Difficulty: Medium
Average Score: 78%
Simulated
A charge nurse observes a nurse administer intermittent tube feedings via an NG tube to a client. Which of the following actions should prompt the charge nurse to intervene?
Correct answer
A
Rationale
Step-by-step rationale for why choice A is correct: The charge nurse should intervene when the nurse allows the client to rest in a supine position during feeding because this can lead to aspiration. When a client is in a supine position, the risk of regurgitation and aspiration increases due to decreased gastric emptying. Clients should be positioned in a semi-Fowler's or high-Fowler's position during and after feedings to reduce this risk. The other choices are incorrect because: B) Aspirating gastric residual before feeding is a standard practice to assess for gastric retention but would not require immediate intervention. C) Irrigating the NG tube with tap water after feeding is unnecessary and not harmful in this scenario. D) Administering the feeding through a syringe barrel by gravity is a common method for administering tube feedings and does not pose an immediate risk to the client.