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A nurse is caring for a client who has a prescription for total parenteral nutrition (TPN). Which of the following routes of administration should the nurse use?
- A. Subcutaneous
- B. Intravenous
- C. Central venous access device
- D. Midline catheter
Correct Answer: C
Rationale: The correct answer is C: Central venous access device. TPN is a highly concentrated solution that provides all the nutrients a person needs intravenously. A central venous access device allows for the infusion of TPN into a large central vein, such as the superior vena cava, ensuring immediate access to the bloodstream for rapid absorption. Using other routes like subcutaneous (A), intravenous (B), or midline catheter (D) may not be suitable due to the high osmolarity of TPN, which can cause irritation and damage to smaller veins. Therefore, a central venous access device is the most appropriate and safe route for administering TPN.
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A nurse is teaching a client who has angina a new prescription for sublingual nitroglycerin tablets. Which of the following instructions should the nurse include in the teaching?
- A. Discard any tablets you do not use every 6 months.
- B. Take one tablet each morning 30 minutes prior to eating.
- C. Keep the tablets at room temperature in their original glass bottle.
- D. Place the tablet between your cheek and gum to dissolve.
Correct Answer: C
Rationale: The correct answer is C: Keep the tablets at room temperature in their original glass bottle. Nitroglycerin tablets are sensitive to light, moisture, and heat. Storing them in their original glass bottle at room temperature helps maintain their potency. Discarding unused tablets every 6 months (choice A) is not necessary as long as they are stored properly. Taking a tablet each morning (choice B) is not recommended as nitroglycerin is usually taken as needed for angina attacks. Placing the tablet between cheek and gum (choice D) is not the correct administration route for sublingual nitroglycerin, as it should be placed under the tongue for rapid absorption.
A nurse is caring for a client who has heart failure. The nurse administered furosemide 60 mg IV bolus 30 min earlier. For which of the following findings should the nurse notify the provider?
- A. Potassium 3.8 mEq/L
- B. The client reports dizziness upon standing.
- C. The client reports difficulty hearing.
- D. BUN 15 mg/dL
Correct Answer: C
Rationale: The correct answer is C: The client reports difficulty hearing. Furosemide is a loop diuretic that can cause ototoxicity, leading to hearing loss. The nurse should notify the provider immediately to prevent further damage. A: Potassium level is within normal range. B: Dizziness upon standing can be expected due to volume loss. D: BUN level is normal and not a priority.
A nurse is preparing to initiate IV therapy for a client. Which of the following sites should the nurse use to place the peripheral IV catheter?
- A. Nondominant dorsal venous arch
- B. Dominant distal dorsal vein
- C. Nondominant forearm basilic vein
- D. Dominant antecubital vein
Correct Answer: A
Rationale: The correct answer is A: Nondominant dorsal venous arch. This site is preferred for peripheral IV catheter placement due to the larger vein diameter, ease of access, and reduced risk of complications like nerve damage or infiltration. The nondominant side is chosen to prevent disruption of daily activities. The dorsal venous arch is a superficial vein that is easily visible and palpable, making it suitable for successful cannulation. It also allows for optimal flow rate and minimizes the risk of phlebitis. Choices B, C, and D are not ideal for various reasons such as smaller vein size, increased risk of nerve damage, and difficulty in accessing or securing the catheter.
A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse take?
- A. Apply firm pressure to the injection site following administration
- B. Administer the medication into the client's muscle
- C. Expel the air bubble from the syringe prior to injection
- D. Insert the syringe needle halfway into the client's skin
Correct Answer: A
Rationale: Correct Answer: A: Apply firm pressure to the injection site following administration.
Rationale: Applying firm pressure to the injection site following administration of enoxaparin helps minimize the risk of bleeding, as enoxaparin is an anticoagulant medication. This pressure promotes clot formation and reduces the likelihood of bruising or hematoma formation at the injection site.
Summary of other choices:
B: Administer the medication into the client's muscle - Incorrect. Enoxaparin is a subcutaneous medication, not meant for intramuscular administration.
C: Expel the air bubble from the syringe prior to injection - Good practice but not directly related to the administration of enoxaparin.
D: Insert the syringe needle halfway into the client's skin - Incorrect. The needle should be fully inserted for proper subcutaneous injection.
A nurse manager is planning an in-service about pain management with opioids for clients who have cancer. Which of the following information should the nurse manager include?
- A. IM administration is recommended if PO opioids are ineffective
- B. Respiratory depression decreases as opioid tolerance develops
- C. Meperidine is the opioid of choice for treating chronic pain
- D. Withhold PRN pain medication for the client who is receiving opioids every 6 hr
Correct Answer: B
Rationale: The correct answer is B because respiratory depression decreases as opioid tolerance develops. Opioid tolerance occurs with prolonged use, leading to a decrease in the side effect of respiratory depression. This information is crucial for healthcare providers managing cancer pain with opioids. Choice A is incorrect because oral administration is preferred over intramuscular for better absorption and convenience. Choice C is incorrect as meperidine is not recommended for chronic pain due to its toxic metabolite. Choice D is incorrect as PRN pain medication should not be withheld for clients on scheduled opioid doses to ensure adequate pain control.