A nurse is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. Which of the following entries should the nurse make in the medical record?

"Morphine 3 mg SQ every 4 hr PRN for pain."

"Morphine 3.0 mg sub q every 4 hr PRN for pain."

"Morphine 3 mg subcutaneous every 4 hr PRN for pain."

"Morphine 3 mg SC q4hr PRN for pain.”

Answer and Explanation

The Correct Answer is C

Rationale:

A. "Morphine 3 mg SQ every 4 hr PRN for pain.": The abbreviation "SQ" is considered unsafe and can be misinterpreted. The Joint Commission recommends avoiding this abbreviation and writing out "subcutaneous" to ensure clarity and patient safety.

B. "Morphine 3.0 mg sub q every 4 hr PRN for pain.": Using a trailing zero (e.g., "3.0 mg") increases the risk of a dosing error if the decimal point is missed. Standard documentation practices recommend omitting trailing zeros for whole numbers.

C. "Morphine 3 mg subcutaneous every 4 hr PRN for pain.": This entry uses the full name "subcutaneous," avoids unsafe abbreviations, and omits the trailing zero, adhering to safe and standardized medication documentation guidelines.

D. "Morphine 3 mg SC q4hr PRN for pain.": Both "SC" and "q4hr" are discouraged abbreviations. "SC" can be confused with "SL" (sublingual), and "q" abbreviations can be misread. Writing terms in full reduces the risk of misinterpretation.

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Correct Answer is A

Explanation

Rationale:

A. Assess the client's peripheral pulses every 15 min: Frequent assessment of peripheral pulses is essential to monitor for signs of arterial obstruction, bleeding, or hematoma formation at the femoral site. This helps ensure adequate perfusion and detect complications early.

B. Elevate the head of the client's bed to 45°: After femoral catheterization, the head of the bed should be elevated no more than 30° to reduce pressure at the puncture site and prevent bleeding. A 45° angle may increase the risk of hemorrhage.

C. Change the client's dressing 4 hr following the procedure: The dressing should remain in place and be monitored for signs of bleeding or saturation. Routine dressing changes shortly after the procedure are not recommended unless soiled or ordered.

D. Instruct the client to flex the right knee every 30 min: Flexing the leg increases the risk of dislodging the clot or reopening the arterial puncture site. The affected leg should remain straight and immobilized for several hours post-procedure.

A. Inject into the vastus lateralis B. Roll the syringe gently to ensure mixture of the insulins C. Draw up regular insulin prior to NPH insulin D. Use a 15 angle for the injection

Correct Answer is C

Explanation

Rationale:

A. Inject into the vastus lateralis: The preferred injection sites for insulin are subcutaneous areas such as the abdomen, upper arms, thighs, or buttocks. The vastus lateralis is used for intramuscular injections, not subcutaneous insulin administration.

B. Roll the syringe gently to ensure mixture of the insulins: Only the NPH (cloudy) insulin should be rolled gently between the hands to mix it evenly before drawing it up. The syringe itself should not be rolled after both insulins are inside, as this may affect accuracy.

C. Draw up regular insulin prior to NPH insulin: When mixing insulins, regular (clear) insulin should be drawn up first to avoid contaminating the vial of regular insulin with the cloudy NPH insulin, which could alter its action and absorption.

D. Use a 15 angle for the injection: Insulin is administered subcutaneously using a 45- to 90-degree angle, depending on the client’s body habitus. A 15-degree angle is too shallow and is used for intradermal injections, not subcutaneous ones.

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A nurse is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. Which of the following entries should the nurse make in the medical record?

Nursing Test Bank

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