Question

A charge nurse is observing a newly licensed nurse prepare a sterile field for a dressing change. Which of the following actions by the newly licensed nurse requires intervention by the charge nurse?

A. Instills 100mL of air into the NG tube after checking for residual
B. Flushes the NG tube with 0.9% sodium chloride irrigation every 2 hr.
C. Adds 20 mL of blue dye to each feeding to help detect aspiration.
D. Keeps the head of the bed elevated to 45 for 1 hr after feedings.

Answer 1

The action by the newly licensed nurse that requires intervention by the charge nurse is instilling air into the NG tube.

Step-by-step explanation:

The action by the newly licensed nurse that requires intervention by the charge nurse is option A. Instilling 100mL of air into the NG tube after checking for residual.

Instilling air into the NG tube can cause harm and is not part of the sterile field preparation for a dressing change. Air should never be instilled into the NG tube as it can lead to complications such as pneumothorax.