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

Nursing Students NCLEX

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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? :uhoh3:

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!

Specializes in Registry, all over the place.
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.[/quote']

Ahhh! There it is, now I understand. Thanks Toby!

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to me, A would be the only one......it is not a nursing function to interpret xrays....instilling air is for NG tubes....removing aspirate is only going to pull out what was pumped in.....where ever it had been pumped into......

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Specializes in ED, ICU, PACU.
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.[/quote']

:yeahthat:

Just keep in the back of your mind the scope of practice for a nurse-this should help being able to eliminate answers that require a practioner's order and assist with the delegation-type NCLEX questions.

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Specializes in PEDS ~ PP ~ NNB & LII Nursery.

Asperate and check the PH.

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Specializes in PEDS ~ PP ~ NNB & LII Nursery.

Sorry, I wasn't finished. To asperate and check PH is the RN's way of testing but the most accurate is to wait for the result to be read on the Xray.

There. NOW I am done. Sorry about that.

rags

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I had an NCLEX practice question and the answer was the Xray, not pH. Even the instructor said that was the way to check in NCLEX ivory tower land. So I'm not sure why the correct answer in your book was the pH. (BTW, we used pH and blowing air in the real world because it was not realistic to do an Xray each time.) Hope that helps!

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I was taught and have always been guided by injecting air bolus and listening over epigastric area, also if bile is aspirated you are in the proper place. Just recently I was shown by ny supervisor to put the end of the ng tube in about 6 inches of water and if water bubbles then itis in the lung. Choosing the chest xray would require an order from the doctor and doctor interpretation ...not something a nurse could perform independently.

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Specializes in Cardiac.

This very question appeared on one of my tests. The answer (as per NCLEX) is always aspirate and check pH.

Although in real life we just check for placement via auscultation.

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Specializes in Neuro/Med-Surg/Oncology.
I had an NCLEX practice question and the answer was the Xray, not pH. Even the instructor said that was the way to check in NCLEX ivory tower land. So I'm not sure why the correct answer in your book was the pH. (BTW, we used pH and blowing air in the real world because it was not realistic to do an Xray each time.) Hope that helps!

You would have to see how your particular practice NCLEX question is worded. This one sepcifies nursing intervention. Reading x-rays is not a nursing intervention.

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But in this case Ivory Towers would be xray. So I don't understand.

I think you have to read the question very closely. It says the "best action" to take.

The choice of the x-ray verification does not indicate a new x-ray verification, so you are verifying where the tube was, but not necessarily where it is.

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Great points everyone. I think looking at these questions from the point of view, what can I do as a nurse, really clears things up.

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Specializes in cardiac/critical care/ informatics.
I was taught and have always been guided by injecting air bolus and listening over epigastric area, also if bile is aspirated you are in the proper place. Just recently I was shown by ny supervisor to put the end of the ng tube in about 6 inches of water and if water bubbles then itis in the lung. Choosing the chest xray would require an order from the doctor and doctor interpretation ...not something a nurse could perform independently.

I think the question is referring to a G-Tube not an NG tube.

Generally G-tubes dont' require an X-ray for placement as they are placed under fluro. so aspirate would be the answer,

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