A nurse is administering a powdered medication to a client.
Which of the following actions should the nurse take first?
Document that the medication was administered.
Mix the medication at the client's bedside.
Check the client for allergies.
Determine the client's response to the medication.
The Correct Answer is C
Choice A rationale
Documenting the medication administration is important but should be done after administering the medication. Documentation ensures proper tracking and accountability but does
not address immediate patient safety concerns like checking for allergies.
Choice B rationale
Mixing the medication at the client's bedside may ensure that the medication is prepared correctly and the client receives it promptly, but it doesn't address the critical step of
ensuring the client's safety by checking for allergies first.
Choice C rationale
Checking the client for allergies is crucial before administering any medication, including powdered forms. Allergic reactions can be severe or life-threatening, so it’s essential to
ensure that the client isn’t allergic to the medication. This step ensures the safety and well-being of the client and prevents potential adverse reactions.
Choice D rationale
Determining the client's response to the medication is important for assessing the medication's effectiveness and identifying any adverse reactions, but it occurs after administration.
Checking for allergies precedes all these steps to prevent any initial harm.
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Correct Answer is A
Explanation
Choice A rationale
Colonoscopy is the recommended test for screening for rectal cancer. It allows for direct visualization of the entire colon and rectum, enabling the detection and biopsy of polyps or
suspicious lesions. It is the gold standard for colorectal cancer screening.
Choice B rationale
Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat conditions of the bile ducts, pancreas, and gallbladder. It’s not typically used for colorectal
cancer screening.
Choice C rationale
An upper GI series involves X-rays of the upper gastrointestinal tract (esophagus, stomach, and duodenum) after swallowing a contrast medium. This test does not visualize the
lower GI tract, including the colon and rectum, and is therefore not suitable for rectal cancer screening.
Choice D rationale
Upper GI endoscopy allows for direct visualization of the upper gastrointestinal tract but does not reach the colon and rectum. Hence, it is not used for screening rectal cancer
Correct Answer is D
Explanation
Choice A rationale
It is best practice to use a new cotton swab for each swipe to avoid contamination. Each area should be cleaned with a separate cotton swab.
Choice B rationale
Oil-based lubricants should not be used with catheters as they can interfere with the material of the catheter. Water-based lubricants are preferred.
Choice C rationale
Testing the balloon on the indwelling urinary catheter before insertion can lead to an increased risk of contamination and potential damage to the catheter.
Choice D rationale
Sterile gloves are essential to prevent infection during the insertion of an indwelling urinary catheter. Maintaining a sterile field is crucial.