BAH Exam 3 - NG Tube & Diabetes Notes PDF

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Basic Adult Health Notes on NG tubes and Diabetes...

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Nasogastric Tube

1. A nurse is caring for a client who has a newly inserted nasogastric tube. Which of the following actions should the nurse use to verify the initial placement of the tube? Ans: Obtain an X-Ray Rationale: the nurse should identify that obtaining an x-ray is the most effective method to verify if the initial placement of a NG tube. 2. A nurse is teaching a group of unit nurses about clients who have a need for gastric decompression. The nurse should identify that which of the following clients needs nasogastric tube intubation for gastric decompression? Ans: A 40-year-old client who has a postoperative bowel obstruction Rationale: a client who has a postoperative bowel obstruction should have a NG tube inserted for decompression to remove gastric secretions. This will assist in relieving abdominal distention, nausea, and pain. Incorrect answers: - A 6-year-old child who ingested a toxic substance: a client who ingested a toxic substance should have a nasogastric tube inserted for gastric lavage within 1 hr. of ingestion. Gastric lavage is used to irrigate the stomach in cases of poisoning. - A 60-year-old client who has a gastrointestinal hemorrhage: a client who has a gastrointestinal hemorrhage should have a nasogastric tube inserted for compression. Gastric compression is an internal application of pressure caused by inflating a balloon. This can assist in stopping or preventing gastrointestinal hemorrhage. - A 20-year-old client who has malabsorption syndrome: a client who has malabsorption syndrome should have a nasogastric tube inserted for enteral feedings.

3. A nurse is caring for a client who is recovering from gastric surgery, is NPO, and has a nasogastric tube connected to suction. Which of the following actions should the nurse take to prevent dry mucous membranes? Ans: Provide frequent mouth care Rationale: The nurse should perform frequent mouth care, such as brushing their teeth and providing oral swabs, to keep the client’s mucous membranes from becoming dry and irritated. 4. A nurse is caring for a client who has a nasogastric tube connected to suction. Which of the following findings indicates that the tube has become occluded? Ans: increased abdominal distention Rationale: Tubes connected to suction decompress the GI Tract, which is needed when peristalsis is absent. If gastric secretions are unable to move through the GI Tract, and if the nasogastric tube is unable to evacuate the stomach due to an occlusion, abdominal distention, nausea, and vomiting can occur. Incorrect Answers: - Active Bowel Sounds – as peristalsis returns, air and fluid move through the intestines, and bowel sounds become active; therefore, the client will have decreased gastric residual. - Passing Flatus – as peristalsis returns, air and fluid move through the intestines and causes flatus. - Increase in gastric secretions – if the tube becomes occlude, secretions will decrease due to the inability to evacuate secretion.

5. A nurse is performing a nasogastric intubation on a client and has reached the tube’s predetermined length. Which of the following actions should the nurse take first? Ans: Inspect the oropharynx with a penlight and a tongue blade Rationale: the first action the nurse should take when using the airway, breathing, circulation approach to client care is inspect the client’s oropharynx with a penlight and a tongue blade to check for kinks and to ensure the tube is not coiled in the client’s airway. If this occurs, the nurse should bull back on the tube and try reinserting. 6. A nurse is checking the client’s nasogastric tube for placement. Which of the following procedures should the nurse implement? Ans: Aspirate stomach contents and check the Ph. Rationale: checking the pH of stomach contents is recommended method for checking tube placement. The pH measurement of gastric aspirate is 4 or less. A Ph measurement of gastric aspirate can be used to monitor placement after the initial placement has been verified. 7. A nurse is informed during shift report that a client has a nasogastric tube connected to continuous suction. The nurse should identify that this client must have which of the following types of tubes? Ans: Salem Sump tube Rationale: Salem sump tube is used for continuous suction to decompress the stomach. The tube has two lumens; one tube removes gastric contents, and the other tube serves as an air vent. The vent lets air enter the stomach, allowing the tube to float freely and preventing damage to the gastric mucosa. Incorrect Answers: - Dobhoff tube – provides nasoduodenal feedings for clients who have impaired swallowing or require enteral feedings - Sengstaken – Blakemore tube – has an inflatable balloon that applies internal pressure to prevent or stop esophageal or gastrointestinal bleeding. - Ewald tube – An Ewald tube is inserted orally and is used to irrigate the stomach in cases of active bleeding.

Diabetes Mellitus Management 1. The nurse is teaching a client who has type 1 diabetes mellitus about the peak time of neutral protamine Hagedorn (NPH) insulin. Which of the following statements by the client indicates an understanding of the teaching? Ans: NPH insulin peaks in 6 to 14 hours Rationale: NPH insulin has an onset of 60 to 120 min, peaks in 6 to 14 hours, and has a duration of 16 to 24 hr. Incorrect Answers: - Regular insulin has an onset of 30 to 60 min, peaks in 1 to 5 hr., and lasts up to 10 hr. - Insulin glargine has an onset of 70 min, it is peak less, and it has a duration of 24h - Insulin detemir has a slow onset, peaks between 12 and 24 hr., and has a duration that varies with the dosage. 2. A nurse is caring for a client who has type 1 diabetes mellitus and reports feeling anxious and having palpitations. The glucometer reads 50 mg/dL. Which of the following actions should the nurse take? Ans: give the client 4 oz of apple juice Rationale: after confirming hypoglycemia, the nurse should give the client 15 to 20 g of a rapid-acting, concentrated carbohydrate source, such as 4 to 6 oz of fruit juice, 8 oz of skim milk, 1 tbsp of honey or commercially prepared glucose tablets per package instructions. Incorrect Answers: - Give the client 1 tsp of honey – does not contain enough carbohydrate to reverse hypoglycemia - Give the client 4 oz of skim milk – does not contain enough carbohydrate to reverse hypoglycemia - Give the client 2 glucose tablets – does not contain enough carbohydrate to reverse hypoglycemia 3. A nurse is reviewing self – administration of insulin using a pre-filled pen with a client who started using the pen the previous week. The client asks what can be done to help reduce injection pain. Which of the following instructions should the nurse give the client? Ans: Keep the pen at room temperature for a few minutes Rationale: injecting room-temperature insulin is less painful than injecting cold insulin Incorrect Answers: - Agitate the syringe slightly before injection – this action resuspends the insulin but does not affect injection pain. - Store the pen with the needle pointing upward – this action keeps the needle from clogging but does not affect injection pain - Insert the needle slowly – inserting the needle rapidly minimizes injection pain.

4. A nurse is teaching a client who has a new diagnosis of type 2 diabetes mellitus about metformin. The nurse should explain that this type of medication works by which of the following mechanisms. Ans: Reducing hepatic glucose production Rationale: Biguanides reduce hepatic glucose production while increasing insulin action on muscle glucose uptake. Incorrect Answers: - Increasing insulin secretion by the pancreas – sulfonylureas and meglitinides increase insulin secretion by the beta cells of the pancreas - Delaying carbohydrate digestion – Alpha-glucosidase inhibitors delay carbohydrate digestion - Increasing the cellular response to insulin – thiazolidinediones increase the cellular response to insulin by decreasing insulin resistance.

5. A nurse is caring for a client who has type 1 diabetes mellitus and needs a long-acting insulin preparation. The nurse anticipates receiving a prescription for which of the following insulins? Ans: Insulin Glargine Rationale: Long-acting insulin, such as insulin glargine, is intended to provide basal glucose control. The dosage is typically once daily at the same time each day. Incorrect Answers: - Insulin Aspart: Rapid-acting insulin - Insulin Glulisine: Rapid -Acting Insulin - Insulin Lispro: Rapid – Actin Insulin

6. A nurse is teaching a client who has type 1 diabetes mellitus about the use of an insulin pump. Which of the following information should the nurse include in the teaching? Ans: the risk for developing DKA can be increased with the use of an insulin pump. Rationale: malfunction of the pump from low battery power, occlusion of tubing or needles or lack of insulin in the pump increases the risk of DKA, particularly if the client is not aware of it. Incorrect Answers: - The pump should remain in place while bathing – the client may disconnect the pump for short periods of time such as bathing and swimming. - Insulin is injected intermittently based on the client’s glucose level – an insulin pump works by delivering a basal rate of insulin all day with the goal of preventing hypo- and hyperglycemic episodes. - The pump uses intermediate-acting insulin.

7. A nurse is teaching a client who was recently diagnosed with type 1 diabetes mellitus how to check blood glucose levels. Which of the following instructions should the nurse include in the teaching? Ans: To collect a sample for testing, hold the test strip next to the blood on the fingertip Rationale: This allows the blood to flow over the reagent pad until the amount of blood on the strip is adequate. A sample that is too small can result in falsely low readings. Incorrect Answers: - Blood can be smeared from the fingertip onto the test strip – this is likely to result in an inaccurate result. - Use a syringe and needle to collect and transfer blood to the test strip – this is an unnecessary use of supplies; it is not necessary to do this to obtain an adequate sample on the test strip. - Use a capillary tube to collect and transfer the blood form the fingertip – unnecessary use of supplies. It is not necessary to do this to obtain an adequate sample on the test strip. 8. A nurse is reviewing the results of routine laboratory test performed as part of a client’s annual physical examination. Which of the following values indicates a fasting blood glucose measurement that is outside of the expected reference range? Ans: 118 mg/dL Rationale: the result exceeds the expected reference range for a fasting blood glucose measurement, which is generally between 74 and 106 mg/dL...