The charge nurse observes a newly hired nurse who is preparing to insert a nasogastric tube. Which action by the charge nurse takes priority?
Demonstrate correct measurement of the tube insertion length.
Remind the nurse to apply lubricant to the tube before insertion.
Confirm that the nurse has auscultated the client's bowel sounds.
Elevate the head of the bed before the nurse inserts the tube.
The Correct Answer is A
Choice A
Demonstrating correct measurement of the tube insertion length is the first priority. Inserting a nasogastric tube to the appropriate length is crucial for ensuring that the tube reaches the stomach and is not inserted too far. Incorrect insertion length can lead to complications, discomfort, or potential harm to the patient. Therefore, demonstrating and ensuring the correct measurement of the tube insertion length takes priority.:
Choice B
Reminding the nurse to apply lubricant to the tube before insertion is not first priority. Applying lubricant helps ease the insertion process, but it is not the most critical step to prioritize initially.
Choice C
Confirming that the nurse has auscultated the client's bowel sounds is not the first priority. Bowel sounds assessment is important to ensure proper placement, but this step can be done after ensuring the correct measurement of the insertion length.
Choice D
Elevating the head of the bed before the nurse inserts the tube is not the first priority: Elevating the head of the bed helps facilitate the passage of the tube into the stomach, but it is not the first priority in this context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A
Beef broth should not be omitted. Generally, clear broths like beef broth are lower in fat and may be a better choice for someone with cholelithiasis compared to creamy or fatty foods.
Choice B
Ketchup should not be omitted. Ketchup is not typically high in fat and may not be a significant concern for someone with cholelithiasis.
Choice C
Ice cream should be omitted. Cholelithiasis refers to the presence of gallstones in the gallbladder. Gallstones can form from substances in the bile, and certain foods can trigger symptoms in individuals with gallbladder issues. One of the common triggers is high-fat foods, which can cause the gallbladder to contract and potentially lead to pain or discomfort.
Choice D
Bread should not be omitted. While bread contains some fat, it's not as high in fat as ice cream. The focus for individuals with cholelithiasis is often on high-fat foods rather than moderate-fat foods like bread.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A
Grilled salmon is correct. Salmon is a good source of protein and healthy omega-3 fatty acids. Protein is essential for wound healing and tissue repair, while omega-3 fatty acids have anti-inflammatory properties that can help with the healing process.
Choice B
Soda crackers is incorrect. Soda crackers are not particularly nutrient-dense and may not contribute significantly to postoperative healing. While they might be a bland option for settling the stomach, they do not offer the same nutritional benefits as the other selected options.
Choice C
Scrambled eggs are correct. Eggs are a good source of high-quality protein and contain essential nutrients like vitamin D and choline. Protein is crucial for tissue repair and recovery, and vitamin D supports bone health.
Choice D
Baked chicken is correct: Lean protein sources like baked chicken are important for wound healing and maintaining muscle mass. Protein helps the body repair and build new tissues.
Choice E
Flavoured gelatine is correct. Flavoured gelatine can be a soft and easily digestible source of hydration and calories. It's also a good option for someone recovering from surgery as it provides some energy and can be gentle on the digestive system.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today