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The healthcare provider has ordered 1000 mL of 0.9% sodium chloride to be administered intravenously over 5 hours. The drop factor on the tubing is 15 drops/mL. How many milliliters per hour and how many drops per minute will you administer?
- A. 200 mL/hr and 45 drops/min
- B. 250 mL/hr and 45 drops/min
- C. 250 mL/hr and 50 drops/min
- D. 200 mL/hr and 50 drops/min
- G. D
Correct Answer: 1000 mL ÷ 5 hr = 200 mL/hr. 200 mL/hr ÷ 60 min = 3.33 mL/min × 15 drops/mL = 49.95 drops/min, rounded to 50. Thus, 200 mL/hr and 50 drops/min.
Rationale: The correct answer is D: 200 mL/hr and 50 drops/min. To calculate the mL per hour, you divide the total mL by the total hours (1000 mL ÷ 5 hr = 200 mL/hr). To find the mL per minute, you divide the mL per hour by 60 minutes (200 mL/hr ÷ 60 min = 3.33 mL/min). Next, to determine the drops per minute, you multiply the mL per minute by the drop factor (3.33 mL/min × 15 drops/mL = 49.95 drops/min, rounded to 50 drops/min). Therefore, the correct administration rate is 200 mL/hr and 50 drops/min.
Choices A, B, and C are incorrect because they do not align with the correct calculation based on the given parameters. Choice A and B have incorrect mL per hour values, and Choice C has an incorrect drops per minute value.
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After taking the medication guaifenesin (Mucinex), the client complains of coughing up phlegm. What is the best response by the nurse?
- A. This means there is probably more pathology present.
- B. This is indicative of an allergic reaction.
- C. This requires further investigation.
- D. This is a normal response to the medication.
- G. D
Correct Answer: Guaifenesin is an expectorant that loosens mucus, making coughing up phlegm a normal response. It's not indicative of more pathology, an allergic reaction, or a need for investigation unless symptoms worsen unusually.
Rationale: Step 1: Identify the medication's action - Guaifenesin is an expectorant that helps loosen and thin mucus in the airways.
Step 2: Understand the expected response - Coughing up phlegm after taking guaifenesin is a normal response due to the medication's action.
Step 3: Evaluate the other choices - A, B, and C are incorrect because coughing up phlegm is not indicative of more pathology, an allergic reaction, or a need for further investigation in this context.
Step 4: Choose the correct response - Option G correctly acknowledges that coughing up phlegm is a normal response to guaifenesin and does not suggest any unnecessary concerns or actions.
A client taking an MAOI should be instructed to avoid which item?
- A. Large amounts of water
- B. A diet that is high in salt
- C. A diet that is high in fat
- D. Foods that contain tyramine and caffeine .
- G. D
Correct Answer: Water, salt, and fat don't interact with MAOIs. Tyramine and caffeine can cause hypertensive crises with MAOIs.
Rationale: The correct answer is D: Foods that contain tyramine and caffeine. MAOIs inhibit the breakdown of tyramine and caffeine, leading to an accumulation in the body. Tyramine can cause a dangerous increase in blood pressure known as a hypertensive crisis. Caffeine can also contribute to this effect. Large amounts of water (A), a high-salt diet (B), and a high-fat diet (C) do not interact with MAOIs in a way that poses a significant risk. Therefore, instructing the client to avoid foods containing tyramine and caffeine is crucial to prevent potential adverse reactions.
Which of the following triggers the pancreas to secrete insulin?
- A. Hypoglycemia
- B. Hyperglycemia
- C. Glucagon
- D. Ketoacids
- G. B
Correct Answer: Hypoglycemia triggers glucagon, not insulin. Hyperglycemia prompts insulin release to lower blood sugar. Glucagon opposes insulin. Ketoacids indicate low glucose, not insulin trigger.
Rationale: The correct answer is B: Hyperglycemia. When blood sugar levels are high, the pancreas responds by releasing insulin to facilitate the uptake of glucose by cells, thereby lowering blood sugar levels. This is a crucial mechanism to maintain glucose homeostasis in the body. Hypoglycemia (A) triggers the release of glucagon to raise blood sugar levels, not insulin. Glucagon (C) is released in response to low blood sugar levels and opposes the action of insulin. Ketoacids (D) indicate a state of low glucose, not a trigger for insulin secretion. Therefore, the correct trigger for the pancreas to secrete insulin is hyperglycemia.
A nurse is reinforcing teaching with a client who was newly prescribed paroxetine (Paxil) (an SSRI) for treatment of panic disorder. Sort the following information by what the nurse should include vs what not to include.
- A. Take this medication just before bedtime to promote sleep.
- B. Herbal medication can be combined with this medication.
- C. Monitor for weight changes while taking this medication.
- D. It can take several weeks before you feel like the medication is helping.
- G. A,C
Correct Answer: Bedtime dosing helps with side effects like drowsiness. Herbal combinations risk serotonin syndrome and should be avoided. Weight changes are a side effect to monitor. It takes weeks for full effect, but this was mislabeled; A and C are correct inclusions.
Rationale: The correct answer is G: A,C. The rationale for this is as follows:
1. A: Taking the medication just before bedtime can help minimize side effects like drowsiness, which is common with SSRIs like paroxetine.
2. C: Monitoring for weight changes is important because weight gain or loss can be a side effect of paroxetine.
3. B: Combining herbal medications with paroxetine can increase the risk of serotonin syndrome, a potentially life-threatening condition.
4. D: It is true that it can take several weeks before feeling the full benefits of paroxetine, but this information was not provided in the question stem.
In summary, A and C are the correct inclusions because they provide important information related to the medication's side effects and administration, while B and D are incorrect because they introduce potential risks and irrelevant information.
Four patients are due to receive their morning insulin and breakfast will be served in 15 minutes. Which patient should the nurse administer insulin to first?
- A. The patient with a pre-meal glucose level of 90 mg/dL, scheduled to receive 10 units of NPH.
- B. The patient with a pre-meal glucose level of 70 mg/dL, scheduled to receive 2 units of aspart (Novolog) insulin.
- C. The patient with a pre-meal glucose level of 120 mg/dL, scheduled to receive 15 units of NPH.
- D. The patient with a pre-meal glucose level of 170 mg/dL, scheduled to receive 5 units of lispro (Humalog) insulin.
- G. D
Correct Answer: 90 mg/dL (NPH) and 70 mg/dL (aspart) are normal/low, less urgent. 120 mg/dL (NPH) is mildly high. 170 mg/dL with rapid-acting lispro needs priority due to significant elevation.
Rationale: The correct answer is D: The patient with a pre-meal glucose level of 170 mg/dL, scheduled to receive 5 units of lispro (Humalog) insulin. This choice is correct because a glucose level of 170 mg/dL is significantly elevated, indicating a need for immediate insulin administration to prevent further hyperglycemia. Lispro is a rapid-acting insulin, which should be administered promptly before breakfast to control the high blood sugar effectively. Choices A, B, and C have glucose levels within normal or slightly elevated ranges, making them less urgent for immediate insulin administration. Choice D is the most critical due to the high glucose level and the type of insulin being rapid-acting, requiring prompt action to manage the patient's blood sugar levels effectively.