Correct Answer: A

Rationale: The correct answer is A: Check the client's current level of pain. The nurse should prioritize assessing the client's pain as grimacing and increased respiratory rate can indicate pain. By assessing the pain level first, the nurse can address the client's immediate needs and provide appropriate pain relief interventions. Option B is incorrect as distraction may not address the underlying cause of the client's discomfort. Option C is also incorrect as repositioning may not alleviate pain. Option D is incorrect as a cold compress may not be the appropriate intervention without assessing the cause of the pain first.

Correct Answer: C

Rationale:
Correct Answer: C - Use the Z-track technique to administer the medication.


Rationale: The Z-track technique should be used when administering IM injections to clients with infectious diseases like gonorrhea to prevent medication leakage into subcutaneous tissue. This technique involves pulling the skin to one side before injecting the medication, which helps to seal the medication in the muscle and reduces the risk of irritation or staining at the injection site. It ensures accurate administration and minimizes the risk of tissue damage or contamination.

Incorrect

Choices:
A: Inject the medication at least 5 cm (2 in) from the umbilicus - This is a general guideline for IM injections but does not specifically address the need for the Z-track technique in clients with gonorrhea.
B: Administer the medication with a 27-gauge /0.5-inch needle - Needle gauge and length are important considerations but not as crucial as using the Z-track technique in this case.
D: Give the medication without aspirating prior to injection

Correct Answer: C

Rationale: The correct answer is C: Pull the pinna up and back to administer medication. This technique helps straighten the ear canal for proper administration of the drops. Pulling the pinna up and back in adults helps to open the ear canal and ensure the drops reach the eardrum effectively.
Choice A is incorrect as chilling ear drops can cause discomfort.
Choice B is incorrect as pressing a cotton ball can prevent the drops from reaching the eardrum.
Choice D is incorrect as placing an applicator into the ear canal can cause injury.

Correct Answer: D

Rationale: The correct answer is D: Reduced triglycerides. Gemfibrozil is a medication commonly used to lower triglyceride levels. It works by decreasing the production of triglycerides in the liver and increasing the removal of triglycerides from the blood.
Therefore, after taking gemfibrozil for 3 months, the nurse should expect a reduction in the client's triglyceride levels as a positive outcome of the medication.

Now, let's analyze why the other choices are incorrect:
A: Increased serum creatinine - Gemfibrozil is not known to affect creatinine levels. It primarily targets lipid levels.
B: Reduced serum calcium - Gemfibrozil does not have an effect on calcium levels.
C: Increased Hgb - Gemfibrozil is not associated with an increase in hemoglobin levels. It primarily targets lipid levels.

In summary, the correct answer is D because gemfibrozil is expected to reduce triglyceride levels, while the other choices are incorrect

Correct Answer: A

Rationale: The correct answer is A: Use a ½-Inch needle. Infants have limited muscle mass, so a shorter needle length is appropriate to prevent reaching deep tissues or causing discomfort.
Choice B, using a 22-gauge needle, is incorrect as a smaller gauge needle is preferred for infants to reduce pain and tissue damage.
Choice C, using the flushing technique, is irrelevant for administering an IM injection.
Choice D, using the deltoid muscle for the injection site, is incorrect as the vastus lateralis muscle is recommended for infants due to better muscle development and less risk of nerve or vascular damage.