A nurse is preparing to check the capillary blood glucose level of a school-age child. Which of the following actions should the nurse plan to take?
Allow the skin antiseptic to dry prior to puncturing the child's finger.
Place a cool washcloth on the child's finger for 5 min prior to the procedure.
Test the first drop of blood obtained after puncturing the child's finger.
Puncture the center of the pad of the child's index finger.
The Correct Answer is A
Choice A rationale:
The correct answer is choice A. This action is crucial to ensure accurate capillary blood glucose testing. Allowing the skin antiseptic to dry before puncturing the child's finger helps prevent contamination of the blood sample, which can lead to inaccurate results. Wet antiseptic can dilute the blood sample and affect the glucose reading.
Choice B rationale:
This choice is incorrect because placing a cool washcloth on the child's finger is not standard practice before capillary blood glucose testing. While warmth can help increase blood flow and make the puncture process more comfortable, using a cool washcloth is not recommended, as it may constrict blood vessels and make it harder to obtain a sufficient blood sample.
Choice C rationale:
This choice is incorrect because testing the first drop of blood obtained after puncturing the child's finger is not recommended. The first drop of blood can be diluted with interstitial fluid and may not provide an accurate glucose reading. It's important to wipe away the first drop and use the subsequent drop of blood for testing.
Choice D rationale:
This choice is incorrect because puncturing the center of the pad of the child's index finger is not the recommended site for capillary blood glucose testing. The sides of the fingertip contain an adequate blood supply and are less painful for the child. Puncturing the center of the fingertip can be more painful and may not yield a sufficient blood sample.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Correct Choice. Current pregnancy is a contraindication to administering the measles, mumps, and rubella (MMR) vaccine. The MMR vaccine contains live attenuated viruses, and it is generally contraindicated during pregnancy due to the potential risk to the developing fetus. Pregnant individuals should wait until after giving birth to receive the MMR vaccine.
Choice B rationale:
Mild ear infection is not a contraindication to administering the MMR vaccine. Mild illnesses, such as mild upper respiratory infections or low-grade fevers, are not typically considered contraindications for vaccination. In fact, immunization might be recommended in these cases to ensure protection against preventable diseases.
Choice C rationale:
A family history of seizures is not a contraindication to administering the MMR vaccine. Seizures are not known to be associated with the MMR vaccine. Therefore, a family history of seizures would not preclude an individual from receiving the vaccine.
Choice D rationale:
Severe peanut allergy is not a contraindication to administering the MMR vaccine. Allergies, including severe peanut allergies, are not considered contraindications for the MMR vaccine. Only individuals with a known severe anaphylactic allergy to a vaccine component (such as gelatin or neomycin) would have a contraindication to receiving the vaccine.
Correct Answer is C
Explanation
Choice A rationale:
Encouraging active range of motion of the extremity is not recommended during the first 12 to 24 hours after a sprained wrist. Early movement can potentially worsen the swelling and delay the healing process.
Choice B rationale:
Applying warm compresses to the extremity is not the best choice to minimize swelling in the initial 12 to 24 hours after a sprained wrist. Heat can actually increase blood flow and promote more swelling in the injured area.
Choice C rationale:
Elevating the extremity above the level of the heart is the correct choice for minimizing swelling in the first 12 to 24 hours after a sprained wrist. Elevating the injured area helps to reduce blood flow to the area, which in turn decreases swelling and promotes healing.
Choice D rationale:
Wrapping the extremity loosely with an elastic bandage might be beneficial for providing support, but it's not the primary intervention for minimizing swelling in the first 12 to 24 hours after a sprained wrist. Elevation is more effective for reducing swelling during this initial period.
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