Advanced Skills Exam: NG Tubes

A client is admitted to the surgical unit from the postanesthesia care unit with a Salem sump nasogastric tube that is to be attached to wall suction. Which nursing action should the nurse implement when caring for this client? 1 Use normal saline to irrigate the tube 2 Employ sterile technique when irrigating the tube 3 Withdraw the tube quickly when decompression is terminated 4 Allow the client to have small sips of ice water unless nauseated

1. Patency of the tube should be maintained to ensure continued suction. Use of normal saline minimizes fluid and electrolyte disturbances during irrigation.

After a partial gastrectomy is performed, a client is returned from the postanesthesia care unit to the surgical unit with an IV solution infusing and a nasogastric tube in place. The nurse identifies that there is no nasogastric drainage for 30 minutes. There is an order for instillation of the nasogastric tube PRN. The nurse should instill: 1. 30 mL of NS and continue the suction 2. 20 mL of air and clamp off the suction for 1 hour 3. 50 mL of saline and increase the pressure of the suction 4. 15 mL of distilled water and disconnect the suction for 30 minutes.

1. Physiologic NS is used in gastric instillations to prevent electrolyte imbalance. Because of the fresh gastric sutures, slow and gentle instillation of saline should be performed to reestablish patency of the tube, and then the tube should be reconnected to suction to ensure stomach decompression.

The client has a NG tube connected to intermittent wall suction. The student nurse asks why the client's respiratory rate has decreased. What is your best response? 1. "It's common for clients with uncomfortable equipment such as NG tubes to have a lower rate of breathing" 2. "The client may have a metabolic alkalosis due to the NG suctioning, and the decreased respiratory rate is a compensatory mechanism." 3. "Whenever a client develops a respiratory acid-base problem, decreasing the respiratory rate helps correct the problem." 4. "The client is hypoventilating because of anxiety, and we will have to stay alert for the development of respiratory acidosis."

2. Nasogastric suctioning can result in a decrease in acid components and metabolic alkalosis. The client's decrease in rate and depth of ventilation is an attempt to compensate by retaining carbon dioxide. The first response may be true, but it does not address all the components of the question. The third and fourth answers are inaccurate.

Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is bright red. What should the nurse do FIRST? 1. Notify the health care provider 2. Clamp the nasogastric tube for one hour 3. Determine that this is an expected finding 4. Irrigate the nasogastric tube with iced saline

3. Nasogastric drainage is expected to be bright red during the first 12 hours after surgery; bleeding lessens gradually during the 12 hours after surgery in response to hemostasis in the surgical area.

A client is to have gastric lavage. In which position should the nurse place the client when the nasogastric tube is being inserted? 1. Supine 2. Mid-fowler 3. High-fowler 4. Trendelenburg

3. This position promotes optimal entry into the esophagus aided by gravity.