A nurse is reinforcing teaching with a client who is to start subcutaneous heparin.
Which of the following information should the nurse include in the teaching?
Use a soft-bristled toothbrush.
Inject the medication deep into the thigh muscle.
Expect stools to become black and tarry.
Easy bruising indicates the medication is effective.
The Correct Answer is A
The nurse should include in the teaching that the client should use a soft-bristled toothbrush.
Heparin is an anticoagulant that decreases the clotting ability of the blood 1.
Using a soft-bristled toothbrush can help prevent bleeding of the gums while brushing teeth.
Choice B is incorrect because heparin should not be injected deep into the thigh muscle.
Instead, it should be given subcutaneously (under the skin) 2.
Choice C is incorrect because black and tarry stools are not an expected side effect of heparin.
Choice D is incorrect because easy bruising does not indicate that the medication is effective.
Instead, easy bruising may be a side effect of heparin and should be reported to the healthcare provider 1.
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Related Questions
Correct Answer is A
Explanation
The client’s symptoms of confusion, flushed appearance, and acetone odor on their breath suggest that they may be experiencing diabetic ketoacidosis (DKA), a serious complication of diabetes that occurs when the body produces high levels of ketones.
Treatment for DKA typically involves administering intravenous fluids and insulin to lower blood sugar levels and suppress ketone production 1.
Regular insulin is a fast-acting insulin that can be given intravenously to quickly lower blood sugar levels 1.
Choice B is incorrect because NPH insulin is an intermediate-acting insulin that takes longer to start working and would not be appropriate for treating DKA.
Choice C is incorrect because lispro insulin is a rapid-acting insulin but it is not typically given intravenously.
Choice D is incorrect because glargine insulin is a long-acting insulin that takes several hours to start working and would not be appropriate for treating DKA.
Correct Answer is ["100"]
Explanation
The nurse should set the IV flow rate to deliver 100 gtt/min.
To calculate the flow rate in gtt/min, you can use the formula: (Volume to be infused (mL) x Drop factor (gtt/mL)) ÷ Time (min) = Flow rate (gtt/min).
Plugging in the values from the question: (100 mL x 60 gtt/mL) ÷ 60 min = 100 gtt/min.
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