An intensive care nurse is configuring an infusion pump for a client requiring deep sedati… — NCLEX-RN

An intensive care nurse is configuring an infusion pump for a client requiring deep sedation. The new medication order specifies remifentanil to run at $0.05\text{ mcg/kg/min}$ . The client's admission weight is $230\text{ lb}$ . The available medication on the unit is a pre-mixed bag containing $2\text{ mg}$ of remifentanil dissolved in $250\text{ mL}$ of normal saline ( $0.9\%\text{ NaCl}$ ). Calculate the required pump setting in $\text{mL/hr}$ . (First, convert and round the client's weight to the nearest tenth of a kilogram. Then, perform your calculations and round the final answer to the nearest tenth.)

Answer: 39.2 mL/hr

Answer

The nurse should set the infusion pump to 39.2 mL/hr.

To find the correct infusion rate, the nurse must first convert the client's weight to kilograms (

230\text{ lb} \div 2.2 = 104.5\text{ kg}

). The weight is then multiplied by the prescribed dose to find the per-minute requirement (

104.5\text{ kg} \times 0.05\text{ mcg/kg/min} = 5.225\text{ mcg/min}

). Because the pump runs in hours, this is multiplied by

60\text{ minutes}

(

313.5\text{ mcg/hr}

). Next, the concentration of the IV bag is determined by converting milligrams to micrograms (

2\text{ mg} = 2,000\text{ mcg}

) and dividing by the total volume (

2,000\text{ mcg} \div 250\text{ mL} = 8\text{ mcg/mL}

). Finally, the hourly dose is divided by the concentration (

313.5 \div 8 = 39.1875

) and rounded to the nearest tenth, resulting in

39.2\text{ mL/hr}

Step-by-Step Solution

Convert the client's weight from pounds (lb) to kilograms (kg) and round to the nearest tenth.

230\text{ lb} \div 2.2\text{ lb/kg} = 104.545... \approx 104.5\text{ kg}

Critical care medication dosing is standardized using metric weights.

Calculate the total dose required per minute based on the client's weight.

104.5\text{ kg} \times 0.05\text{ mcg/kg/min} = 5.225\text{ mcg/min}

The prescription dictates how many micrograms the client needs for each kilogram of body weight every minute.

Convert the per-minute dose to an hourly dose.

5.225\text{ mcg/min} \times 60\text{ min/hr} = 313.5\text{ mcg/hr}

Intravenous infusion pumps are programmed in volume per hour (mL/hr), so the time unit must match.

Convert the total drug amount in the IV bag from milligrams (mg) to micrograms (mcg).

2\text{ mg} \times 1,000\text{ mcg/mg} = 2,000\text{ mcg}

The calculated dose is in micrograms, so the available medication supply must be converted to matching units.

Determine the concentration of the IV solution.

2,000\text{ mcg} \div 250\text{ mL} = 8\text{ mcg/mL}

Knowing how many micrograms are in a single milliliter allows you to calculate the total fluid volume needed to deliver the hourly dose.

Calculate the final infusion pump rate.

313.5\text{ mcg/hr} \div 8\text{ mcg/mL} = 39.1875\text{ mL/hr}

Dividing the total hourly medication requirement by the concentration yields the fluid rate in mL/hr.

Round the final rate to the nearest tenth.

39.1875\text{ mL/hr} \approx 39.2\text{ mL/hr}

The problem explicitly requires the final answer to be rounded to the nearest tenth.

Key Concept

Calculating complex weight-based continuous intravenous infusion rates requiring sequential conversions (lbs to kg, minutes to hours, and mg to mcg).

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