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Physiological Integrity

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Question 901Question →

The healthcare provider has prescribed an intermittent intravenous (IV) infusion of potassium chloride for a client experiencing severe hypokalemia. Which of the following safety measures must the registered nurse implement? Select all that apply.

Select all that apply

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Answer: Verify that the client has a urine output of at least 30 mL/hr before initiating the infusion.; Administer the solution using an electronic volumetric infusion pump.; Assess the intravenous insertion site for patency and signs of infiltration prior to beginning the infusion.

Answer

The correct safety measures are verifying that the client has adequate urine output, administering the solution using an electronic infusion pump, and assessing the IV site for patency before the infusion begins.
Intravenous potassium chloride requires strict adherence to safety protocols. The nurse must verify adequate renal function (urine output of at least 30 mL/hr) because potassium is excreted by the kidneys; poor renal function can lead to life-threatening hyperkalemia. It must always be administered using an electronic volumetric infusion pump to guarantee a precise rate and prevent rapid infusion. Furthermore, because potassium can cause severe tissue damage if it leaks into surrounding tissues, assessing the IV site for patency and infiltration before administration is mandatory.

Step-by-Step Solution

1
Identify the primary risks associated with the prescribed medication.
Intravenous potassium chloride is a high-alert medication that can cause fatal cardiac arrhythmias if administered too quickly, and tissue necrosis if it extravasates.
Understanding the specific dangers of the medication guides the necessary safety interventions.
2
Evaluate each option against established parenteral therapy safety standards.
Using a pump, checking for IV patency, and ensuring renal clearance are all required safety standards.
These actions directly mitigate the known risks of hyperkalemia, rapid infusion, and tissue damage.

Key Concept

Safe Administration of Intravenous Potassium Chloride
Question 902Question →

A nurse is preparing to administer a prescribed intravenous (IV) push medication through a client's existing continuous IV fluid infusion. Which action should the nurse take first to ensure client safety?

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Answer: Verify the compatibility of the medication with the primary IV fluid.

Answer

Verify the compatibility of the medication with the primary IV fluid.
Before administering any IV medication into an existing line, the nurse must verify that the medication is compatible with the running continuous IV fluid. If the substances are incompatible, they can form precipitates or crystalize in the tubing, which can act as emboli and cause severe harm to the client. If they are incompatible, the nurse must stop the fluid and flush the line thoroughly with normal saline before and after drug administration.

Step-by-Step Solution

1
Identify the clinical scenario
The nurse needs to administer an IV push medication into an existing continuous IV line.
Understanding the route and concurrent therapies determines the safety steps required.
2
Determine the highest risk associated with this specific procedure
Mixing two different intravenous substances carries a high risk of chemical or physical incompatibility.
Incompatibility can lead to crystal formation in the tubing, emboli in the client, or neutralization of the drug's therapeutic effect.
3
Select the priority intervention based on the identified risk
The nurse must verify compatibility in a drug reference guide or with the pharmacy before proceeding.
Preventing the administration of incompatible fluids is the most critical step to ensure physiological integrity.

Key Concept

Intravenous Medication Compatibility and Safety
Estimated Time:45s
Question 903Question →

A nurse is reviewing the medication administration record for a client admitted with a severe lower respiratory tract infection. The client is scheduled to receive a newly prescribed dose of intravenous (IV) ceftriaxone. During the pre-administration assessment, the nurse notes that the client has a documented allergy to amoxicillin, with the reaction listed as anaphylactic shock. Which of the following actions is the priority for the nurse?

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Answer: Withhold the scheduled ceftriaxone dose and immediately notify the prescribing healthcare provider.

Answer

The nurse must withhold the scheduled ceftriaxone dose and immediately notify the prescribing healthcare provider.
Ceftriaxone is a third-generation cephalosporin. Because cephalosporins and penicillins (like amoxicillin) share a structural component known as a beta-lactam ring, there is a recognized risk of cross-reactivity. For a client who has experienced an anaphylactic reaction to penicillin, cephalosporins are generally contraindicated. The safest and most appropriate action is to withhold the dose and contact the healthcare provider for an alternative prescription.

Step-by-Step Solution

1
Assess the client's allergy history and the newly prescribed medication.
The client has a severe allergy (anaphylaxis) to amoxicillin, which is a penicillin. The prescribed medication is ceftriaxone, which is a cephalosporin.
Identifying potential allergens is a critical first step in safe medication administration.
2
Recognize the pharmacological relationship between the two drug classes.
Penicillins and cephalosporins both contain a beta-lactam ring, leading to a risk of allergic cross-sensitivity.
Understanding drug classifications helps the nurse predict potential adverse reactions.
3
Determine the safest priority nursing intervention based on the assessment.
The medication must be withheld and the provider notified to request a safe alternative antibiotic.
Administering a cephalosporin to a client with a history of penicillin-induced anaphylaxis is contraindicated due to the high risk of a fatal reaction.

Key Concept

Cross-sensitivity between penicillins and cephalosporins
Question 904Question →

A nurse is caring for a client who is actively experiencing status epilepticus. The healthcare provider prescribes phenytoin IV push. The client has an existing continuous peripheral IV infusion of 5% dextrose in water (D5W) infusing at 100 mL/hr. Which action should the nurse take?

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Answer: Stop the D5W infusion, flush the line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.

Answer

Stop the D5W infusion, flush the line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.
Phenytoin is physically incompatible with solutions containing dextrose (such as D5W) and will precipitate if they come into contact. To safely administer the medication through the same IV line, the nurse must temporarily stop the continuous D5W infusion and flush the line with a compatible solution, specifically 0.9% sodium chloride (normal saline), both before and after the phenytoin is given.

Step-by-Step Solution

1
Identify the primary IV fluid.
The client is receiving 5% dextrose in water (D5W).
Knowing the primary fluid is necessary to verify medication compatibility.
2
Verify the compatibility of the prescribed IV medication with the primary fluid.
Phenytoin is physically incompatible with dextrose solutions and will form a solid precipitate if mixed.
Administering incompatible medications can cause crystallization, leading to loss of IV access or a life-threatening embolism.
3
Determine the correct administration technique for the incompatible medication.
The continuous infusion must be paused, and the line must be flushed with a compatible solution (0.9% sodium chloride) before and after the phenytoin is administered.
Flushing clears the line of the incompatible fluid, ensuring safe delivery of the medication.

Key Concept

Phenytoin is physically incompatible with dextrose solutions and must be administered using 0.9% sodium chloride to prevent precipitation.
Question 905Question →

A nurse is caring for a client in septic shock who is receiving a continuous intravenous (IV) infusion of norepinephrine through a dedicated single-lumen peripherally inserted central catheter (PICC). The client's current blood pressure is 86/48 mmHg. The healthcare provider prescribes pantoprazole 40 mg IV push daily. Which action should the nurse take first?

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Answer: Establish a new peripheral intravenous access for the pantoprazole administration.

Answer

Establish a new peripheral intravenous access for the pantoprazole administration.
Norepinephrine is a critical, life-sustaining vasoactive medication with a very short half-life. Pausing the infusion even briefly can result in a precipitous and potentially fatal drop in blood pressure. Furthermore, administering an IV push medication through a line actively infusing a vasopressor can 'flush' a rapid bolus of the vasopressor into the client, causing a severe hypertensive crisis. Therefore, the only safe priority action is to establish a completely separate IV access for the pantoprazole.

Step-by-Step Solution

1
Analyze the client's current hemodynamic status and current continuous infusions.
The client is in septic shock with a dangerously low blood pressure (86/48 mmHg) dependent on a continuous norepinephrine infusion.
Norepinephrine has a very short half-life and must be infused continuously without interruption to maintain perfusion.
2
Evaluate the prescribed medication and route.
Pantoprazole 40 mg is prescribed via IV push, which typically requires administration over at least 2 minutes.
Safe medication administration requires knowing the correct rate and ensuring the route will not compromise other treatments.
3
Assess the compatibility and safety of using the existing IV line.
The existing line is a single-lumen PICC dedicated to a vasopressor. Pushing a medication into this line or pausing the pump is contraindicated.
Pushing medication into a vasopressor line can flush a large bolus of the vasopressor into the client (causing hypertensive crisis), and pausing the pump will cause a precipitous drop in blood pressure.
4
Determine the safest alternative intervention.
The nurse must start a separate peripheral IV line to administer the pantoprazole safely.
Establishing a second IV access allows the routine medication to be given without interrupting or altering the delivery of the life-sustaining vasopressor.

Key Concept

Safe administration of IV push medications with concurrent vasoactive infusions
Question 906Question →

A nurse is preparing to administer 2 mg of intravenous morphine sulfate to a client experiencing acute postoperative pain. The medication is supplied in a glass ampule containing 4 mg/mL. Arrange the following steps for preparing this medication from the ampule in the correct chronological order.

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Answer

The correct chronological sequence is: Tap the top of the ampule, place a gauze pad around the neck, snap the neck away from the body, attach a filter needle, and withdraw the medication.
Safe medication preparation from a glass ampule requires a precise, sequential approach to prevent injury and contamination. The nurse must first ensure all fluid is in the base of the ampule by tapping it. Next, the nurse protects their hands with a gauze pad and snaps the neck away from their body to prevent injury from glass shards. A filter needle must then be attached to the syringe to prevent glass particles from being drawn up. Finally, the medication is withdrawn; unlike a sealed vial, air should not be injected into an open ampule as it is an open system and air pressure will displace the fluid.

Step-by-Step Solution

1
Tap the top of the ampule.
Trapped fluid moves from the neck to the base of the ampule.
This ensures the entire volume of medication is accessible for accurate dosing.
2
Place a gauze pad around the ampule neck.
A protective barrier is established.
This step prevents sharps injury from the glass edges during the snapping process.
3
Snap the ampule neck away from the body.
The ampule is safely opened.
Directing the break away from the body ensures glass shards do not fly toward the nurse's face or the sterile field.
4
Attach a filter needle to the syringe.
The syringe is equipped to filter out particulate matter.
Filter needles catch microscopic glass fragments that may have fallen into the medication when the neck was broken.
5
Withdraw the medication.
The correct dose is safely drawn into the syringe.
Injecting air is avoided because the open ampule is not under vacuum; adding air would displace and spill the fluid.

Key Concept

Safe preparation of parenteral medications from a glass ampule
Question 907Question →

A nurse is teaching a client who has a casted right tibia fracture and is strictly non-weight-bearing on the right leg how to ascend stairs using axillary crutches. Arrange the following instructions in the exact chronological order the nurse should teach the client to perform them.

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Answer

The correct sequence is: 1) Assume a tripod position; 2) Transfer weight to the crutches; 3) Advance the unaffected left foot up; 4) Shift weight onto the unaffected left leg; 5) Bring the crutches and the affected right leg up.
When ascending stairs with axillary crutches and a non-weight-bearing leg, the sequence must prioritize stability and upward power. The client establishes a tripod base, transfers weight entirely to the crutches, steps up with the unaffected ('good') leg, shifts their weight onto that unaffected leg, and finally brings up the crutches alongside the affected ('bad') leg. The standard clinical mnemonic 'up with the good, down with the bad' dictates this process.

Step-by-Step Solution

1
Assume a tripod position facing the bottom of the stairs.
The client establishes a secure center of gravity.
A stable starting stance is critical before attempting any weight transfer or elevation change on uneven surfaces.
2
Transfer all body weight firmly onto the handgrips of both crutches.
The unaffected left leg is freed from bearing weight.
The client must rely entirely on their upper body strength and the crutches temporarily so they can lift their strong leg against gravity.
3
Advance the unaffected left foot upward and place it flat on the next step.
The strong leg is positioned on the higher elevation.
The rule for stairs is 'up with the good.' The unaffected leg is moved first because it has the quadriceps strength to lift the client's entire body weight up to the next level.
4
Shift the body weight upward from the crutches onto the unaffected left leg.
The body weight is fully supported by the strong leg on the new step.
Weight must be transferred to the strong leg to allow the client to safely lift the crutches and the injured leg without losing balance or falling backward.
5
Bring both crutches and the affected right leg up to the same step.
The client is fully stabilized on the new step in the tripod position.
The crutches and the affected leg follow the strong leg, realigning the client's center of gravity and completing the movement cycle.

Key Concept

Assistive Devices: Crutch Walking (Stairs)
Estimated Time:1m 30s
Question 908Question →

A client with diabetes mellitus is prescribed a morning dose of 10 units of regular insulin and 20 units of NPH insulin. The nurse will mix both insulins in a single syringe. In what order should the nurse perform the following actions? Arrange the steps in the correct chronological sequence from first to last.

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Answer

The correct sequence is: Roll the NPH vial, inject air into the NPH vial, inject air into the regular insulin vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
The correct sequence for mixing insulins is designed to prevent the contamination of the short-acting (clear) insulin with the intermediate-acting (cloudy) insulin. The correct sequence for injecting air is the reverse of drawing up: air into NPH (cloudy), air into Regular (clear). Then, draw up Regular (clear), followed by drawing up NPH (cloudy).

Step-by-Step Solution

1
Mix the NPH insulin suspension.
The NPH insulin becomes uniformly cloudy.
NPH insulin contains particles that settle at the bottom of the vial. Rolling it between the hands resuspends the particles evenly without creating air bubbles.
2
Inject air into the NPH vial.
The NPH vial is pressurized for later withdrawal.
Injecting air prevents a vacuum from forming, which makes withdrawing the medication easier. Doing this first (without touching the liquid) keeps the needle free of NPH insulin.
3
Inject air into the regular insulin vial.
The regular insulin vial is pressurized.
Injecting air prevents a vacuum in the regular insulin vial.
4
Withdraw the regular insulin.
10 units of clear insulin enter the syringe.
Regular insulin is drawn up first ('clear before cloudy') to ensure that the rapid- or short-acting insulin vial is never contaminated with intermediate-acting insulin.
5
Withdraw the NPH insulin.
20 units of cloudy insulin are added, bringing the total volume to 30 units.
NPH insulin is drawn up last to complete the mixture.

Key Concept

When mixing insulins in a single syringe, always draw up the clear (short-acting or rapid-acting) insulin before the cloudy (intermediate-acting) insulin to prevent cross-contamination.
Question 909Question →

A client is admitted to the intensive care unit recovering from a severe gastrointestinal hemorrhage. The client has a double-lumen peripherally inserted central catheter (PICC). Lumen one is dedicated to a continuous infusion of total parenteral nutrition (TPN). Lumen two is infusing a continuous IV drip of pantoprazole. The client suddenly reports severe dizziness. The cardiac monitor displays sinus bradycardia at 32 beats/min, and the client's blood pressure drops to 76/40 mmHg. The healthcare provider orders atropine 1 mg IV push STAT. The client does not have a patent peripheral IV line. Which of the following is the most appropriate nursing action to administer the medication?

Show answer & explanation

Answer: Pause the pantoprazole infusion, flush the lumen with 10 mL of 0.9% sodium chloride, administer the atropine, flush again with 10 mL of 0.9% sodium chloride, and resume the pantoprazole.

Answer

Pause the pantoprazole infusion, flush the lumen with 10 mL of 0.9% sodium chloride, administer the atropine, flush again with 10 mL of 0.9% sodium chloride, and resume the pantoprazole.
The client is experiencing symptomatic bradycardia, a medical emergency requiring immediate administration of atropine. Since the client only has a double-lumen PICC, the nurse must use one of the existing lumens. The TPN lumen must remain dedicated and cannot be used. The pantoprazole lumen is currently infusing a medication that is highly incompatible with other drugs. To safely administer the atropine without causing precipitation, the nurse must pause the pantoprazole, flush the line thoroughly with normal saline to clear the drug, administer the atropine, flush again, and then resume the continuous infusion. This ensures immediate drug delivery while maintaining IV compatibility.

Step-by-Step Solution

1
Assess the client's clinical presentation and the urgency of the ordered medication.
The client has symptomatic bradycardia (hypotension, dizziness), which is a medical emergency requiring immediate administration of atropine.
Symptomatic bradycardia can lead to decreased cardiac output and cardiac arrest if not treated promptly.
2
Evaluate the available intravenous access routes.
The client has a double-lumen PICC with TPN infusing in one lumen and pantoprazole infusing in the other. There is no peripheral IV access.
Medications must be administered through a safe, patent line. Establishing new access would cause a dangerous delay in this emergency.
3
Determine the compatibility and dedicated line rules for the existing infusions.
TPN requires a strictly dedicated line and cannot be used for IV push medications. Pantoprazole is chemically incompatible with most medications and must not be mixed at the Y-site.
Using the TPN line risks severe infection and emulsion instability. Mixing atropine with pantoprazole risks chemical precipitation.
4
Select the safest method for medication administration using the available access.
The pantoprazole line must be temporarily paused, flushed with normal saline to clear the line of the incompatible drug, used to push the atropine, flushed again to clear the atropine, and then the pantoprazole infusion is resumed.
This 'flush-administer-flush' method prevents drug precipitation in the tubing while allowing immediate administration of the life-saving medication.

Key Concept

When administering an IV push medication through a line infusing an incompatible continuous medication (excluding dedicated lines like TPN), the nurse must pause the infusion, flush with normal saline, administer the drug, flush again, and resume the infusion.
Question 910Question →

An adult client on the medical-surgical unit is 15 minutes into a packed red blood cell (PRBC) transfusion. The client suddenly reports severe lower back pain, shortness of breath, and chills. The client's temperature has spiked to 38.9°C (102.0°F). Arrange the following nursing interventions in the correct chronological sequence to manage this acute event.

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Answer

The correct sequence is: 1) Halt the transfusion, 2) Replace tubing with a new saline-primed set, 3) Assess vital signs and respiratory status, 4) Report to the provider and blood bank, and 5) Collect lab specimens and return the blood bag.
In the event of an acute hemolytic transfusion reaction (indicated by chills, back pain, and fever), the nurse must first stop the transfusion to halt the antigen exposure. Next, maintaining IV access is critical for resuscitation; however, the nurse must disconnect the blood tubing and use new tubing primed with saline to avoid pushing residual blood into the client. Once the source is removed and access is secured, the nurse performs a focused assessment to determine hemodynamic stability. This assessment data is then urgently reported to the healthcare provider and the blood bank. Finally, as part of the formal reaction protocol, the nurse collects necessary blood and urine samples and returns the remaining blood product to the lab for investigation.

Step-by-Step Solution

1
Stop the transfusion immediately.
Prevents further administration of the incompatible blood product.
Immediate cessation is the highest priority to minimize exposure to the antigen causing the severe hemolytic reaction.
2
Change IV tubing and infuse normal saline.
Maintains IV access without flushing residual blood into the client.
A new tubing set primed with 0.9% sodium chloride ensures the vein remains open for emergency drugs or fluids while preventing any remaining PRBCs in the old tubing from entering circulation.
3
Assess the client.
Provides baseline data on the client's current physiological status.
Vital signs and respiratory assessment determine the severity of the hemolytic response and guide subsequent medical orders.
4
Notify the provider and blood bank.
Initiates medical intervention and the institutional investigation process.
The provider must prescribe emergency treatments, and the blood bank must begin tracking the cause of the reaction.
5
Collect samples and return the blood bag.
Facilitates laboratory analysis to identify the exact cause of the reaction.
Urine is checked for hemoglobinuria indicating hemolysis, and the blood bag and tubing are analyzed for cross-matching errors or contamination.

Key Concept

Management of acute hemolytic transfusion reactions requires immediate cessation of the blood product, maintenance of IV access with new tubing, client assessment, provider notification, and execution of institutional reaction protocols.
Question 911Question →

A nurse is caring for a postoperative client who is currently receiving a continuous transfusion of packed red blood cells through a 20-gauge peripheral intravenous (IV) catheter. The client reports sudden, severe incisional pain rated 9 on a 0-to-10 pain scale. The healthcare provider has prescribed as-needed intravenous push hydromorphone for severe pain. Which action should the nurse take next?

Show answer & explanation

Answer: Establish a second peripheral IV access to administer the hydromorphone

Answer

Establish a second peripheral IV access to administer the hydromorphone.
Standard intravenous therapy protocols dictate that blood tubing must be dedicated exclusively to blood products and 0.9% sodium chloride. No medications should ever be added to the blood bag, administered through the Y-port, or pushed into the line, even if paused and flushed. Because the client is experiencing severe pain that requires immediate pharmacological intervention, establishing a separate, second peripheral IV site is the safest and most appropriate way to administer the prescribed hydromorphone promptly.

Step-by-Step Solution

1
Assess the client's current intravenous access and prescribed therapies.
The client has a single IV line dedicated to an active blood transfusion but requires immediate intravenous pain medication.
To determine if the medication can be safely administered through the existing line.
2
Identify compatibility constraints for blood product administration.
Standard safety protocols state that no medications or solutions other than 0.9% sodium chloride can be administered through blood administration tubing.
Mixing medications with blood products can cause hemolysis, precipitation, or alter the therapeutic effect of the drug.
3
Determine the priority intervention for a client experiencing severe acute pain.
A second IV line must be inserted immediately to provide timely pain relief without interrupting the necessary blood transfusion.
Delaying pain management for a severe pain rating (9/10) is a failure to prioritize an acute physiological need.

Key Concept

Blood product compatibility and prioritization of safe medication administration
Question 912Question →

A nurse is caring for a client with a pulmonary embolism who requires a continuous IV infusion of heparin. The client's weight is 176 lbs176\text{ lbs}. The healthcare provider prescribes heparin at a rate of 18 units/kg/hr18\text{ units/kg/hr}. The available medication is heparin sodium 25,000 units25,000\text{ units} in 250 mL250\text{ mL} of 0.9%0.9\% sodium chloride. What rate should the nurse program into the infusion pump in mL/hr\text{mL/hr}? Record your answer using one decimal place.

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Answer: 14.4

Answer

14.4
The correct infusion rate of 14.4 mL/hr14.4\text{ mL/hr} is achieved by first converting the client's weight to 80 kg80\text{ kg}. Next, the weight is multiplied by the prescribed 18 units/kg/hr18\text{ units/kg/hr} to find an hourly dose of 1,440 units/hr1,440\text{ units/hr}. Finally, since the IV bag concentration is 100 units/mL100\text{ units/mL} (derived from 25,000 units/250 mL25,000\text{ units} / 250\text{ mL}), dividing the hourly dose by the concentration yields the correct pump setting.

Step-by-Step Solution

1
Convert the client's weight from pounds to kilograms.
176 lbs÷2.2 lbs/kg=80 kg176\text{ lbs} \div 2.2\text{ lbs/kg} = 80\text{ kg}
The medication is prescribed in units per kilogram, requiring a weight conversion to metric units.
2
Calculate the hourly dose of heparin in units.
80 kg×18 units/kg/hr=1,440 units/hr80\text{ kg} \times 18\text{ units/kg/hr} = 1,440\text{ units/hr}
This determines the exact amount of active medication the client needs every hour based on their body weight.
3
Calculate the infusion pump rate in mL/hr.
1,440 units/hr÷100 units/mL=14.4 mL/hr1,440\text{ units/hr} \div 100\text{ units/mL} = 14.4\text{ mL/hr}
The concentration is 25,000 units÷250 mL=100 units/mL25,000\text{ units} \div 250\text{ mL} = 100\text{ units/mL}. Dividing the hourly dose by the concentration provides the volume to be infused per hour.

Key Concept

Weight-based continuous intravenous infusion calculation
Question 913Question →

A nurse is caring for a client who is prescribed a continuous intravenous (IV) infusion of 1,0001,000 mL of 0.9%0.9\% sodium chloride to infuse over 88 hours. The nurse should set the IV infusion pump to deliver how many mL/hr? (Record answer as a whole number. Do not use a trailing zero.)

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Answer: 125

Answer

125
To determine the correct setting for an IV infusion pump, the nurse must calculate the hourly rate. This is achieved by dividing the total volume of fluid to be infused (1,0001,000 mL) by the total duration of the infusion in hours (88 hours). Therefore, 1000÷8=1251000 \div 8 = 125 mL/hr.

Step-by-Step Solution

1
Identify the given parameters for the infusion.
Total Volume = 1,0001,000 mL; Total Time = 88 hours.
These variables are required to calculate the standard IV pump rate.
2
Apply the IV pump rate formula.
1000 mL8 hours=125 mL/hr\frac{1000 \text{ mL}}{8 \text{ hours}} = 125 \text{ mL/hr}.
IV infusion pumps deliver fluids at an hourly rate, calculated by dividing total volume by total hours.

Key Concept

Basic intravenous infusion rate calculation for continuous fluids.
Question 914Question →

An intensive care nurse is preparing to initiate a continuous intravenous infusion of milrinone for a client experiencing cardiogenic shock.

The client's admission weight is 8080 kg. The prescribed dose is 0.50.5 mcg/kg/min. The pharmacy has provided a premixed bag containing 2020 mg of milrinone in 100100 mL of 5%5\% dextrose in water (D5WD_5W).

Calculate the required infusion pump setting in mL/hr. (Record your answer as a whole number).

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Answer: 12

Answer

12
The correct infusion rate is 12 mL/hr, determined by first calculating the total required hourly dose based on weight (2.4 mg/hr) and dividing it by the concentration of the prepared medication (0.2 mg/mL).

Step-by-Step Solution

1
Calculate the per-minute dose required.
4040 mcg/min
Multiplying the prescribed dose (0.50.5 mcg/kg/min) by the client's weight (8080 kg) gives the total amount needed per minute.
2
Convert the per-minute dose to an hourly dose.
24002400 mcg/hr
Infusion pumps deliver fluid in mL per hour, so the required rate must reflect an hourly time frame (40×6040 \times 60).
3
Convert the dose from micrograms to milligrams.
2.42.4 mg/hr
The available medication is measured in milligrams, requiring unit alignment before calculating the required volume.
4
Determine the concentration of the available solution.
0.20.2 mg/mL
Dividing the total drug amount (2020 mg) by the total volume (100100 mL) establishes how much medication is in each milliliter.
5
Calculate the final infusion rate.
1212 mL/hr
Dividing the required hourly dose (2.42.4 mg/hr) by the concentration (0.20.2 mg/mL) yields the final volume per hour to program into the pump.

Key Concept

Weight-based intravenous infusion pump rate calculation for critical care medications.
Question 915Question →

An oncology client arrives at the outpatient infusion clinic to receive an intravenous antibiotic. The client has an implanted central venous access device (port) that is currently de-accessed. Place the nursing actions for accessing and preparing the port in the correct chronological sequence.

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Answer

The correct sequence prioritizes infection control and patient safety: mask/hand hygiene, don sterile gloves and cleanse, allow to air-dry, insert a non-coring needle, aspirate for blood return, and finally flush with saline.
Accessing an implanted port requires strict aseptic technique and safety verification. Masking the client and nurse prevents respiratory droplet contamination. Hand hygiene and sterile gloves are mandatory for central line procedures. Chlorhexidine with friction effectively reduces skin flora, but it must air-dry completely to be bactericidal. A non-coring (Huber) needle is required to prevent damaging the port's silicone septum. Crucially, before injecting any fluids, the nurse must aspirate for a blood return to verify the needle is within the port reservoir and the catheter tip is in the central vasculature. Flushing with saline only occurs after placement is confirmed, ensuring patency and clearing any locking solutions.

Step-by-Step Solution

1
Place a surgical mask on both the client and the nurse, and perform hand hygiene.
Airborne and droplet infection control is established.
Prevents respiratory droplets from contaminating the sterile insertion site.
2
Don sterile gloves and cleanse the skin over the port with chlorhexidine using back-and-forth friction.
The skin is chemically prepared.
Friction helps the chlorhexidine penetrate the epidermal layers to effectively reduce microbial flora.
3
Allow the cleansed area to air-dry completely without fanning or blotting.
The site becomes maximally aseptic.
Chlorhexidine requires adequate drying time to achieve its full bactericidal effect; fanning introduces new pathogens.
4
Stabilize the port using the non-dominant hand and insert a non-coring needle perpendicular to the septum.
The port is successfully accessed.
A non-coring (Huber) needle prevents slicing or damaging the port's self-sealing silicone septum.
5
Aspirate the attached syringe to check for a blood return to confirm correct needle placement.
Placement in the central vasculature is verified.
Aspiration ensures the catheter tip is correctly positioned before any medications or fluids are injected.
6
Flush the port with 10 mL of 0.9% sodium chloride to assess patency and clear the line.
The port is ready for the prescribed antibiotic infusion.
Flushing confirms patency and safely clears any residual concentrated heparin lock solution from the catheter.

Key Concept

Implanted Venous Port (Port-a-Cath) Access Sequence and Central Line Infection Prevention
Question 916Question →

A client with advanced cancer has a single-lumen peripherally inserted central catheter (PICC). A primary infusion of 0.9% sodium chloride is running at 50 mL/hr, and a continuous infusion of hydromorphone for severe, intractable pain is connected via a Y-site to the primary line. The nurse needs to administer a scheduled dose of intravenous vancomycin over 90 minutes. A drug reference indicates that vancomycin is physically incompatible with hydromorphone. Which of the following is the most appropriate nursing action?

Show answer & explanation

Answer: Establish a separate peripheral intravenous catheter to administer the vancomycin infusion.

Answer

Establish a separate peripheral intravenous catheter to administer the vancomycin infusion.
When a client requires a continuous infusion of a critical, life-sustaining, or symptom-controlling medication (such as opioid analgesics for severe pain, or vasopressors) and a scheduled intermittent medication that is physically incompatible, the nurse must establish a separate intravenous access site. Pausing the hydromorphone for 90 minutes would result in a severe exacerbation of cancer pain. The two medications cannot be run in the same single-lumen line because they will precipitate when they meet in the common tubing.

Step-by-Step Solution

1
Identify the physical incompatibility between the ordered medications.
Vancomycin and hydromorphone are physically incompatible and cannot be mixed in the same intravenous line or lumen.
Mixing them will cause chemical precipitation, which can lead to catheter occlusion or a life-threatening embolism.
2
Evaluate the clinical significance of the continuous hydromorphone infusion.
The hydromorphone infusion is critical for managing the client's severe, intractable cancer pain.
Pausing the infusion for the 90-minute duration of the vancomycin dose would result in unacceptable breakthrough pain and potential withdrawal symptoms.
3
Determine the safest method of administration for both medications.
A new, separate peripheral IV line must be started.
This is the only way to allow both the critical continuous analgesia and the scheduled antibiotic to infuse simultaneously and safely without mixing.

Key Concept

Management of incompatible intravenous medications with critical continuous infusions
Question 917Question →

A pediatric client is prescribed ibuprofen 200200 mg by mouth for a fever. The pharmacy dispenses an ibuprofen oral suspension labeled 100100 mg/55 mL. How many milliliters will the nurse administer to the client for this single dose?

Show answer & explanation

Answer: 1010 mL

Answer

1010 mL
To determine the correct volume to administer, the standard dosage calculation formula DesiredHave×Volume\frac{\text{Desired}}{\text{Have}} \times \text{Volume} is used. The desired dose is 200200 mg, the available dose is 100100 mg, and the available volume is 55 mL. Therefore, 200100×5=2×5=10\frac{200}{100} \times 5 = 2 \times 5 = 10 mL. Administering 1010 mL safely provides the prescribed 200200 mg of ibuprofen.

Step-by-Step Solution

1
Identify the prescribed dose (Desired) and the available concentration (Have).
Desired = 200200 mg; Have = 100100 mg in 55 mL.
Accurate identification of prescription parameters is required for safe dosage calculation.
2
Apply the standard dosage calculation formula: DesiredHave×Volume\frac{\text{Desired}}{\text{Have}} \times \text{Volume}.
200 mg100 mg×5 mL\frac{200\text{ mg}}{100\text{ mg}} \times 5\text{ mL}.
This formula ensures the correct volume is administered to deliver the exact prescribed milligram dose.
3
Perform the mathematical calculation to find the final volume.
2×5 mL=10 mL2 \times 5\text{ mL} = 10\text{ mL}.
Completing the arithmetic provides the correct volume to be administered to the client.

Key Concept

Dosage Calculation for Oral Suspensions
Question 918Question →

A nurse is preparing to administer a scheduled dose of intravenous phenytoin to a client with a seizure disorder. The client has a single peripheral intravenous line with a continuous infusion of 5% dextrose in water (D5W) infusing at 75 mL/hr. Based on the safe administration guidelines for this medication, which action should the nurse take?

Show answer & explanation

Answer: Pause the continuous infusion, flush the intravenous line thoroughly with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride before restarting the infusion.

Answer

Pause the continuous infusion, flush the intravenous line thoroughly with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride before restarting the infusion.
The correct action ensures patient safety by preventing a dangerous chemical incompatibility. Phenytoin is incompatible with dextrose solutions (D5W) and will precipitate, creating solid particles in the IV line that can lead to an embolism. To safely use the same IV site, the nurse must pause the incompatible fluid, flush the line with a compatible fluid (0.9% sodium chloride), administer the medication, and flush again to clear the tubing before resuming the D5W.

Step-by-Step Solution

1
Identify the primary continuous infusion fluid.
The client is receiving 5% dextrose in water (D5W).
Knowing the primary fluid is necessary to determine compatibility with the medication to be administered.
2
Determine the compatibility of intravenous phenytoin with the primary fluid.
Phenytoin is incompatible with D5W and will rapidly precipitate if mixed.
Phenytoin is only compatible with 0.9% sodium chloride (normal saline). Mixing it with dextrose causes crystallization.
3
Select the appropriate intervention to safely deliver the medication through the existing line.
The D5W must be paused, and the line must be flushed with 0.9% sodium chloride before and after the phenytoin administration.
Flushing creates a safe barrier in the tubing, preventing the phenytoin from coming into contact with the incompatible dextrose solution.

Key Concept

Intravenous Compatibility and Safe Administration of Phenytoin
Question 919Question →

A client admitted with cardiogenic shock requires hemodynamic support. The healthcare provider prescribes a continuous intravenous infusion of dobutamine at 2.72.7 mcg/kg/min. The client's most recent weight is 209209 lbs. The pharmacy dispenses a premixed IV bag containing dobutamine 500500 mg in 250250 mL of 5%5\% dextrose in water. Calculate the appropriate infusion pump rate in mL/hr. (Round the final answer to the nearest tenth.)

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Answer: 7.7

Answer

The infusion pump should be set to 7.7 mL/hr.
The correct infusion rate is calculated by first determining the client's weight in kilograms (209÷2.2=95209 \div 2.2 = 95 kg). The total minute dose is found by multiplying the weight by the ordered dose (95×2.7=256.595 \times 2.7 = 256.5 mcg/min). This minute dose is then multiplied by 6060 to find the hourly dose (256.5×60=15,390256.5 \times 60 = 15,390 mcg/hr). Because the supplied medication is in milligrams, the hourly dose must be converted (15,390÷1,000=15.3915,390 \div 1,000 = 15.39 mg/hr). The concentration of the supplied IV bag is 22 mg/mL (500500 mg ÷250\div 250 mL). Dividing the required hourly dose by the concentration provides the pump rate (15.39÷2=7.69515.39 \div 2 = 7.695 mL/hr). Finally, rounding 7.6957.695 to the nearest tenth yields 7.77.7 mL/hr.

Step-by-Step Solution

1
Convert the client's weight from pounds to kilograms.
209 lbs÷2.2 lbs/kg=95 kg209 \text{ lbs} \div 2.2 \text{ lbs/kg} = 95 \text{ kg}
The medication dosage is prescribed based on kilograms of body weight.
2
Calculate the prescribed dose per minute.
95 kg×2.7 mcg/kg/min=256.5 mcg/min95 \text{ kg} \times 2.7 \text{ mcg/kg/min} = 256.5 \text{ mcg/min}
To determine the total amount of dobutamine the client requires each minute.
3
Convert the dose per minute to the dose per hour.
256.5 mcg/min×60 min/hr=15,390 mcg/hr256.5 \text{ mcg/min} \times 60 \text{ min/hr} = 15,390 \text{ mcg/hr}
Intravenous infusion pumps are programmed in hourly rates (mL/hr).
4
Convert the hourly dose from micrograms (mcg) to milligrams (mg).
15,390 mcg÷1,000 mcg/mg=15.39 mg/hr15,390 \text{ mcg} \div 1,000 \text{ mcg/mg} = 15.39 \text{ mg/hr}
The medication provided by the pharmacy is measured in milligrams, so units must match.
5
Determine the concentration of the provided intravenous solution.
500 mg÷250 mL=2 mg/mL500 \text{ mg} \div 250 \text{ mL} = 2 \text{ mg/mL}
To identify how many milligrams of dobutamine are contained in each milliliter of the fluid.
6
Calculate the final volume to be infused per hour and round to the nearest tenth.
15.39 mg/hr÷2 mg/mL=7.695 mL/hr15.39 \text{ mg/hr} \div 2 \text{ mg/mL} = 7.695 \text{ mL/hr}, which rounds to 7.7 mL/hr7.7 \text{ mL/hr}
Dividing the required hourly dose by the fluid concentration yields the final pump setting.

Key Concept

Weight-based continuous intravenous medication titration requires converting client weight to kilograms, establishing an hourly dosage rate, and applying the supplied medication concentration to determine the final pump setting.
Question 920Question →

A nurse is caring for a client with acute decompensated heart failure and atrial fibrillation. The client has a double-lumen central venous catheter (CVC) with the following continuous infusions:

* Lumen 1: Dobutamine at 10 mcg/kg/min10 \text{ mcg/kg/min}
* Lumen 2: Heparin at 1,200 units/hr1,200 \text{ units/hr}

The client develops sudden, severe dyspnea and crackles bilaterally. The provider prescribes furosemide 40 mg40 \text{ mg} IV push STAT. The client does not have peripheral intravenous access. Which action by the nurse is the most appropriate method to administer the furosemide?

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Answer: Pause the heparin infusion, flush Lumen 2 with 0.9%0.9\% sodium chloride, administer the furosemide, flush again, and resume the heparin

Answer

The most appropriate action is to pause the heparin infusion, flush the lumen with 0.9% sodium chloride, administer the furosemide, flush again, and resume the heparin.
Heparin is a non-vasoactive continuous infusion with a relatively long half-life (60-90 minutes). Pausing it briefly (3-5 minutes) to flush the line, administer a STAT, incompatible medication like furosemide, and flush again is standard and safe critical care practice. This utilizes the available access without compromising hemodynamic stability.

Step-by-Step Solution

1
Identify the constraints of the scenario
The furosemide must be administered through one of the two existing central line lumens.
The client lacks peripheral IV access and the medication is a STAT priority.
2
Evaluate Lumen 1 (Dobutamine) for safety
Lumen 1 cannot be used for the IV push.
Pushing medication into a vasoactive line inadvertently boluses the vasoactive drug into the client. Additionally, pausing a short-acting life-sustaining inotrope causes rapid hemodynamic collapse.
3
Evaluate Lumen 2 (Heparin) for safety and compatibility
Heparin and furosemide are physically incompatible, meaning they cannot mix in the tubing.
Furosemide will immediately precipitate if administered via the Y-site of a running heparin infusion.
4
Determine the safest administration sequence
Pause heparin, flush the line, push furosemide, flush the line, and restart heparin.
Heparin has a 60-90 minute half-life; a 3-5 minute pause will not harm the client. Flushing the line before and after completely prevents the incompatible furosemide and heparin from mixing.

Key Concept

Safe administration of IV push medications via central lines with vasoactive and incompatible continuous infusions.
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