RN Nursing · Respiratory Assessment · Practice question
A client has just been intubated with an endotracheal tube. Which of the following methods is one of the reliable ways to confirm proper placement of the tube?
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Checking the indelible marking on the tube at the naris against previous documentation.
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✓
Auscultating for breath sounds bilaterally and observing symmetric chest movement.
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Evaluating the client's ability to speak while the cuff is inflated.
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Injecting air through the tube and listening for gurgling sounds in the stomach.
Answer & explanation
Correct: Auscultating for breath sounds bilaterally and observing symmetric chest movement.
Confirming proper endotracheal tube placement is a critical patient safety step immediately after intubation. Auscultating for bilateral breath sounds over both lung fields and observing symmetric chest rise and fall is one of the reliable clinical methods to confirm that the tube is positioned in the trachea above the carina and not in the esophagus or mainstem bronchus. This is performed alongside capnography (end-tidal CO2 detection) and chest radiography, which are additional confirmation methods. Checking the indelible marking on the tube at the naris against previous documentation is a monitoring step used after confirmed placement to detect tube migration but is not a method of confirming initial proper placement. Evaluating the client's ability to speak while the cuff is inflated is actually a sign of incorrect placement or cuff failure — a properly placed and inflated endotracheal tube prevents phonation because air bypasses the vocal cords. Injecting air through the tube and listening for gurgling sounds over the stomach is a method used for confirming nasogastric tube placement, not endotracheal tube placement; gurgling over the stomach after intubation would strongly suggest esophageal misplacement, which is a life-threatening emergency.
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