The correct nursing action when a client begins to cough as a nasogastric tube is passed into the oropharynx… - IGNOU PB. Bsc. Nsg. Entrance-2025

IGNOU PB. Bsc. Nsg. Entrance-2025

Nursing Foundation

Hard

Appeared in: IGNOU PB. Bsc. Nsg. Entrance-2025

Explanation

When the NG tube reaches the oropharynx, coughing indicates it may be near the larynx.
Instructing the client to swallow or sip water is the correct action.
Swallowing causes the epiglottis to cover the trachea, which helps guide the tube into the esophagus and prevents it from entering the airway.
This action facilitates safe and correct placement of the tube into the stomach.

Option B: Completely removing the tube is not the immediate correct action for a simple cough. The nurse should first pause, pull back slightly, and then try advancing again while the patient swallows. This option is too drastic for the initial response.
Option C: Forcing a tube against resistance is never safe and can cause significant trauma, such as perforation of the pharynx or esophagus. The glottis is the opening to the trachea (airway), and the tube should never be directed there.
Option D: Having the client tilt their head back is the initial position to pass the tube through the nasopharynx. However, once it reaches the oropharynx, the head should be flexed forward (chin to chest) to close the airway and open the esophagus.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nasogastric (NG) Tube Insertion Procedure to guide bedside assessment, documentation, and the next nursing action.
Patient Safety: Incorrect NG tube placement can lead to life-threatening complications like aspiration pneumonia. The nurse's immediate and correct response to signs of misplacement, like coughing, is crucial for patient safety.
Verification is Key: Regardless of how smoothly the insertion proceeds, placement must always be confirmed by a reliable method (X-ray is the gold standard) before the first use for feeding or medication administration.
What if? If the patient was unconscious or had an impaired gag reflex, the nurse would not rely on coughing as a sign of misplacement. In this case, continuous monitoring of oxygen saturation and capnography (if available), followed by radiographic confirmation, would be even more critical.

How to Approach the Question

First, identify the clinical procedure being performed: insertion of a nasogastric tube.
Next, recognize the specific event or complication described: the client begins to cough as the tube enters the oropharynx.
Think about the underlying anatomy. The oropharynx is a crossroads for both the respiratory tract (trachea) and the digestive tract (esophagus). Coughing is a protective reflex to prevent foreign objects from entering the airway.
Evaluate each option based on its effect on this anatomy. The goal is to guide the tube into the esophagus while protecting the airway.
Option A (swallowing) closes the airway (epiglottis covers trachea) and opens the esophagus. This is a safe and effective action.
Options B, C, and D either increase the risk of harm (forcing the tube), are premature (removing the tube), or facilitate incorrect placement (tilting head back).

Concept Tested & Keywords

Concept Tested: Nasogastric (NG) Tube Insertion Procedure
Stem keywords: nasogastric tube, oropharynx, cough
Lead-in keywords: correct nursing action
Clinical cues: Coughing during NG tube insertion is a critical sign that the tube may be entering the airway.

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