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When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should:
- A. Inject air in the vial with the long-acting insulin first.
- B. Draw up the long-acting insulin first.
- C. Draw up either insulin first.
- D. Use a high-dose insulin syringe.
Correct Answer: C
Rationale: Either insulin can be drawn up first, as long as air is injected into both vials in the reverse order and clear (short-acting) is drawn before cloudy (long-acting).
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The nurse has just received the change of shift report on the following clients on the labor, delivery, recovery, and postpartum unit. Which of these clients should the nurse assess first?
- A. An 18-year-old single primigravid client, in labor for 9 hours, with cervical dilation at 6 cm, 0$ station, contractions occurring every 5 minutes, and receiving epidural anesthesia.
- B. A 24-year-old multiparous client who delivered a 4,200g infant 2 hours ago, whose fundus is firm and who is having light lochia flow.
- C. A 30-year-old multigravid client who delivered a 3,500g infant 6 hours ago by cesarean section and who is complaining of abdominal pain at the incision site.
- D. A 35-year-old primigravid client, 36 weeks' gestation, who was admitted with preterm labor and is receiving magnesium sulfate therapy.
Correct Answer: D
Rationale: The client with preterm labor on magnesium sulfate requires immediate assessment due to the risk of toxicity and preterm delivery complications.
A 6-month-old has had a pyloromyotomy to correct a pyloric stenosis. Three days after surgery, the parents have placed their infant in his own infant seat (see fi gure). The nurse should do which of the following?
- A. Reposition the infant to the left side.
- B. Ask the parents to put the infant back in his crib
- C. Remind the parents that the infant cannot use a pacifier now.
- D. Tell the parents they have positioned their infant correctly
Correct Answer: D
Rationale: Following pyloromyotomy the infant should be positioned with the head elevated and slightly on the right side to promote gastric emptying; the parents have positioned their infant correctly. The infant should be positioned on the right side, not the left side. When the child is in a crib, the head can be elevated and the infant can be propped on the right side. The infant can use a pacifi er if needed.
The nurse receives a client from the postanesthesia care unit who has had skeletal traction applied in the operating room. The nurse should take immediate action to correct which problem with the traction setup when it is noted?
- A. Knots are secured tightly.
- B. There are weights at both ends of the bed.
- C. Weights are resting against the foot of the bed.
- D. Pin site is exposed to air without any dressing.
Correct Answer: C
Rationale: The traction setup is checked to ensure that weights are hanging freely from the ropes and knots are tied securely. The weights should not be resting on the bed. Countertraction is commonly supplied by the client's body weight or by weights pulling in the opposite direction. Therefore, there can be weights at both ends of the bed. Pin-site care varies but usually includes regularly removing exudate with half-strength hydrogen peroxide, rinsing pin sites with sterile saline, and drying the area with sterile gauze; the pin site is left open to air. If any problems are noted, they should be fixed immediately.
The nurse has done preoperative teaching with a client scheduled for percutaneous insertion of an inferior vena cava (IVC) filter. Which client statement indicates the need for further teaching about the procedure?
- A. This is done under general anesthesia.
- B. This procedure is rarely associated with complications.
- C. It may cause congestion when clots get trapped at the filter.
- D. This could possibly eliminate the need for anticoagulant therapy.
Correct Answer: A
Rationale: The percutaneous approach uses local anesthesia. Complications after insertion of an IVC filter are rare. When they do occur, they include air embolism, improper placement, and filter migration. Venous congestion can occur from accumulation of thrombi on the filter, but the process usually occurs gradually. There is usually no need for anticoagulant therapy after surgery.
A client with a history of type 2 diabetes mellitus is prescribed pioglitazone (Actos). The nurse should monitor the client for which of the following side effects?
- A. Hypoglycemia.
- B. Weight gain.
- C. Hypertension.
- D. Dry skin.
Correct Answer: B
Rationale: Pioglitazone can cause weight gain due to fluid retention, requiring monitoring in diabetic clients.