A nurse is preparing to administer a medication from an ampule. Which of the following is an appropriate action for the nurse to take?
Cleanse the tip of the ampule with an alcohol swab after opening.
Add 0.5 mL of diluent to the medication.
Use a filter needle to aspirate the medication.
Inject air into the ampule prior to drawing the medication into a syringe.
The Correct Answer is C
The correct answer is choice C. Use a filter needle to aspirate the medication.
This is because a filter needle can prevent glass particles from being drawn into the syringe when aspirating medication from an ampule.
Glass particles can cause harm to the patient if injected.
Choice A is wrong because cleansing the tip of the ampule with an alcohol swab after opening is not necessary and may contaminate the medication.
Choice B is wrong because adding 0.5 mL of diluent to the medication may alter the concentration and dosage of the medication.
Choice D is wrong because injecting air into the ampule prior to drawing the medication into a syringe is not required and may create pressure that can cause the ampule to break.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A. Use a communication board to interact with the client.
A communication board is a tool that allows the client to point to words, pictures, or symbols that express their needs, feelings, or pain level.
This is an effective way to communicate with a client who speaks a different language than the nurse and is unable to verbalize their pain.
Choice B is wrong because an assistive personnel who speaks the same language as the client is not a qualified interpreter and may not be able to convey the client’s pain accurately or maintain confidentiality.
Choice C is wrong because the FLACC scale is a measurement used to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain.
It is not appropriate for a client who is 6 hours postoperative and can communicate their pain using a communication board.
Choice D is wrong because the FACES pain scale is a self-report measure of pain intensity developed for children.
It uses facial expressions to rate the severity of pain in children from 0-103.
It is not suitable for a client who speaks a different language than the nurse and may not understand the meaning of the faces.
Correct Answer is D
Explanation
It's common practice to check blood pressure in both arms when there is a significant discrepancy in blood pressure readings between the arms. This discrepancy could be due to factors like arterial blockages or other conditions. By measuring the blood pressure in the other arm, the nurse can confirm whether the high blood pressure is consistent on both sides or if there was an issue with the initial measurement. This step helps provide a more accurate assessment of the client's blood pressure.
- The other options are not appropriate at this stage:
Deflating the cuff faster may not resolve the issue and could lead to inaccurate measurements.
Requesting a prescription for an antihypertensive medication should only be done after confirming the blood pressure is consistently elevated and under the direction of a healthcare provider.
Using a narrower cuff is not indicated in this situation. It's more important to assess the other arm's blood pressure to identify any discrepancies.
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