A nurse is using a glucometer to measure a client's capillary blood glucose level. Which of the following actions should the nurse take?
Select the central tip of a finger.
Wear sterile gloves.
Keep the finger in a dependent position.
Milk or massage the finger site.
The Correct Answer is C
Choice A Reason:
Select the central tip of a finger is incorrect. The nurse should select a puncture site on the side of the finger, slightly off-center from the central tip, as it tends to be less painful. The side of the finger has an adequate blood supply and can provide an accurate blood sample without causing excessive discomfort.
Choice B Reason:
Wearing sterile gloves is incorrect. Sterile gloves are not typically necessary for routine capillary blood glucose monitoring. However, clean hands and proper hand hygiene are essential. The nurse should perform hand hygiene before the procedure.
Choice C Reason:
Keeping the finger in a dependent position is correct. Keeping the finger in a dependent position (hanging down) can promote blood flow and make it easier to obtain a blood sample. This is a recommended technique to facilitate the puncture and collection of blood.
Choice D Reason:
Milking may hemolyze specimen and introduce excess tissue fluid.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
c. New onset of hearing loss.
When collecting data from a client who is receiving gentamicin via IV infusion, the nurse should identify new onset of hearing loss as an adverse effect of the treatment¹. Gentamicin can cause vestibulocochlear nerve damage, which can affect hearing and balance¹.
Correct Answer is D
Explanation
Choice A Reason:
The surgeon is incorrect. Surgeons primarily focus on the surgical procedure itself and the immediate postoperative care related to the surgery. They may not have a direct role in medication management or overall postoperative care beyond the surgical site.
Choice B Reason:
The pharmacist is incorrect. While pharmacists play a vital role in medication management, they typically focus on dispensing medications, providing drug information, and ensuring proper dosages and administration. They may not be directly involved in assessing fall rates or postoperative outcomes.
Choice C Reason:
The case manager is incorrect. Case managers are responsible for coordinating a patient's care and ensuring that it meets their overall healthcare needs. They may not have the expertise or authority to investigate and address specific safety concerns related to medication use and fall rates.
Choice D Reason:
The risk manager is correct. When a nurse identifies an issue related to patient safety, such as an increased fall rate associated with a specific medication like zolpidem, it is important to report these findings to the risk manager. The risk manager is responsible for assessing and addressing issues related to patient safety and quality improvement within the healthcare facility. They can investigate the matter further, collaborate with other members of the healthcare team, and implement necessary changes or protocols to mitigate the risk and improve patient safety. Reporting such findings to the risk manager is a crucial step in ensuring patient safety and quality of care.
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