The nurse is preparing to administer medication using a client’s nasogastric tube. Which actions should the nurse take before administering the medication? Select all that apply.

Let’s calculate the IV infusion rate step by step.

Step 1: Determine the total volume to be infused.

The total volume ordered is 1,000 mL.

Step 2: Determine the total time for the infusion.

The total time is 8 hours.

Step 3: Calculate the infusion rate in mL per hour.

Total volume (1,000 mL) ÷ Total time (8 hours) = 125 mL per hour.

Result: 125

Step 4: Determine the drop factor.

The IV tubing delivers 15 drops per milliliter.

Step 5: Calculate the infusion rate in drops per minute.

Infusion rate (125 mL per hour) × Drop factor (15 drops per mL) = 1,875 drops per hour.

Result: 1,875

Step 6: Convert the infusion rate to drops per minute.

Total drops per hour (1,875 drops) ÷ 60 minutes = 31.25 drops per minute.

Result: 31.25

Step 7: Round the result to the nearest whole number if necessary.

31.25 rounded to the nearest whole number is 31.

The nurse should run the IV infusion at a rate of 31 drops per minute.

Choice A Reason:

Documenting that the nasogastric tube is in the correct place is not appropriate in this scenario. A gastric pH of 7.35 is too high for stomach contents, which typically have a pH between 1.5 and 3.5. This high pH suggests that the tube may be misplaced, possibly in the respiratory tract or another non-gastric location. Therefore, documenting the tube as correctly placed could lead to serious complications if the tube is indeed misplaced.

Choice B Reason:

Notifying the health care provider is the most appropriate action. A pH of 7.35 is indicative of a potential misplacement of the nasogastric tube. The health care provider needs to be informed immediately to take corrective actions, such as ordering an X-ray to confirm the tube’s placement or re-evaluating the tube’s position. This step is crucial to ensure patient safety and prevent complications such as aspiration pneumonia or other adverse effects.

Choice C Reason:

Checking for placement by auscultating for air injected into the tube is an outdated and unreliable method. This technique can sometimes give false assurance of correct placement, as the sound of air can be heard even if the tube is in the respiratory tract. Current best practices recommend using pH testing and radiographic confirmation for accurate placement verification.

Choice D Reason:

Retesting the pH using another strip might seem like a reasonable step, but it is not the best immediate action. If the initial pH test shows a value of 7.35, it is unlikely that retesting will yield a significantly different result. The priority should be to notify the health care provider to address the potential misplacement promptly.

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