A nurse is caring for a client with a nasogastric tube. Which action is essential for the nurse to perform before administering an intermittent tube feeding?

Choice A rationale Flushing a nasogastric tube (NGT) with normal saline is necessary to maintain patency before and after feeding or medication administration, but using only 10 mL is typically insufficient, and this action must occur after confirming correct tube placement to prevent accidental instillation into the respiratory tract, which is a life-threatening complication. Standard practice requires at least 30 mL. Choice B rationale Positioning the client flat in bed is contraindicated for tube feeding because it significantly increases the risk of pulmonary aspiration, where feeding contents enter the lungs, potentially leading to aspiration pneumonia. The client's head of bed should be elevated to at least 30 to 45 degrees, and this position must be maintained for at least 30 to 60 minutes after the feeding to facilitate gastric emptying. Choice C rationale Verifying the placement of the nasogastric tube is the most critical safety step before initiating any feeding to ensure the distal tip is securely located in the stomach or small intestine, not in the lungs. Placement verification should be done using two methods, with X-ray confirmation being the gold standard, alongside bedside methods like pH testing of aspirate (expected pH ≤ 5.5). Choice D rationale Clamping the tube after feeding is not the standard procedure for an intermittent feeding. Instead, after flushing the tube to clear it of residual feeding, the tube is typically capped or plugged to prevent reflux of gastric contents or air entry. Clamping the tube might be done briefly during specific procedures but not routinely for 30 minutes post-feeding.