Question

The nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts to slowly advance the NG tube with each swallow. The client begins to cough, gag, and choke. Which actions should the nurse take that will result in proper tube insertion and promote client relaxation?

Option 1: Pull the tube back slightly.
Option 2: Instruct the client to breathe slowly.
Option 3: Assist the client to take sips of water.
Option 4: Continue to slowly advance the tube to the desired distance.
Option 5: Check the back of the pharynx using a tongue blade and flashlight.

Answer 1

To ensure proper NG tube insertion and prevent discomfort, the nurse should pull back the tube, instruct relaxed breathing, guide sips of water if permitted, and check the pharynx with a blade and flashlight.

Step-by-step explanation:

When a client begins to cough, gag, and choke during nasogastric (NG) tube insertion, it suggests that the tube may have entered the trachea instead of the esophagus. The appropriate action for the nurse would be to first pull the tube back slightly to alleviate the discomfort and prevent further insertion into the respiratory tract, which may cause aspiration. Next, the nurse should instruct the client to breathe slowly and remain calm as this can help to relax the throat and facilitate correct placement of the tube. After these steps, the nurse may verbally guide the client to take sips of water, if permitted, which can help facilitate the swallowing process and correct advancement of the tube. Lastly, a check of the back of the pharynx using a tongue blade and flashlight by the nurse may be performed to ensure proper tube placement.