The nurse is inserting nasogastric tube to a client, tube is inserting gently downwards and it reached nasopharynx and there is slightly resistance occurs. What would be the nurse's next action?

1. A

   Withdraw the tube

2. B

   Wait for 5 minutes and further insert the tube

3. C

   Instruct the patient to swallow or engulf

4. D

   Notify the physician

Appeared in: NORCET -4 , 2023

Explanation

Listen in Hindi

• When the NG tube reaches the nasopharynx, slight resistance is expected due to the anatomical curve of the throat.
• Instructing the patient to swallow is the correct action as it facilitates the passage of the tube into the esophagus.
• Swallowing causes the epiglottis to close over the trachea, preventing the tube from entering the airway.
• Simultaneously, swallowing opens the upper esophageal sphincter, allowing the tube to advance smoothly.

Why Other Options Were Wrong

• Option A: Withdrawing the tube is not the initial action for slight, expected resistance. This action is reserved for signs of respiratory distress (e.g., coughing, choking, cyanosis), which indicate the tube may be in the airway.
• Option B: Waiting for 5 minutes is an arbitrary delay that does not address the mechanical resistance. It is not a recognized nursing intervention and would unnecessarily prolong the procedure and patient discomfort.
• Option D: Notifying the physician is an unnecessary escalation of care for an expected finding. Nurses are trained to manage slight resistance during NG tube insertion independently.

Related Visual

• Visual 1: Anatomical Diagram - A sagittal view of the head and neck showing the path of a nasogastric tube from the nostril, through the nasopharynx, and into the esophagus. This helps visualize the curve where resistance occurs.
• Visual 2: Flowchart - A step-by-step guide for NG tube insertion, with a decision point for 'Resistance Felt' branching to 'Instruct Patient to Swallow'.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Procedure for Nasogastric (NG) Tube Insertion to guide bedside assessment, documentation, and the next nursing action.
• Procedural Competence: Knowing to have the patient swallow is a fundamental skill for safe NG tube insertion, preventing patient discomfort and complications.
• Patient Safety: Correct technique prevents inadvertent placement of the tube into the trachea, which can lead to aspiration pneumonia, a serious and potentially fatal complication.
• What if? Scenario: If the patient is unconscious or unable to follow commands to swallow, the nurse should time the advancement of the tube with the patient's exhalation and apply gentle, steady pressure. If resistance persists, the attempt should be paused.

How to Approach the Question

• Identify the core of the question: It's asking for the correct nursing action during a specific step of a common procedure (NG tube insertion).
• Pinpoint the event: The key event is encountering 'slight resistance' as the tube reaches the 'nasopharynx'.
• Recall the anatomy and physiology: Remember that the path from the nasopharynx to the esophagus involves a curve. Think about what physiological action helps guide something down the esophagus instead of the trachea.
• Evaluate the options based on standard procedure:
• Swallowing is a known technique to facilitate passage past the oropharynx.
• Withdrawing is for complications (airway entry).

Concept Tested & Keywords

• Concept Tested: Procedure for Nasogastric (NG) Tube Insertion
• Stem keywords: nasogastric tube, inserting, nasopharynx, slight resistance
• Lead-in keywords: next action
• Clinical cues: Slight resistance at the nasopharynx is an expected finding, not a complication.

Question ID

Qu945DXtTSKUjRPWJk8feJ

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