While assessing placement of a nasogastric tube (NGT), the nurse aspirates cloudy green fluid into a syringe. Which intervention should the nurse implement?
Send fluid specimen to the lab.
Withdraw the NGT and reinsert.
Connect the NGT to wall suction.
Determine pH value of specimen.
The Correct Answer is A
Choice A
Sending fluid specimen to the lab should be implemented. Cloudy green fluid aspirated from a nasogastric tube (NGT) can indicate that the tube is in the wrong place, likely in the respiratory tract (trachea) instead of the gastrointestinal tract (stomach). The green colour suggests the presence of bile, which is normally found in the stomach but not in the respiratory tract. This is a serious situation that requires immediate attention.
The most appropriate intervention in this case is to send the fluid specimen to the lab for analysis. This is important for confirmation of the content and to guide further steps. The nurse should also consult the healthcare provider to determine the appropriate course of action, which might involve removing and reinserting the NGT correctly.
Choice B
Withdrawing the NGT and reinsert should not be implemented. If the NGT is in the wrong place, reinserting it without further assessment could worsen the situation. The nurse should not reinsert the NGT until the correct placement is confirmed.
Choice C
Connecting the NGT to wall suction should not be implemented. Connecting the NGT to wall suction without verifying its placement could cause harm, especially if the tube is in the respiratory tract.
Choice D
Determine pH value of specimen should not be implemented. While assessing the pH of aspirated fluid can help confirm the location of the NGT, sending the specimen to the lab for analysis is a more comprehensive action in this situation, as it allows for more detailed examination and guidance for appropriate next steps.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is B
Explanation
Choice A
Apples and blueberries are incorrect. While apples and blueberries are sources of nutrients, they are not as high in potassium as avocados and bananas.
Choice B
Avocados and bananas are correct. Chronic kidney disease (CKD) often requires dietary modifications to manage electrolyte and mineral imbalances. In CKD stage 4, the kidney's ability to filter waste and excess substances from the blood is significantly impaired. Therefore, certain foods that are high in potassium should be limited to prevent hyperkalaemia (elevated blood potassium levels).
Choice C
Cherries and cranberries are incorrect. Cherries and cranberries are also sources of nutrients, but their potassium content is not as high as that of avocados and bananas.
Choice D
Carrots and green beans are incorrect. Carrots and green beans are vegetables that are generally lower in potassium compared to fruits like avocados and bananas.
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