Nokea
A nurse is assisting with the care of a client who has a prescription for 3,000 mL of intravenous fluids over the next 24 hours. The nurse should set the volumetric pump to deliver how many milliliters per hour?
- A. 125 mL/hr.
- B. 130 mL/hr.
- C. 135 mL/hr.
- D. 140 mL/hr.
Correct Answer: A
Rationale: The correct answer is A: 125 mL/hr. To calculate the rate of IV fluid administration, divide the total volume by the total time: 3000 mL ÷ 24 hours = 125 mL/hr. This ensures a consistent and safe delivery of fluids over the prescribed time frame. Choices B, C, and D are incorrect as they do not accurately divide the total volume by the total time. It's important to calculate the rate precisely to prevent under or over infusion, which can lead to adverse effects.
You may also like to solve these questions
A nurse is preparing to administer heparin subcutaneously to a client. Which of the following is an appropriate action by the nurse?
- A. Use a 1-inch needle to inject the medication.
- B. Use a 22-gauge needle to inject the medication.
- C. Massage the injection site after administration of the medication.
- D. Inject the medication into the abdomen above the level of the iliac crest.
Correct Answer: D
Rationale: Correct Answer: D. Inject the medication into the abdomen above the level of the iliac crest.
Rationale:
1. The abdomen is a common site for subcutaneous heparin injection due to better absorption.
2. Injection above the iliac crest avoids the risk of hitting major blood vessels or organs.
3. Subcutaneous heparin should be administered in fatty tissue for optimal absorption.
4. Massaging the site can cause bruising and should be avoided.
5. Using a shorter, finer needle (e.g., 5/8 inch, 25-gauge) is appropriate for subcutaneous injections.
6. A 22-gauge needle is too large for subcutaneous injections and may cause discomfort and tissue damage.
Summary:
A: Using a 1-inch needle is too long for subcutaneous injection.
B: A 22-gauge needle is too large for subcutaneous injection.
C: Massaging the site is not recommended.
D: Correct
A nurse is preparing to administer dextrose 5% in water IV to infuse at 100 mL/60 min. The drop factor on the manual IV tubing is 60 gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min. (Round to the nearest whole number.).
- A. 100 gtt/min.
Correct Answer: A
Rationale: The correct answer is A: 100 gtt/min. To calculate the IV flow rate, we first convert the prescribed volume (100 mL) and time (60 min) to drop factor per minute. 100 mL / 60 min = 1.67 mL/min. Then, we convert mL to drops using the drop factor (60 gtt/mL): 1.67 mL/min * 60 gtt/mL = 100.2 gtt/min. Rounding to the nearest whole number, the nurse should set the IV flow rate to 100 gtt/min.
Other choices (B-G) are incorrect as they are not calculated based on the given information and would lead to incorrect infusion rates.
A nurse suspects that another nurse on the unit is removing a small amount of morphine from the syringe before administering the medication to the client. Which of the following actions should the nurse take?
- A. Inform the charge nurse about her suspicion.
- B. Report the incident to the hospital security department.
- C. Ask the assistant personnel (AP) to observe the other nurse's actions.
- D. Approach the other nurse to discuss her suspicion.
Correct Answer: A
Rationale: The correct answer is A: Inform the charge nurse about her suspicion. This is the appropriate action as it involves escalating the concern to the appropriate authority, who can investigate the issue further. The charge nurse has the authority to address the situation and take necessary actions to ensure patient safety. Reporting to the security department (B) may not be necessary at this initial stage. Asking the assistant personnel (C) may not be effective in addressing the issue discreetly. Approaching the other nurse directly (D) may lead to confrontation and compromise the investigation process.
A nurse is caring for a client who has asthma. The client asks the nurse how albuterol helps his breathing. Which of the following information should the nurse include in the response? (Select all that apply).
- A. The medication will increase the amount of mucus.
- B. The medication will prevent wheezing.
- C. The medication will open the airways.
- D. The medication will decrease coughing.
Correct Answer: B,C,D
Rationale: The correct answers are B, C, and D. Albuterol helps breathing by preventing wheezing (B), opening the airways (C), and decreasing coughing (D). Wheezing is caused by narrowed airways due to inflammation in asthma, so preventing it helps improve airflow. Opening the airways allows more air to enter the lungs, making breathing easier. Decreasing coughing helps reduce airway irritation and allows for better lung function. Choice A is incorrect as albuterol does not increase mucus production; it actually helps to decrease it by reducing inflammation. Choices E, F, and G are not applicable as they were left blank.
A nurse is preparing to administer levothyroxine 100mcg po to a client who has hypothyroidism. Available levothyroxine is 50 mcg tablets. How many tablets should the nurse administer? (Round off to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
- A. 1 tablet.
- B. 2 tablets.
- C. 3 tablets.
- D. 4 tablets.
Correct Answer: B
Rationale: To determine the number of tablets to administer, divide the prescribed dose by the available dose per tablet. In this case, 100mcg ÷ 50mcg = 2 tablets. The correct answer is B because administering 2 tablets of 50mcg each will provide the total prescribed dose of 100mcg. Choice A is incorrect as it would only provide 50mcg, while choices C and D would exceed the prescribed dose. Choices E, F, and G are not applicable.