A nurse is planning care for a client who is receiving an IV fluid infusion. Which of the following interventions should the nurse implement to maintain asepsis?

Change the secondary IV infusion set twice weekly.

Change a continuously infusing IV bag after 48 hr.

Change the primary IV infusion set every 96 hr.

Change the extension tubing once per week.

Answer and Explanation

The Correct Answer is C

A. Change the secondary IV infusion set twice weekly: Secondary IV sets, such as piggyback infusions, should generally be changed every 24 hours to reduce the risk of contamination and infection. Changing them twice weekly would not maintain proper asepsis.

B. Change a continuously infusing IV bag after 48 hr: Continuous IV bags should be replaced at least every 24 hours to prevent bacterial growth. Waiting 48 hours increases the risk of microbial contamination and bloodstream infections.

C. Change the primary IV infusion set every 96 hr: Changing the primary IV infusion set every 96 hours (4 days) aligns with standard infection-control guidelines. This interval helps maintain asepsis while minimizing the risk of IV-related infections.

D. Change the extension tubing once per week: Extension tubing connected to the IV line should be changed more frequently, typically every 72 to 96 hours, to prevent contamination. Once per week is too infrequent and increases infection risk.

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

Explanation

A. Establish the client's learning needs: Identifying what the client needs to know about managing type 2 diabetes is essential for creating a focused and effective teaching plan. This ensures the teaching is relevant and addresses gaps in knowledge.

B. Determine the client's literacy level: Assessing literacy helps the nurse tailor educational materials and teaching methods so the client can understand instructions, especially when managing medications, diet, and blood glucose monitoring.

C. Evaluate the client's readiness for learning: Readiness includes emotional, cognitive, and physical factors. A client who is stressed, anxious, or fatigued may not retain information effectively, making this assessment crucial before teaching.

D. Verify the client's computer access: While useful for online education, access to technology is not a prerequisite for general diabetes teaching. Education can be provided through verbal instruction, print materials, or demonstrations.

E. Identify the client's learning style: Understanding whether the client learns best through visual, auditory, or kinesthetic methods allows the nurse to adapt teaching strategies, improving comprehension and retention of diabetes self-management skills.

A. An older adult client who began volunteering at a local clinic following their partner's death B. An adolescent client who reports spending more time with friends than close family C. A client who is being discharged to a rehabilitation facility rather than home following surgery D. A client who is terminally ill and whose family members are in denial of the impending death

Correct Answer is D

Explanation

A. An older adult client who began volunteering at a local clinic following their partner's death: Volunteering encourages social interaction and helps prevent loneliness. This client is actively engaging with others, which reduces the likelihood of isolation.

B. An adolescent client who reports spending more time with friends than close family: Adolescents commonly shift toward peer-centered relationships. Spending more time with friends than family is developmentally appropriate and does not indicate social isolation.

C. A client who is being discharged to a rehabilitation facility rather than home following surgery: While moving to a facility may temporarily disrupt social networks, rehabilitation centers provide structured interactions with staff and other clients, reducing the risk of isolation.

D. A client who is terminally ill and whose family members are in denial of the impending death: This client faces a greater risk of social isolation because the family’s denial can limit open communication and emotional support. The client may feel alone in processing their condition and preparing for end-of-life needs.

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A nurse is planning care for a client who is receiving an IV fluid infusion. Which of the following interventions should the nurse implement to maintain asepsis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning teaching for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following actions should the nurse take prior to performing the teaching? (Select all that apply.)

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

Explanation

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Correct Answer is D

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