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: D

Rationale: The correct answer is D because renal excretion time slows for medication in older adults due to decreased kidney function. As people age, their kidneys may not work as efficiently as before, leading to a slower excretion of medications. This can result in medications staying in the body longer and potentially causing adverse effects.

A: Incorrect - Hepatic enzymes actually process medications more slowly in older adults, not more rapidly.
B: Incorrect - Gastric emptying rate usually decreases, not increases, in older adults, affecting medication absorption.
C: Incorrect - Brain receptors may become more sensitive, not less, to medications in older adults due to changes in neurotransmitter levels.

Correct Answer: A

Rationale: The correct answer is A. Ondansetron is an antiemetic used to treat nausea and vomiting. In a postoperative client reporting nausea, administering ondansetron can help alleviate the symptom.

Choices B, C, and D do not indicate a need for ondansetron. Incisional pain (
B) would require analgesics, not ondansetron. A respiratory rate of 14/min (
C) within normal range doesn't require ondansetron. A blood pressure of 110/72 mm Hg (
D) is normal and doesn't necessitate ondansetron.

Correct Answer: 167 mL/hr

Rationale:
To calculate the IV pump rate, divide the total volume (1L = 1000mL) by the total time in hours (6hr).
1000mL / 6hr = 166.67 mL/hr, rounded to the nearest whole number is 167 mL/hr.
This rate ensures the administration of 1L over 6 hours.
Option A: Incorrect as it does not match the calculated rate.
Options B-G: Irrelevant as they do not align with the correct calculation.

Correct Answer: A

Rationale: The correct answer is A: Identify the client using two means of identification. This should be the first action taken by the nurse to ensure the right medication is being given to the right patient. By confirming the client's identity with two separate identifiers, such as asking for their name and date of birth or checking their hospital wristband and asking for confirmation verbally, the nurse can prevent medication errors. Documenting the time of administration (
B) should come after confirming the client's identity. Validating the prescription with available medication (
C) and calculating the correct amount of medication (
D) should be done after confirming the client's identity to ensure the medication is being given to the right person.