The patient is ordered a nasal spray. Which intervention should the nurse instruct the patient to do prior to administration of the nasal spray?
Ask the patient to use the bathroom
Instruct the patient to look up at the ceiling
Ask the patient to take a deep breath
Ask the patient to blow his/her nose to clear the nasal passages
The Correct Answer is D
A. Asking the patient to use the bathroom is unrelated to the administration of nasal spray and is not necessary.
B. Instructing the patient to look up at the ceiling is not required for nasal spray administration and does not facilitate the process.
C. Asking the patient to take a deep breath is not directly related to the administration of nasal spray and does not affect its effectiveness.
D. Asking the patient to blow his/her nose to clear the nasal passages is important before administering nasal spray. Clearing nasal passages helps ensure that the medication can reach the nasal mucosa effectively, improving absorption and efficacy of the spray.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Administering heparin without clarifying the client's existing anticoagulation therapy could lead to potential overdosing or adverse effects due to cumulative anticoagulant effects.
B. While informing the client of her right to refuse treatment is important, it does not address the potential risk of duplicative therapy in this situation.
C. Contacting OSHA is not relevant to the situation of clarifying medication orders.
D. Clarifying the prescription with the provider is essential to ensure the safety and appropriateness of administering heparin in the context of the client's existing therapy, preventing medication errors and ensuring optimal patient care.
Correct Answer is C
Explanation
A. Lecture involves one-way communication where information is delivered by the nurse to the client without active participation. It does not confirm understanding or assess learning through client feedback.
B. Question and answer involves the nurse posing questions to assess understanding but may not actively involve the client in demonstrating knowledge or skills.
C. Teach-back is an effective teaching method where the nurse asks the client to explain the procedure back in their own words. This technique helps assess the client's understanding, clarify information, and reinforce learning, promoting patient empowerment and adherence to treatment plans.
D. Role play involves simulating scenarios to practice skills or behaviors, which may not directly assess the client's understanding of a specific procedure.
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