The nurse is assisting with a patient being intubated at the bedside. After endotracheal tube insertion and the cuff inflation, what are the next appropriate actions to confirm placement before securing the airway? Select all that apply.

Choice A rationale Administering sedative or paralytic agents is typically performed prior to or during the actual intubation process to facilitate tube passage and prevent airway trauma. Once the tube is inserted and the cuff is inflated, the priority shifts to verification of placement rather than further sedation. Giving these drugs after insertion does not provide any diagnostic data regarding whether the tube is in the trachea or the esophagus. Choice B rationale A chest x-ray is the definitive gold standard for confirming the depth of endotracheal tube placement. It ensures the distal tip of the tube is positioned approximately 2 to 5 cm above the carina. While other methods confirm the tube is in the trachea, the x-ray is essential to ensure it has not migrated into the right mainstem bronchus, which would cause unilateral lung expansion and potential collapse. Choice C rationale End-tidal carbon dioxide detection provides immediate physiological feedback that the tube is located within the respiratory tract. Since CO2 is a byproduct of alveolar gas exchange, its presence in exhaled air indicates the tube is in the trachea rather than the esophagus. A colorimetric changer or capnography waveform is a primary tool used immediately after intubation to rule out esophageal placement before further interventions are performed. Choice D rationale Auscultation is a critical immediate step to verify bilateral lung expansion and rule out unintentional esophageal or endobronchial intubation. The nurse should listen for equal breath sounds over the midaxillary lines and ensure there are no gurgling sounds over the epigastrium. Epigastric sounds suggest the tube is in the stomach. Breath sounds must be assessed early to ensure both lungs are being ventilated prior to securing the device. Choice E rationale Arterial blood gases are useful for evaluating the long-term effectiveness of ventilation and oxygenation after the patient is stabilized on a ventilator. However, they are not used for the initial confirmation of tube placement because the results take too long to obtain. Verification must be instantaneous using physical assessment and CO2 detection to prevent hypoxia. Normal pH is 7.35 to 7.45, and normal PaO2 is 80 to 100 mmHg.