A charge nurse is teaching a newly licensed nurse about administering heparin to a client. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

"I will check the client's INR before administering the heparin."

"I will aspirate before administering the heparin."

"I will massage the site after the injecting the heparin."

"I will apply pressure for 1 minute after the injection."

Answer and Explanation

The Correct Answer is D

Choice A Reason:
"I will check the client's INR before administering the heparin." is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps reduce the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in minimizing bleeding at the injection site.

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Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A Reason:
Levothyroxine 100 mcg PO every morning is incorrect. Indicates the dosage (100 mcg) and the route (by mouth) to be taken every morning.
Choice B Reason:
Simvastatin 40 mg PO at bedtime: Specifies the dosage (40 mg) and the timing (at bedtime) for administration.
Choice C Reason:
Acetaminophen 500 mg every 4 hr RN for fever is correct. The term "RN" in this context might be interpreted as "right now" rather than the intended meaning, which could cause confusion regarding the frequency of acetaminophen administration. The nurse should seek clarification to ensure accurate and safe dosing instructions.
Choice D Reason:
Morphine 4 mg IV every 4 hr PRN for pain: Specifies the dosage (4 mg), the route (intravenous), and the frequency (every 4 hours as needed) for pain management.

A. Withdraw the NPH insulin from the vial. B. Inject air into the regular insulin vial. C. Inject air into the NPH vial. D. Withdraw the regular insulin from the vial.

Correct Answer is C

Explanation

Choice A Reason:
Withdrawing the NPH insulin from the vial should come after injecting air into the NPH vial.
Choice B Reason:
Injecting air into the regular insulin vial should occur after withdrawing the NPH insulin from its vial.
Choice C Reason:
Inject air into the NPH vial is correct. The sequence for mixing regular insulin (clear) and NPH insulin (cloudy) in the same syringe typically involves injecting air into the NPH (cloudy) insulin vial first. This step prevents excess pressure buildup when withdrawing the solution, making it easier to draw the correct amount of NPH insulin into the syringe.
Choice D Reason:
Withdrawing the regular insulin from the vial should occur after withdrawing the correct amount of NPH insulin into the syringe.

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A charge nurse is teaching a newly licensed nurse about administering heparin to a client. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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