Editing Nutrition – RN Practice Questions (section)

==Question 3==
A client receiving a continuous nasogastric tube feeding suddenly begins coughing forcefully, and the nurse notes new crackles in the right lower lobe and an oxygen saturation that has fallen from 96% to 88%. Which action should the nurse take '''first'''?
# Auscultate over the epigastrium while injecting 30 mL of air.
# Lower the head of the bed to reduce reflux.
# Stop the tube feeding.
# Obtain an order for a chest radiograph.

'''Answer:''' 3. Stop the tube feeding.

''Rationale:'' These findings indicate aspiration. The first action is to stop the source of ongoing harm by turning off the feeding, then turn the client to the side, suction, apply oxygen, and notify the provider. A chest radiograph will be needed, but it is not the first action. Lowering the head of the bed worsens reflux and aspiration; the head of the bed should stay elevated. Auscultating an injected air bolus is an obsolete and unreliable placement check that has been abandoned in practice, and it does nothing for an actively aspirating client.