A nurse is preparing to administer subcutaneous enoxaparin. In which order should the nurse perform the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Locate the injection site 5 cm (2 in) to the right or left of the umbilicus.
Check the medication administration record to verify the client's allergies.
Slowly inject the medication into the site without aspirating.
Pinch clean skin at the injection site and dart the needle into the skinfold at a 90° angle.
Ensure an air bubble is present in the prefilled enoxaparin syringe.
The Correct Answer is B, E, A, D, C
B. Check the medication administration record to verify the client's allergies. Before preparing or administering any medication, the nurse must verify the client’s medication order and allergies to ensure safety. E. Ensure an air bubble is present in the prefilled enoxaparin syringe. The prefilled syringe contains an air bubble that should remain to ensure the entire dose is administered and to prevent medication from tracking back through the tissue. A. Locate the injection site 5 cm (2 in) to the right or left of the umbilicus. Enoxaparin should be administered in the subcutaneous tissue of the abdomen, avoiding areas near the umbilicus to reduce the risk of irritation and bruising. D. Pinch clean skin at the injection site and dart the needle into the skinfold at a 90° angle. Pinching the skin ensures the medication is delivered into the subcutaneous tissue, and injecting at a 90° angle minimizes pain and ensures proper technique. C. Slowly inject the medication into the site without aspirating. Aspiration is not necessary for subcutaneous injections. Slowly injecting reduces discomfort and ensures proper absorption.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Choice A Reason:
Maintaining skin integrity over the blisters is correct. Blisters form as a protective mechanism for the skin underneath. Popping or breaking blisters increases the risk of infection as it exposes the raw skin to bacteria and other contaminants.
Choice B Reason:
Applying ice to the larger blisters is incorrect.
Reason: Applying ice directly to a burn, especially to blisters, can further damage the skin and exacerbate the injury. Ice can cause additional skin damage and can potentially increase pain and delay healing.
Choice C Reason:
Administering ibuprofen for pain is correct. Ibuprofen is an effective over-the-counter pain reliever that can help manage the discomfort caused by a minor burn. It also has anti-inflammatory properties that can reduce swelling associated with burns.
Choice D Reason:
Running cool water over the affected area is correct. Running cool (not cold) water over the burn helps to cool down the burned area, soothes the pain, and helps prevent further damage to the skin. It's recommended to run water over the burn for around 10-15 minutes to effectively cool the area.
Choice E Reason:
Allowing the affected area to remain open to air is incorrect. Keeping a minor burn uncovered can increase the risk of infection as it exposes the burn to external contaminants. Covering the burn with a sterile, non-stick dressing can protect it from further damage and reduce the risk of infection.
Correct Answer is B
Explanation
Choice A Reason:
Place on airborne precautions. This is incorrect. Tinea corporis isn't transmitted through the air. Airborne precautions are specific infection control measures for diseases transmitted through airborne particles, like tuberculosis or measles, which are caused by specific bacteria or viruses.
Choice B Reason:
Avoid direct contact is correct. Direct contact is a crucial precaution to prevent the spread of tinea corporis. It's a contagious infection, often transmitted through skin-to-skin contact or by sharing contaminated items such as clothing, towels, or bedding. Encouraging precautions like not sharing personal items and avoiding direct skin contact helps prevent the spread of the infection to others.
Choice C Reason:
Isolate for 24 hr. after lesions appear is incorrect. While it's essential to take precautions to prevent spread, isolating for only 24 hours after lesions appear might not be sufficient. The infection can remain contagious until it's effectively treated and lesions have resolved. More extended isolation or precautions might be necessary until the infection is no longer transmissible.
Choice D Reason:
Administer a broad-spectrum antibiotic is incorrect. Tinea corporis is a fungal infection, not a bacterial one, so antibiotics would not be effective against it. Antifungal medications, such as topical or oral antifungals, are the primary treatment for tinea corporis. Using an antibiotic would not treat the fungal infection and might lead to inappropriate medication use.
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