Complete the following using the list of options.

The nurse is admitting a new client to the hall.

While looking at the orders, she notes a medication order for Lasix 40 mg PO daily.
The nurse knows that this is an example of?

Choice A rationale

Using a large bore needle (e.g., 18-gauge) for withdrawing medication from an ampule is generally avoided unless the medication is highly viscous, because it can create a larger hole in the ampule, increasing the risk of glass particle introduction. The primary concern with ampules is preventing glass shards from entering the syringe, which is addressed by filtration, not needle bore size alone.

Choice B rationale

Ampules are single-dose glass containers. When an ampule is opened, small, invisible glass fragments can break off. A filter needle contains a microscopic filter that traps these glass particles, preventing their aspiration into the syringe and subsequent injection into the patient, thus mitigating the risk of phlebitis, emboli, or other complications from particulate matter.

Choice C rationale

A small gauge needle (e.g., 25-gauge) has a very narrow lumen, which would make withdrawing medication from an ampule unnecessarily difficult and slow, especially for viscous solutions. Furthermore, a small gauge needle does not mitigate the risk of glass particle aspiration, which is the paramount concern when withdrawing medication from a glass ampule.

Choice D rationale

Placing a cotton ball over the opening of an ampule is not a scientifically sound method to prevent being cut or to prevent glass shards from entering the medication. Ampules are designed to be broken cleanly. Proper ampule opening techniques and the use of a filter needle are the established safety measures to prevent injury and contamination.

Choice A rationale

The bell of the stethoscope is designed to auscultate low-frequency sounds, such as certain heart murmurs or bowel sounds, due to its larger surface area and lower diaphragm tension. Breath sounds, however, are generally higher frequency and require the diaphragm for optimal clarity and discrimination of adventitious sounds, which are often subtle and require careful attention to pitch and quality.

Choice B rationale

Limiting auscultation to only the posterior chest misses significant lung fields, especially the anterior and lateral segments of the upper and middle lobes. Comprehensive respiratory assessment necessitates evaluating all accessible lung surfaces to detect localized abnormalities, ensuring no consolidation, atelectasis, or pleural effusions are overlooked, providing a complete diagnostic picture.

Choice C rationale

Instructing the patient to breathe in and hold their breath would prevent the continuous airflow necessary to generate breath sounds. Auscultation relies on the movement of air through the tracheobronchial tree. Holding the breath eliminates this vital acoustic phenomenon, rendering the assessment ineffective for evaluating air entry, presence of adventitious sounds, or symmetry.

Choice D rationale

Comparing sounds on the left and right sides allows for the identification of unilateral abnormalities, which are crucial for diagnosing localized pathologies. This systematic approach helps detect differences in breath intensity, the presence of unilateral adventitious sounds like wheezes or crackles, or diminished air entry, guiding further diagnostic investigation and treatment.