A nurse is performing blood glucose monitoring on a client. Which of the following actions should the nurse take?

Position the client's finger above their heart.

Apply sterile gloves prior to performing the test.

Puncture the side of the client's finger.

Milk the finger site.

Answer and Explanation

The Correct Answer is C

A. Position the client's finger above their heart: The finger should be positioned below the level of the heart to encourage blood flow, making it easier to obtain a sufficient blood sample for testing. Elevating the finger would decrease blood flow and make collection more difficult.

B. Apply sterile gloves prior to performing the test: Clean, non-sterile gloves are sufficient for routine blood glucose monitoring. Sterile gloves are not necessary unless performing procedures that require a sterile environment, such as surgery or central line dressing changes.

C. Puncture the side of the client's finger: The sides of the fingertips have fewer nerve endings compared to the pads, making the procedure less painful. Additionally, puncturing the side helps promote better blood flow and reduces the risk of bruising and soreness.

D. Milk the finger site: Milking or squeezing the finger excessively can cause hemolysis or contamination of the blood sample with tissue fluid, leading to inaccurate glucose readings. Gentle pressure may be used if needed, but forceful milking should be avoided.

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Correct Answer is A

Explanation

A. Take the medication with crackers: Taking doxycycline with food can help reduce gastrointestinal irritation, including nausea and vomiting. While it is not usually recommended to take doxycycline with food to ensure full absorption, in this case, eating crackers can help alleviate nausea and make the medication more tolerable.

B. Take the medication with an antacid: Antacids can interfere with the absorption of doxycycline, decreasing its effectiveness. Therefore, it is not recommended to take doxycycline with an antacid.

C. Take the medication and then lay down for 30 min: Lying down after taking doxycycline can increase the risk of esophageal irritation and ulceration. The medication should be taken while sitting or standing, and the client should remain upright for at least 30 minutes afterward.

D. Take the medication with calcium-fortified orange juice: Calcium can bind to doxycycline, decreasing its absorption and effectiveness. Therefore, it is not recommended to take doxycycline with calcium-fortified beverages.

A. Decreased bowel sounds B. Urine output of 360 mL/12 hr C. Blood pressure of 100/74 mm Hg D. Distended neck veins

Correct Answer is D

Explanation

A. Decreased bowel sounds: Decreased bowel sounds are often associated with conditions like ileus, abdominal surgery, or bowel obstruction, rather than directly indicating fluid volume excess. Fluid overload typically affects the cardiovascular and respiratory systems first.

B. Urine output of 360 mL/12 hr: While this is a low urine output and could suggest dehydration or renal impairment, it is more indicative of fluid volume deficit rather than fluid volume excess. Excess fluid volume would generally be associated with adequate or increased urine output if renal function is normal.

C. Blood pressure of 100/74 mm Hg: This blood pressure reading is within normal limits for many adults and does not specifically suggest fluid overload. In cases of fluid volume excess, a client might actually exhibit elevated blood pressure due to increased circulatory volume.

D. Distended neck veins: Distended neck veins, also known as jugular venous distention, are a classic sign of fluid volume excess. They occur because increased intravascular volume causes elevated venous pressure, which becomes visible in the neck veins when the client is positioned at a 30- to 45-degree angle.

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A nurse is performing blood glucose monitoring on a client. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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