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 apply pressure for 1 minute after the Injection
I will massage the site after the injecting the heparin
I will aspirate before administering the heparin
None
None
The Correct Answer is B
A. I will check the client's INR before administering the heparin:
Checking the International Normalized Ratio (INR) is more relevant for monitoring the effects of warfarin, not heparin. Heparin is typically monitored by activated partial thromboplastin time (aPTT) or anti-Xa levels.
B. "I will apply pressure for 1 minute after the injection:"
Applying gentle pressure to the injection site for about 1 minute after administering heparin is appropriate to prevent bleeding or bruising. Since heparin is an anticoagulant, there's an increased risk of bleeding at the injection site.
C. I will massage the site after injecting the heparin:
Massaging the site after injecting heparin is not recommended. It can increase the risk of hematoma formation. After subcutaneous injection, it is generally advised to avoid massaging the site.
D. I will aspirate before administering the heparin:
Aspiration is not recommended when administering heparin subcutaneously, as it can increase the risk of tissue damage and bruising. The nurse should inject the heparin without aspirating.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Hypocalcemia: Hydrochlorothiazide is not typically associated with lowering calcium levels. Hypocalcemia is not a common adverse effect of this medication.
B. Hypernatremia: Hydrochlorothiazide is a diuretic that increases urination, leading to the loss of water and sodium. While it can cause sodium depletion, it's less likely to result in hypernatremia, which refers to high sodium levels in the blood.
C. Hypokalemia: Hydrochlorothiazide is a thiazide diuretic that can increase the excretion of potassium in the urine. Hypokalemia (low potassium levels) is a known adverse effect of this medication due to its action on the kidneys leading to potassium loss.
D. Hypermagnesemia: Hydrochlorothiazide does not typically cause an increase in magnesium levels. It's more likely to cause magnesium loss through increased urination, potentially leading to hypomagnesemia (low magnesium levels) rather than hypermagnesemia.
Correct Answer is B
Explanation
A. "You will need to undergo tuberculin skin tests every 6 months while taking medication for your disease."
Tuberculin skin tests are typically used for screening and diagnosis, not for monitoring the effectiveness of tuberculosis treatment. Monitoring for treatment effectiveness involves assessing symptoms, sputum cultures, and other diagnostic tests.
B. "You will need to take two or more medications to treat your disease."
This is the correct answer. Tuberculosis is usually treated with a combination of antibiotics to prevent the development of drug resistance. Multidrug therapy is a standard approach to tuberculosis treatment.
C. "You should anticipate taking medication to treat your disease for at least the next 3 years."
The duration of tuberculosis treatment is generally shorter than 3 years. The standard treatment duration is typically 6 to 9 months, depending on the specific regimen used.
D. "You should report monthly to have your blood drawn to monitor kidney function while taking medication."
Monitoring kidney function is important for some medications, but it is not a standard monthly requirement for tuberculosis treatment. Monitoring typically involves assessing liver function, as certain tuberculosis medications can affect the liver.
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