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Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 90/60. What action should the healthcare provider take?
- A. Notify the healthcare provider or anesthesiologist immediately.
- B. Continue to assess the blood pressure every 5 minutes.
- C. Place the woman in a lateral position.
- D. Turn off the continuous epidural.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Insulin therapy is initiated for a 12-year-old child who is admitted with diabetic ketoacidosis (DKA). Which action is most important for the nurse to include in the child's plan of care?
- A. Monitor serum glucose for adjustment in the infusion rate of regular insulin (Novolin R).
- B. Determine the child's compliance schedule for subcutaneous NPH insulin (Humulin N).
- C. Demonstrate to the parents how to program an insulin pen for daily glucose regulation.
- D. Consult with the healthcare provider about the use of insulin detemir (Levemir Flex Pen).
Correct Answer: A
Rationale: In managing diabetic ketoacidosis (DKA), monitoring serum glucose levels is crucial to adjust the infusion rate of regular insulin effectively. This helps in controlling blood glucose levels and preventing complications associated with DKA. Close monitoring and adjustments based on glucose levels are essential for the successful management of DKA.
The healthcare provider prescribes magnesium sulfate 6 grams intravenously (IV) to be infused over 20 minutes for a client with preterm labor. The IV bag contains magnesium sulfate 20 grams in dextrose 5% in water 500 mL. How many mL/hour should the nurse set the infusion pump?
- A. 150 mL/hour
- B. 250 mL/hour
- C. 50 mL/hour
- D. 275 mL/hour
Correct Answer: A
Rationale: To calculate the infusion rate, first, determine the total volume to be infused (6 grams of magnesium sulfate) over a specific time frame (20 minutes). Then, calculate the concentration of magnesium sulfate in the IV bag to determine the mL/hour rate. In this case, with 20 grams of magnesium sulfate in 500 mL of solution, there are 4 grams of magnesium sulfate per 100 mL. Since 6 grams are required, the nurse should set the pump to deliver 150 mL/hour to infuse the prescribed dose over 20 minutes. This calculation ensures the correct dose is delivered within the specified time frame.
A client addicted to heroin and newly pregnant asks a nurse about ensuring her baby's health while on methadone. What should the nurse advise?
- A. Sign up for group therapy sessions.
- B. Discontinue the methadone right away.
- C. Start prenatal care as soon as possible.
- D. Describe genetic testing protocol.
Correct Answer: C
Rationale: Initiating prenatal care promptly is essential for monitoring the well-being of both the mother and the fetus, particularly in high-risk pregnancies involving substance use. Early prenatal care allows for timely interventions, education, and support to promote a healthier pregnancy and birth outcomes.
The healthcare provider is assessing a 38-week gestation newborn infant immediately following a vaginal birth. Which assessment finding best indicates that the infant is transitioning well to extrauterine life?
- A. Positive Babinski reflex.
- B. Flexion of all four extremities.
- C. Heart rate of 220 beats/min.
- D. Cries vigorously when stimulated.
Correct Answer: D
Rationale: A vigorous cry upon stimulation indicates that the newborn has good respiratory effort and is transitioning well to life outside the womb. It shows that the infant's airways are clear, and they are able to establish effective breathing, a crucial aspect of transitioning successfully to extrauterine life.
A loading dose of terbutaline (Brethine) 250 mcg IV is prescribed for a client in preterm labor. Brethine 20 mg is added to 1,000 mL of D5W. How many milliliters of the solution should the nurse administer?
- A. 45
- B. 15 mL
- C. 4
- D. 13
Correct Answer: D
Rationale: To calculate the amount of terbutaline to administer, first convert the dose to the same unit. 250 mcg = 0.25 mg. Next, set up a proportion: 20 mg is to 1000 mL as 0.25 mg is to X mL. Cross multiply and solve for X: 20 X = 0.25 1000. X = (0.25 1000) / 20 = 12.5 mL. Therefore, the nurse should administer 13 mL of the solution.