Number the steps to irrigate a nasogastric tube in correct order:
a. Clamp and disconnect the NG tube
b. Slowly aspirate the syringe and reconnect the NG tube to suction
c. Insert tip of syringe into NG tube and slowly inject 30 ml saline
d. Perform hand hygiene and apply clean gloves

Appeared in: MNS 2024

Explanation

The correct sequence begins with performing hand hygiene and applying gloves (D) to prevent infection, which is a universal first step in nursing procedures.
Next, the NG tube is clamped and disconnected (A) to prevent leakage of gastric contents and avoid introducing air into the stomach.
Following disconnection, the nurse irrigates the tube by slowly injecting 30 mL of saline (C) to ensure and maintain its patency.
Finally, the nurse aspirates the fluid to confirm patency and then reconnects the NG tube to suction or feeding (B) to resume its function.

Option B: This sequence (B, C, D, A) is incorrect because it starts with aspirating the syringe (B) before performing hand hygiene (D) or disconnecting the tube (A), which violates safety and infection control protocols.
Option C: This sequence (A, D, C, B) is incorrect because it involves touching the NG tube (A) before performing hand hygiene (D). Standard precautions mandate hand hygiene before any patient or equipment contact.
Option D: This sequence (D, B, A, C) is incorrect because it attempts to aspirate the syringe (B) before the tube has been disconnected (A) or irrigated (C). Aspiration is performed after instilling the irrigant.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Procedural Steps for Nasogastric (NG) Tube Irrigation in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Following the correct procedural sequence for NG tube irrigation is essential for patient safety. It prevents complications such as aspiration pneumonia, electrolyte imbalance, and infection.
Maintaining NG tube patency ensures effective gastric decompression or enteral feeding, which is vital for the patient's treatment plan and nutritional status.
What if? If the nurse encounters resistance when injecting the saline (Step C), they should not force the fluid. Instead, they should check for kinks in the tubing and reposition the patient. If resistance persists, it may indicate a serious blockage or tube misplacement, and the healthcare provider must be notified.

How to Approach the Question

For procedural sequence questions, first identify the absolute first and last steps.
In most nursing procedures, 'Perform hand hygiene' (D) is the initial step to ensure infection control.
The final step often involves completing the procedure and resuming the original therapy, in this case, 'reconnect the NG tube to suction' (B).
With the first (D) and last (B) steps identified, evaluate the options. Only 'D, A, C, B' fits this framework.
Logically order the intermediate steps: you must disconnect the tube (A) before you can inject fluid into it (C).

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 6 pp. 57-59, 58-60

Practise the full MNS 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.