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A nurse is obtaining a blood sample from a client's central venous access device. Which of the following actions should the nurse take?

Flush the catheter with sterile water after specimen collection.

Use a vacuum tube to obtain a specimen from the catheter hub.

Cleanse the connections with povidone-iodine.

Flush the catheter with a 5 mL syringe.

Answer and Explanation

The Correct Answer is C

A. Sterile water is not recommended for flushing central lines; normal saline should be used.

B. A vacuum tube may cause excessive suction and is not recommended; the nurse should use a syringe.

C. Cleansing the connections with povidone-iodine helps prevent infection and ensures aseptic technique.

D. A 5 mL syringe is too small; a 10 mL syringe should be used to avoid excessive pressure which could damage the catheter.

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Correct Answer is C

Explanation

A. Requesting a nightly sedative for a client with dementia is not typically recommended as it may increase the risk of confusion and falls, and sedatives can interfere with normal sleep patterns.

B. Turning off all lights in the room can increase disorientation and confusion in clients with dementia. A nightlight or dim light is usually more appropriate to provide a sense of security and reduce fear.

C. Placing the client's bed at the lowest height helps to reduce the risk of falls and injuries if the client tries to get out of bed independently. This is a practical safety measure for clients with dementia who may have impaired judgment and coordination.

D. Assisting with toileting at least once every 4 hours might not be frequent enough for clients with dementia, who may have difficulty communicating their needs or may forget to use the restroom. Individualized toileting schedules based on the client's needs are more effective.

A. Collect three samples from a single bowel movement. B. Wear sterile gloves when collecting the sample. C. Take the sample from the outer edge of formed stool. D. Discard samples that contain urine.

Correct Answer is D

Explanation

A. For fecal occult blood testing, samples should be collected from different bowel movements rather than from a single bowel movement to ensure accuracy.

B. Sterile gloves are not necessary for this procedure; clean gloves are sufficient.

C. The sample should be taken from different areas of the stool, not just the outer edge, to improve test accuracy.

D. Urine contamination can affect the accuracy of the test, so any samples containing urine should be discarded and a new sample should be collected.

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A nurse is obtaining a blood sample from a client's central venous access device. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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