The client has diabetes Type I, a body mass index (BMI) of 17 and poor skin turgor. How should the nurse plan to administer the prescribed.
Humulin R 7 units subcutaneously?

Select an insulin syringe, 31 gauge 6 mm needle and inject insulin at a 45-degree angle.

Select a 0.5 mL syringe, 30 gauge, 8 mm needle and inject at a 90-degree angle.

Select a 0.5 mL syringe, 29 gauge 8 mm needle, pinch the skin, and inject at 45 degrees.

Select a 1.0 mL syringe, 28 gauge 12.7 mm needle, and inject at 90 degrees.

Answer and Explanation

The Correct Answer is B

Select a 0.5 mL syringe, 30 gauge, 8 mm needle and inject at a 90-degree angle. This is because Humulin R is a clear and colorless solution that can be given by subcutaneous injection.

A 0.5 mL syringe can hold up to 50 units of insulin, which is enough for the prescribed dose of 7 units. A 30 gauge, 8 mm needle is suitable for thin patients with poor skin turgor. Injecting at a 90-degree angle ensures that the insulin reaches the subcutaneous tissue and not the muscle.

Choice A is wrong because a 31 gauge, 6 mm needle is too short and may not deliver the insulin into the subcutaneous tissue.

Choice C is wrong because pinching the skin is not necessary for thin patients with poor skin turgor.

Choice D is wrong because a 1.0 mL syringe is too large for the prescribed dose of 7 units and may cause dosing errors. A 28 gauge, 12.7 mm needle is too long and may inject the insulin into the muscle, which can affect its absorption and action.

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Correct Answer is A

Explanation

This is because coughing can indicate aspiration of the feeding into the lungs, which can lead to pneumonia and other serious complications. Aspiration is reported in up to 89% of patients receiving nasogastric tube feeding.

Therefore, the nurse should prioritize assessing the client for signs of aspiration and ensuring proper tube placement.

Choice B is wrong because mild abdominal cramps are a common side effect of nasogastric tube feeding and do not require immediate intervention unless they are severe or persistent.

Choice C is wrong because high-pitched bowel sounds are normal and indicate peristalsis and digestion.

They do not indicate a problem with the tube feeding.

Choice D is wrong because one to two soft bowel movements per day are desirable and indicate adequate nutrition and hydration.

They do not indicate a problem with the tube feeding.

Normal ranges for gastric residual volume are less than 200 mL for adults and less than 100 mL for children. Normal ranges for pH of gastric aspirate are 1 to 5.

A. The nurse establishes rapport with the client in an inpatient psychiatric setting. B. The nurse documents accurately and honestly in the electronic health record. C. The nurse refuses to care for someone who reminds her of a family member after interviewing the client upon admission. D. The nurse refers to the policy of the inpatient psychiatric setting when uncertain of a standard of care.

Correct Answer is C

Explanation

The nurse refuses to care for someone who reminds her of a family member after interviewing the client upon admission. This action is not appropriate in the prevention of liability because it violates the client’s right to receive care and may be considered as discrimination or abandonment. The nurse has a duty to provide care to all clients regardless of their personal feelings or preferences.

Choice A is wrong because establishing rapport with the client in an inpatient psychiatric setting is an appropriate action to prevent liability. It helps to build trust and communication between the nurse and the client and reduces the risk of misunderstanding or conflict.

Choice B is wrong because documenting accurately and honestly in the electronic health record is an appropriate action to prevent liability. It provides evidence of the care provided, the client’s condition and response, and any incidents or complications that occurred.

Choice D is wrong because referring to the policy of the inpatient psychiatric setting when uncertain of a standard of care is an appropriate action to prevent liability. It helps the nurse to follow the best practices and guidelines for providing safe and effective care to the client.

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The client has diabetes Type I, a body mass index (BMI) of 17 and poor skin turgor. How should the nurse plan to administer the prescribed. Humulin R 7 units subcutaneously?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which symptom experienced by a client receiving a continuous enteral feeding via a nasogastric tube requires priority follow-up by the nurse?

Correct Answer is A

Explanation

A nurse takes actions to avoid liability when caring for a client with a psychiatric disorder. Which action is not appropriate in the prevention of liability?

Correct Answer is C

Explanation

Which client assessment should a nurse immediately report to the health care provider?

Which technique is most reliable to confirm correct placement of a nasogastric tube prior to initiating tube feedings?

Which statement provides the best documentation of the amount of wound drainage?

The nurse observes the unlicensed assistive personnel (UAP) obtain vital signs on four adult clients. For which client should the nurse intervene to redirect to use of proper method?

A young woman arrives to the Emergency Department and reports that she was raped and stabbed. What should the nurse do first?

The nurse calls the healthcare provider using SBAR Communication. Which statement should the nurse make first?

Which action will prevent spreading organisms from one eye to the other when bathing a client?

The nurse is assessing a client experiencing acute pain. What assessments should validate the client with acute pain? Select all that apply.

The client has diabetes Type I, a body mass index (BMI) of 17 and poor skin turgor. How should the nurse plan to administer the prescribed.
Humulin R 7 units subcutaneously?