# A nurse has just completed the insertion of a nasogastric (NG) tube for a 70-year-old client with dysphagia following a stroke. Which action should the nurse prioritize next?

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> language: ko  
> subject: Adult Health

## 문제

A nurse has just completed the insertion of a nasogastric (NG) tube for a 70-year-old client with dysphagia following a stroke. Which action should the nurse prioritize next?

## 보기

1. Verify correct tube placement by checking pH of gastric aspirate and obtaining chest X-ray confirmation. **✔ 정답**
2. Secure the tube to the client's nose with tape to prevent displacement and accidental removal.
3. Connect the tube to low intermittent suction as prescribed to decompress the stomach.
4. Document the insertion procedure and initial assessment findings in the client's chart.

**정답: 1**

## 해설

Verifying NG tube placement via pH testing and chest X-ray is the most definitive method to prevent severe complications like aspiration. Other actions (securing, suctioning, documenting) are important but must follow confirmation of correct placement to ensure patient safety.

## 심화 해설

Understanding the Priority: Safety First in NG Tube Insertion

Following the insertion of a nasogastric (NG) tube, the nurse's immediate and most critical priority is to verify correct placement before using the tube for any purpose. This principle is rooted in patient safety, as the consequences of a misplaced tube can be severe and life-threatening. For a 70-year-old client with dysphagia following a stroke, the risk of aspiration is already elevated, making accurate placement verification even more crucial. Misplacement into the trachea or lungs can lead to pneumothorax, aspiration pneumonia, or even death if feedings or medications are administered [1].

Why Verification is the First Step

The rationale for prioritizing placement verification over securing, connecting to suction, or documenting is based on a hierarchy of clinical risk. The initial action must rule out the most immediate danger. While securing the tube (Option 2) is important to prevent dislodgement, it is a secondary step. Securing a malpositioned tube creates a false sense of security and delays the detection of a critical error. Similarly, connecting the tube to suction (Option 3) or documenting the procedure (Option 4) are contraindicated until correct gastric positioning is objectively confirmed. The "gold standard" for verification remains the chest X-ray, which provides a definitive visual of the tube's path and tip location [2,3]. However, guidelines also recommend a preliminary bedside check using gastric aspirate pH testing to reduce unnecessary radiation exposure [1].

Clinical Application of Verification Methods

The correct action sequence begins with obtaining gastric aspirate and testing its pH. A pH value of

## 임상 시나리오

NG Tube Insertion Safety ProtocolVerification must precede any use of the tube
The immediate priority after insertion is placement verification. The gold standard is a chest X-ray to visualize the tip in the stomach. A preliminary bedside check involves testing gastric aspirate for a pH of 1 to 5.5.

Securing the tube, connecting to suction, or documenting must be delayed until correct positioning is objectively confirmed. Acting otherwise risks pneumothorax or fatal aspiration, especially in high-risk patients with dysphagia.

CautionNever rely on auscultation of insufflated air as a primary verification method; it is unreliable for distinguishing gastric from respiratory placement.

## 핵심 개념

- **Chest X-ray confirmation** — The gold standard for verifying NG tube placement, providing a definitive visual of the tube's path and tip location in the stomach.
- **Gastric aspirate pH** — A bedside check where aspirate from the tube is tested; a pH of 1 to 5.5 typically indicates gastric placement.
- **Dysphagia** — Difficulty swallowing, which increases the risk of aspiration and makes accurate NG tube placement critical.
- **Pneumothorax** — A potential complication of NG tube misplacement into the trachea or lungs, causing air to enter the pleural space and collapse the lung.

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