A nurse is assisting in the care of a client who is receiving newly prescribed IV antibiotics. Which of the following findings should the nurse report immediately?

Small, raised vesicles over the body

Rhinitis

Itching of the skin

Severe wheezing

Answer and Explanation

The Correct Answer is D

Rationale:

A. Small, raised vesicles over the body may indicate an allergic reaction but are not typically associated with IV antibiotics.

B. Rhinitis may indicate an allergic reaction but is not typically associated with IV antibiotics.

C. Itching of the skin may indicate an allergic reaction but is not typically associated with IV antibiotics.

D. Severe wheezing may indicate an allergic reaction or anaphylaxis and should be reported immediately.

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Correct Answer is ["B","E"]

Explanation

A. Squeezing the client's finger can cause hemolysis and affect test accuracy.
B. Pricking the side of the finger is recommended because it is less painful and provides better blood flow.
C. Keeping the hand below heart level promotes better blood flow; elevating it can reduce blood flow.
D. Alcohol is preferred for cleansing; iodine can interfere with test results.
E. Wearing clean gloves is necessary for infection control and safety.

A. A pair of sterile forceps is allowed to rest in a container of sterile water on the field. B. The sterile solution is poured with the bottle held over the field. C. Unnecessary sterile items are placed on the field. D. The handle of a pair of sterile scissors is resting 5 cm (2 in) from the field's edge.

Correct Answer is B

Explanation

Rationale:

A. Allowing sterile forceps to rest in a container of sterile does not affect the sterility of the field.

B. Pouring sterile solution with the bottle held over the field is an inappropriate technique since it breaches the sterility of the field.

C. Placing unnecessary sterile items on the field is not ideal, but it does not indicate contamination of the surgical field.

D. The handle of a pair of sterile scissors resting 5 cm (2 in) from the field's edge does not indicate contamination of the surgical field. The scissors should be placed within easy reach of the nurse but should not touch non-sterile items.

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A nurse is assisting in the care of a client who is receiving newly prescribed IV antibiotics. Which of the following findings should the nurse report immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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