Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A patient's NG tube has become clogged after the nurse instilled a medication that was insufficiently crushed. The nurse has attempted to aspirate with a large-bore syringe, with no success. What should the nurse do next?
A. Remove the NG tube promptly and obtain an order for reinsertion from the primary care provider.
Removing the NG tube without further attempts to unclog it may not be necessary and could be an unnecessary intervention.
B. Attach a syringe filled with warm water and attempt an in-and-out motion of instilling and aspirating.
This statement is correct. Attempting to unclog the NG tube with warm water and an in-and-out motion is an appropriate next step.
C. Withdraw the NG tube slightly and attempt to dislodge by flicking the tube with the fingers.
Flicking the tube with the fingers may not be effective in dislodging the clog, and it could potentially cause harm to the patient.
D. Withdraw the NG tube 3 to 5 cm and reattempt aspiration.
Withdrawing the tube 3 to 5 cm may not effectively address the clog and could potentially lead to complications.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Med Surg Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason:
Removing the NG tube without further attempts to unclog it may not be necessary and could be an unnecessary intervention.
Choice B reason:
This statement is correct. Attempting to unclog the NG tube with warm water and an in-and-out motion is an appropriate next step.
Choice C reason:
Flicking the tube with the fingers may not be effective in dislodging the clog, and it could potentially cause harm to the patient.
Choice D reason:
Withdrawing the tube 3 to 5 cm may not effectively address the clog and could potentially lead to complications.
Similar Questions
A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?
A. Assess for signs of infection.
While assessing for signs of infection is important, ensuring a patent airway takes precedence immediately following surgery.
B. Assess for a patent airway.
This statement is correct. Assessing for a patent airway is the top priority in postoperative care to ensure the patient can breathe effectively.
C. Assess ability to clear oral secretions.
Assessing the ability to clear oral secretions is important, but it is secondary to ensuring a patent airway.
D. Assess for ability to communicate.
Assessing the ability to communicate is important, but it is not the immediate priority after surgical resection for oropharyngeal cancer.
Full Explanation
Choice A reason:
While assessing for signs of infection is important, ensuring a patent airway takes precedence immediately following surgery.
Choice B reason:
This statement is correct. Assessing for a patent airway is the top priority in postoperative care to ensure the patient can breathe effectively.
Choice C reason:
Assessing the ability to clear oral secretions is important, but it is secondary to ensuring a patent airway.
Choice D reason:
Assessing the ability to communicate is important, but it is not the immediate priority after surgical resection for oropharyngeal cancer.
A nurse is caring for a client who has acute pancreatitis.
Complete the following sentence.
When prioritizing client needs, the nurse should first address the
Full Explanation
-blood glucose level of 250 mg/dL, which indicates hyperglycemia and can worsen the inflammation of the pancreas
- hemoglobin level of 8 g/dL and hematocrit of 24%, which indicate anemia and can impair oxygen delivery to the tissues
A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client for which of the following findings as an indication of gastrointestinal perforation?
A. Increased blood pressure
Increased blood pressure is not typically associated with gastrointestinal perforation; hypotension may be more indicative.
B. Hyperactive bowel sounds
Hyperactive bowel sounds may be present in various gastrointestinal conditions, but they are not specific to perforation.
C. Bradycardia
Bradycardia is not a typical sign of gastrointestinal perforation; tachycardia may be more indicative of this condition.
D. Sudden abdominal pain
This statement is correct. Sudden abdominal pain is a key indication of gastrointestinal perforation, and it should be monitored closely.
Full Explanation
Choice A reason:
Increased blood pressure is not typically associated with gastrointestinal perforation; hypotension may be more indicative.
Choice B reason:
Hyperactive bowel sounds may be present in various gastrointestinal conditions, but they are not specific to perforation.
Choice C reason:
Bradycardia is not a typical sign of gastrointestinal perforation; tachycardia may be more indicative of this condition.
Choice D reason:
This statement is correct. Sudden abdominal pain is a key indication of gastrointestinal perforation, and it should be monitored closely.