Difficulty: Medium
Average Score: 74%
Simulated
A nurse is participating in the care plan for a patient with an intestinal obstruction who is undergoing continuous gastrointestinal decompression using a nasogastric tube. What interventions should the nurse include in the care plan?
Correct answer
A ,B ,D
Rationale
Correct Answer: A, B, D
Rationale:
A: Daily measurement of abdominal girth is important to monitor for signs of intestinal obstruction progression or resolution.
B: Maintaining the patient in Fowler's position helps prevent aspiration and aids in the proper drainage of gastric contents.
D: Using sterile water to irrigate the nasogastric tube prevents introducing bacteria into the gastrointestinal tract.
Summary:
C: Moistening the patient's lips with lemon glycerin swabs may provide comfort but is not essential in the management of intestinal obstruction.
E, F, G: These choices are omitted as they do not directly relate to the care plan for a patient with an intestinal obstruction undergoing gastrointestinal decompression.
Rationale:
A: Daily measurement of abdominal girth is important to monitor for signs of intestinal obstruction progression or resolution.
B: Maintaining the patient in Fowler's position helps prevent aspiration and aids in the proper drainage of gastric contents.
D: Using sterile water to irrigate the nasogastric tube prevents introducing bacteria into the gastrointestinal tract.
Summary:
C: Moistening the patient's lips with lemon glycerin swabs may provide comfort but is not essential in the management of intestinal obstruction.
E, F, G: These choices are omitted as they do not directly relate to the care plan for a patient with an intestinal obstruction undergoing gastrointestinal decompression.