A charge nurse is teaching a newly licensed nurse about administering heparin to a client. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
"I will check the client's INR before administering the heparin."
"I will aspirate before administering the heparin."
"I will massage the site after the injecting the heparin."
"I will apply pressure for 1 minute after the injection."
The Correct Answer is D
Choice A Reason:
. "I will check the client's INR before administering the heparin." Is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps minimize the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in reducing bleeding at the injection site.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
Meloxicam is incorrect. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) used primarily for managing mild to moderate pain and inflammation. While it can provide relief for mild pain, it may not be potent enough to effectively manage severe pain, especially in cases of advanced cancer-related pain, where stronger analgesics are often necessary.
Choice B Reason:
Aspirin is incorrect. Aspirin, like meloxicam, is an NSAID used for mild to moderate pain relief and has anti-inflammatory properties. While it can be effective for certain types of pain, it's generally not the first choice for severe pain management, particularly in cases of advanced cancer-related pain where stronger opioids are typically required for adequate relief.
Choice C Reason:
Hydromorphone is correct. Hydromorphone is a potent opioid analgesic used to manage severe pain, especially in cancer-related pain or post-operative settings. In cases of severe pain, opioids like hydromorphone are commonly utilized due to their effectiveness in providing relief.
Choice D Reason:
Caldofor is incorrect. The term "Caldofor" does not appear to correspond to any recognized medication commonly used for pain relief. It's possible that this might be a misspelling or an unfamiliar or less common drug name. Without a specific drug identification, it's challenging to assess its suitability or effectiveness for managing severe pain associated with pancreatic cancer.

Correct Answer is A
Explanation
Choice A Reason:
Identify the client using two identifiers is correct. Prior to administering any medication, especially controlled substances, it's crucial to confirm the client's identity using two unique identifiers, such as their name and date of birth or an identification band and verbal confirmation. Ensuring accurate identification helps prevent medication errors and ensures the right medication is given to the right patient.
Choice B Reason:
Compare the amount of medication available to the inventory record is incorrect. This is part of maintaining accurate documentation and inventory control, ensuring that the amount of medication matches the recorded inventory. However, it typically occurs after confirming the client's identity.
Choice C Reason:
Document the administration of the medication is incorrect. Documentation of medication administration is crucial for legal and medical purposes but should occur after the medication has been safely administered to the correct patient.
Choice D Reason:
Remove the medication from the medication dispensing cabinet is incorrect. Retrieving the medication from the dispensing cabinet is an essential step in the administration process, but it should occur after confirming the client's identity to ensure the right medication is administered to the right individual.
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