Which of the following is the most appropriate situation for nurses to insert a nasogastric feeding tube without physician supervision?

• A. In a patient status post stroke on the inpatient medical unit
• B. Pre-operatively just prior to transfer to the operating room
• C. In a patient with head and neck trauma admitted to the ICU
• D. In a stable outpatient setting

Answer: (A)

The key idea is understanding when a nurse may perform a nasogastric feeding tube insertion under an established protocol without the physician being present. In an inpatient medical unit with a patient who is status post stroke, there is often a clear need for feeding access due to dysphagia, and the facility may have standing orders or a policy that allows trained nurses to place an NG tube when criteria are met and monitoring is available. This arrangement enables timely nutrition support while still keeping the care team involved.

In contrast, pre-operative placement right before transfer to the operating room typically requires coordination with the surgical or anesthesia teams and a physician’s order; it’s not a setting where independent nurse-initiated placement is standard. A patient with head and neck trauma in the ICU carries higher risk for airway compromise, skull-base injury, or other complications, demanding physician oversight and possibly imaging or special precautions. An outpatient, stable setting generally lacks the policy framework and supervised environment needed for a nurse to perform this invasive procedure independently. Thus, the inpatient post-stroke scenario best aligns with appropriate nursing scope under protocol without immediate physician supervision.