A nurse is inserting an NG tube for a client. Which of the following actions should the nurse take?
Wear sterile gloves to insert the NG tube.
Ask the client to cough while inserting the NG tube.
Place the client into a left lateral position before inserting the NG tube.
Determine the length of the NG tube to be inserted prior to the procedure.
The Correct Answer is D
Choice A reason: Sterile gloves are not required for inserting an NG tube; clean gloves are sufficient as the nasal
cavity is not a sterile environment.
Choice B reason: The client should not be asked to cough while inserting the NG tube as this could disrupt the placement process. Instead, the client may be asked to swallow to facilitate the passage of the tube.
Choice C reason: Placing the client into a left lateral position is not the standard position for NG tube insertion. The
client should be in an upright or semi-Fowler's position to aid in the insertion process.
Choice D reason: Determining the length of the NG tube to be inserted is a crucial step to ensure that the tube
reaches the stomach without coiling in the esophagus or extending into the small intestine.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Evaluation is the final step of the nursing process, where the nurse assesses the client's response to the nursing interventions.
Choice B reason: Data Collection is the first step of the nursing process, where the nurse gathers information about the client's health status.
Choice C reason: Re-collection of Data may be necessary if there are changes in the client's condition, but it is not the immediate next step after planning.
Choice D reason: Implementation is the correct answer because it is the step where the nurse puts the care plan into action, following the planning step.
Correct Answer is C
Explanation
Choice A reason: Metabolic Acidosis typically results from conditions that increase acid production or decrease acid excretion, not from vomiting.
Choice B reason: Respiratory Acidosis is caused by hypoventilation leading to an accumulation of carbon dioxide, which is not directly related to vomiting.
Choice C reason: Metabolic Alkalosis can occur due to the loss of stomach acids through prolonged vomiting, leading to an excess of bicarbonate in the body fluids.
Choice D reason: Respiratory Alkalosis is usually caused by hyperventilation, not by vomiting.
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