Nokea
A nurse is preparing to administer 40 mg of furosemide IV. Available is furosemide 10 mg/mL. How many mL should the nurse administer per dose?
Correct Answer: 4
Rationale: Correct Answer: A nurse should administer 4 mL of furosemide per dose. To calculate this, divide the total dose (40 mg) by the concentration (10 mg/mL). 40 mg ÷ 10 mg/mL = 4 mL. This ensures the correct dosage is administered.
Choice B: Incorrect. This choice does not follow the correct calculation method and does not provide the accurate dosage.
Choice C: Incorrect. This choice does not consider the concentration of the medication and does not provide the correct amount to administer.
Choice D: Incorrect. This choice does not involve the necessary division of the total dose by the concentration, resulting in an incorrect answer.
Choice E: Incorrect. This choice does not show a clear calculation method or consideration of the medication concentration.
Choice F: Incorrect. This choice lacks any calculation or explanation, making it an insufficient answer.
Choice G: Incorrect. This choice does not provide any reasoning or calculation to support the amount to administer, making it an inadequate
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A nurse is giving a change-of-shift report using SBAR to the oncoming nurse on a client who has a traumatic brain injury. Which of the following information should the nurse include in the background segment of SBAR?
- A. Plan of care changes for the upcoming shift
- B. Intracranial pressure readings
- C. Glasgow results
- D. Code status
Correct Answer: D
Rationale: The correct answer is D: Code status. In the background segment of SBAR, the nurse should include the client's code status to ensure the oncoming nurse is aware of the client's wishes in case of a medical emergency. This information is crucial for providing appropriate care and making decisions aligned with the client's preferences. Intracranial pressure readings (B) and Glasgow results (C) are more specific to the current condition of the client and would be included in the assessment segment of SBAR. Plan of care changes for the upcoming shift (A) would be part of the recommendation segment.
A nurse is preparing to turn a client who is obese following a spinal fusion. The nurse should plan to use which of the following techniques to turn this client?
- A. Draw sheet
- B. Log roll
- C. Sliding board
- D. Hoyer lift
Correct Answer: B
Rationale: The correct answer is B: Log roll. When turning an obese client following spinal fusion, using a log roll technique is most appropriate. This technique involves turning the client as a single unit to prevent twisting or bending of the spine, reducing the risk of injury. The nurse should assist the client by coordinating the movement with other staff members to ensure a smooth and safe transition. The other choices are not suitable for this scenario: A) Draw sheet is typically used for moving a client up in bed, not for turning an obese client after spinal fusion. C) Sliding board is used for transferring clients from one surface to another, not for turning in bed. D) Hoyer lift is used for lifting and transferring clients who are unable to bear weight, not for turning a client in bed.
A nurse is reviewing the laboratory results of a client who has a pressure ulcer. The nurse should identify an elevation in which of the following laboratory values as an indication that the client has developed an infection?
- A. WBC count
- B. BUN
- C. Potassium
Correct Answer: A
Rationale: The correct answer is A: WBC count. An elevation in WBC count indicates the presence of infection as the body releases more white blood cells to fight off pathogens. In the case of a pressure ulcer, an increased WBC count suggests bacterial invasion and inflammation at the site of the ulcer. BUN (choice B) and Potassium (choice C) are not specific indicators of infection and are more related to kidney function and electrolyte balance, respectively. Therefore, they are not appropriate for determining infection in this context.
A nurse is instructing a female client on obtaining a midstream urine specimen. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will wipe from the back to front with the cleaning cloth.
- B. I need to urinate a small amount in the toilet before collecting the sample.
- C. I should let the urine cool to room temperature before sending it to the lab.
- D. I should not collect a urine sample when I am menstruating.
Correct Answer: B
Rationale: Correct Answer: B - "I need to urinate a small amount in the toilet before collecting the sample."
Rationale:
1. This statement indicates the client understands the importance of collecting a midstream urine sample.
2. By urinating a small amount first, the initial stream clears any bacteria present in the urethra, ensuring a more accurate sample.
3. Collecting a midstream sample helps to avoid contamination from the surrounding genital area.
4. This method is essential for accurate urinalysis results and diagnosis of potential urinary tract infections.
Incorrect Choices:
A: Incorrect - Wiping from back to front can introduce bacteria from the anal region into the urethra, leading to contamination.
C: Incorrect - Cooling the urine to room temperature is not necessary for a midstream urine sample collection.
D: Incorrect - Menstruation does not interfere with the accuracy of a midstream urine sample collection.
A nurse is caring for a client who develops an airway obstruction from a foreign body but remains conscious. Which of the following actions should the nurse take first?
- A. Perform a blind finger sweep.
- B. Turn the client to the side.
- C. Insert an oral airway.
- D. Administer the abdominal thrust maneuver.
Correct Answer: D
Rationale: The correct answer is D: Administer the abdominal thrust maneuver. This action should be taken first because it is the appropriate intervention for a conscious individual with an airway obstruction. The abdominal thrust maneuver helps dislodge the foreign body by creating pressure to expel it. Performing a blind finger sweep (A) can push the object further down the airway. Turning the client to the side (B) may not effectively clear the airway obstruction. Inserting an oral airway (C) could worsen the obstruction if not inserted correctly. Therefore, administering the abdominal thrust maneuver is the priority to clear the airway obstruction in a conscious individual.