawyer to complete a health care proxy form, but you need to sign it in front of two witnesses.
Choice C reason: You can decline to have certain medical procedures performed in your living will. A living will is another type of advance directive that allows you to state your preferences for life-sustaining treatments, such as CPR, artificial ventilation, or feeding tubes. You can specify which treatments you want or do not want, and under what circumstances. You can also include your values and beliefs about your quality of life and end-of-life care.
Choice D reason: A living will cannot be an oral statement that you agree upon with your provider. A living will must be a written document that is signed by you and witnessed by two people. An oral statement may not be legally valid or enforceable, and it may not reflect your current wishes. You should review and update your living will periodically, and share it with your provider, your designee, and your family.
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