A nurse is providing discharge teaching to a client who will be self-administering insulin at home. Which of the following information should the nurse include regarding needle disposal?

"Remove the needle from the syringe before you place it in the trash."

"Secure the cap tightly over the needle before you discard it"

"Place your storage container in a recycle bin when it is full."

"You can discard needles in an empty bleach bottle with a lid."

Answer and Explanation

The Correct Answer is D

Rationale:

A. "Remove the needle from the syringe before you place it in the trash." Needles should not be removed from syringes before disposal. This can increase the risk of needle-stick injuries. The entire syringe and needle should be disposed of intact in a proper sharps container.

B. "Secure the cap tightly over the needle before you discard it" Securing the cap over the needle increases the risk of needle-stick injuries. The needle should be placed directly in a sharps container without recapping.

C. "Place your storage container in a recycle bin when it is full." Sharps containers should never be placed in a recycle bin due to the risk of injury. Once full, the sharps container should be disposed of in a designated waste disposal service.

D. "You can discard needles in an empty bleach bottle with a lid.” The nurse should instruct the client to dispose of used needles in a rigid, puncture-proof container, such as an empty bleach bottle with a secure lid, until a proper sharps container is available. This helps prevent injury to others.

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Correct Answer is ["C","D","E","G"]

Explanation

Rationale:

A. Blood glucose level: The blood glucose level of 103 mg/dL is within normal limits (74 to 106 mg/dL) and does not require immediate follow-up. While the client has type 2 diabetes mellitus, the blood glucose is not abnormal at this time.

B. Bowel sounds: Bowel sounds are present in all four quadrants and do not require immediate follow-up. This finding is normal and is unrelated to the acute symptoms being assessed for a possible myocardial infarction.

C. Blood pressure: The client’s blood pressure is elevated at 164/80 mm Hg, which requires immediate attention in the context of chest pain and other symptoms that may suggest an acute myocardial infarction (MI).

D. Pain level: The client rates their chest pain as 7 out of 10, which is significant and consistent with potential myocardial ischemia or infarction. The pain’s radiation to the left arm, along with other symptoms like nausea and diaphoresis, suggest an urgent need for intervention.

E. Electrocardiogram findings: The 12-lead ECG shows tachycardia, ST segment elevation, and T wave changes, which are indicative of acute myocardial injury, such as an ST-elevation myocardial infarction (STEMI). This requires immediate intervention to prevent further myocardial damage.

F. Lung sounds: The lung sounds are clear in all lobes, which is reassuring and does not indicate an immediate concern.

G. Troponin T level: The elevated Troponin T level (0.40 ng/mL) is a key biomarker for myocardial injury. The elevation indicates ongoing cardiac damage, which requires immediate follow-up to assess for the extent of the infarction and initiate treatment.

A. Friction rub B. Xerostomia C. Agitation D. Decreased end-tidal CO

Correct Answer is C

Explanation

Rationale:

A. Friction rub: A friction rub is a sound heard on auscultation, typically due to the rubbing of the pleurae, and is more associated with pleuritis or pleural effusion rather than respiratory failure.

B. Xerostomia: Xerostomia, or dry mouth, can be a side effect of medications or dehydration but is not directly an indication of respiratory failure.

C. Agitation: Agitation is a common early sign of respiratory failure. As oxygen levels decrease or carbon dioxide levels increase in the bloodstream, the body may respond with restlessness or agitation due to insufficient oxygenation to the brain.

D. Decreased end-tidal CO2: A decreased end-tidal CO2 can indicate poor ventilation or respiratory distress, but it is not as specific as agitation in signaling respiratory failure. Agitation is a more direct response to inadequate gas exchange.

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A nurse is providing discharge teaching to a client who will be self-administering insulin at home. Which of the following information should the nurse include regarding needle disposal?

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