A patient with a nasogastric (NG) tube in place is experiencing respiratory distress. What is the most appropriate initial nursing intervention?

Elevate the head of the bed to 90 degrees

Administer a bronchodilator as prescribed.

Check the placement of the NG tube to ensure it has not dislodged into the lungs.

Increase the flow rate of the patient’s oxygen therapy.

Answer and Explanation

The Correct Answer is C

A. Elevate the head of the bed to 90 degrees: While elevating the head of the bed may help ease breathing, it does not address the potential issue of NG tube misplacement.

B. Administer a bronchodilator as prescribed: This would only be appropriate if the patient’s respiratory distress were related to bronchospasm or asthma, not NG tube displacement.

C. Check the placement of the NG tube to ensure it has not dislodged into the lungs. When a patient with an NG tube experiences respiratory distress, the tube may have dislodged and entered the respiratory tract, which could obstruct breathing. Verifying the placement of the NG tube is critical to preventing aspiration or further complications.

D. Increase the flow rate of the patient’s oxygen therapy: This may provide temporary relief but does not resolve the underlying cause of the distress if the NG tube has entered the respiratory tract.

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Correct Answer is A

Explanation

A. A low-fat diet: A low-fat diet is recommended for clients with chronic cholecystitis to reduce the workload on the gallbladder and prevent biliary colic, which can be triggered by the digestion of fats.

B. A low-sodium diet: While a low-sodium diet may be recommended for other conditions, it is not specifically indicated for biliary colic or cholecystitis.

C. A high-fiber diet: Although fiber is beneficial for overall health, it does not directly prevent biliary colic related to cholecystitis.

D. A high-protein diet:A high-protein diet is not recommended for biliary colic. Fat content is the primary concern, not protein.

A. Instruct the patient to change positions slowly prevent dizziness and falls. B. Advise the patient to avoid all physical activity to prevent exacerbation of symptoms. C. Encourage the patient to drink plenty of fluids to prevent dehydration. D. Recommend wearing tight clothing to support the abdominal area.

Correct Answer is A

Explanation

A. Instruct the patient to change positions slowly to prevent dizziness and falls. Ascites can cause a shift in fluid balance, leading to orthostatic hypotension. Changing positions slowly reduces the risk of dizziness and falls, which are common in patients with fluid shifts.

B. Advise the patient to avoid all physical activity to prevent exacerbation of symptoms: Complete avoidance of physical activity is not recommended. Mild activity may help with overall health and mobility unless contraindicated. Bedrest is typically only recommended for acute or severe cases.

C. Encourage the patient to drink plenty of fluids to prevent dehydration: Patients with ascites are often on fluid restrictions to manage excess fluid accumulation. Encouraging excess fluid intake can worsen the condition.

D. Recommend wearing tight clothing to support the abdominal area: Tight clothing could cause discomfort and increase abdominal pressure, which could exacerbate symptoms or complications related to ascites.

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A patient with a nasogastric (NG) tube in place is experiencing respiratory distress. What is the most appropriate initial nursing intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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