A client returns from surgery with a nasogastric tube and intermittent gastric suction to provide abdominal decompression. Which of the following are correct nursing activities for managing the equipment and drainage? Select all that apply. a. When irrigating the nasogastric tube, use sterile water b. Document the consistency and amount of drainage c. Wear sterile gloves when irrigating the nasogastric tube d. Wear nonsterile gloves when emptying the drainage container e. Apply water-soluble lubricant if the client’s lips are dry
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A client returns from surgery with a nasogastric tube and intermittent gastric suction to provide abdominal decompression. Which of the following are correct nursing activities for managing the equipment and drainage? Select all that apply.
When irrigating the nasogastric tube, use sterile water
Document the consistency and amount of drainage
Wear sterile gloves when irrigating the nasogastric tube
Wear nonsterile gloves when emptying the drainage container
Apply water-soluble lubricant if the client’s lips are dry
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- The nurse is administering a medication to a patient via anasogastric tube. Which are accurate guidelines related to thisprocedure? Select all that apply.a. Crush the enteric-coated pill for mixing in a liquid.b. Flush open the tube with 60 mL of very warm water.c. Check for proper placement of the nasogastric tube.d. Give each medication separately and flush with waterbetween each drug.e. Lower the head of the bed to prevent reflux.f. Adjust the amount of water used if patient’s fluid intake isrestricted.Which assessments and interventions should the nurseconsider when performing tracheal suctioning? Selectall that apply.a. Closely assess the patient before, during, and after theprocedure.b. Hyperoxygenate the patient before and aftersuctioning.c. Limit the application of suction to 20 to 30 seconds. d. Monitor the patient’s pulse frequently to detectpotential effects of hypoxia and stimulation of thevagus nerve.e. Use an appropriate suction pressure (80–150 mm Hg).f. Insert the suction catheter no further than 1 cm past thelength of the tracheal or endotracheal tube.Which among the following is an appropriate nursing care after Foley's catheter insertion? a. if the patient feels discomfort, instruct the him to take deep breaths and reassure him that this is a normal sign b. instruct the patient to pull off the Foley's catheter if he feels pain.. c. attach the drainage bag above the level of the bladder. d. attach the drainage bag below the level of bladder.
- A nurse is caring for a patient who has a nasogastric tube inplace for gastric decompression. Which nursing actions areappropriate when irrigating a nasogastric tube connected tosuction? Select all that apply.a. Draw up 30 mL of saline solution into the syringe.b. Unclamp the suction tubing near the connection site toinstill solution. c. Place the tip of the syringe in the tube to gently insertsaline solution.d. Place syringe in the blue air vent of a Salem sump ordouble-lumen tube.e. After instilling irrigant, hold the end of the NG tube overan irrigation tray.f. Observe for return flow of NG drainage into an availablecontainer.A nurse is administering a blood transfusion for a patient following surgery. During the transfusion, the patient dis-plays signs of dyspnea, dry cough, and pulmonary edema. What would be the nurse’s priority actions related to thesesymptoms?a. Slow or stop the infusion; monitor vital signs, notify thephysician, place the patient in upright position with feetdependent.b. Stop the transfusion immediately and keep the vein openwith normal saline, notify the physician stat, administerantihistamine parenterally as needed.c. Stop the transfusion immediately and keep the veinopen with normal saline, notify the physician, andtreat symptoms.d. Stop the infusion immediately, obtain a culture of thepatient’s blood, monitor vital signs, notify the physician,administer antibiotics stat.A nurse is administering heparin subcutaneously to a patient.What is the correct technique for this procedure?a. Aspirate before giving and gently massage after theinjection.b. Do not aspirate; massage the site for 1 minute.c. Do not aspirate before or massage after the injection. d. Massage the site of the injection; aspiration is not neces-sary but will do no harm.
- A client is prescribed and receiving hydromorphone. Upon assessment the client's respiratory rate is 11 breaths per minutes. What is the most appropriate next action by the nurse? A. Administer the hydromorphone as scheduled B. Apply oxygen before hydromorphone administration C. Hold the hydromorphone and contact the prescriber D. Discontinue the hydromorphoneA nurse is caring for a patient who has a nasogastric tube inplace for gastric decompression. Which nursing actions areappropriate when irrigating a nasogastric tube connected tosuction? Select all that apply.a. Draw up 30 mL of saline solution into the syringe.b. Unclamp the suction tubing near the connection site toinstill solution.While Administering an enema, the patient complains of abdominal cramps. Which of the following is the best action by the nurse? Answer Choices: a. Continue giving enema as abdominal cramping is a normal phenomenon. b. Slow down the rate of infusion c. Stop giving the enema d. Administer analgesics
- A nurse is monitoring a patient who is receiving an IVinfusion of normal saline. The patient is apprehensive andpresents with a pounding headache, rapid pulse rate, chills,and dyspnea. What would be the nurse’s priority interventionrelated to these symptoms?a. Discontinue the infusion immediately, monitor vitalsigns, and report findings to primary care providerimmediately.b. Slow the rate of infusion, notify the primary care providerimmediately and monitor vital signs.c. Pinch off the catheter or secure the system to prevent entryof air, place the patient in the Trendelenburg position, andcall for assistance.d. Discontinue the infusion immediately, apply warm, moistcompresses to the site, and restart the IV at another site.What is the priority assessment for the nurse to evaluate the effectiveness of the furosemide for this patient? A. Assess breath sounds B. provide incentive spirometer C. begin CPR D. raise the head of the bed E. apply oxygenthe nurse is presenting a post conference seminar to a group of nursing students on the topic of nasal/oral suctioning of a child. which statement made by a student demonstrates a need for further instruction on the procedure. a. sterile normal saline drops are used to looosen the dried secretions prior to nasal suctioning b. If possible, the child should be asked to cough before suctioning c. The purpose of this form of suctioning is to removes secretions from the nose and mouth d. Such suturing is only done with a bulb syring