Geeta returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gallbladder surgery. She continues to complain of nausea. Which action would the nurse take?

1. A

   Call the physician immediately

2. B

   Administer the prescribed antiemetic

3. C

   Check the patency of the nasogastric tube for any obstruction

4. D

   Change the patient's position

Appeared in: OSSSC Nursing Officer-2023

Explanation

• The primary purpose of a nasogastric (NG) tube after abdominal surgery is often for gastric decompression to prevent nausea, vomiting, and abdominal distension.
• A complaint of nausea is a key sign that the NG tube may be occluded or displaced, preventing it from decompressing the stomach effectively.
• According to the nursing process (Assess, Diagnose, Plan, Implement, Evaluate), the nurse's first action should be to assess the situation.
• Checking the patency of the NG tube is the most appropriate initial assessment to determine the cause of the nausea before any other intervention is performed.

Why Other Options Were Wrong

• Option A: Calling the physician is premature. The nurse should first perform a basic assessment and troubleshooting, which is within the nursing scope of practice.
• Option B: Administering an antiemetic treats the symptom (nausea) but does not address the potential underlying cause, which could be a mechanical blockage of the NG tube.
• Option D: While changing the patient's position can sometimes help facilitate drainage, it is not the priority action. The primary issue could be a kink or clog that repositioning will not fix.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Postoperative nursing care and management of a nasogastric (NG) tube helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Failure to ensure NG tube patency can lead to gastric distension, vomiting, and a high risk of pulmonary aspiration, which is a serious postoperative complication.
• Prompt assessment and management of NG tube issues are fundamental nursing responsibilities that directly impact patient safety and comfort.
• What if? If the patient were vomiting large amounts of fluid around the NG tube, this would indicate a severe blockage. The nurse should still check for kinks but would need to notify the physician more urgently as simple irrigation may not be sufficient.

How to Approach the Question

• First, identify the key elements of the clinical scenario: a postoperative patient, a specific intervention (NG tube), and a problem (nausea).
• Recall the purpose of the intervention. An NG tube after abdominal surgery is typically for gastric decompression to prevent nausea.
• Connect the problem to the intervention. If the patient is nauseous, the decompression is likely failing.
• Apply the nursing process (ADPIE). The first step is always Assessment.
• Evaluate the options to see which one represents an assessment. 'Check the patency of the nasogastric tube' is an assessment action.
• The other options (administering medication, changing position, calling the doctor) are interventions or escalations that should follow a thorough assessment.

Concept Tested & Keywords

• Concept Tested: Postoperative nursing care and management of a nasogastric (NG) tube.
• Stem keywords: Post-anesthesia Care Unit, nasogastric tube, gallbladder surgery, nausea
• Lead-in keywords: Which action
• Clinical cues: The patient has an NG tube in place for a reason (gastric decompression).
• Clinical cues: The symptom (nausea) directly relates to the function of the NG tube.

Question ID

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Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 58-60