Physiological Integrity

A registered nurse is providing care for multiple clients and preparing to administer prescribed medications. Which of the following actions demonstrate safe pharmacological and parenteral practices? Select all that apply.

A critical care nurse is caring for a client with septic shock who has a multi-lumen central venous catheter. The client is receiving a continuous intravenous infusion of norepinephrine and is now prescribed an intermittent intravenous infusion of vancomycin. Which of the following nursing actions ensure safe pharmacological and parenteral therapy administration? (Select all that apply.)

A critical care nurse is managing a client with severe sepsis. The client is receiving a continuous intravenous infusion of norepinephrine.

Client Data:
- Weight: $220$ lb
- Current mean arterial pressure (MAP): $54$ mm Hg
- Current infusion pump rate: $18$ mL/hr
- Medication concentration: Norepinephrine $8$ mg in $250$ mL $5\%$ Dextrose in Water (D5W)
- Provider titration protocol: "Increase norepinephrine by $0.04$ mcg/kg/min every $5$ minutes until MAP is $\geq 65$ mm Hg."

The nurse determines the need to increase the infusion rate according to the protocol. What should be the newly programmed infusion pump rate in mL/hr?

*Round the final answer to the nearest tenth.*

A critical care nurse is managing a client with a double-lumen central venous catheter. One lumen is actively infusing continuous total parenteral nutrition (TPN). The second lumen is infusing continuous norepinephrine to maintain the client's mean arterial pressure. The provider writes a new order for an intravenous antibiotic, piperacillin-tazobactam, to be administered over 30 minutes. What is the most appropriate action by the nurse?

A nurse is preparing to administer a transfusion of packed red blood cells (PRBCs) to a client with severe anemia. Which of the following intravenous fluids should the nurse use to prime the blood administration tubing?

A nurse is preparing to administer an intravenous (IV) antibiotic piggyback to a client who is receiving a continuous primary IV infusion. Which of the following actions must the nurse prioritize before connecting the secondary infusion?

A nurse is preparing to mix regular insulin and NPH insulin in a single syringe for a client with diabetes mellitus. Arrange the following steps in the correct sequence for drawing up these medications.

An older adult client is receiving a continuous intravenous infusion of unfractionated heparin for the treatment of a deep vein thrombosis. The client's most recent activated partial thromboplastin time (aPTT) is 118 seconds. During an assessment, the client reports a sudden onset of severe, localized lumbar back pain. The nurse notes a heart rate of 124 bpm, a blood pressure of 84/48 mmHg, and pale, diaphoretic skin. Which action should the nurse take first?

During morning interdisciplinary rounds, the healthcare team reviews the treatment plan for a 74-year-old client admitted with a severe systemic infection, chronic kidney disease, and atrial fibrillation. The client is currently receiving a continuous intravenous heparin infusion, intermittent intravenous vancomycin, and a scheduled daily oral dose of digoxin. The morning laboratory report indicates a serum potassium of 3.2 mEq/L (3.2 mmol/L) and a serum creatinine of 2.4 mg/dL (212.2 mcmol/L). Which nursing interventions are appropriate for this client? Select all that apply.

A nurse is preparing to administer an intravenous piggyback (IVPB) antibiotic through an established, continuously infusing primary peripheral IV line. Arrange the following nursing actions in the correct chronological sequence to safely initiate the secondary infusion.

The nurse is reviewing new medication prescriptions for a client admitted with severe hypokalemia. The healthcare provider has ordered 40 mEq of intravenous potassium chloride (KCl) mixed in 100 mL of 0.9% sodium chloride to be infused immediately. The client currently has a single 22-gauge peripheral intravenous catheter in the left hand. Which action by the nurse represents the safest pharmacological practice?

A nurse is assigned to care for a client who is experiencing recurrent seizures and has a new prescription for an intravenous loading dose of phenytoin. The client currently has a continuous peripheral intravenous infusion of 5% dextrose in water (D5W) running at 100 mL/hr. Which nursing actions are required to safely prepare and administer this medication? (Select all that apply.)

Fifteen minutes after the initiation of a packed red blood cell (PRBC) transfusion, a client reports sudden severe lower back pain and develops chills. Which action must the nurse take first?

The nurse is preparing to administer an intermittent enteral feeding to a client via a nasogastric tube. In what order should the nurse perform the following actions? (Arrange the steps in the correct sequence from first to last.)

A nurse is preparing to obtain a blood specimen for laboratory testing from a client's multi-lumen central venous catheter (CVC). The selected lumen currently has a continuous infusion of 0.9% sodium chloride. Arrange the following steps for obtaining the blood sample in the correct clinical sequence.

A client is receiving a continuous intravenous (IV) infusion of unfractionated heparin for the treatment of a pulmonary embolism. Routine morning laboratory results reveal a sudden decrease in the client's platelet count from 180,000/mm³ (180 x 10^9/L) on admission to 60,000/mm³ (60 x 10^9/L) today. The client reports no active bleeding. Which action is the priority for the nurse to take?

A 78-year-old client is 2 days postoperative following a right total hip arthroplasty (posterior approach). The client has a history of chronic obstructive pulmonary disease (COPD) and a recent stroke resulting in dysphagia. They are receiving continuous enteral feeding via a nasogastric (NG) tube. The client is intermittently confused and attempting to pull at the NG tube. Which nursing action is most appropriate when providing basic care and comfort?

A client admitted with diabetic ketoacidosis (DKA) is receiving a continuous intravenous (IV) infusion of regular insulin at $0.1\text{ units/kg/hr}$. The client's baseline serum potassium was $5.4\text{ mEq/L}$ and blood glucose was $680\text{ mg/dL}$. Four hours later, the current blood glucose is $245\text{ mg/dL}$, and the cardiac monitor reveals new-onset premature ventricular contractions and prominent U waves. The current primary IV fluid is $0.9\%$ sodium chloride infusing at $150\text{ mL/hr}$. Based on these findings, which of the following is the priority nursing action?

A healthcare provider prescribes an intravenous infusion of dopamine for a client diagnosed with cardiogenic shock. The prescribed dose is $10 \text{ mcg/kg/min}$. The client weighs $176 \text{ lb}$. The pharmacy dispenses a pre-mixed bag containing $800 \text{ mg}$ of dopamine in $250 \text{ mL}$ of $5\%$ dextrose in water. The nurse should set the intravenous infusion pump to deliver how many mL/hr? (Record your answer as a whole number).

A nurse is preparing to administer a prescribed dose of intravenous (IV) furosemide via direct IV push into a client's continuous peripheral infusion of 5% dextrose in water (D5W). Which of the following actions indicate safe medication administration? (Select all that apply)