NG Tube Insertion Answers and Rationale

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 Answer: C. Notify the physician that the attempts were unsuccessful. 

Rationale:  The nurse should notify the physician because he or she will need to attempt to insert the tube or determine another treatment option. Attempting to insert a tube again after trying both nares may harm the patient. Although documentation is necessary, it does not address the patient’s need for a nasogastric tube. Delaying an attempt at inserting the nasogastric tube does not ensure it will be successful and risks harming the patient. 

Answer:  B. Withdraw the tube to the nasopharynx.

Rationale: If the patient starts to cough, experiences a drop in oxygen saturation, or shows other signs of respiratory distress, withdraw the tube into the posterior nasopharynx until normal breathing resumes. Do not force the tube or push it against resistance. Coughing will not help remove the source of resistance; rather, it is an indication that the tube is misplaced. If the tube meets resistance, neither swallowing nor hyperextending the neck will help to advance it.

 Answer: A. A 28-year-old patient who fractured a femur after heavy drinking.

Rationale: Neither the patient’s broken femur nor the patient’s alcohol consumption would contraindicate placement of a nasogastric tube. A 73-year-old patient on anticoagulation therapy would be at high risk for bleeding, which is a contraindication for tube feeding. A 54-year-old patient with facial trauma is a contraindication for a nasogastric tube. A 67-year-old patient with unexplained nosebleeds would contraindicate placement of a nasogastric tube.

Answer: A. Examine each naris for patency and skin breakdown.

Rationale: Examining each naris for patency and signs of skin breakdown will help the nurse determine which naris will accommodate a nasogastric tube with less discomfort. Although the high-Fowler’s position is recommended for insertion of a nasogastric tube, the position itself will not reduce discomfort. Anesthetizing the throat would hinder the patient’s ability to swallow safely during insertion of the nasogastric tube. Sipping water will not reduce the patient’s discomfort.

Answer:  A. Positioning the patient in a high-Fowler’s position.

Rationale: Positioning the patient is within NAP scope of practice. NAP are not permitted to assess bowel sounds. It is not within NAP scope of practice to determine any portion of the patient’s medical history. Patient education may not be delegated to NAP.