Nokea
The nurse has an order to administer 100 units of regular insulin in 500 mL of 0.9% NS to infuse at 12 units per hour. The nurse should program the IV pump to deliver how many mLs per hour?
Correct Answer: 60
Rationale: Concentration: 100 units/500 mL = 0.2 units/mL. To deliver 12 units/hour: 12 ÷ 0.2 = 60 mL/hour.
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The client with varicella will most likely have an order for which category of medication?
- A. Antibiotics
- B. Antipyretics
- C. Antivirals
- D. Anticoagulants
Correct Answer: C
Rationale: Varicella (chickenpox) is a viral infection, and antivirals like acyclovir are commonly prescribed to reduce severity and duration.
A client with hemophilia has a nosebleed. Which nursing action is most appropriate to control the bleeding?
- A. Place the client in a sitting position.
- B. Administer acetaminophen (Tylenol).
- C. Pinch the soft lower part of the nose.
- D. Apply ice packs to the forehead.
Correct Answer: C
Rationale: Pinching the soft lower part of the nose is the most effective way to control a nosebleed in a client with hemophilia, as it applies direct pressure to the bleeding site.
A client is confused after receiving morphine for analgesia and repeatedly tries to pull out the intravenous (IV) line in her left arm. Which of the following actions is the best initial solution?
- A. Attempt to camouflage the IV and tie a piece of tubing to the bedrail so the client can pull on that safely.
- B. Apply wrist restraints.
- C. Apply wrist and vest restraints.
- D. Discontinue the IV line and reinsert at a more distant site.
Correct Answer: A
Rationale: Camouflaging the IV and providing a safe alternative (A) is a least-restrictive, non-invasive initial approach to prevent the client from pulling out the IV. Restraints (B, C) should be a last resort, and discontinuing the IV (D) is unnecessary.
The nurse is caring for a client who abuses narcotics. The client is exhibiting a respiratory rate of 10 and dilated pupils. Which drug would the nurse expect to administer?
- A. Meperidine (Demerol)
- B. Naloxone (Narcan)
- C. Chlordiazepoxide (Librium)
- D. Haloperidol (Haldol)
Correct Answer: B
Rationale: Respiratory depression (rate of 10) and dilated pupils suggest opioid overdose. Naloxone (Narcan) is the antidote to reverse opioid toxicity.
The physician has ordered an infusion of Osmitrol (mannitol) for a client with increased intracranial pressure. Which finding indicates the direct effectiveness of the drug?
- A. Increased pulse rate
- B. Increased urinary output
- C. Decreased diastolic blood pressure
- D. Increased pupil size
Correct Answer: B
Rationale: Mannitol is an osmotic diuretic that reduces intracranial pressure by increasing urinary output, drawing fluid out of the brain tissue.