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A nurse is preparing to administer methylprednisolone acetate (Depo-Medrol) 10 mg by IV bolus. The amount available is 40 mg/mL. How many mL should the nurse administer?
Correct Answer: 0.3
Rationale: Correct Answer: 0.3 mL
Rationale:
1. Calculate the total dose needed: 10 mg.
2. Determine the concentration: 40 mg/mL.
3. Use the formula: dose needed / concentration available = volume to administer.
4. Plug in the values: 10 mg / 40 mg/mL = 0.25 mL.
5. Round up to the nearest practical dose increment: 0.3 mL.
Summary:
Choice A (0.5 mL): Incorrect, as it does not accurately calculate the volume needed.
Choices B-G: Irrelevant, as they do not follow the correct calculation method.
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A nurse is working with a newly hired nurse who is administering meds to clients. Which of the following actions by the newly hired nurse indicates an understanding of med error prevention?
- A. Taking all meds out of the unit-dose wrappers before entering the client's room.
- B. Checking with the provider when a single dose requires administration of multiple tablets.
- C. Administering a med, then looking up the usual dosage range.
- D. Relying on another nurse to clarify a med prescription.
Correct Answer: B
Rationale: Correct Answer: B
Rationale: Choice B demonstrates understanding of med error prevention because checking with the provider when a single dose requires administration of multiple tablets ensures accuracy in medication administration. This step helps prevent medication errors related to dosage calculation and administration. By consulting the provider, the nurse confirms the correct dosage and avoids potential overdosing or underdosing, which are common causes of medication errors. This action aligns with the principles of safe medication administration and prioritizes patient safety.
Incorrect Choices:
A: Taking all meds out of the unit-dose wrappers before entering the client's room can lead to medication mix-ups and errors, as it increases the risk of confusion and misidentification of medications.
C: Administering a med, then looking up the usual dosage range is risky as it may result in incorrect dosing and jeopardize patient safety.
D: Relying on another nurse to clarify a med prescription is problematic as it bypasses the responsibility of verifying medication orders directly with the prescriber
A client who has had a cerebrovascular accident has persistent problems w/dysphagia. The nurse caring for the client should initiate a referral w/which of the following members of the interprofessional care team? Select all.
- A. Social worker
- B. CNA
- C. Occupational therapist
- D. Speech-language pathologist
Correct Answer: C, D
Rationale: The correct answer is C and D. The occupational therapist (C) can help with improving the client's ability to eat independently by providing adaptive equipment and strategies. A speech-language pathologist (D) is crucial for assessing and treating dysphagia to prevent aspiration and improve swallowing function. The social worker (A) may address psychosocial needs but does not directly address dysphagia. The CNA (B) primarily assists with daily living activities.
A client is about to undergo an elective surgical procedure. Which of the following actions are appropriate for the nurse who is providing preop care regarding informed consent? Select all.
- A. Make sure the surgeon obtained the client's consent
- B. Witness the client's signature on the consent form
- C. Explain the risks and benefits of the procedure
- D. Describe the consequences of choosing not to have the surgery
- E. Tell the client about alternatives to having the surgery
Correct Answer: A, B
Rationale: Correct Answer: A, B
Rationale:
A: The nurse should ensure the surgeon obtained the client's consent as the surgeon is responsible for informing the client about the procedure and obtaining consent.
B: Witnessing the client's signature on the consent form ensures that the client signed voluntarily and with full understanding.
Summary:
C: While explaining risks and benefits is important, it is primarily the surgeon's responsibility.
D: Describing consequences of not having surgery is relevant but not directly related to obtaining informed consent.
E: Although discussing alternatives is crucial, it is not a direct part of the informed consent process.
A nurse manager of a med-surg unit is assigning care responsibilities for the oncoming shift. A client is awaiting transfer back to the unit from the PACU following thoracic surgery. To which staff member should the nurse assign this client?
- A. Charge nurse
- B. RN
- C. LPN
- D. AP
Correct Answer: B
Rationale: The correct answer is B: RN. A registered nurse (RN) is the most appropriate staff member to care for a client awaiting transfer from the PACU following thoracic surgery due to their advanced training and skill set. RNs are qualified to assess, monitor, and manage complex post-operative care needs, including respiratory status, pain management, and hemodynamic stability. Charge nurses may have administrative duties and may not be available to provide direct patient care. LPNs have a more limited scope of practice and may not have the necessary skills to care for a post-thoracic surgery patient. Advanced practice nurses (AP) typically have specialized roles and responsibilities that may not align with providing direct care in this situation.
A nurse is obtaining history from a client who has pain. The nurse's guiding principle throughout this process should be that:
- A. Some clients exaggerate their level of pain
- B. Pain must have an identifiable source to justify the use of opioids.
- C. Objective data are essential in assessing pain
- D. Pain is whatever the client says it is.
Correct Answer: D
Rationale: Step-by-step rationale for why answer D is correct:
1. Pain is a subjective experience: Pain perception varies among individuals, making it crucial to consider the client's own description.
2. Client-centered care: Acknowledging the client's self-report of pain is essential in providing effective and compassionate care.
3. Holistic approach: Recognizing the client's perspective on pain helps in addressing their physical, emotional, and psychological needs.
4. Trust and rapport: Valuing the client's self-assessment of pain fosters a trusting relationship between the nurse and the client.
5. Evidence-based practice: Research supports that self-reporting of pain is the most reliable indicator of pain intensity.
Summary:
- Choice A is incorrect as assuming clients exaggerate pain undermines their credibility and may lead to inadequate pain management.
- Choice B is incorrect as pain is not always identifiable, and opioids may be justified based on the client's report.
- Choice C is incorrect as relying solely on objective data overlooks the