Nursing 400 Final Exam combined study guides
questions with Complete Solutions
Dysphagia Correct Answer-inability to swallow or difficulty in
swallowing
2 key points about Dysphagia Correct Answer-1. 30 mins prior to meal
time, the pt needs to be sitting at 90 degree unless its contraindicated
2. Monitor for possibility of aspiration
-s/s of aspiration
-Coughing
-Wheezing
-Redness of face
-Decrease O2 sat
2 key points about Nasogastric Tube Correct Answer-Used for pt who
suffers from dysphagia (difficulty swallowing)
Residual volume must always be checked q4h d/t risk for aspiration ***
if there is a large amount of residual volume, that means pt is not
digesting the food - inform MD**
Nasogastric Tube Supplies Correct Answer-Nasogastric tube
,Irrigation tray - 60 ml syringe
A bottle of sterile water
lubricant
NGT insertion Correct Answer-1. Measure the tube from the nose to the
back of the ear and down a little pass the bottom of the xiphoid process
2. Mark the tube (sharpie)
3. Have the patient swallow while inserting the tube (with or without ice
chips)
NGT placement Correct Answer-1. Once the NGT is inserted, aspirate
30 mL of air
2. Place the stethoscope over the stomach and listen to the "wooooosh"
sound as you inject the air
3. If necessary, get an order for x ray for proper placement.
NGT medication administration Correct Answer-1. Check if pt is on any
fluid restrictions
,2. Check gastric residual and put it back after.
3. Make sure to kink the tube so that air won't go in the tube (air causes
bloating)
4. Crush medication and mix with water until diluted and poured in the
syringe. [except enteric coated or with granules (Protonix)]
5. Flush 5-10 mL in between medications
6. Flush 30 mL after all medication has been administered
NGT removal Correct Answer-1. Needs a doctor's order
2. Flush with 10 mL water/NS or 30-50 mL of air
3. Have pt take a deep breath while removing the tube quickly
7 Rules about Body mechanics Correct Answer--Always bend the knee
and have a wide base for support
-Always point your toes to the direction you're going
, -When transferring a patient to a chair or wheelchair, have them hold on
to your shoulders and have your dominant foot in between their legs.
-Always count (1-2-3) out loud and tell them how to position or move
themselves.
a. If the patient is weaker on one side, have them put their weight on the
stronger side before standing up.
b. Turn your entire body rather than pivoting to avoid hurting your back
-When re positioning the patient, you has always make sure to avoid
hurting your wrists
-Make sure the bed is at your hip level.
-If the patient is too heavy, ask for help.
How do we measure syringe gauge sizes? Correct Answer-THE
SMALLER THE NUMBER, THE BIGGER THE DIAMETER
(GAUGE) OF NEEDLE
IV site inspection Correct Answer-look atthe IV catheter insertion site
for redness, swelling, or bruising. Redness can indicate irritation,
inflammation, infection, or thrombus formation. ... Assess the condition
of the transparent catheter dressing. The dressing should be clean, dry,
and adhere securely to the skin around the IV catheter insertion site
questions with Complete Solutions
Dysphagia Correct Answer-inability to swallow or difficulty in
swallowing
2 key points about Dysphagia Correct Answer-1. 30 mins prior to meal
time, the pt needs to be sitting at 90 degree unless its contraindicated
2. Monitor for possibility of aspiration
-s/s of aspiration
-Coughing
-Wheezing
-Redness of face
-Decrease O2 sat
2 key points about Nasogastric Tube Correct Answer-Used for pt who
suffers from dysphagia (difficulty swallowing)
Residual volume must always be checked q4h d/t risk for aspiration ***
if there is a large amount of residual volume, that means pt is not
digesting the food - inform MD**
Nasogastric Tube Supplies Correct Answer-Nasogastric tube
,Irrigation tray - 60 ml syringe
A bottle of sterile water
lubricant
NGT insertion Correct Answer-1. Measure the tube from the nose to the
back of the ear and down a little pass the bottom of the xiphoid process
2. Mark the tube (sharpie)
3. Have the patient swallow while inserting the tube (with or without ice
chips)
NGT placement Correct Answer-1. Once the NGT is inserted, aspirate
30 mL of air
2. Place the stethoscope over the stomach and listen to the "wooooosh"
sound as you inject the air
3. If necessary, get an order for x ray for proper placement.
NGT medication administration Correct Answer-1. Check if pt is on any
fluid restrictions
,2. Check gastric residual and put it back after.
3. Make sure to kink the tube so that air won't go in the tube (air causes
bloating)
4. Crush medication and mix with water until diluted and poured in the
syringe. [except enteric coated or with granules (Protonix)]
5. Flush 5-10 mL in between medications
6. Flush 30 mL after all medication has been administered
NGT removal Correct Answer-1. Needs a doctor's order
2. Flush with 10 mL water/NS or 30-50 mL of air
3. Have pt take a deep breath while removing the tube quickly
7 Rules about Body mechanics Correct Answer--Always bend the knee
and have a wide base for support
-Always point your toes to the direction you're going
, -When transferring a patient to a chair or wheelchair, have them hold on
to your shoulders and have your dominant foot in between their legs.
-Always count (1-2-3) out loud and tell them how to position or move
themselves.
a. If the patient is weaker on one side, have them put their weight on the
stronger side before standing up.
b. Turn your entire body rather than pivoting to avoid hurting your back
-When re positioning the patient, you has always make sure to avoid
hurting your wrists
-Make sure the bed is at your hip level.
-If the patient is too heavy, ask for help.
How do we measure syringe gauge sizes? Correct Answer-THE
SMALLER THE NUMBER, THE BIGGER THE DIAMETER
(GAUGE) OF NEEDLE
IV site inspection Correct Answer-look atthe IV catheter insertion site
for redness, swelling, or bruising. Redness can indicate irritation,
inflammation, infection, or thrombus formation. ... Assess the condition
of the transparent catheter dressing. The dressing should be clean, dry,
and adhere securely to the skin around the IV catheter insertion site
