A nurse is preparing to administer a medication from an ampule.
Which of the following is an appropriate action for the nurse to take?
Inject air into the ampule prior to drawing the medication into a syringe.
Add 0.5 mL of diluent to the medication.
Use a filter needle to aspirate the medication.
Cleanse the tip of the ampule with an alcohol swab after opening.
The Correct Answer is C
Choice A rationale
Injecting air into the ampule prior to drawing the medication into a syringe is incorrect because ampules are sealed glass containers, and injecting air could cause the liquid to spill out due to pressure changes.
Choice B rationale
Adding 0.5 mL of diluent to the medication is not appropriate for most medications in ampules unless specifically instructed by the medication guidelines. Ampules typically contain ready-to-use medication.
Choice C rationale
Using a filter needle to aspirate the medication is the correct action. A filter needle is used to prevent any glass particles from being drawn into the syringe, ensuring the medication is safe for administration.
Choice D rationale
Cleansing the tip of the ampule with an alcohol swab after opening is unnecessary because the ampule's contents are sterile and the risk of contamination is minimized if the ampule is handled correctly.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale
Reminding the client that they must receive the medication as prescribed may increase their anxiety and does not address the fear of needles. It is essential to consider the client's emotional state and explore alternative solutions.
Choice B rationale
Telling the client not to worry because the pain will be temporary does not validate their fear or provide a solution to their anxiety about needles. It is important to address the client's concerns empathetically.
Choice C rationale
Requesting a change in the medication route to PO addresses the client's fear of needles directly and provides an alternative method of administration. This approach considers the client's comfort and preferences while ensuring they receive the necessary medication.
Choice D rationale
Asking one of the client's loved ones to encourage them to receive the IM medication may help, but it does not address the underlying fear of needles. It is essential to find a solution that directly addresses the client's anxiety.
Correct Answer is A
Explanation
Choice A rationale
Securing the catheter helps prevent it from moving, which reduces the risk of urethral trauma and infection. Proper fixation is essential for patient safety and comfort.
Choice B rationale
Urine should not be obtained from the drainage bag for specimen collection as it may be contaminated. Fresh urine samples directly from the catheter port are more accurate.
Choice C rationale
Catheter bags should be changed based on clinical need, which can be more frequent than every 3 days. This ensures hygiene and reduces infection risks.
Choice D rationale
The drainage bag should be kept below the bladder level to prevent backflow of urine, which can lead to infection.
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