A nurse is administering nasal decongestant drops for a client.
Which of the following actions should the nurse take?
Assist the client to a side-lying position.
Hold the dropper 2 cm (1 in) above the naris.
Instruct the client to stay in the same position for 2 min.
Tell the client to blow her nose gently before the instillation.
The Correct Answer is D
The correct answer is choice D.
Choice A rationale:
Assisting the client to a side-lying position is not necessary when administering nasal decongestant drops. The client can be in an upright position or slightly tilted back.
Choice B rationale:
Holding the dropper 2 cm (1 in) above the naris is not a standard guideline for administering nasal decongestant drops. The dropper should be inserted into the nostril without touching the inside of the nostril to avoid contamination.
Choice C rationale:
Instructing the client to stay in the same position for 2 min is not necessary. After the administration of the nasal decongestant drops, the client can resume their normal activities.
Choice D rationale:
Telling the client to blow her nose gently before the instillation is the correct action. This action will help remove any secretions or crusts that could interfere with the distribution and absorption of the medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
The National Student Nurses Association is primarily focused on students and recent graduates. While it can be an excellent organization for student nurses, it may not provide opportunities for a nurse looking to become involved in nursing on a national level beyond their student years.
Choice B rationale:
The National Academy of Medicine is an organization that focuses on health policy and research. While it is a prestigious organization, it is not specifically a nursing organization, and its focus may not align with the goals of a nurse seeking to become more involved in nursing on a national level.
Choice C rationale:
The American Nurses Association (ANA) is a national organization specifically dedicated to advancing the nursing profession. It offers various opportunities for nurses to get involved in national-level nursing advocacy, policy development, and professional growth. Joining the ANA is a suitable choice for a nurse looking to make a national impact in the field of nursing.
Choice D rationale:
The National League for Nursing (NLN) is an organization that primarily focuses on nursing education. While it plays a crucial role in the field of nursing, its focus is more on education and may not align with a nurse's goal to become involved in nursing on a national level from a broader perspective.
Correct Answer is D
Explanation
The correct answer is choiced. Location of blood pressure cuff.
Choice A rationale:The systolic blood pressure of 102 mm Hg is within a normal range and does not require clarification.
Choice B rationale:The position of the client, “sitting up in a chair,” is clearly documented and does not need further clarification.
Choice C rationale:The unit of measurement, “mm Hg,” is the standard unit for blood pressure and is correctly documented.
Choice D rationale:The location of the blood pressure cuff is not specified in the documentation. It is important to document whether the blood pressure was taken on the left or right arm, or another location, to ensure accuracy and consistency in future measurements.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.