A nurse is preparing to administer a subcutaneous injection of heparin to a client. Which of the following actions should the nurse plan to take?

Aspirate before administering the medication.

Withhold the medication for an elevated platelet count.

Monitor INR levels.

Validate the dosage with a second nurse.

Answer and Explanation

The Correct Answer is D

A. Aspirating is not necessary for subcutaneous injections, as it is not a deep intramuscular injection.

B. Withholding heparin for an elevated platelet count is unnecessary unless there is a confirmed heparin-induced thrombocytopenia (HIT).

C. INR is not used to monitor heparin therapy. Heparin is monitored using aPTT (activated partial thromboplastin time) or anti-Xa levels.

D. It is standard practice to validate heparin dosage with a second nurse to ensure safety due to the high risk of bleeding associated with this medication.

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Free Nursing Study Resources

Correct Answer is ["A","B","D"]

Explanation

Client reports feeling more tired since starting the medication: Fatigue is a common side effect of beta-blockers due to decreased cardiac output.

Client states, "I have also had loose stools several times this week": Gastrointestinal disturbances, including diarrhea, can occur with labetalol.

Client states, "I often get dizzy whenever I stand up.": This suggests orthostatic hypotension, a known adverse effect of labetalol due to vasodilation and decreased sympathetic response.

Heart rate 56/min: This is bradycardia, a classic adverse effect of beta-blockers, particularly in clients without prior use.

The temperature, respiratory rate, and blood pressure are all within normal ranges.

A. A vein in the client's dominant arm B. A vein proximal to the previous site C. A vein that feels hard to the touch D. A vein on the client's wrist

Correct Answer is B

Explanation

A. A vein in the dominant arm can be used, but it is not necessarily the best choice for a re-insertion.

B. A vein proximal to the previous site is the best option to avoid using the same vein where complications (e.g., infiltration, thrombosis) have occurred.

C. A vein that feels hard to the touch may indicate previous injury or sclerosis, making it unsuitable for insertion.

D. The wrist vein is less ideal because it is smaller and more difficult to access compared to veins in the forearm.

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A nurse is preparing to administer a subcutaneous injection of heparin to a client. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","B","D"]

Explanation

A nurse is caring for a client who requires a re-insertion of a short peripheral venous catheter. In which of the following locations should the nurse place the catheter?

Correct Answer is B

Explanation

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