A nurse is preparing to administer a nasogastric (NG) tube feeding to a school-age child. Which of the following actions should the nurse plan to take?
Measure the tubing from the nose to the distal port.
Position the chud at a 10 to 20 angle after feeding.
Complete the feeding in 5 min.
Warm the formula in the microwave
The Correct Answer is A
A. Measure the tubing from the nose to the distal port. Proper placement of an NG tube requires measuring from the tip of the nose to the earlobe, then to the xiphoid process. This ensures the tube reaches the stomach without curling or entering the airway.
B. Position the child at a 10 to 20 angle after feeding. A head elevation of at least 30 to 45 degrees is necessary during and after NG feedings to reduce the risk of aspiration. A 10 to 20 degree angle is too low and unsafe for post-feeding positioning.
C. Complete the feeding in 5 min. NG feedings should be given slowly over 20 to 30 minutes to prevent gastrointestinal discomfort, cramping, or vomiting. A 5-minute infusion is too rapid and may overwhelm the child’s digestive capacity.
D. Warm the formula in the microwave. Microwaving formula can lead to uneven heating and hot spots, which pose a burn risk to the child. Formula should be warmed by placing the container in warm water and testing the temperature before administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
A. Potential complications. The provider is responsible for informing the client of possible risks and complications associated with the procedure. This ensures the client understands what to expect and can make an informed decision.
B. Cost of the procedure. While cost is an important consideration, it is not part of the informed consent process that the provider must explain. Financial discussions are typically handled by billing or administrative personnel.
C. Possible alternative treatments. Informed consent includes a discussion of reasonable alternatives so the client can weigh all available options. This allows for autonomous decision-making regarding their care.
D. Explanation of the procedure. The provider must describe the nature and details of the procedure, including what it involves and how it will be performed. This ensures the client understands what they are consenting to.
E. Expected outcome of the procedure. Clients should be informed of the anticipated results and benefits of the surgery. This helps set realistic expectations and supports informed decision-making.
Correct Answer is B
Explanation
A. Perform the Credé’s maneuver. This technique, involving manual pressure on the bladder, is used to promote urination in clients with bladder retention. It is not appropriate for a client with a catheter and continuous bladder irrigation in place.
B. Maintain the irrigation solution rate. Pink-tinged urine is an expected finding 4 hours after a TURP as minor bleeding can occur. There is no need to adjust the irrigation rate unless clots form or the urine becomes bright red or obstructed.
C. Warm the irrigation solution. Warming the solution is not a standard intervention and does not directly manage postoperative bleeding or pink urine. Room temperature solution is typically used unless otherwise specified by the provider.
D. Replace the indwelling urinary catheter. There is no indication the catheter is malfunctioning or obstructed. Pink urine alone does not warrant replacement, and unnecessary catheter changes can increase infection risk.
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