What is the first step in placing a nasogastric tube?

• A. Tell client to extend neck back
• B. Measure, mark, and lubricate
• C. Tell client to flex neck forward and swallow
• D. Insert tube past nasopharynx

Answer: (B)

Starting with measuring, marking, and lubricating the tube sets you up for safe, accurate placement. Measuring from the nostril to the earlobe and down to the expected depth reaches the stomach, and marking that point on the tube provides a reliable stop depth to prevent under-insertion or over-insertion. Lubrication makes the tube glide smoothly and reduces mucosal irritation. Once these steps are done, you position the patient, insert along the nasal floor, and advance the tube guided by the patient’s swallow to help direct the tube into the esophagus. Extending the neck or inserting past the nasopharynx are not the initial steps and can misdirect or hinder correct placement.