A nurse is preparing to perform a blood glucose test. After performing hand hygiene and donning gloves, in which order should the nurse perform the following actions to obtain a capillary blood sample? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Choice A Reason:

The client has a delayed response to verbal commands. This finding can indicate increased intracranial pressure. Changes in responsiveness, such as delayed responses to verbal commands or other stimuli, can be indicative of neurological impairment due to elevated pressure within the skull.

Choice B Reason:

The client has ecchymosis around the eyes. Ecchymosis around the eyes (raccoon eyes) can occur with certain head injuries, but it's not a direct sign of increased intracranial pressure. It's more commonly associated with basilar skull fractures rather than specifically reflecting increased pressure within the skull.

Choice C Reason:

The client is unable to remember details of the motor-vehicle crash. Memory impairment or amnesia regarding the event can occur due to head trauma, but it might not directly correlate with an increase in intracranial pressure. It's more related to the effects of the injury on memory function.

Choice D Reason:

The client reports ringing in the ears. Tinnitus or ringing in the ears might occur in some cases of head trauma but is not a direct indicator of increased intracranial pressure. It might result from the impact of the injury or other associated factors.

Choice A Reason:
"Will use ibuprofen when I have a headache." This statement is inappropriate. Enoxaparin is an anticoagulant, and using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can increase the risk of bleeding. So, using ibuprofen isn't recommended without consulting a healthcare professional while on enoxaparin.
Choice B Reason:
“Will use an electric razor for shaving.” This statement is correct. Enoxaparin is an anticoagulant, and using a sharp razor increases the risk of bleeding. Using an electric razor reduces the chance of nicks or cuts that could lead to bleeding complications while on this medication.
Choice C Reason:
“Will avoid the use of stool softeners." This statement is inappropriate. Enoxaparin doesn't directly interact with stool softeners. However, it's crucial to consult a healthcare provider before taking any new medications, including stool softeners, while on enoxaparin, as there might be potential interactions or effects on clotting.
Choice D Reason:
"I will massage the site after each injection." This statement is inappropriate. Massaging the site after an enoxaparin injection could potentially cause bruising or irritation. The usual recommendation is to apply gentle pressure at the injection site for a short time after the injection but not to massage it vigorously.