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An order is written for liquid acetaminophen at $15 \text{ mg/kg}$ per dose for a toddler who weighs $16 \text{ kg}$ . The medication bottle is labeled $160 \text{ mg}/5 \text{ mL}$ . Calculate the total volume in $\text{mL}$ that should be administered for a single dose. (Record your answer to one decimal place.)

Show answer & explanation

Answer: 7.5

Answer

7.5

The correct dose is found in two steps. First, find the total mg needed by multiplying the toddler's weight (

16 \text{ kg}

) by the prescribed amount (

15 \text{ mg/kg}

), which equals

240 \text{ mg}

. Second, use the concentration of the liquid medication to find the volume. Dividing the desired dose (

240 \text{ mg}

) by the on-hand dose (

160 \text{ mg}

) and multiplying by the volume (

5 \text{ mL}

) yields exactly

7.5 \text{ mL}

Step-by-Step Solution

Calculate the total required dose in milligrams.

16 \text{ kg} \times 15 \text{ mg/kg} = 240 \text{ mg}

The prescription is weight-based, meaning the patient's exact weight must be multiplied by the prescribed weight-based dosage.

Determine the required liquid volume using the supplied medication concentration.

(240 \text{ mg} / 160 \text{ mg}) \times 5 \text{ mL} = 7.5 \text{ mL}

Using the standard formula (Desired Dose / Available Dose) × Available Volume, the calculated milligram requirement is converted into the volume to be administered.

Key Concept

Weight-based pediatric dosage calculation

Question 82Question →

A nurse is caring for a laboring client at 37 weeks gestation who has severe preeclampsia. The provider has prescribed a strict total fluid restriction of $125\text{ mL/hr}$ , which includes all oral and intravenous (IV) intake.

The client is receiving a continuous IV infusion of magnesium sulfate at a rate of $2\text{ g/hr}$ . The magnesium sulfate is supplied as $40\text{ g}$ in $1,000\text{ mL}$ of sterile water. The client also has a continuous IV infusion of oxytocin running at $15\text{ mL/hr}$ . Over the past 4 hours, the client has consumed $4\text{ oz}$ of ice chips and $120\text{ mL}$ of water.

Assuming the oral intake is distributed evenly across the 4 hours, what is the maximum rate in $\text{mL/hr}$ at which the nurse should program the primary IV pump to deliver lactated Ringer's solution? (Record your answer as a whole number.)

Show answer & explanation

Answer: 15

Answer

Clients with severe preeclampsia are at high risk for pulmonary edema and require strict fluid restriction, typically limited to

125\text{ mL/hr}

from all sources. To calculate the remaining allowable fluid for the primary IV, the nurse must sum all current hourly intakes and subtract this from the

125\text{ mL/hr}

limit.

First, calculate the magnesium sulfate rate:

40\text{ g}

1,000\text{ mL}

yields a concentration of

0.04\text{ g/mL}

. The prescribed rate is

2\text{ g/hr}

, which requires

50\text{ mL/hr}

(

2 \div 0.04

).

Second, determine the hourly oral intake. The client consumed

4\text{ oz}

of ice chips, which equals

120\text{ mL}

. Because ice chips melt to half their volume, this counts as

60\text{ mL}

of intake. Added to the

120\text{ mL}

of water, the total oral intake is

180\text{ mL}

over 4 hours, resulting in an average of

45\text{ mL/hr}

.

The total current intake is

50\text{ mL/hr}

(magnesium) +

15\text{ mL/hr}

(oxytocin) +

45\text{ mL/hr}

(oral fluids) =

110\text{ mL/hr}

.

Finally, subtract this from the restriction limit:

125\text{ mL/hr} - 110\text{ mL/hr} = 15\text{ mL/hr}

. The primary IV should be set at a maximum of

15\text{ mL/hr}

Step-by-Step Solution

Calculate the IV rate for the magnesium sulfate infusion.

50\text{ mL/hr}

The concentration is

40\text{ g}

1,000\text{ mL}

(or

0.04\text{ g/mL}

). The prescribed dose is

2\text{ g/hr}

. Therefore,

2\text{ g/hr} \div 0.04\text{ g/mL} = 50\text{ mL/hr}

Calculate the total volume of oral intake over the 4-hour period.

180\text{ mL}

Standard conversion:

1\text{ oz} = 30\text{ mL}

4\text{ oz}

of ice chips =

120\text{ mL}

. Ice chips melt to half their volume, providing

60\text{ mL}

of fluid. Adding the

120\text{ mL}

of water gives a total of

180\text{ mL}

(

60\text{ mL} + 120\text{ mL}

Calculate the average hourly oral intake.

45\text{ mL/hr}

The

180\text{ mL}

of oral intake was consumed over 4 hours.

180\text{ mL} \div 4\text{ hr} = 45\text{ mL/hr}

Calculate the total current hourly fluid intake.

110\text{ mL/hr}

Add the rates of all current intake sources:

50\text{ mL/hr}

(magnesium) +

15\text{ mL/hr}

(oxytocin) +

45\text{ mL/hr}

(oral fluids) =

110\text{ mL/hr}

Determine the maximum rate for the primary IV lactated Ringer's.

15\text{ mL/hr}

Subtract the current total intake from the strict restriction limit:

125\text{ mL/hr} - 110\text{ mL/hr} = 15\text{ mL/hr}

Key Concept

Fluid Volume Calculation and Restriction Management in Preeclampsia

Question 83Question →

A critical care nurse is managing a client diagnosed with acute respiratory failure who is receiving mechanical ventilation. The laboratory reports the following arterial blood gas results: pH 7.28, PaCO2 62 mm Hg, PaO2 55 mm Hg, and HCO3 24 mEq/L. To reduce the risk of further physiological deterioration, which of the following interventions are appropriate? Select all that apply.

Select all that apply

Auscultate breath sounds and assess oxygen saturation prior to initiating endotracheal suctioning

Maintain the client's upper body in a semi-Fowler's alignment to prevent ventilator-associated complications

Administer prescribed intravenous sodium bicarbonate to correct the identified uncompensated metabolic acidosis

Reposition the client into a flat, dorsal recumbent alignment to maximize pulmonary blood flow

Palpate the abdominal quadrants for distention before auscultating for bowel sounds during the physical assessment

Continue the client's scheduled daily hygiene care before responding to a sustained high-pressure ventilator alarm

Show answer & explanation

Answer: Auscultate breath sounds and assess oxygen saturation prior to initiating endotracheal suctioning; Maintain the client's upper body in a semi-Fowler's alignment to prevent ventilator-associated complications

Answer

The appropriate interventions are to auscultate breath sounds prior to endotracheal suctioning and to maintain the client's upper body in a semi-Fowler's alignment.

The correct actions focus on evidence-based risk reduction strategies for mechanically ventilated clients. Assessing lung sounds before suctioning prevents unnecessary trauma and hypoxia, while maintaining an elevated upper body reduces the risk of aspiration and ventilator-associated pneumonia. These actions directly mitigate physiological risks.

Step-by-Step Solution

Analyze the arterial blood gas (ABG) results.

The pH is 7.28 (acidosis), PaCO2 is 62 mm Hg (respiratory), and HCO3 is 24 mEq/L (normal), indicating uncompensated respiratory acidosis.

Accurate interpretation dictates the correct clinical interventions and prevents the administration of inappropriate treatments like sodium bicarbonate.

Evaluate positioning requirements for a mechanically ventilated client.

The client requires an elevated upper body.

A semi-Fowler's alignment reduces the risk of aspiration and ventilator-associated pneumonia, whereas a flat position is contraindicated.

Apply the airway, breathing, and circulation (ABC) prioritization framework.

Airway and ventilation issues must be addressed before routine care.

A high-pressure ventilator alarm indicates a life-threatening airway compromise that takes absolute precedence over hygiene.

Key Concept

Prioritization and risk reduction in mechanically ventilated clients, including accurate ABG interpretation and implementation of ventilator safety bundles.

Estimated Time:2m 0s

Question 84Question →

A clinical educator on a specialized oncology unit is reviewing case studies with the nursing staff to reinforce ethical decision-making. Connect each specialized nursing intervention to the primary ethical principle it demonstrates by matching the items below.

Click a left item, then click its matching right item

Show answer & explanation

Answer

The correct pairings are: Administering prophylactic antiemetics aligns with Beneficence. Protecting medical records aligns with Confidentiality. Returning at a promised time aligns with Fidelity. Providing unbiased care to an incarcerated client aligns with Justice. Explaining severe side effects honestly aligns with Veracity.

Each specific nursing intervention in the oncology unit serves as a direct clinical application of a foundational ethical principle required for safe and effective care.

Step-by-Step Solution

Analyze the action of administering antiemetics for comfort.

This action actively promotes the client's well-being and prevents suffering.

Taking positive action to help others corresponds to the principle of Beneficence.

Evaluate the action of withholding records from visiting relatives based on client request.

This action protects the client's private information from being shared without consent.

This corresponds to the principle of Confidentiality.

Assess the action of keeping a promise to return at a specific time.

This action builds trust by honoring commitments made to the client.

Following through on promises corresponds to the principle of Fidelity.

Review the action of providing unbiased care to an incarcerated individual.

This action ensures that personal biases or legal status do not alter the quality of healthcare.

Fair and equitable treatment corresponds to the principle of Justice.

Analyze the action of fully explaining medication side effects without minimizing them.

This action ensures the client receives truthful and accurate information for informed consent.

Truth-telling corresponds to the principle of Veracity.

Key Concept

Ethical Principles in Nursing Practice

Question 85Question →

A client recovering from a complex coronary artery bypass graft (CABG) surgery develops acute postoperative delirium. The client becomes highly agitated and continuously attempts to pull out their epicardial pacing wires and mediastinal chest tubes. After documenting the failure of multiple less restrictive interventions, the healthcare provider prescribes bilateral soft wrist restraints. Which intervention demonstrates correct adherence to restraint safety protocols?

Removing one restraint at a time every 2 hours to provide skin care, perform passive range of motion, and evaluate the client's behavior.

Securing the restraint straps to the bed's side rails using a quick-release slip knot to facilitate immediate removal during an emergency.

Delegating the hourly assessment of the client's peripheral pulses, capillary refill, and skin integrity to the unlicensed assistive personnel (UAP).

Requesting that the healthcare provider change the continuous restraint prescription to a PRN (as needed) order to minimize overall usage.

Show answer & explanation

Answer: Removing one restraint at a time every 2 hours to provide skin care, perform passive range of motion, and evaluate the client's behavior.

Answer

The nurse should remove one restraint at a time every 2 hours to provide skin care, perform range of motion, and evaluate the client's ongoing need for the restraints.

For non-violent (medical-surgical) restraints, the standard of care requires the nurse to temporarily release the restraints at least every 2 hours. This must be done one extremity at a time to maintain safety. During this release, the nurse must provide skin care, perform passive range-of-motion exercises, assess neurovascular status (pulses, color, temperature, sensation), and evaluate if the client's behavior indicates the restraints can be safely discontinued.

Step-by-Step Solution

Analyze the client's clinical situation and the type of restraint ordered.

The client has non-violent (medical-surgical) soft wrist restraints applied to prevent the removal of life-sustaining medical devices (pacing wires and chest tubes).

Identifying the restraint category dictates the specific regulatory timeline for assessment, release, and prescription renewal.

Evaluate each nursing intervention against evidence-based safety and regulatory standards.

Tying restraints to side rails causes injury. PRN restraint orders are illegal. Delegating clinical assessments to a UAP violates the nurse practice act.

Eliminating unsafe practices isolates the correct evidence-based nursing action.

Identify the standard of care for maintaining client safety while restrained.

Releasing the restraints sequentially every 2 hours allows for necessary skin and circulatory care while maintaining the client's overall safety.

This action balances the need for device protection with the client's physiological needs and comfort.

Key Concept

Safe Management of Physical Restraints

Question 86Question →

A nurse manager is observing staff members on a medical-surgical unit to ensure adherence to confidentiality, information security, and legal mandates. Which of the following actions by the staff demonstrate appropriate compliance? (Select all that apply.)

Select all that apply

Disposing of handwritten client assignment sheets in a designated locked shredding bin before leaving the unit.

Logging off the electronic health record (EHR) terminal immediately after documenting medication administration.

Assuring an older adult client that their statements regarding physical abuse by a caregiver will be kept strictly confidential.

Delegating the task of explaining abnormal laboratory results to family members to an unlicensed assistive personnel (UAP).

Asking a client non-therapeutic 'why' questions about their psychiatric history while waiting in a public hospital corridor.

Positioning the computer monitor screen away from the doorway and visitors to prevent unauthorized viewing of protected health information.

Show answer & explanation

Answer: Disposing of handwritten client assignment sheets in a designated locked shredding bin before leaving the unit.; Logging off the electronic health record (EHR) terminal immediately after documenting medication administration.; Positioning the computer monitor screen away from the doorway and visitors to prevent unauthorized viewing of protected health information.

Answer

The correct actions include disposing of assignment sheets in a locked shredding bin, logging off the EHR terminal immediately after use, and positioning the computer monitor away from doorways and visitors.

The correct actions demonstrate adherence to the Health Insurance Portability and Accountability Act (HIPAA) and general privacy principles. Proper disposal of printed health information in locked shredding bins ensures data cannot be intercepted. Logging off electronic terminals immediately after use prevents unauthorized access to the client's chart. Positioning monitors away from public view prevents incidental disclosure of protected health information to visitors or passersby.

Step-by-Step Solution

Analyze the request

Identify actions that demonstrate compliance with confidentiality and information security protocols.

To distinguish between safe, compliant practices and privacy breaches or legal errors.

Evaluate the actions related to physical and electronic records

Shredding handwritten notes, logging off terminals, and shielding screens are all appropriate safeguards.

These actions actively protect Protected Health Information (PHI) from unauthorized access, adhering to HIPAA guidelines.

Evaluate the action regarding mandatory reporting

Promising confidentiality for reports of physical abuse is incorrect.

Nurses are legally mandated to report suspected abuse of vulnerable populations; this mandate supersedes general confidentiality principles.

Evaluate the action involving delegation

Delegating the explanation of lab results to a UAP is incorrect.

This task requires nursing judgment (improper delegation) and sharing it with family without verifying consent breaches confidentiality.

Evaluate the action regarding communication location

Discussing psychiatric history in a public corridor is incorrect.

Sensitive conversations must occur in private settings to prevent incidental disclosure and protect the client's privacy.

Key Concept

Information Security and Legal Mandates

Question 87Question →

While a unit of packed red blood cells (PRBCs) is infusing, the client suddenly develops severe lower back pain, dyspnea, and visible shivering. The nurse suspects an acute hemolytic transfusion reaction. Arrange the following nursing interventions in the correct chronological order of priority. (Place the first action at the top and the last action at the bottom.)

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence is to first stop the transfusion, then disconnect the blood tubing, attach new tubing primed with 0.9% sodium chloride, assess the client's status, notify the provider and blood bank, and finally send the equipment to the blood bank for testing.

The correct sequence prioritizes immediate patient safety by stopping the administration of the offending agent, physically disconnecting it, and securing venous access with a new line. Only after these lifesaving actions are complete should the nurse gather assessment data to communicate with the medical team, and finally preserve the evidence for laboratory investigation.

Step-by-Step Solution

Stop the blood transfusion.

The infusion of the potentially incompatible blood product is halted.

This is the most critical first step to prevent further physiological harm to a client experiencing an acute hemolytic reaction.

Disconnect the blood administration set from the intravenous hub.

The source of the incompatible blood is physically separated from the client's vascular access.

This prevents inadvertently pushing the remaining blood in the tubing into the client during the subsequent flush.

Attach a new intravenous tubing primed with 0.9% sodium chloride.

A patent intravenous line is secured with a compatible isotonic fluid.

Intravenous access must be maintained for potential emergency interventions, fluid resuscitation, and blood pressure support.

Assess the client's vital signs and clinical status.

Objective data regarding the severity of the reaction is gathered.

The nurse must evaluate the client's respiratory, hemodynamic, and neurological status to provide accurate and current information to the healthcare provider.

Notify the primary healthcare provider and the blood bank.

The medical team is alerted, and further emergency orders can be obtained.

The provider needs the assessment data to prescribe interventions (e.g., epinephrine, vasopressors, antihistamines), and the blood bank must initiate a reaction investigation.

Send the discontinued blood bag and administration set to the blood bank.

The suspected blood product is transported for laboratory analysis.

Testing the remaining blood and tubing is required to confirm the type of reaction, such as an ABO incompatibility.

Key Concept

Management of Acute Hemolytic Transfusion Reaction

Estimated Time:2m 0s

Question 88Question →

A client diagnosed with a pulmonary embolism has a documented admission weight of 187 lbs. The healthcare provider orders a continuous intravenous (IV) heparin infusion at a dose of 18 units/kg/hr. The pharmacy dispenses an IV bag containing 25,000 units of heparin in 250 mL of 5% dextrose in water. Calculate the required infusion pump rate in mL/hr. (Round the answer to the nearest tenth.)

Show answer & explanation

Answer: 15.3

Answer

15.3

To safely administer a weight-based continuous intravenous infusion, the nurse must first establish the client's weight in kilograms (

187 \text{ lbs} \div 2.2 = 85

kg). The weight is then multiplied by the ordered dose to find the hourly medication requirement (

85 \text{ kg} \times 18 \text{ units/kg/hr} = 1530 \text{ units/hr}

). Finally, the nurse determines the fluid volume needed to deliver this dose by dividing the hourly requirement by the concentration of the IV solution (

25,000 \text{ units} \div 250 \text{ mL} = 100 \text{ units/mL}

). Therefore,

1530 \text{ units/hr} \div 100 \text{ units/mL} = 15.3 \text{ mL/hr}

Step-by-Step Solution

Convert weight to kilograms.

85 kg

The prescribed dose is weight-based in kg, so the client's weight in lbs must be converted by dividing by 2.2.

Calculate the hourly heparin dose.

1530 units/hr

Multiplying the client's weight in kg by the prescribed hourly dose of 18 units/kg/hr provides the total required units per hour.

Calculate the volume rate of the infusion.

15.3 mL/hr

Dividing the required hourly dose (1530 units/hr) by the medication concentration (100 units/mL) yields the infusion pump rate in mL/hr.

Key Concept

Weight-Based Intravenous Medication Calculation

Alternative Method

Dimensional analysis can be used to set up the entire equation in one continuous step:

\frac{18 \text{ units}}{\text{kg} \cdot \text{hr}} \times \frac{1 \text{ kg}}{2.2 \text{ lbs}} \times 187 \text{ lbs} \times \frac{250 \text{ mL}}{25,000 \text{ units}} = 15.3 \text{ mL/hr}

Estimated Time:1m 30s

Question 89Question →

A nurse is monitoring a client who is receiving a continuous intravenous regular insulin infusion for the treatment of diabetic ketoacidosis (DKA). The client's current blood glucose level is $240$ mg/dL ( $13.3$ mmol/L). Which laboratory finding poses the greatest risk for a physiological complication and requires immediate intervention?

Serum potassium level of

3.1

mEq/L (

3.1

mmol/L)

Arterial blood pH of

7.28

Serum sodium level of

132

mEq/L (

132

mmol/L)

Blood urea nitrogen (BUN) level of

38

mg/dL (

13.6

mmol/L)

Show answer & explanation

Answer: Serum potassium level of $3.1$ mEq/L ( $3.1$ mmol/L)

Answer

The correct finding that requires immediate intervention is the serum potassium level of 3.1 mEq/L (3.1 mmol/L).

Intravenous regular insulin effectively lowers blood glucose levels by allowing glucose to enter the cells. However, a major physiological consequence of this therapy is that it actively drives potassium out of the intravascular space and into the intracellular space, rapidly depleting serum potassium levels. A serum potassium level of

3.1

mEq/L indicates clinically significant hypokalemia (normal range is

3.5

5.0

mEq/L). Because severe hypokalemia places the client at an immediate risk for life-threatening cardiac dysrhythmias (such as ventricular fibrillation), the nurse must promptly intervene by alerting the provider and preparing to administer supplemental intravenous potassium to reduce the risk of a fatal complication.

Step-by-Step Solution

Analyze the physiological effect of the prescribed therapy (intravenous insulin) on the client's cellular metabolism.

Intravenous insulin drives glucose out of the bloodstream and into the cells, but it also actively drives potassium into the intracellular space.

Understanding the side effects of DKA treatment is critical to anticipating potential complications.

Evaluate the provided laboratory values against normal reference ranges.

The potassium level of 3.1 mEq/L is critically below the normal range of 3.5 to 5.0 mEq/L, indicating hypokalemia.

Identifying which lab values are outside normal limits is the first step in clinical decision-making.

Prioritize the abnormal findings based on the ABCs (Airway, Breathing, Circulation) and immediate threat to life.

Hypokalemia poses a severe and immediate risk for fatal cardiac dysrhythmias (Circulation), making it the highest priority over expected dehydration or resolving acidosis.

Risk reduction requires the nurse to address the most acutely life-threatening complication first.

Key Concept

Reduction of Risk Potential: Anticipating and managing treatment-induced hypokalemia during Diabetic Ketoacidosis (DKA) management.

Estimated Time:1m 0s

Question 90Question →

An adult client is receiving care in the intensive care unit for massive gastrointestinal hemorrhage. Despite aggressive fluid resuscitation, the bleeding persists. Which assessment findings suggest that the client has entered the progressive (uncompensated) stage of hypovolemic shock? Select all that apply.

Select all that apply

Mean arterial pressure (MAP) of

54\text{ mm Hg}

Arterial blood gas demonstrating a pH of

7.22

and an

\text{HCO}_3^-

14\text{ mEq/L}

A widening pulse pressure from

40\text{ mm Hg}

55\text{ mm Hg}

Arterial blood gas demonstrating a pH of

7.45

and a

\text{PaCO}_2

30\text{ mm Hg}

Urine output of

10\text{ mL/hr}

over the past two hours

Show answer & explanation

Answer: Mean arterial pressure (MAP) of $54\text{ mm Hg}$ ; Arterial blood gas demonstrating a pH of $7.22$ and an $\text{HCO}_3^-$ of $14\text{ mEq/L}$ ; Urine output of $10\text{ mL/hr}$ over the past two hours

Answer

The findings indicating the progressive stage of hypovolemic shock are a MAP of 54 mm Hg, an ABG showing metabolic acidosis (pH 7.22, HCO3- 14 mEq/L), and severe oliguria (10 mL/hr).

The progressive (uncompensated) stage of shock is characterized by the failure of compensatory mechanisms to maintain adequate tissue perfusion. A mean arterial pressure (MAP) below

65\text{ mm Hg}

indicates significant hypotension and loss of hemodynamic compensation. Tissue hypoxia forces cells into anaerobic metabolism, producing lactic acid and resulting in severe metabolic acidosis (pH

7.22

\text{HCO}_3^-

14\text{ mEq/L}

). Additionally, severe vasoconstriction and hypoperfusion to the kidneys cause profound oliguria, such as a urine output of

10\text{ mL/hr}

Step-by-Step Solution

Analyze the client's clinical scenario.

The client has a severe hemorrhage leading to hypovolemia. The task is to identify signs of progressive (uncompensated) shock.

Understanding the sequential stages of shock is necessary to differentiate early compensatory signs from late progressive signs.

Evaluate the hemodynamic parameters.

A MAP below 65 mm Hg (e.g., 54 mm Hg) indicates failure of compensatory mechanisms and inadequate tissue perfusion.

Compensatory mechanisms initially maintain blood pressure; profound hypotension marks the transition to the progressive stage.

Interpret the arterial blood gas (ABG) values.

A pH of 7.22 with an HCO3- of 14 mEq/L indicates uncompensated metabolic acidosis, typical of progressive shock. A pH of 7.45 indicates alkalosis, which is an early compensatory sign.

Anaerobic metabolism in progressive shock generates lactic acid, leading to severe metabolic acidosis.

Assess organ perfusion indicators such as urine output and pulse pressure.

Urine output of 10 mL/hr reflects severe renal hypoperfusion. Pulse pressure typically narrows in hypovolemic shock, not widens.

Oliguria is a classic sign of progressive shock due to the shunting of blood away from the kidneys.

Key Concept

In the progressive (uncompensated) stage of hypovolemic shock, compensatory mechanisms fail, leading to significant hypotension (MAP < 65 mm Hg), altered tissue perfusion (profound oliguria), and anaerobic metabolism causing metabolic acidosis.

Question 91Question →

A gravid client at 40 weeks of gestation is undergoing an induction of labor with intravenous oxytocin. The external fetal monitor displays a continuous pattern where the fetal heart rate gradually decreases, with the nadir occurring consistently after the peak of the uterine contractions. The heart rate recovers to the baseline only after the contractions have completely ended. Based on these findings, which intervention is most critical for the nurse to implement?

Suspend the continuous oxytocin infusion, assist the client into a lateral position, and administer an isotonic fluid bolus.

Document the fetal monitor findings as a benign physiological response to head compression and continue routine observation.

Place the client in a flat, supine position and elevate the lower extremities to increase maternal venous return.

Perform an immediate sterile vaginal examination to assess for the presence of a prolapsed umbilical cord.

Show answer & explanation

Answer: Suspend the continuous oxytocin infusion, assist the client into a lateral position, and administer an isotonic fluid bolus.

Answer

The most critical intervention is to suspend the continuous oxytocin infusion, assist the client into a lateral position, and administer an isotonic fluid bolus.

The scenario describes late decelerations, which are characterized by a gradual decrease in the fetal heart rate that reaches its lowest point after the peak of the uterine contraction. This pattern indicates uteroplacental insufficiency and potential fetal hypoxia. The immediate priority is intrauterine resuscitation to improve placental blood flow and fetal oxygenation. This involves a sequence of actions often remembered by the acronym POISE or similar protocols: stopping the oxytocin (to reduce uterine activity), positioning the client laterally (to relieve aortocaval compression), increasing intravenous fluids (to optimize maternal cardiac output), and administering oxygen.

Step-by-Step Solution

Analyze the fetal heart rate tracing described in the scenario.

The gradual decrease in fetal heart rate with the nadir occurring after the peak of the contraction identifies the pattern as late decelerations.

Accurate pattern recognition is necessary to determine the underlying physiological cause.

Determine the pathophysiological cause of late decelerations.

Late decelerations are caused by uteroplacental insufficiency, meaning the fetus is experiencing transient hypoxemia during contractions.

Understanding the cause dictates the appropriate clinical interventions to restore adequate oxygenation.

Select the appropriate nursing interventions for intrauterine resuscitation.

The nurse must improve placental blood flow and oxygenation by stopping the oxytocin (which causes the contractions), repositioning the client laterally (to relieve vena cava compression), and administering an IV fluid bolus (to increase maternal blood volume).

These combined actions directly address the uteroplacental insufficiency and prevent further fetal compromise.

Key Concept

Intrauterine resuscitation for late decelerations

Question 92Question →

A client diagnosed with active pulmonary tuberculosis and a concurrent Clostridioides difficile infection requires an urgent abdominal computed tomography (CT) scan. Which actions should the nurse implement when preparing for and facilitating this client's transport? Select all that apply.

Select all that apply

Place a standard medical-surgical mask on the client before exiting the isolation room.

Place a fit-tested N95 particulate respirator on the client to prevent airborne transmission in the corridors.

Perform hand hygiene using soap and water immediately after removing gloves.

Disinfect the transport stretcher using a standard quaternary ammonium germicidal wipe after the procedure.

Cover the client with a clean sheet or blanket over their hospital gown prior to entering the hallway.

Postpone the urgent CT scan until the client has received at least 24 hours of antitubercular and antibiotic therapy.

Show answer & explanation

Answer: Place a standard medical-surgical mask on the client before exiting the isolation room.; Perform hand hygiene using soap and water immediately after removing gloves.; Cover the client with a clean sheet or blanket over their hospital gown prior to entering the hallway.

Answer

The correct actions are placing a standard medical-surgical mask on the client, performing hand hygiene with soap and water, and covering the client with a clean sheet or blanket during transport.

Transporting a client with multiple infections requires layering protective strategies. A standard surgical mask on the client effectively contains tuberculosis respiratory secretions without compromising the client's breathing. Covering the client with a clean sheet contains C. diff organisms to the stretcher environment. Finally, because C. diff forms spores that are resistant to alcohol, staff must strictly use soap and water for hand hygiene.

Step-by-Step Solution

Identify the transmission-based precautions required for the client's concurrent infections.

The client requires Airborne Precautions for active pulmonary tuberculosis and Contact/Enteric Precautions for Clostridioides difficile.

Accurate identification of required isolation categories dictates the specific interventions needed during transport.

Apply Airborne Precaution guidelines for client transport.

The client must wear a standard medical-surgical mask to contain respiratory secretions.

Airborne pathogens are expelled through coughing or exhaling. A standard mask effectively traps these source droplets before they evaporate into airborne nuclei.

Apply Contact/Enteric Precaution guidelines for client transport and environmental cleaning.

The client must be covered with a clean sheet, hand hygiene must be performed with soap and water, and equipment must be cleaned with sporicidal wipes.

Contact precautions require preventing environmental contamination during transport. Enteric precautions specifically mandate soap and water and bleach-based disinfectants because spores are resistant to alcohol and standard germicides.

Evaluate the clinical priority of the diagnostic test against infection control risks.

The urgent CT scan must proceed with strict precautions in place.

An urgent medical need supersedes the general preference to limit movement of isolated clients, provided transmission risks are mitigated.

Key Concept

Managing Dual Transmission-Based Precautions During Client Transport

Question 93Question →

A medical-surgical nurse is developing a care plan for a client who is admitted with pneumonia caused by *Haemophilus influenzae* type b (Hib) and has a concurrent sacral wound infected with Vancomycin-resistant enterococci (VRE). Which interventions should the nurse include to maintain appropriate transmission-based precautions? Select all that apply.

Select all that apply

Instruct all personnel to don a surgical mask upon entering the client's room.

Keep a dedicated stethoscope and blood pressure cuff inside the client's room.

Assign the client to a negative-pressure airborne infection isolation room.

Require staff to perform hand hygiene exclusively with soap and water upon exiting the room.

Apply a standard surgical mask to the client when transport to the radiology department is necessary.

Delegate the assessment and disposal of the client's soiled wound dressings to unlicensed assistive personnel (UAP).

Show answer & explanation

Answer: Instruct all personnel to don a surgical mask upon entering the client's room.; Keep a dedicated stethoscope and blood pressure cuff inside the client's room.; Apply a standard surgical mask to the client when transport to the radiology department is necessary.

Answer

The correct interventions include instructing personnel to wear a surgical mask, leaving dedicated equipment in the room, and placing a surgical mask on the client during transport.

The client requires a combination of Droplet and Contact precautions. Droplet precautions mandate that healthcare personnel wear a surgical mask upon entry and that the client wears one during transport to contain respiratory secretions. Contact precautions require the use of dedicated patient-care equipment to prevent indirect transmission of the pathogen to other clients via shared tools.

Step-by-Step Solution

Analyze the client's diagnoses and determine the required isolation categories.

Hib pneumonia requires Droplet precautions. VRE wound infection requires Contact precautions.

Accurate identification of transmission routes dictates the necessary personal protective equipment (PPE) and environmental controls.

Select interventions that align with Droplet precautions.

Identified the need for staff to wear surgical masks upon entry and for the client to wear a surgical mask during transport.

Droplet precautions target large respiratory particles that travel short distances, requiring barrier protection for the mucous membranes of nearby individuals.

Select interventions that align with Contact precautions.

Identified the need to dedicate reusable, non-critical equipment (stethoscope, blood pressure cuff) to the client's room.

Contact precautions prevent transmission of multidrug-resistant organisms spread through direct patient contact or indirect contact with contaminated environmental surfaces.

Evaluate the remaining options for clinical and delegation inaccuracies.

Eliminated the negative-pressure room (only for Airborne), exclusive soap-and-water handwashing (only for spore-forming organisms), and delegating wound assessment to UAP (outside scope of practice).

Ensures adherence to evidence-based infection control standards and safe delegation guidelines.

Key Concept

Clients with multiple transmissible infections require a combination of precautions. Droplet precautions require surgical masks for staff and for the client during transport. Contact precautions necessitate dedicated equipment and proper hand hygiene, though alcohol-based rubs remain acceptable unless spore-forming organisms are present.

Question 94Question →

Following a total thyroidectomy, an adult client is admitted to the surgical step-down unit. To minimize the potential for severe postoperative complications, which actions and assessments must the nurse include in the plan of care? Select all that apply.

Select all that apply

Maintain the client in a semi-Fowler's position with the head and neck supported by pillows.

Verify that a tracheostomy tray, oxygen, and suction equipment are present at the bedside.

Encourage the client to actively extend and flex the neck to prevent postoperative muscle stiffness.

Monitor the client for reports of circumoral numbness, tingling, or muscle twitching.

Delegate the hourly evaluation of the client's voice quality and swallowing ability to the nursing assistant.

Delay inspecting the posterior neck for bleeding as long as the anterior surgical dressing remains dry.

Show answer & explanation

Answer: Maintain the client in a semi-Fowler's position with the head and neck supported by pillows.; Verify that a tracheostomy tray, oxygen, and suction equipment are present at the bedside.; Monitor the client for reports of circumoral numbness, tingling, or muscle twitching.

Answer

The correct interventions include maintaining a semi-Fowler's position with neck support, ensuring emergency airway equipment is at the bedside, and monitoring for signs of hypocalcemia such as circumoral numbness.

Following a thyroidectomy, clients are at extremely high risk for airway compromise, hemorrhage, and hypocalcemia. Maintaining a semi-Fowler's position reduces edema and minimizes tension on the anterior neck incision. Having a tracheostomy tray and suction equipment readily available is essential for immediate airway management if a rapid hematoma develops. Furthermore, monitoring for circumoral numbness or muscle twitching allows for early detection of hypocalcemia, a common complication resulting from inadvertent parathyroid gland injury.

Step-by-Step Solution

Identify the primary life-threatening complications associated with a total thyroidectomy.

The major risks are airway obstruction (from edema or hematoma), severe hemorrhage, and acute hypocalcemia (from parathyroid damage).

Understanding the specific risks guides the nurse in prioritizing appropriate reduction strategies.

Determine the optimal positioning to reduce surgical site complications.

The client should be placed in a semi-Fowler's position with the head and neck carefully supported by pillows or sandbags.

This position promotes venous return to reduce swelling and prevents hyper-extension of the neck, which could tear the suture line.

Select interventions that prepare for sudden airway emergencies.

A tracheostomy tray, suction equipment, and oxygen must be immediately accessible at the bedside.

If a hematoma rapidly expands and compresses the trachea, an emergency tracheostomy may be required to save the client's life.

Identify early clinical markers of parathyroid gland injury.

The nurse must assess for circumoral numbness, tingling in the extremities, and muscle twitching (Chvostek's or Trousseau's signs).

Inadvertent removal or trauma to the parathyroid glands during surgery causes a sudden drop in serum calcium, requiring immediate calcium gluconate administration.

Key Concept

Thyroidectomy Postoperative Care and Complication Mitigation

Question 95Question →

Following a positive sputum acid-fast bacillus (AFB) smear, an adult client is placed in an airborne infection isolation room. As the care team coordinates daily care, which specific precautions must be enforced? (Select all that apply.)

Select all that apply

Ensure the isolation room maintains negative pressure with at least 6 to 12 air changes per hour.

Place a standard surgical mask over the client's mouth and nose when transport outside the room is necessary.

Require all healthcare personnel to don a fit-tested N95 respirator or PAPR prior to entering the client's room.

Delegate the initial education regarding cough etiquette and respiratory hygiene to the unlicensed assistive personnel.

Discontinue airborne precautions once the client completes 24 hours of appropriate antitubercular pharmacotherapy.

Keep the client's room door propped open slightly to promote continuous air circulation with the hallway.

Show answer & explanation

Answer: Ensure the isolation room maintains negative pressure with at least 6 to 12 air changes per hour.; Place a standard surgical mask over the client's mouth and nose when transport outside the room is necessary.; Require all healthcare personnel to don a fit-tested N95 respirator or PAPR prior to entering the client's room.

Answer

The correct interventions are maintaining negative pressure with 6-12 air changes per hour, placing a surgical mask on the client during transport, and requiring all healthcare personnel to wear an N95 respirator or PAPR before entering.

Active pulmonary tuberculosis requires strict airborne precautions because the pathogen is transmitted via very small droplet nuclei that remain suspended in the air. Proper management involves placing the client in a negative-pressure Airborne Infection Isolation Room (AIIR) with 6 to 12 air changes per hour. Furthermore, all personnel must wear respiratory protection (N95 or PAPR) when entering the space, and the client must wear a standard surgical mask to contain their own respiratory secretions during any essential transport.

Step-by-Step Solution

Analyze the client's clinical data and diagnosis.

The client has a positive AFB smear, which confirms active pulmonary tuberculosis.

Identifying the specific pathogen and its mode of transmission dictates the appropriate tier of transmission-based precautions.

Determine the required isolation category based on the pathogen.

Tuberculosis requires Airborne Precautions because it is transmitted via aerosolized droplet nuclei.

Airborne pathogens can remain suspended in the air for long periods and travel over long distances.

Evaluate each option against Airborne Precaution standards and delegation rules.

Negative pressure rooms, N95 respirators for staff, and surgical masks for client transport are standard protocols. Propping the door open, early discontinuation of precautions, and delegating initial teaching are incorrect.

Strict adherence to infection control parameters prevents healthcare-associated transmission, while safe delegation ensures competent care delivery.

Key Concept

Airborne Precautions for Tuberculosis Management

Question 96Question →

Mid-morning on a high-acuity infectious disease ward, the charge nurse must dynamically adjust client assignments for a multi-disciplinary team. The current staffing includes a registered nurse (RN), a licensed practical nurse (LPN/VN), and unlicensed assistive personnel (UAP). Which task reallocation represents the safest application of delegation principles?

Transitioning the care of a client with a resolving methicillin-resistant Staphylococcus aureus (MRSA) wound infection to the LPN/VN to administer scheduled oral antibiotics and perform a sterile dressing change.

Reassigning the LPN/VN to assume primary care for a client who recently returned from a thoracentesis and is suddenly manifesting tachycardia, tachypnea, and a narrowing pulse pressure.

Directing the UAP to provide hygiene care for a client newly diagnosed with disseminated herpes zoster (shingles) without verifying the UAP's immunity status or issuing an N95 respirator.

Instructing the UAP to evaluate a client's balance and readiness to independently ambulate with a new assistive device prior to the client's scheduled discharge.

Show answer & explanation

Answer: Transitioning the care of a client with a resolving methicillin-resistant Staphylococcus aureus (MRSA) wound infection to the LPN/VN to administer scheduled oral antibiotics and perform a sterile dressing change.

Answer

The most appropriate delegation is assigning the LPN/VN to administer oral antibiotics and perform a sterile dressing change for the stable client with a resolving MRSA infection.

The correct answer involves assigning an LPN/VN to perform routine, standard procedures (oral medication administration and sterile dressing changes) for a client whose condition is explicitly stated as 'resolving.' Because the client is stable and the tasks do not require initial assessment or complex clinical judgment, this falls perfectly within the LPN/VN scope of practice.

Step-by-Step Solution

Analyze the core principles of delegation and the legal scope of practice.

Identify that RNs cannot delegate assessment, teaching, clinical judgment, or evaluation (EAT). LPN/VNs can perform complex but routine skills (like sterile dressings) on stable clients. UAPs handle standard, non-invasive tasks.

Establishing the baseline rules of delegation is necessary to evaluate each option.

Evaluate the stability and needs of the client returning from a thoracentesis.

The client has tachycardia, tachypnea, and a narrowing pulse pressure, indicating acute deterioration (potential shock or pneumothorax). This requires an RN.

Unstable clients with unpredictable outcomes must remain under the direct care of a registered nurse.

Assess the infection control requirements for disseminated herpes zoster.

Disseminated shingles requires airborne and contact precautions. The UAP was not provided proper PPE (N95) or vetted for immunity, making the assignment unsafe.

Delegation includes ensuring the environment and instructions are safe for the personnel performing the task.

Review the task delegated to the UAP regarding ambulation.

The task asks the UAP to 'evaluate' readiness, which violates the rule against delegating evaluation or clinical judgment.

Only an RN or physical therapist can perform the initial assessment and evaluation of a client's ability to use a new assistive device safely.

Verify the appropriateness of the MRSA client assignment.

The client is stable ('resolving'). Oral medications and sterile dressing changes are within the LPN/VN scope, making this the only safe delegation.

Matching a stable client with predictable needs to the LPN/VN's skill set represents proper resource allocation.

Key Concept

Scope of Practice and Safe Delegation Principles

Question 97Question →

A registered nurse has completed wound care for a client placed on contact and droplet precautions. The nurse is wearing a disposable gown, non-sterile gloves, a face shield, and a surgical mask. Arrange the steps for removing the personal protective equipment (PPE) in the correct chronological sequence according to standard infection control guidelines.

Drag items to arrange them in the correct order

Show answer & explanation

Answer

The correct sequence for removing (doffing) PPE is: remove gloves first, then the face shield, followed by the gown, the surgical mask, and finally perform hand hygiene.

According to standard Centers for Disease Control and Prevention (CDC) guidelines for PPE removal (doffing), the most contaminated items should be removed first to minimize the risk of self-contamination. Gloves are removed first, followed by eye protection (face shield or goggles). The gown is then removed, followed by the mask or respirator. Hand hygiene is absolutely required as the final step after all PPE has been removed.

Step-by-Step Solution

Remove the contaminated gloves.

Hands are freed from the most highly contaminated item.

Prevents cross-contamination to the face, eyes, or clean areas of the body during subsequent removal steps.

Remove the face shield by the headband or ear pieces.

Eye and face protection is safely discarded.

The outside of the shield is contaminated; handling only the back straps prevents pathogen transfer to the bare hands.

Remove the disposable gown by pulling it away from the neck and shoulders.

Body protection is safely discarded.

The front and sleeves are heavily contaminated. Rolling it outward traps pathogens on the inside of the bundle.

Remove the surgical mask by grasping the ties or elastics.

Respiratory protection is safely discarded.

The mask is removed last to maintain respiratory and mucous membrane protection until all other contaminated items have been safely disposed of.

Perform hand hygiene with an alcohol-based rub or soap and water.

Hands are completely sanitized.

Eradicates any transient pathogens that may have inadvertently transferred to the hands during the doffing process.

Key Concept

Standard doffing sequence to prevent self-contamination

Question 98Question →

An occupational health nurse is called to the human resources department to assist an employee who was just informed of their unexpected, immediate termination after 20 years with the company. The employee is sitting rigidly in a chair, hyperventilating, staring blankly, and repeating, "This cannot be happening. How will I feed my children?" Which of the following is the priority nursing action?

Escort the employee to a quiet, private room and remain present while offering a glass of water.

Assess the employee's past coping mechanisms for dealing with significant life changes.

Reassure the employee that their extensive work experience will help them find a new job quickly.

Provide immediate referrals for local unemployment assistance and financial counseling.

Show answer & explanation

Answer: Escort the employee to a quiet, private room and remain present while offering a glass of water.

Answer

The correct action is to escort the employee to a quiet, private room and remain present while offering a glass of water.

During the initial phase of a crisis, the client's anxiety level is often severe to panic. The absolute priority is to ensure safety and physiological stabilization while decreasing environmental stimuli. Remaining present with the client in a quiet environment and providing a simple grounding action, such as offering a drink of water, addresses immediate Maslow's basic needs and helps de-escalate the panic state.

Step-by-Step Solution

Analyze the client's current presentation.

The client is exhibiting signs of acute severe anxiety and panic (hyperventilation, rigidity, repetitive speech) due to a sudden situational crisis.

Identifying the current phase of the crisis determines the appropriate level of intervention required.

Apply crisis intervention prioritization principles.

Immediate physiological and psychological safety takes precedence over long-term planning, teaching, or psychosocial assessment.

A client in severe anxiety has a significantly narrowed perceptual field and cannot process new information or engage in problem-solving.

Select the intervention that directly addresses immediate stabilization.

Moving the client to a quiet area reduces environmental stimuli, and offering water addresses basic physiological needs while grounding the client.

This promotes immediate safety and de-escalation, laying the foundation for further therapeutic work.

Key Concept

Crisis Intervention Prioritization

Question 99Question →

During a severe weather emergency, a medical-surgical unit is operating with a modified staffing model consisting of one registered nurse (RN) and one unlicensed assistive personnel (UAP). To maintain safe and effective care, which of the following client care activities is most appropriate for the RN to delegate to the UAP?

Assisting a clinically stable client who had an ischemic stroke three days ago with routine oral hygiene and turning.

Evaluating the swallowing ability of a client with new-onset dysphagia before providing their first oral feeding.

Demonstrating proper crutch-walking techniques to a client who is scheduled for discharge later in the shift.

Obtaining the initial set of vital signs for a client arriving directly from the emergency department with suspected sepsis.

Show answer & explanation

Answer: Assisting a clinically stable client who had an ischemic stroke three days ago with routine oral hygiene and turning.

Answer

Assisting a clinically stable client who had an ischemic stroke three days ago with routine oral hygiene and turning.

The correct delegation decision involves assigning routine, predictable tasks that do not require nursing judgment to the unlicensed assistive personnel. Assisting a stable client with activities of daily living perfectly matches the UAP's scope of practice.

Step-by-Step Solution

Analyze each client care activity to identify requirements for clinical judgment, assessment, evaluation, or teaching.

Evaluating swallowing, demonstrating crutch-walking, and conducting an admission assessment all require RN-level cognitive skills and licensure.

The National Council of State Boards of Nursing (NCSBN) explicitly prohibits the delegation of nursing judgment, assessment, and teaching to unlicensed personnel.

Determine the clinical stability and acuity of the clients described in each scenario.

The newly admitted client with sepsis is highly unstable, whereas the client who had an ischemic stroke three days ago is described as clinically stable.

Delegation is only appropriate for clients whose conditions are stable and whose care yields predictable outcomes.

Apply the Five Rights of Delegation to select the appropriate activity for the UAP.

Providing routine oral hygiene and assisting with turning for the stable stroke client is the only legally and clinically safe task to delegate.

This task involves routine activities of daily living (ADLs) that are standard within the UAP's training and do not require nursing judgment.

Key Concept

Delegation of client care tasks and UAP scope of practice

Question 100Question →

A nurse is performing a reassessment on a young adult client admitted with an acute asthma exacerbation. The client initially presented with marked tachypnea, use of accessory muscles, and loud bilateral wheezing. Thirty minutes later, the nurse observes that the client's respirations have become shallow, wheezing is no longer audible, and the client appears drowsy. Arterial blood gas (ABG) results reveal a $\text{pH}$ of $7.28$ , a $\text{PaCO}_2$ of $58\text{ mm Hg}$ , and an $\text{HCO}_3^-$ of $24\text{ mEq/L}$ . Which of the following is the priority nursing action?

Administer the prescribed PRN nebulized albuterol treatment immediately

Continue to monitor as the absence of wheezing indicates a positive response to initial therapy

Notify the rapid response team and gather supplies for endotracheal intubation

Prepare to administer a continuous intravenous infusion of sodium bicarbonate

Show answer & explanation

Answer: Notify the rapid response team and gather supplies for endotracheal intubation

Answer

Notify the rapid response team and gather supplies for endotracheal intubation.

The combination of a 'silent chest' (absent wheezing with shallow respirations), drowsiness, and respiratory acidosis (

\text{pH}

7.28,

\text{PaCO}_2

58) in an asthma patient signifies profound muscle fatigue and impending respiratory failure. Immediate intubation and mechanical ventilation are required to save the client's life.

Step-by-Step Solution

Analyze the physical assessment changes.

The client transitioned from tachypnea and loud wheezing to shallow respirations, no audible wheezing ('silent chest'), and drowsiness.

Sudden loss of wheezing with decreased level of consciousness indicates extreme muscle fatigue and complete airway obstruction, a medical emergency.

Interpret the arterial blood gas (ABG) results.

The pH is 7.28 (acidosis) and PaCO2 is 58 mm Hg (elevated), indicating uncompensated respiratory acidosis.

Early asthma exacerbations typically present with respiratory alkalosis due to hyperventilation. A shift to respiratory acidosis signifies that the client can no longer maintain adequate ventilation.

Determine the priority clinical intervention.

The nurse must immediately call for help and prepare for advanced airway management (intubation and mechanical ventilation).

The client is in impending respiratory failure. Airway and breathing take the highest priority, and pharmacological interventions will not be effective without adequate airflow.

Key Concept

Recognizing impending respiratory failure in asthma (silent chest and respiratory acidosis).

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