A family requested a visit from a hospice nurse as they think the client appears to be nearing the end of life. The nurse assesses the client.

Which of the following signs indicate that the client is near death?

Choice A rationale
Expelling the air in the prefilled syringe prior to injection is not recommended for low molecular weight heparin (LMWH) administration. The air bubble in the prefilled syringe helps ensure the entire dose is delivered and prevents leakage of the medication. Removing the air bubble can lead to an incomplete dose and reduced efficacy of the medication.
Choice B rationale
Rotating injections between the abdomen and gluteal areas is not recommended for LMWH administration. The preferred site for LMWH injections is the abdominal area, specifically at least 2 inches (5.1 cm) from the umbilicus. This site provides better absorption and reduces the risk of complications such as hematoma formation.
Choice C rationale
Massaging the injection site to increase absorption is not recommended for LMWH administration. Massaging the site can cause bruising and hematoma formation, which can be painful and may affect the absorption of the medication. It is important to avoid massaging the injection site to minimize these risks.
Choice D rationale
Injecting in the abdominal area at least 2 inches (5.1 cm) from the umbilicus is the correct instruction for LMWH administration. This site provides optimal absorption and reduces the risk of complications. The abdominal area has a good blood supply, which helps in the effective
absorption of the medication. Additionally, injecting at least 2 inches (5.1 cm) from the umbilicus helps avoid the umbilical area, which is more prone to bruising and discomfort.

Choice A rationale
Double-checking all dosage calculations is a crucial step in preventing medication errors. This process involves verifying the calculations to ensure the correct dose is administered.
However, while important, it is not the most effective technique on its own. It must be combined with other strategies to ensure comprehensive error prevention.
Choice B rationale
Identifying unusually large or small doses is essential in preventing medication errors. This involves recognizing doses that fall outside the typical range for a given medication and patient population. However, this technique alone does not address other potential errors, such as patient misidentification or incorrect medication administration.
Choice C rationale
Comparing the medication label to the order is a fundamental step in preventing medication errors. This process ensures that the correct medication is being administered as per the physician’s order. However, this technique alone does not address other potential errors, such as incorrect dosage calculations or patient misidentification.
Choice D rationale

Using at least two client identifiers before administering a dose is the most effective technique in preventing medication errors. This process ensures that the correct patient is receiving the correct medication. It addresses the critical issue of patient misidentification, which is a common cause of medication errors. By confirming the patient’s identity using two identifiers, such as name and date of birth, the risk of administering medication to the wrong patient is significantly reduced.
Choice E rationale
Involving and educating clients in medication administration is an important strategy in preventing medication errors. Educated clients are more likely to understand their medication regimen and recognize potential errors. However, this technique alone does not address other potential errors, such as incorrect dosage calculations or patient misidentification.
Choice F rationale
Documenting all medication in the electronic record as soon as it is given is a crucial step in preventing medication errors. This process ensures that there is an accurate and up-to-date record of all medications administered. However, this technique alone does not address other potential errors, such as incorrect dosage calculations or patient misidentification.