Nokea
A nurse cares for a client who is prescribed 4 mg of calcium gluconate to infuse over 5 hours. The pharmacy provides 2 premixed infusion bags with 2 mg of calcium gluconate in 100 mL of D5W. At what rate should the nurse administer this medication? (Record your answer using a whole number.)
Correct Answer: 40 mL/hr
Rationale: Two bags of 2 mg calcium gluconate in 100 mL D5W each provide a total of 4 mg in 200 mL. To infuse over 5 hours: 200 mL ÷ 5 hr = 40 mL/hr.
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A nurse cares for a client who has obstructive jaundice. The client asks, 'Why is my skin so itchy?' How should the nurse respond?
- A. Bile salts accumulate in the skin and cause the itching.
- B. Toxes released from an inflamed gallbladder lead to itching.
- C. The nurse assesses the client who is itching.
- D. Itching is caused by a hypersensitivity reaction.
Correct Answer: A
Rationale: In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.
A nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure? (Select all that apply.)
- A. Clay-colored stools
- B. Substernal chest pain
- C. Shortness of breath
- D. Lack of bowel sounds and flatus
- E. Urine output of 20 mL/6 hr
Correct Answer: B,C,D,E
Rationale: Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and renal failure (urine output of 20 mL/6 hr) are complications of a Whipple procedure. Clay-colored stools are not a typical complication of this procedure.
A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort?
- A. Administer morphine sulfate intravenously every 4 hours as needed.
- B. Maintain nothing by mouth (NPO) and administer intravenous fluids.
- C. Provide small, frequent feedings with no concentrated sweets.
- D. Place the client in semi-Fowler's position with the head of bed elevated.
Correct Answer: B
Rationale: The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 5 hours. A fetal position with legs drawn up to the chest will promote comfort.
A nurse cares for a client with acute pancreatitis. The client states, 'I am hungry.' How should the nurse reply?
- A. Are your bowels rumbling, or do you have bowel sounds?
- B. I need to check your gag reflex before you can eat.
- C. You will not be able to eat until the pain subsides.
- D. You can have a small snack to tide you over.
Correct Answer: C
Rationale: Paralytic ileus is a common complication of acute pancreatitis. The client should not eat until this has resolved. Bowel sounds and decreased pain are not reliable indicators of peristalsis. Instead, the nurse should assess for passage of flatus or bowel movement.
A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge?
- A. Do you have a one- or two-story home?
- B. Can you check your own pulse rate?
- C. Do you prepare your own meals?
- D. Do you have access to alcohol?
Correct Answer: A
Rationale: A client recovering from chronic pancreatitis should be limited to one floor until strength and activity increase. The client will need a bathroom on the same floor for frequent defecation. Assessing pulse rate and preparation of meals is not specific to chronic pancreatitis. Although the client should be encouraged to stop drinking alcohol, assessing alcohol availability is not adequate to assess safety.