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A nurse is using a glucometer to measure a client's capillary blood glucose level.

Which of the following actions should the nurse take?

Keep the finger in a dependent position.

Wear sterile gloves.

Select the central tip of a finger

Test the first drop of blood that forms after the puncture.

Answer and Explanation

The Correct Answer is A

A. Keep the finger in a dependent position:

Keeping the finger in a dependent position (lower than the heart) helps promote blood flow to the fingertips, making it easier to obtain a blood sample. This position can facilitate the formation of a blood drop, improving the chances of obtaining an adequate sample for testing.

B. Wear sterile gloves:

Sterile gloves are not typically necessary for routine capillary blood glucose monitoring. Clean, non-sterile gloves are generally sufficient for this procedure. However, the nurse should perform proper hand hygiene to minimize the risk of contamination.

C. Select the central tip of a finger:

The central tip of the finger is more sensitive, and choosing this area may cause greater discomfort for the client. The sides of the fingertips are often preferred for capillary blood glucose testing as they have a good blood supply and are less sensitive.

D. Test the first drop of blood that forms after the puncture:

The initial drop may contain tissue fluid or contaminants from the puncture site, so it is important to use the first drop to obtain a representative blood sample. This step contributes to the accuracy of the blood glucose measurement.

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Correct Answer is A

Explanation

The correct answer is A. Muscle cramps. Hyponatremia is a condition where sodium levels in the blood are lower than normal, which can cause water to move into body cells and make them swell. This can affect muscle cells and cause cramps, spasms or weakness. The other options are not typical signs of hyponatremia.

A. Irrigation of a wound with antibiotic solution B. Placement of a central venous catheter C. Insertion of a nasogastric tube D. Administration of an iron injection using the Z-track technique

Correct Answer is B

Explanation

The correct answer is B. Placement of a central venous catheter.

Rationale: The nurse should identify that informed consent is required for the placement of a central venous catheter, as this is an invasive procedure that carries significant risks and benefits that need to be explained to the client before obtaining consent. Informed consent is not required for irrigation of a wound with antibiotic solution, as this is a routine nursing intervention that does not involve significant risks or benefits.

Informed consent is not required for the insertion of a nasogastric tube, as this is a common nursing procedure that does not involve significant risks or benefits. Informed consent is not required for the administration of an iron injection using the Z-track technique, as this is a standard medication administration technique that does not involve significant risks or benefits.

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A nurse is using a glucometer to measure a client's capillary blood glucose level.

Which of the following actions should the nurse take?