Verification of NG tube after initial placement is performed by which of the following methods?
Testing of aspirate pH
Measuring tube length
X-ray
Administering air into the tube ("Whoosh test")
Show the answer and explanation
Answer: C. X-ray
Topic: Nasogastric Tube Verification
Radiographic confirmation is the gold‑standard method for verifying nasogastric tube placement after initial insertion because it directly visualizes the tube tip in the stomach and prevents pulmonary misplacement.
Why the others are wrong
A – Aspirate pH can be misleading; acidic gastric fluid may be absent or contaminated.
B – Length measurement only estimates insertion depth; it cannot ensure the tip is in the stomach.
D – Air insufflation does not confirm intragastric location; it may produce sounds even if misplaced.
Remember: X‑ray sees the tip; other tests just guess.
The nurse is providing care for a patient who has an order to include "TKO" fluid infusion. The nurse understands that TKO fluids should be infusing at the following rate:
10-20 mL/hr
5 mL/hr
100 mL/hr
50 mL/hr
Show the answer and explanation
Answer: A. 10-20 mL/hr
Topic: TKO Fluid Administration
TKO (to keep open) fluids are administered at a low rate, typically 10–20 mL per hour, sufficient to maintain catheter patency without fluid overload.
Why the others are wrong
B – 5 mL/hr is too low; line may clot.
C – 100 mL/hr is a therapeutic rate, not a keep‑open rate.
D – 50 mL/hr exceeds TKO purpose; risks fluid overload.
Remember: TKO = tiny drip, 10‑20 mL/hr keeps line open.
The nurse is caring for a patient with a central venous access catheter. The nurse is repositioning the patient in bed when the CVAD extension tubing becomes tangled under the patient. As the patient is being turned, the tubing pulls the central venous catheter from the patient. What is the most appropriate first action?
Cover the insertion site and apply direct manual pressure
Attempt to reinsert the line
Have the patient "bear down"
Call a Code Blue
Show the answer and explanation
Answer: A. Cover the insertion site and apply direct manual pressure
Topic: Central Venous Catheter Management
When a central line is inadvertently pulled out, the first priority is to control bleeding and protect the site; covering the insertion site and applying direct manual pressure prevents hemorrhage and infection before further interventions.
Why the others are wrong
B – Reinsertion must wait until bleeding is controlled and a qualified provider acts.
C – Bearing down can increase intrathoracic pressure and worsen bleeding.
D – The patient is not in cardiac arrest; a Code Blue is unnecessary.
A nurse is caring for a patient with an infusing IV who is receiving 2 grams of Rocephin (Ancef) into their 20 gauge right forearm PIV. The nurse notes that the IV site is swelling, reddened, and fluid is leaking at the infusion site. The nurse takes which of the following actions to appropriate address the complication?
Attempt to reposition the cannula and re-tape the infusion site to stabilize the device
Stop the infusion and remove the cannula
Increase the infusion rate to finish the Ancef infusion and then discontinue the site.
Slow the infusion and elevate the extremity
Show the answer and explanation
Answer: B. Stop the infusion and remove the cannula
Topic: IV Infiltration Management
The swelling, redness, and leaking indicate infiltration. The immediate priority is to stop the medication, disconnect the line, and remove the peripheral catheter to prevent tissue damage and allow assessment.
Why the others are wrong
A – Repositioning a compromised catheter risks further tissue injury.
C – Increasing rate worsens infiltration and delays necessary intervention.
D – Slowing infusion and elevating does not stop ongoing infiltration.
A nurse receives an order to place an NG tube to decompress a patient's stomach due to ileus. The nurse correctly selects which type of tube to assist with stomach decompression?
Levin
Dobhoff
Salem Sump
Any of these tubes are appropriate
Show the answer and explanation
Answer: C. Salem Sump
Topic: Gastric Decompression Tubes
The Salem Sump tube has a larger lumen and a distal suction port with side holes, allowing effective gastric decompression and continuous suction, which is required for an ileus.
Why the others are wrong
A – Levin tubes are single‑lumen and lack suction ports, unsuitable for decompression.
B – Dobhoff tubes are small‑bore feeding catheters, not designed for gastric suction.
D – All tubes cannot decompress; only a dedicated suction tube works.
Remember: Salem Sump = suction, side holes, decompression.
When estimating the length of tubing for NG tube insertion, the nurse estimates that which of the following lengths would be most appropriate for inserting the tube to terminate in the adult patient's stomach?
12 cm
75 cm
25 cm
55 cm
Show the answer and explanation
Answer: D. 55 cm
Topic: NG Tube Insertion Length
55 cm corresponds to the measured NEX distance (nose‑ear‑xiphoid) plus a few centimeters, which places the tip in the gastric antrum for most adults, ensuring proper placement without coiling.
Why the others are wrong
A – 12 cm is far too short; tube would remain in the nasopharynx.
B – 75 cm risks coiling in the stomach or entering the duodenum.
C – 25 cm does not reach the stomach; it ends in the esophagus.
Remember: NG tube length ≈ NEX distance, about 55 cm in adults.
When selecting an IV size for an elderly patient with fragile veins, which of the following IV cannula sizes would be most appropriate?
22 gauge
18 gauge
14 gauge
16 gauge
Show the answer and explanation
Answer: A. 22 gauge
Topic: IV Cannula Selection
A 22‑gauge cannula is the smallest standard size, causing minimal trauma to delicate, fragile veins in elderly patients while still allowing adequate fluid administration for most medications.
Why the others are wrong
B – Larger than optimal; increased risk of bruising and vein damage.
C – Too large; risks vein rupture and hematoma in fragile veins.
D – Relatively large; may cause trauma and infiltration in delicate veins.
Remember: Small gauge, gentle veins: choose 22‑gauge.
Marcus is speaking with a pulmonology provider in the critical care environment about the condition of one of his patients. The provider reports that the patient requires a blood test to evaluate the acid base balance in the bloodstream. Marcus understands that which one of the following blood collection measures will be needed to gather the appropriate blood sample?
Venous blood sample
Capillary blood sample
Mixed venous blood sample
Arterial blood sample
Show the answer and explanation
Answer: D. Arterial blood sample
Topic: Arterial Blood Gas Sampling
An arterial blood sample is required for an arterial blood gas analysis. This test provides the most accurate and definitive evaluation of systemic oxygenation, ventilation, and acid-base balance in critically ill patients.
Why the others are wrong
A – Venous blood reflects localized tissue metabolism rather than precise systemic acid-base status.
B – Capillary blood is less accurate and typically reserved for neonates or glucose monitoring.
C – Mixed venous blood assesses oxygen delivery and consumption, not standard systemic acid-base balance.
Remember: Arterial blood gives the gold standard for acid-base balance.
A nurse is attempting to draw a blood sample from a PICC line and notes resistance when withdrawing blood. Which of the following actions should the nurse attempt first?
Reposition the client's arm
Notify the healthcare provider
Attempt to flush the line slowly with saline
Attempt a periperhal blood draw from a different site
Show the answer and explanation
Answer: A. Reposition the client's arm
Topic: Peripherally Inserted Central Catheter
Repositioning the client’s arm may relieve kinking or malposition of the PICC, restoring patency and allowing blood return before any further flushing or provider notification.
Why the others are wrong
B – Provider notification can wait until simple corrective measures are tried.
C – Flushing may worsen occlusion; position should be checked first.
D – Peripheral draw is unnecessary until the PICC line issue is addressed.
Remember: Arm position often kinks PICC lines—adjust before any other step.
After the first few minutes of transfusing packed RBCs, the patient has a temperature of 101.5° F (38.6° C), heart rate of 120 bpm, and blood pressure of 90/50 mm Hg with complaints of back pain. Which of the following should be the priority nursing action?
Stop the transfusion.
Administer diphenhydramine (Benadryl).
Flush the line with normal saline.
Notify the health care provider.
Show the answer and explanation
Answer: A. Stop the transfusion.
Topic: Transfusion Reactions
Stopping the transfusion is the first step because fever, tachycardia, hypotension, and back pain indicate an acute hemolytic reaction; continuing could worsen hemolysis and cause severe complications.
Why the others are wrong
B – Benadryl treats allergic reactions, not acute hemolytic transfusion reactions.
C – Flushing does not address the reaction and may worsen hemolysis.
D – Provider notification follows stopping the transfusion, not before.
Remember: Stop the bag first when transfusion reaction signs appear.
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