NCLEX Practice Exam for Patient Tubes (NGT, Chest, and Tracheostomy)

1. Which of the following is not true regarding the types of a nasogastric tube?

1. Cantor tube is a single-lumen long tube with a small inflatable bag at the distal end.
   
2. Miller-Abbott tube is a long double-lumen used to drain and decompress the small intestine.
3. Levin tube is a double lumen nasogastric tube with an air vent.
4. Sengstaken-Blakemore tube is a three-lumen tube.

2. A newly RN nurse is about to insert a nasogastric tube to a client with Guillain-Barre Syndrome. To determine the accurate measurement of the length of the tube be inserted, the nurse should:

1. Place the tube at the tip of the nose, and measure by extending the tube to the earlobe and then down to the top of the sternum.
2. Place the tube at the tip of the nose, and measure by extending the tube to the earlobe and then down to the xiphoid process.
3. Place the tube at the tip of the nose, and measure by extending the tube down to the chin and then down to the top of the xiphoid process.
4. Place the tube at the base of the nose, and measure by extending the tube to the earlobe and then down to the top of the sternum.

3. A stroke client who was initially on NGT feeding was able to tolerate soft diet so the physician ordered for the removal of it. The nurse would instruct the client to do which of the following before he removes the tube?

1. Inhale and exhale simultaneously.
2. Take a long breath and hold it.
3. Do a Valsalva maneuver.
4. Blow the nose.

4. The nurse is preparing to give bolus enteral feedings via a nasogastric tube to a comatose client. Which of the following actions is an inappropriate practice by the nurse?

1. If bowel sounds are absent, hold the feeding and notify the physician.
2. Assess tube placement by aspirating gastric content and check the PH level.
3. Warm the feeding to room temperature to prevent the occurrence of diarrhea and cramps.
4. Elevate the head of the bed to 45 degrees and maintains for 30 minutes after instillation of feeding.

5. A nurse is checking the nasogastric tube position of a client receiving a long term therapy of Omeprazole (Prisolec) by aspirating the stomach contents to check for the PH level. The nurse proves that correct tube placement if the PH level is?

1. 7.75.
2. 7.5.
3. 6.5.
4. 5.5.

6. Before feeding a client via NGT, the nurse checks for residual and obtains a residual amount of 90ml. What is the appropriate action for the nurse to take?

1. Discard the residual amount.
2. Hold the due feeding.
3. Skip the feeding and administer the next feeding due in 4 hours.
4. Reinstill the amount and continue with administering the feeding.

7. Continuous type of feedings is administered over a __ hour period.?

1. 4.
2. 12.
3. 24.
4. 36.

8. A client is subjected to undergo a chest x-ray to confirm the endotracheal tube placement. The tube should be how many centimeters above the carina?

1. 2-4 cm.
2. 1.5-3 cm.
3. 1-2 cm.
4. 0.5-1 cm.

9. After the client had tolerated the weaning process, the physician ordered the removal of the endotracheal tube and will be shifted into a nasal cannula. Which of the following findings after the removal requires immediate intervention by the physician?

1. Sore throat.
2. Hoarseness of the voice.
   
3. Coughing out blood.
4. Neck discomfort.

10. The nurse is assessing a client with an endotracheal tube and observes that the client can make verbal sounds. What is the most likely cause of this?

1. This is a normal finding.
2. There is a leak.
3. There is an occlusion.
4. The endotracheal tube is displaced.

11. While changing the tapes on a tracheostomy tube, the client coughs and the tube is dislodged. Which is the initial nursing action?

1. Call a respiratory therapist to reinsert the tracheotomy.
2. Cover the tracheostomy site with a sterile dressing.
3. Call the physician to reinsert the tracheotomy.
4. Grasp the retention sutures to spread the opening.

12. The nurse caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is most appropriate of the nurse?

1. Increase the suction pressure so that the bubbling becomes vigorous.
2. Do nothing since this is an expected finding.
3. Immediately clamp the chest tube and notify the physician.
4. Check for an air leak because the bubbling should be intermittent.

13. The nurse is assessing the functioning of a chest tube drainage system in a client with hemothorax. Which of the following findings should prompt the nurse to notify the physician?

1. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation.
2. Drainage system maintained below the client’s chest.
3. Drainage amount of 100ml in the drainage collection chamber.
4. Occlusive dressing in place over the chest tube insertion site.

14. A nurse is supervising a student nurse who is performing tracheostomy care for a client. Which of the following actions by the student should the nurse intervene?

1. Removing the inner cannula and cleaning using universal precaution.
2. Suctioning the tracheostomy tube before performing tracheostomy care.
3. Changing the old tracheotomy ties and securing the tube in place.
4. Replacing the inner cannula and cleaning the site of the stoma.

15. The nurse is handling a client with a chest tube. Suddenly, the chest drainage system is accidentally disconnected, what is the most appropriate action for the nurse to take?

1. Secure the chest tube using a tape.
2. Clamp the chest tube immediately.
3. Place the end of the chest tube in a container of normal sterile saline.
4. Apply an occlusive dressing and notify the physician.

Answers and Rationale

1. Answer: C. Levin tube is a double lumen nasogastric tube with an air vent. A levin tube is a single lumen nasogastric tube while a Salem sump tube is the double lumen nasogastric tube with an air vent.

2. Answer: B. Place the tube at the tip of the nose, and measure by extending the tube to the earlobe and then down to the xiphoid process.

3. Answer: B. Take a long breath and hold it. Holding the breath closes the glottis hence it will be easier to withdraw the tube through the esophagus into the nose. and this method will also prevent aspiration.

4. Answer: D. Elevate the head of the bed to 25 degrees and maintains for 30 minutes after instillation of feeding. If the client is comatose, place in a high-fowlers which is in a 90-degree level.

5. Answer: D. 5.5. Gastric placement is indicated by a pH of less than 4, but may increase to between pH 4-6 if the patient is receiving acid-inhibiting drugs.

6. Answer: D. Reinstill the amount and continue with administering the feeding. If the residual feeding is less than 100ml, feeding is administered.

7 Answer: C. 24.  Continuous feeding is administered for 24 hours. An infusion pump regulates the flow.

8. Answer: C. 1-2 cm. Placement of an endotracheal tube is confirmed by a chest x-ray and the correct placement is 1 to 2 cm above the carina.

9. Answer: C. Coughing out blood. A sign of a tracheal or esophageal perforation which prevents oxygen from reaching the lungs and can result in internal bleeding. This life-threatening side effect of being intubated requires immediate medical intervention.

• Options A, B, and D are normal and that the client should limit talking if it occurs.

10. Answer: B. There is a leak. When conducting the minimal leak technique the client should not be able to make verbal sounds or no air should be felt coming out of the client’s mouth.

11. Answer: D. Grasp the retention sutures to spread the opening. If the tube is dislodged accidentally, the initial nursing action is to grasp the retention sutures and spread the opening.

• Options A and C: Calling respiratory therapist or the physician will delay treatment in this emergency situation.
• Option B: Covering the tracheostomy site will block the airway.

12. Answer: B. Do nothing since this is an expected finding. Continuous gentle bubbling should be noted in the suction control chamber. Bubbling should be continuous in the suction control chamber and not intermittent.

• Option A:  Increasing the suction pressure only increases the rate of evaporation of water in the drainage system. and this is not done without any prescription of the physician.
• Options C and D: Chest tubes should only be clamped to check for an air leak or when changing drainage devices.

13. Answer: C. Drainage amount of 100ml in the drainage collection chamber. Drainage of more than 70 to 100 mL/hour is not normal and requires the immediate notification of the physician.

14. Answer: A. Removing the inner cannula and cleaning using universal precaution. When performing tracheostomy care, a sterile field is set up and sterile technique is required. Standard precautions such as washing hands must also be maintained but are not enough when performing tracheostomy care. The presence of tracheostomy tube provides direct access to the lungs for organisms, so sterile technique is used to prevent infection.

15. Answer: C. Place the end of the chest tube in a container of normal sterile saline. If a chest drainage system is disconnected, the nurse can place the end of the chest tube in a container of normal sterile saline to prevent air from entering the chest tube, thereby preventing negative respiratory pressure.

• Option A: The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected.
• Option B: The nurse should not clamp the chest tube because doing so increases the risk of tension pneumothorax.
• Option D: The nurse should apply an occlusive dressing if the chest tube is pulled out and not if the system is disconnected.