A nurse is preparing to administer enteral medication to a client who has a gastrostomy tube. Which of the following actions should the nurse take first?
Flush the tube with water.
Measure stomach contents.
Elevate the head of the bed.
Return gastric content into the gastrostomy tube.
The Correct Answer is B
A. Flushing the tube with water is necessary after checking residual stomach contents to clear the tube, but measuring stomach contents comes first to ensure the tube is clear for proper medication administration.
B. Measuring stomach contents is crucial before administering enteral medication to confirm the tube's placement and ensure medication reaches the stomach appropriately, preventing complications such as aspiration.
C. Elevating the head of the bed is important during and after enteral feeding to prevent aspiration, but it is not the first action before medication administration.
D. Returning gastric content into the gastrostomy tube may be necessary after assessing and managing residual stomach contents, but it is not the initial step in medication administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Asking the client to remain in a side-lying position comes after administering the drops to facilitate medication retention, but it's not the first action.
B. Pulling the client's pinna down and back straightens the ear canal, but this technique is used for children < 3years. For adults the pinna should be pulled upwards and outwards.
C. Warming the medication may not be necessary to prevent dizziness.
D. Placing a cotton ball in the ear canal after instillation is not necessary for otic medication administration and should not be done routinely.
Correct Answer is C
Explanation
A. Lecture involves one-way communication where information is delivered by the nurse to the client without active participation. It does not confirm understanding or assess learning through client feedback.
B. Question and answer involves the nurse posing questions to assess understanding but may not actively involve the client in demonstrating knowledge or skills.
C. Teach-back is an effective teaching method where the nurse asks the client to explain the procedure back in their own words. This technique helps assess the client's understanding, clarify information, and reinforce learning, promoting patient empowerment and adherence to treatment plans.
D. Role play involves simulating scenarios to practice skills or behaviors, which may not directly assess the client's understanding of a specific procedure.
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