Determining G-Tube placement, what's the NCLEX answer?

  1. i encountered the following question during nclex review:

    the best action to establish correct placement of a gastric tube is for the nurse to
    a) aspirate for the color and ph test b) inject air while listening for the gastric gurgle c) check the results of the x-ray results of tube placement d) measure the residual volume then reinsert the aspirate

    you chose:c)check the results of the x-ray results of tube placement
    the correct answer is a: aspirate for the color and ph test. all of the options are safe actions. however checking the color and ph are the best actions for verification of tube placement.
    i selected xray, because visualization is the best confirmation is it not? i consulted my saunders review book and it states that the most reliable method of placement confirmation is xray after initial placement. thereafter, aspiration and ph test should be used to check placement most accurately.

    okay, am i missing something in this question? i was taught not to assume, but am i supposed to assume that this is after initial placement, or that the xray results are not from a current xray but from the initial placement?

    the question asked best action of the nurse, the only way that i would be able to understand why this answer is correct is if checking the results of an xray is not an action of the nurse. how would you answer this question for nclex purposes, a or c, and if you could please explain your thinking.

    thanks to all who answer!
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  2. 24 Comments

  3. by   TheCommuter
    While x-ray is the safest method of ensuring proper g-tube placement, it is not the realistic method in everyday nursing.

    Imagine that you worked on a sub-acute floor of an extended care facility and cared for 10 g-tube patients who are all comatose and ventilator dependent. Since these patients are to have absolutely nothing by mouth, you must crush their meds and administer them via g-tube.

    There is no facility in existence that would allow you to x-ray all 10 patients on a daily basis to check their g-tube placement before passing their meds. Checking placement is performed every single time you push anything into their tube, including water and medication. The quickest and most realistic way to check their placement would be to aspirate the stomach contents and check the pH.

    By the way, you must return all stomach contents that you remove.
  4. by   Bonny619
    I would have picked C. That question is tough.
  5. by   Hoping LVN2BSN
    Quote from TheCommuter
    While x-ray is the safest method of ensuring proper g-tube placement, it is not the realistic method in everyday nursing.

    There is no facility in existence that would allow you to x-ray all 10 patients on a daily basis to check their g-tube placement before passing their meds.
    I understand xray not being realistic on a daily basis after initial placement verification. But the question asked for the best and did not state when passing meds., or during initial placement. Am I to put a realistic answer or what is stated in the NCLEX guides as well as my nursing text?

    I am cursed with a compulsion to know why, sometimes it drives me crazy!!!!!!! :trout: :trout:
  6. by   EricJRN
    See, I'm pretty sure that gastric pH is falling out of favor, especially over the last year or two. That's weird.
  7. by   Bonny619
    Eric, that's what our instructors have been telling us over and over.
  8. by   Hoping LVN2BSN
    Quote from EricEnfermero
    See, I'm pretty sure that gastric pH is falling out of favor, especially over the last year or two. That's weird.

    At my school anyway and the clinicals sites I have been to didn't check this way, we inject air. I only knew of this from my books. Once again this was a real world vs. test purpose answer. I wish somehow the real world and the NCLEX could synchronize.
  9. by   Bonny619
    We are constantly being told about "Ivory Tower" nursing. Meaning we are being taught the correct way, but you don't always do it that way. They tell us NCLEX is Ivory Towers.
  10. by   Hoping LVN2BSN
    Quote from Bonny619
    They tell us NCLEX is Ivory Towers.

    Ohhhhhhh... I've heard of Ivory Towers, but never knew.
  11. by   Bonny619
    But in this case Ivory Towers would be xray. So I don't understand.
  12. by   Leilah75_RN
    depending on hospital policy and procedure, one of the most accurate and inexpensive way to determine tube placement is the PH factor. We have this PH strip with 10 colors on it, dark green for safe,green,yellow green and so on, and yellow if not. the middle color (5th) is orange which is 50/50 yes or no. we do check the air injection altho it isnt always reliable. if in turn you always get the 50/50 ph result and the nurse is in doubt, xray is the last resort. thats is the policy in high dependecy unit, in ICU however, xray is always the choice since there are tubes other than the ngt is inserted to the client.
  13. by   Toby's mum
    Hoping, the NCLEX answers can be frustrating. You are correct that an XRay would be the ideal way to verify placement, however, you need a MD order to do so--the NCLEX focuses on what you as the nurse can do without needing MD's order. Therefore, the right answer for this NCLEX question is A. It takes a while to get used to this way of thinking--the NCLEX way--but once you get it, you begin to dismiss answers that require a MD order and select the one that you as a nurse can do. Hope this helps.
  14. by   Hoping LVN2BSN
    Quote from Toby's mum
    Hoping, the NCLEX answers can be frustrating. You are correct that an XRay would be the ideal way to verify placement, however, you need a MD order to do so.
    Ahhh! There it is, now I understand. Thanks Toby!:spin:

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