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Week 7 NCO
Week & NCO Evaluation of Nursing Practice
| Question | Answer |
|---|---|
| What is the nurse's best action if the patient begins to gag or choke while the nasogastric tube is being inserted? | Stop advancing the tube, pull tube back, and start over. |
| Did you notice any errors in practice in the performance of this skill? | The nurse incorrectly measures the length of tubing for insertion. |
| What is the potential risk to the patient from the identified error? | The tube could be inserted farther than intended. |
| What steps should be taken to facilitate insertion of a nasogatric tube into the stomach? (Select all that apply.) | 1. Advance tube each time patient swallows. 2. Have the patient flex head toward chest after tube has passed 3. through nasopharynx. 4 .Dip tube into glass of water or apply water-soluble lubricant 5. Determine which naris has greatest patency. |
| What steps should be taken to reduce the risk of aspiration with a nasogastric tube? (Select all that apply.) | 1. Determine placement by aspirating and testing the pH of stomach contents before every instillation. 2. Keep the head of the bed elevated at least 30 degrees. 3. Observe the external portion of the tube for movement of the ink mark away from the nari |
| You are inserting a nasogastric feeding tube in an elderly patient. The patient continues to gag, so you tell her to open her mouth. You see the feeding tube coiled in the back of her throat. What action should you take at this time? | Pull the tube back to the patient’s oropharynx and insert when the patient swallows. |
| The nurse tells you in change of shift report that your patient has a feeding tube with a continuous feeding. What other information would you want to know? (Select all that apply.) | 1. The rate at which the feeding is being administered. 2. The type of feeding tube. 3. The enteric residual volumes. 4. When the tube feeding bag was last changed. 5.The type of enteral formula being administered. |
| Place the steps for preparing the glucose meter prior to obtaining a blood glucose measurement in the correct order. (You have already performed hand hygiene.) | 1 - Remove the reagent strip from vial and tightly seal cap. 2 - Insert the strip into the meter. (The meter automatically turns on.) 3 - Remove unused reagent strip from meter. 4 - Place unused reagent strip on paper towel with test pad up. 5 - Confi |
| Place the steps for preparing the lancet device prior to obtaining a blood glucose measurement in the correct order. | 1. - Perform hand hygiene and apply clean gloves. 2 - Remove cap from lancet device; insert new lancet. 3 - Remove protective cover on tip of lancet. 4 - Replace cap of lancet device. 5 - Cock lancet device, adjusting for proper puncture depth. |
| Place the steps for performing a blood glucose measurement in the correct order. The glucose meter and lancet device are ready to use. Hand hygiene has been performed and clean gloves have been applied. | 1 - Wipe patient's finger or forearm lightly with antiseptic swab. Allow area to dry. 2 - Hold area to be punctured in dependent position. Hold tip of lancet device against test site. 3 - Press release button on lancet device. Allow round drop of blood |
| The nurse informs the patient that the patient’s fasting blood glucose reading was 86. The patient asks the nurse what this means. Which of the following is an accurate response by the nurse? | "Your blood sugar is within normal range, I will document the finding.".........Normal fasting blood glucose is 70-110 mg/dL. The nurse should document this normal finding. |
| The nurse confirms the diabetic patient has a fasting blood glucose reading of 76. Which statement, if made by the patient, indicates further teaching is needed? | “That’s really good, I can eat anything I want today.” |
| The nurse observes the NAP obtain a patient’s blood glucose measurement. Which of the following, if observed, would require correction by the nurse? (Select all that apply.) | 1. The NAP scrapes the drop of blood onto the test strip and waits for test results. 2. The NAP cleans the central tip of the finger with an antiseptic swab and allows it to air dry. 3. The NAP milks the patient’s finger before pressing the release butt |
| The student nurse has attempted to obtain a patient’s blood glucose measurement but is unable to obtain a drop of blood from the patient. What could be a possible explanation for this difficulty? (Select all that apply.) | 1. The lancet device was not adjusted to a depth of insertion that could penetrate the patient’s skin. 2. The student nurse did not remove the protective cover on the tip of the lancet. |
Created by:
Brandi Sizemore
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