A nurse is collecting data from a client who has peritonitis.Which of the following findings should the nurse expect?

Choice Drationale

Checking the medication administration record to verify the client's allergies ensures patient safety by preventing allergic reactions to enoxaparin. Allergies to medications can cause adverse reactions, which can be life-threatening. This step confirms that enoxaparin is safe for administration to the client.

Choice Arationale

Locating the injection site 5 cm (2 in) to the right or left of the umbilicus ensures that the injection is given in the appropriate subcutaneous tissue. This site has fewer blood vessels and nerves, reducing the risk of injury and ensuring proper absorption of the medication.

Choice Erationale

Ensuring an air bubble is present in the prefilled enoxaparin syringe helps to lock the medication into the subcutaneous tissue and prevents the medication from leaking out. The air bubble technique is specific to enoxaparin administration.

Choice Crationale

Pinching clean skin at the injection site and darting the needle into the skinfold at a 90° angle ensures that the medication is administered into the subcutaneous tissue. This technique minimizes pain and ensures that the medication is delivered correctly.

Choice Brationale

Slowly injecting the medication into the site without aspirating prevents tissue damage and ensures that the medication is delivered into the subcutaneous tissue. Aspirating is not required for subcutaneous injections and can cause unnecessary pain and discomfort.

Choice A rationale

Placing throw rugs on the floor increases the risk of falls, which is particularly dangerous for clients with Alzheimer's disease due to potential mobility and cognitive impairments. Fall prevention measures are critical in their care.

Choice B rationale

Leaving the television on can contribute to sensory overload and confusion in clients with Alzheimer's disease. A calm and structured environment with minimal distractions is more beneficial for their cognitive function and well-being.

Choice C rationale

Installing locks at the top of doors helps prevent clients with Alzheimer's disease from wandering and ensures their safety. This modification addresses the common issue of wandering and helps keep the client secure in their environment.

Choice D rationale

Scheduling alternate caregivers is important for managing caregiver fatigue but is not directly related to environmental modifications in the home. Caregiver support is crucial, but the focus here is on physical safety within the home environment.