A nurse is flushing a client's intermittent infusion device. The client states, "Why do you have to do that if you are not giving me medicine?" Which of the following statements should the nurse make?
"This helps to keep you hydrated."
"This clears blood from the tubing and the catheter."
"This makes sure it stays sterile."
"This prevents leakage of fluid and medication."
The Correct Answer is B
Rationale:
A. "This helps to keep you hydrated.": Flushing an intermittent infusion device does not hydrate the client, as the small amount of saline used is not intended for fluid replacement. Hydration is achieved through continuous or scheduled fluid administration, not flushes.
B. "This clears blood from the tubing and the catheter.": Flushing helps maintain catheter patency by preventing blood from clotting inside the lumen. It ensures the device remains functional and ready for medication administration when needed.
C. "This makes sure it stays sterile.": Flushing does not sterilize the device. Sterility is maintained through proper handling and use of aseptic technique. The purpose of flushing is mechanical, not antimicrobial.
D. "This prevents leakage of fluid and medication.": While flushing may help confirm that the device is intact, the primary reason is not to prevent leakage but to maintain patency and ensure the catheter is free of occlusions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
Rationale:
A. A client who moved to an apartment located on higher ground than her previous home: Relocating for safety is a rational coping mechanism and does not, on its own, indicate PTSD. This action reflects adaptation rather than signs of trauma-related distress.
B. A client who has frequent nightmares about the hurricane: Recurrent nightmares related to the traumatic event are a hallmark symptom of PTSD and suggest that the client is experiencing persistent re-experiencing of the trauma.
C. A client who expresses a realization that life will not return to the way it was before the hurricane: This statement reflects acceptance and realistic processing of the event, not necessarily indicative of emotional distress or dysfunction associated with PTSD.
D. A client who describes having persistent feelings of anger about the hurricane: Chronic irritability or anger following trauma is a recognized symptom of PTSD and may indicate the client is struggling with emotional regulation due to unresolved trauma.
E. A client who describes feeling disconnected from those around him following the hurricane: Emotional numbing or detachment from others is a common symptom of PTSD, often associated with difficulty in re-establishing interpersonal connections after trauma.
Correct Answer is B
Explanation
Rationale:
A. Canned black beans: While black beans are a healthy source of protein and fiber, canned varieties are often high in sodium unless labeled low-sodium. High sodium intake can worsen hypertension, so these should be limited or thoroughly rinsed before use.
B. Fish: Fish, particularly those high in omega-3 fatty acids like salmon and mackerel, can help lower blood pressure and reduce cardiovascular risk. They are a heart-healthy protein source recommended in hypertension management.
C. Red meat: Red meat is often high in saturated fat and cholesterol, which can contribute to elevated blood pressure and heart disease. It should be limited in a diet designed to control hypertension.
D. Cheese: Many cheeses are high in sodium and saturated fat, which can increase blood pressure and cardiovascular strain. Even small portions may contain significant sodium, making them less ideal for clients with hypertension.
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