A nurse is contributing to the plan of care of a client who is postoperative following a gastrectomy and has a double-lumen nasogastric (NG) tube. Which of the following interventions should the nurse include in the plan?

Avoid replacing the NG tube if it is accidentally dislodged.

Irrigate the blue pigtail port with sterile saline.

Verify tube placement by injecting air into the larger lumen.

Avoid the nares when providing hygiene care.

Answer and Explanation

The Correct Answer is A

A. Avoid replacing the NG tube if it is accidentally dislodged: After a gastrectomy, improper placement or reinsertion of the NG tube can disrupt the surgical site, leading to complications such as bleeding, leakage, or perforation. If the tube is accidentally dislodged, the nurse should notify the surgeon or provider, as reinsertions in postoperative gastric surgery clients are typically performed under their direction.

B. Irrigate the blue pigtail port with sterile saline: The blue pigtail port (air vent) of a double-lumen NG tube (e.g., Salem sump) should not be irrigated with saline because it functions as an air vent to prevent suction from damaging the stomach lining.

C. Verify tube placement by injecting air into the larger lumen: Injecting air to verify NG tube placement is no longer considered a reliable or evidence-based practice. Placement should be verified by other methods, such as aspiration of gastric contents, pH testing, or radiographic confirmation, especially in postoperative clients.

D. Avoid the nares when providing hygiene care: Hygiene care for the nares is essential to prevent skin breakdown and discomfort in clients with an NG tube. Neglecting the nares could lead to excoriation, pressure injuries, or infection.

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Correct Answer is B

Explanation

A. A nephrostomy tube to a drainage bag:
A nephrostomy tube drains urine from the kidney to a drainage bag. While it's essential for urinary drainage, it doesn't lead to significant potassium loss, as potassium is primarily excreted through the urine.

B. An NG tube to suction:
An NG tube (Nasogastric tube) is inserted through the nose into the stomach. When connected to suction, it can remove stomach contents, including gastric acid and potassium. Excessive suctioning can lead to significant potassium loss, potentially causing hypokalemia.

C. An indwelling urinary catheter to gravity drainage:
An indwelling urinary catheter drains urine from the bladder into a drainage bag by gravity. While potassium can be found in urine, the drainage through a catheter does not cause significant potassium loss unless there are underlying kidney issues, which are not specified in this scenario.

D. A chest tube to water-seal drainage:
A chest tube removes air or fluid from the pleural space around the lungs. While chest tubes are vital for lung expansion, they don't result in significant potassium loss as they are not connected to body fluids rich in potassium, like gastric acid or urine.

A. Perform leg exercises every 2 hr. B. Irrigate the nasogastric tube every 4 to 8 hr. C. Maintain bed rest for 48 hr following surgery. D. Encourage hourly use of an incentive spirometer while awake. E. Document the color, consistency, and amount of nasogastric drainage.

Correct Answer is ["A","D","E"]

Explanation

A. Perform leg exercises every 2 hr:
After surgery, especially abdominal surgery, patients are at risk of developing deep vein thrombosis (DVT) due to decreased mobility. Performing leg exercises every 2 hours helps in improving blood circulation and preventing blood clots in the legs.

B. Irrigate the nasogastric tube every 4 to 8 hr:
Irrigating the nasogastric tube (inserting fluid into the tube) at regular intervals is not a standard practice. Nasogastric tubes are primarily used for decompression (removing stomach contents) or drainage, not for irrigation. Inserting fluids without a specific medical reason can disrupt the balance in the gastrointestinal tract and lead to complications.

C. Maintain bed rest for 48 hr following surgery:
Encouraging early mobility is a standard practice after surgery. Prolonged bed rest increases the risk of complications such as pneumonia, blood clots, and muscle weakness. Patients are typically encouraged to start moving and walking around as soon as it's safe to do so, usually within a few hours to a day after surgery, depending on the type of surgery and the patient's overall condition.

D. Encourage hourly use of an incentive spirometer while awake:
An incentive spirometer is a medical device used to help patients improve the functioning of their lungs. It encourages patients to take slow, deep breaths, which helps in expanding the lungs and preventing atelectasis (partial lung collapse) that can occur after surgery when patients may not be taking deep breaths as usual.

E. Document the color, consistency, and amount of nasogastric drainage:
Monitoring and documenting the characteristics of nasogastric drainage is essential for assessing the patient's condition. Changes in the color, consistency, or amount of drainage can indicate various issues, including bleeding, infection, or bowel perforation. This documentation helps the healthcare team make informed decisions about the patient's care.

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A nurse is contributing to the plan of care of a client who is postoperative following a gastrectomy and has a double-lumen nasogastric (NG) tube. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for four clients who have drainage tubes. The nurse should identify the client who has which of the following tubes as being at risk for hypokalemia?

Correct Answer is B

Explanation

A nurse is assisting in the plan of care for a client who had surgery for a bowel obstruction. The client has a nasogastric tube in place. Which of the following actions should the nurse include in the client's plan of care? (Select all that apply.)

Correct Answer is ["A","D","E"]

Explanation

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