A nurse is administering an IM injection using a passive needle-safety device. After injection, which of the following actions should the nurse take?
Activate the device immediately after injection.
Remove the safety device before disposal.
Make sure the needle retracts into the barrel of the syringe.
Pull the plastic sheath over the needle.
The Correct Answer is A
A. After administering the injection, activating the passive needle-safety device involves a mechanism where the safety feature automatically engages. This can include a shield that covers the needle or a mechanism that retracts the needle into the syringe or device. It's crucial to activate this immediately after injection to prevent accidental needlestick injuries.
B. The safety device, once activated, should remain in place and intact on the needle until it is safely disposed of in an appropriate sharps container. Removing the safety device before disposal would expose healthcare workers to potential needlestick injuries.
C. There is no need to make sure the needle retracts into the barrel of the syringe, as the safety device is designed to cover the needle after use.
D. While some devices have a plastic sheath or shield that covers the needle before and after use, the primary action for a passive device is to activate the safety feature that automatically covers or retracts the needle post-injection. Pulling a sheath over the needle manually is more typical for active safety devices or conventional needles with manual sheath covers.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. This option involves informing the healthcare provider about the lack of urinary output. This is important because it could indicate an obstruction or clot formation in the urinary catheter or drainage system, which may require immediate intervention.
B. Checking the patency of the urinary catheter tubing is crucial. The nurse should assess for any kinks, twists, or clots that may be obstructing urine flow. Flushing the catheter per protocol or irrigating it with sterile saline may help clear any obstruction.
C. Increasing oral fluids may help promote urine production once any obstruction or issue with the catheter is resolved. However, this action should come after addressing the immediate concern of no urinary output and ensuring the catheter's patency.
D. While pain management is important postoperatively, administering an analgesic is not the priority in this scenario where there is no urinary output. Pain from the procedure is typically managed with medications prescribed on a schedule or as needed, but it does not address the acute issue of urinary obstruction.
Correct Answer is B
Explanation
A. This instruction is incorrect for a 24-hour urine collection. During a 24-hour urine collection, the client should urinate into a designated collection container at the start of the collection period and continue to collect all urine voided over the next 24 hours. The nurse should instruct the client to empty their bladder completely at the end of the 24-hour period into the same container used throughout the collection period. This ensures that all urine produced over the 24 hours is included in the specimen.
B. Discarding the first urine voided at the beginning of the collection period is a common instruction for some types of urine tests, such as for urinary catecholamines or specific timed collections. However, for a 24-hour urine collection, the client should start collecting urine from the very first void and include all subsequent urine produced over the next 24 hours.
C. This instruction is incorrect for a 24-hour urine collection. All urine produced during the 24-hour period should be saved in a single designated collection container. Using separate containers for each void would make it difficult to accurately measure the total volume of urine collected over the specified time frame.
D. Storing the urine collection container at room temperature is generally appropriate for a 24-hour urine collection. This helps maintain the stability of the urine sample and ensures accurate test results. Refrigeration may be required if specified by the healthcare provider for specific tests, but this should be clearly communicated to the client if necessary.
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