Physiological Integrity

1960 soru

Soru 1101Soru →

A healthcare provider prescribes 1,000 mL of lactated Ringer's solution to infuse intravenously over 8 hours. The manual intravenous (IV) administration set delivers 15 drops per milliliter (gtt/mL). Which of the following represents the correct drip rate for this infusion? (Round the final answer to the nearest whole number).

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Cevap: 31 gtt/min

Cevap

31 gtt/min
To calculate the correct manual IV drip rate, use the formula: Volume×Drop FactorTime in minutes\frac{\text{Volume} \times \text{Drop Factor}}{\text{Time in minutes}}. First, convert the 8-hour infusion time to 480 minutes. Next, calculate: 1000 mL×15 gtt/mL480 minutes=31.25\frac{1000 \text{ mL} \times 15 \text{ gtt/mL}}{480 \text{ minutes}} = 31.25. Because partial drops cannot be administered manually, round 31.2531.25 to the nearest whole number, resulting in 3131 gtt/min.

Adım Adım Çözüm

1
Determine the total volume to be infused and convert the prescribed infusion time from hours into minutes.
Total Volume = 1,0001,000 mL. Total Time = 8×60=4808 \times 60 = 480 minutes.
The standard IV manual drip rate formula requires the time variable to be expressed in minutes.
2
Apply the standard IV drip rate formula: Total Volume (mL)×Drop Factor (gtt/mL)Total Time (minutes)\frac{\text{Total Volume (mL)} \times \text{Drop Factor (gtt/mL)}}{\text{Total Time (minutes)}}.
1000×15480\frac{1000 \times 15}{480}
This formula calculates the exact number of drops that must fall per minute to deliver the total fluid volume over the prescribed duration.
3
Perform the calculation and round the result to the nearest whole number.
15000480=31.25\frac{15000}{480} = 31.25. Rounded to the nearest whole number is 3131 gtt/min.
Manual IV drip rates can only be administered as whole drops.

Anahtar Kavram

Intravenous (IV) manual flow rate calculation
Soru 1102Soru →

A nurse is caring for a client who underwent a left above-the-knee amputation 48 hours ago. The client reports mild discomfort in the residual limb and requests to be repositioned. Which of the following nursing actions is most appropriate to promote comfort and prevent musculoskeletal complications?

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Cevap: Assist the client into a prone position for 20 to 30 minutes, several times a day.

Cevap

Assist the client into a prone position for 20 to 30 minutes, several times a day.
Following an above-the-knee amputation, the client is at a very high risk for developing hip flexion contractures, which can impede future rehabilitation and prosthetic use. Assisting the client into a prone position for 20 to 30 minutes, 3 to 4 times a day, actively stretches the hip flexor muscles and prevents contracture formation. This is a critical basic care and comfort measure.

Adım Adım Çözüm

1
Analyze the client's post-operative timeline and surgical procedure.
The client is 48 hours post-operative from a left above-the-knee amputation.
The precise timeframe determines which positioning interventions are indicated and which are contraindicated.
2
Identify the primary musculoskeletal complication associated with this specific procedure.
The most significant risk is the development of hip flexion contractures.
Contractures can severely impair the client's ability to use a prosthesis and mobilize in the future.
3
Evaluate the safety and efficacy of each proposed positioning or delegation action.
Prone positioning actively stretches the hip flexors, while elevation or high-Fowler's positioning continuously flexes the hip. Delegation of assessment is unsafe.
Interventions must directly counteract the tendency for the flexor muscles to shorten without violating scope of practice.

Anahtar Kavram

Post-amputation positioning and contracture prevention
Soru 1103Soru →

An 82-year-old client with advanced Alzheimer's disease and a history of dysphagia is admitted for the treatment of aspiration pneumonia. During the night shift, the client experiences a sudden onset of severe agitation, repeatedly attempts to dislodge a peripheral intravenous (IV) catheter, and demonstrates an inability to remain in bed. To promote the client's basic care and comfort while ensuring safety, which action should the nurse take?

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Cevap: Conceal the intravenous site using a tubular elastic bandage, provide a sensory activity apron for tactile diversion, and assist the client to sit in a bedside rocking chair.

Cevap

The correct action is to conceal the intravenous site using a tubular elastic bandage, provide a sensory activity apron, and assist the client to sit in a bedside rocking chair.
The correct nursing action synthesizes basic care and comfort principles by utilizing non-pharmacological de-escalation techniques. Camouflaging the IV site with an elastic sleeve removes the visual stimulus that prompts the client to pull at it, acting as a highly effective, non-restrictive alternative to restraints. Furthermore, providing a sensory apron offers safe tactile diversion, and the rhythmic motion of a rocking chair promotes self-soothing, effectively addressing the psychomotor agitation often seen in clients with dementia and delirium.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client has advanced dementia, aspiration pneumonia, and sudden severe agitation with a risk of IV dislodgment.
Understanding the intersection of cognitive impairment, respiratory distress, and safety risks dictates the priority of care.
2
Evaluate the requirement for safety versus the standard of basic care and comfort.
Interventions must prevent the removal of the IV line while adhering to the principle of using the least restrictive measures possible.
Restraints can exacerbate agitation in dementia clients and are strictly regulated as a last-resort intervention.
3
Identify appropriate non-pharmacological comfort measures.
Select interventions that provide distraction and physical soothing (sensory aprons, rocking chairs) and remove visual triggers (camouflaging the IV).
These methods directly address the psychomotor agitation associated with dementia and delirium without compromising physiological safety.
4
Critically evaluate all other options for clinical contraindications.
Eliminate options that involve premature restraints, improper delegation of a high-risk assessment, or positioning that increases aspiration risk.
Ensuring holistic safety requires recognizing hidden hazards in seemingly routine interventions.

Anahtar Kavram

Non-Pharmacological Comfort and Restraint Alternatives in Dementia Care
Tahmini Süre:1m 30s
Soru 1104Soru →

A client at 35 weeks gestation is receiving a continuous intravenous (IV) infusion of magnesium sulfate for the management of severe preeclampsia. During an hourly assessment, the nurse notes the client is difficult to arouse, has a respiratory rate of 10 breaths/minute10\text{ breaths/minute}, and deep tendon reflexes are absent. Which of the following is the priority nursing action?

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Cevap: Discontinue the magnesium sulfate infusion immediately and prepare to administer calcium gluconate.

Cevap

The priority action is to immediately discontinue the magnesium sulfate infusion and prepare to administer the antidote, calcium gluconate.
The client is exhibiting signs of severe magnesium sulfate toxicity, specifically a respiratory rate below 12 breaths/minute12\text{ breaths/minute}, absent deep tendon reflexes, and a decreased level of consciousness. The absolute highest priority action is to stop the continuous infusion immediately to prevent progression to respiratory or cardiac arrest. Once the infusion is stopped, the nurse prepares the antidote, calcium gluconate.

Adım Adım Çözüm

1
Analyze the client's clinical presentation.
The client has lethargy, a respiratory rate of 10 breaths/minute, and absent deep tendon reflexes.
These are classic, life-threatening indicators of magnesium sulfate toxicity.
2
Determine the highest priority intervention based on the clinical findings.
The continuous infusion must be stopped.
When an infused medication causes acute toxicity, the immediate physiological priority is to remove the source of the harm before attempting to reverse its effects.
3
Identify the correct protocol for administering the antidote.
Calcium gluconate must be prepared for slow IV administration in a flushed or separate IV line.
Rapid push of calcium gluconate causes cardiac complications, and pushing it through an actively infusing toxic line delivers a lethal bolus.

Anahtar Kavram

Management of Magnesium Sulfate Toxicity
Soru 1105Soru →

A client with hepatic cirrhosis is recovering on the medical-surgical unit 30 minutes after a bedside paracentesis, during which 3.5 liters of ascitic fluid was removed. The client suddenly reports feeling dizzy and lightheaded. The nurse assesses a heart rate of 118 bpm, a blood pressure of 86/54 mmHg, and a respiratory rate of 18/min. Which action should the nurse take immediately to reduce the client's risk of severe circulatory compromise?

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Cevap: Place the client in a supine position and elevate the lower extremities.

Cevap

Place the client in a supine position and elevate the lower extremities.
The client is experiencing early signs of hypovolemic shock due to rapid fluid shifts from the intravascular space into the peritoneal cavity following the removal of a large volume of ascitic fluid. Placing the client in a supine position with the lower extremities elevated (modified Trendelenburg) utilizes gravity to promote venous return to the heart and immediately increases cerebral perfusion, which is the priority to mitigate circulatory collapse.

Adım Adım Çözüm

1
Analyze the client's vital signs and clinical presentation.
The client is tachycardic, hypotensive, and dizzy 30 minutes after the removal of a large volume (3.5 liters) of fluid.
Identifying abnormal trends is necessary to detect post-procedure complications early.
2
Determine the underlying pathophysiology.
The findings indicate hypovolemic shock caused by rapid fluid shifts from the intravascular space into the peritoneal cavity following the paracentesis.
Understanding the cause directs the appropriate, life-saving nursing intervention.
3
Select the immediate priority action.
The nurse must improve venous return and cerebral perfusion by placing the client supine with elevated legs.
This physical positioning maneuver rapidly increases blood flow to vital organs before pharmacological volume expansion (like IV albumin) can be initiated.

Anahtar Kavram

Early recognition and immediate positioning for hypovolemic shock post-paracentesis.
Tahmini Süre:1m 0s
Soru 1106Soru →

A nurse is preparing to administer a prescribed intermittent enteral tube feeding to a client. Arrange the following nursing actions in the correct chronological order.

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Cevap

The correct sequence is to first elevate the head of the bed, verify tube placement and residual volume, flush the tube to confirm patency, administer the enteral feeding, and finally flush the tube again.
Safe administration of an intermittent enteral feeding follows a specific clinical protocol to prevent severe complications such as aspiration and tube occlusion. The nurse must first elevate the head of the bed to at least 30 degrees to minimize aspiration risk. Next, tube placement and gastric residual volume are assessed to ensure gastrointestinal readiness. The tube is then flushed with water to confirm patency. After these safety measures are complete, the feeding formula is administered. Finally, a post-feeding flush is performed to clear the tubing and prevent clogging.

Adım Adım Çözüm

1
Position the client with the head of the bed elevated.
The client is in a safe, upright position.
Elevating the head of the bed to at least 30 degrees uses gravity to prevent reflux and decreases the risk of aspiration.
2
Verify tube placement and check the gastric residual volume.
Tube location is confirmed and gastric emptying is assessed.
This ensures the feeding will go directly into the stomach and that the client is safely digesting previous feedings.
3
Flush the enteral tube with 30 mL of water.
The tube is cleared and patency is confirmed.
Flushing verifies that the tube is not blocked before introducing the viscous feeding formula.
4
Administer the prescribed intermittent enteral feeding.
The client receives the required nutrition.
The formula is administered only after safety checks and patency are clearly established.
5
Flush the enteral tube again with 30 mL of water.
The tube is cleared of any remaining formula.
A post-feeding flush prevents the formula from clogging the tube and reduces the risk of bacterial growth inside the lumen.

Anahtar Kavram

Enteral Tube Feeding Administration
Soru 1107Soru →

While reviewing the chart of a client hospitalized with severe bilateral pneumonia, the central monitor alarms. The nurse enters the room and observes the client is highly agitated, diaphoretic, and increasingly confused. The client is currently receiving oxygen therapy via a non-rebreather mask at 15 L/min. Current vitals indicate a heart rate of 134 bpm, blood pressure of 84/46 mmHg, respiratory rate of 38 breaths/min, and an oxygen saturation of 84%. A stat arterial blood gas (ABG) is drawn and reports: pH 7.21, PaCO2 68 mm Hg, PaO2 50 mm Hg, and HCO3- 23 mEq/L. Which action is the priority for this client?

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Cevap: Prepare the client for immediate endotracheal intubation and mechanical ventilation.

Cevap

Prepare the client for immediate endotracheal intubation and mechanical ventilation.
The correct action directly addresses the most critical and life-threatening issue. The ABG results demonstrate uncompensated respiratory acidosis and severe hypoxemia despite maximum non-invasive oxygen delivery (non-rebreather at 15 L/min). Coupled with the client's altered mental status (confusion, agitation) and hemodynamic instability (hypotension, tachycardia), the client has exhausted their compensatory mechanisms and is in acute respiratory failure. The priority is to secure the airway and mechanically ventilate.

Adım Adım Çözüm

1
Analyze the client's physical assessment findings.
The client is agitated, confused, diaphoretic, tachypneic (38 breaths/min), tachycardic (134 bpm), and hypotensive (84/46 mmHg).
Identifying these clinical manifestations points toward severe hypoxemia and inadequate tissue perfusion, suggesting the client is in a life-threatening physiological crisis.
2
Interpret the arterial blood gas (ABG) results in the context of the oxygen therapy.
pH 7.21 (acidosis), PaCO2 68 (respiratory cause), HCO3- 23 (normal/uncompensated), and PaO2 50 (severe hypoxemia) despite being on 15 L/min via non-rebreather.
This confirms acute uncompensated respiratory acidosis with refractory hypoxemia. The client's respiratory effort is failing to adequately ventilate or oxygenate.
3
Prioritize nursing interventions based on the ABCs (Airway, Breathing, Circulation).
Airway and Breathing are severely compromised and must be addressed first before Circulation (fluids).
Because the client cannot maintain oxygenation on maximum non-invasive support and has an altered level of consciousness, mechanical ventilation is the immediate life-saving priority.

Anahtar Kavram

Prioritization of advanced airway management in acute uncompensated respiratory acidosis with refractory hypoxemia.
Soru 1108Soru →

A postoperative client has an order for intravenous pantoprazole. The medication is prepared in a 100 mL100\text{ mL} bag of 0.9%0.9\% sodium chloride and needs to be infused over 15 minutes15\text{ minutes}. At what rate, in mL/hr\text{mL/hr}, will the nurse set the infusion pump?

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Cevap: 400

Cevap

The nurse should set the infusion pump to 400 mL/hr400\text{ mL/hr}.
To determine the correct IV pump setting in mL/hr\text{mL/hr}, the nurse must calculate the hourly rate of the infusion. Because the medication is ordered to infuse over a fraction of an hour (15 minutes15\text{ minutes} is 0.25 hours0.25\text{ hours}), dividing the total volume (100 mL100\text{ mL}) by the time in hours (0.25 hours0.25\text{ hours}) yields 400 mL/hr400\text{ mL/hr}. Alternatively, setting up a direct proportion (100 mL100\text{ mL} in 15 minutes15\text{ minutes} is equivalent to X mLX\text{ mL} in 60 minutes60\text{ minutes}) also results in 400 mL/hr400\text{ mL/hr}.

Adım Adım Çözüm

1
Identify the total volume of fluid to be infused.
100 mL100\text{ mL}
The infusion pump rate calculation requires the total volume of the medication bag.
2
Convert the infusion time from minutes to hours.
15 minutes÷60=0.25 hours15 \text{ minutes} \div 60 = 0.25\text{ hours}
Intravenous infusion pumps are programmed in mL/hr\text{mL/hr}, so the time must be standardized to hours.
3
Calculate the final infusion rate by dividing the volume by the time in hours.
100 mL÷0.25 hours=400 mL/hr100\text{ mL} \div 0.25\text{ hours} = 400\text{ mL/hr}
The formula for IV pump rate is Total Volume (mL) divided by Total Time (hr).

Anahtar Kavram

Calculating intravenous infusion pump rates for secondary medications
Tahmini Süre:1m 0s
Soru 1109Soru →

A nurse is caring for a client who returned to the medical-surgical unit 1 hour ago following a cardiac catheterization performed via the right femoral artery. Which intervention should the nurse prioritize to reduce the client's risk for a post-procedure complication?

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Cevap: Instruct the client to keep the right leg straight and minimize movement.

Cevap

Instruct the client to keep the right leg straight and minimize movement.
Following a femoral cardiac catheterization, the most critical intervention to reduce the risk of hemorrhage is maintaining the affected extremity in a straight, neutral position. This prevents the groin crease from bending, allowing the arterial puncture site to clot securely.

Adım Adım Çözüm

1
Identify the procedure and the specific anatomical site used.
The client had a cardiac catheterization via the right femoral artery.
Knowing the insertion site determines the specific local complications to anticipate.
2
Determine the most significant acute post-procedure risk.
The primary immediate risk is arterial hemorrhage or hematoma formation at the femoral puncture site.
The femoral artery is a major vessel under high pressure, making bleeding a life-threatening risk.
3
Select the intervention that directly mitigates this specific risk.
Keeping the affected leg straight prevents mechanical stress on the arterial puncture site.
Bending the hip joint would disrupt the clot formation and promote bleeding.

Anahtar Kavram

Post-Cardiac Catheterization Hemorrhage Prevention
Soru 1110Soru →

A nurse is caring for an older adult client who has been diagnosed with dysphagia and is preparing to eat a meal. Which basic care actions should the nurse implement to promote comfort and ensure safety? Select all that apply.

Geçerli olan tümünü seçin

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Cevap: Elevate the head of the bed to 90 degrees before initiating the meal.; Instruct the client to tilt their chin slightly downward while swallowing.; Maintain the client in an upright position for at least 30 minutes after eating.

Cevap

The correct actions are elevating the head of the bed to 90 degrees, instructing the client to use the chin-tuck method, and maintaining an upright position for at least 30 minutes after the meal.
Safe oral intake for a client with dysphagia relies heavily on proper body alignment. High-Fowler's position (90 degrees) and the chin-tuck maneuver protect the airway anatomically during the meal, while remaining upright for 30 to 45 minutes afterward prevents reflux and delayed aspiration.

Adım Adım Çözüm

1
Identify the primary risks associated with dysphagia.
The main risk is the aspiration of food or fluids into the respiratory tract.
Understanding the risk guides the selection of safe positioning and appropriate feeding techniques.
2
Evaluate each intervention for its effect on swallowing safety.
Upright positioning and the chin-tuck maneuver physically protect the airway.
Gravity and anatomical positioning are the primary non-pharmacologic defenses against aspiration.
3
Determine appropriate delegation for the task.
Initial assessment and feeding of a client with a new dysphagia diagnosis must be performed by the registered nurse.
UAPs cannot perform initial clinical assessments or evaluate swallowing effectiveness.

Anahtar Kavram

Basic care and safety measures for clients with dysphagia primarily involve proper positioning to prevent aspiration and retaining initial nursing assessments rather than delegating them.
Soru 1111Soru →

The nursing team is developing a care plan for a client recovering from a traumatic brain injury. To minimize the risk of dangerous elevations in intracranial pressure (ICP), which specific actions are appropriate to implement? Select all that apply.

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Cevap: Keep the client's cervical spine in a neutral, midline position.; Maintain the mattress backrest at a 30-degree angle.; Administer prescribed docusate sodium daily.

Cevap

The correct actions to reduce the risk of increased intracranial pressure include keeping the cervical spine in a neutral, midline position, maintaining the mattress backrest at a 30-degree angle, and administering a prescribed stool softener daily.
Keeping the neck in a neutral midline position and raising the backrest to 30 degrees directly facilitates jugular venous drainage, which lowers intracranial volume and pressure. Administering a stool softener prevents constipation and the associated Valsalva maneuver (straining), which is known to cause dangerous spikes in intracranial pressure.

Adım Adım Çözüm

1
Analyze the clinical goal of the scenario.
The primary objective is to prevent spikes in intracranial pressure (ICP) by promoting venous drainage from the brain and minimizing stimuli that increase intrathoracic or intra-abdominal pressure.
Understanding the physiological drivers of increased ICP is necessary to select safe and effective nursing interventions.
2
Evaluate positioning and alignment interventions.
Keeping the neck neutral and raising the backrest to 30 degrees promote optimal jugular venous outflow. Conversely, extreme hip flexion must be avoided because it increases intra-abdominal pressure.
Proper body alignment and gravity assist in reducing cranial blood volume, while poor positioning directly obstructs venous return.
3
Evaluate systemic interventions and environmental stimuli.
Providing stool softeners safely prevents Valsalva maneuvers (straining). Routine suctioning and grouping excessive care activities are contraindicated because they cause sudden or cumulative spikes in ICP.
Minimizing noxious stimuli and preventing straining are critical, foundational steps in ICP risk reduction.

Anahtar Kavram

Reduction of Risk Potential: Intracranial Pressure Management
Soru 1112Soru →

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central venous catheter (CVC). During an intravenous tubing change, the client suddenly grasps their chest and reports severe shortness of breath. The client's oxygen saturation drops rapidly to 85%. Suspecting a central line-associated air embolism, which of the following immediate actions should the nurse take? (Select all that apply.)

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Cevap: Clamp the central venous catheter immediately.; Place the client in the left lateral Trendelenburg position.; Administer 100% oxygen via a non-rebreather mask.

Cevap

The correct actions include clamping the central venous catheter, placing the client in the left lateral Trendelenburg position, and administering 100% oxygen.
An air embolism is a life-threatening complication of parenteral therapies involving central venous access devices. The immediate priorities are to stop further air entry by clamping the line, prevent the existing air from migrating to the pulmonary circulation by placing the client in the left lateral Trendelenburg position, and treat hypoxia while facilitating nitrogen resorption by applying high-flow oxygen.

Adım Adım Çözüm

1
Identify the complication based on the clinical presentation.
The combination of a central line tubing change, sudden chest pain, and severe hypoxia strongly indicates a central line-associated air embolism.
Air embolism is a known critical risk when a central venous system is opened to atmospheric pressure.
2
Stop the source of the air leak.
The central venous catheter is immediately clamped.
Clamping the catheter prevents any further atmospheric air from being drawn into the central venous circulation.
3
Reposition the client to trap the air.
The client is placed in the left lateral Trendelenburg position (Durant's maneuver).
This positioning utilizes gravity to keep the air embolus suspended in the right atrium or right ventricle, preventing it from occluding the pulmonary circulation.
4
Address the resulting hypoxemia and promote air resorption.
High-flow oxygen (100%) is administered via a non-rebreather mask.
Oxygen treats the immediate hypoxia and creates a nitrogen gradient that accelerates the resorption of the air bubble.

Anahtar Kavram

Management of Central Line-Associated Air Embolism
Soru 1113Soru →

A nurse is caring for an older adult client who returned to the medical unit one hour ago following a percutaneous liver biopsy. The client reports a strong urge to void and requests assistance to walk to the bathroom. Which nursing intervention is the most appropriate?

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Cevap: Explain the requirement for strict bedrest and provide a fracture pan while keeping the client in a right side-lying position.

Cevap

Explain the requirement for strict bedrest and provide a fracture pan while keeping the client in a right side-lying position.
Following a percutaneous liver biopsy, clients must remain on strict bedrest in a right side-lying (lateral) position for at least two hours. This position applies direct pressure to the liver capsule at the puncture site, minimizing the risk of hemorrhage. Providing a fracture pan allows the nurse to fulfill the client's basic elimination and comfort needs without compromising this critical therapeutic positioning.

Adım Adım Çözüm

1
Identify the client's clinical status and recent procedure.
The client is one hour post-percutaneous liver biopsy.
Understanding the procedure dictates the specific post-operative care and mobility restrictions required.
2
Determine the required positioning for a post-liver biopsy client.
The client must remain on strict bedrest in a right side-lying position.
The right side-lying position applies direct physical pressure against the liver capsule and the puncture site, which is essential to prevent hemorrhage.
3
Evaluate the client's request against the physiological safety requirements.
Walking to the bathroom or using a commode is contraindicated due to strict bedrest and the need for sustained right lateral positioning.
Prioritizing physiological safety (hemorrhage prevention) over the preferred method of elimination is necessary.
4
Select the intervention that addresses the basic care need while maintaining safety.
Using a fracture pan while the client remains on their right side.
A fracture pan can be carefully slipped under the client without requiring them to lift their hips or roll off their right side, safely addressing their comfort and elimination needs.

Anahtar Kavram

Post-procedure positioning and basic elimination care
Soru 1114Soru →

A nurse is caring for a client with cardiogenic shock and metabolic acidosis who currently has a single peripheral intravenous (IV) line. The client is receiving a continuous IV infusion of 8.4%8.4\% sodium bicarbonate at 50 mL/hr50\text{ mL/hr}. The healthcare provider prescribes a new continuous IV infusion of dopamine at 5 mcg/kg/min5\text{ mcg/kg/min}. The client weighs 176 lbs176\text{ lbs}. The pharmacy dispenses dopamine 400 mg400\text{ mg} diluted in 250 mL250\text{ mL} of 5%5\% dextrose in water (D5W). Based on this prescription, which of the following actions is the most appropriate for the nurse to take?

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Cevap: Establish a secondary peripheral IV line, set the dopamine infusion pump to 15 mL/hr15\text{ mL/hr}, and monitor the insertion site closely for extravasation.

Cevap

The most appropriate action is to establish a secondary peripheral IV line, set the dopamine infusion pump to 15 mL/hr15\text{ mL/hr}, and monitor the insertion site closely for extravasation.
The correct action requires both accurate dosage calculation and knowledge of intravenous compatibility. First, dopamine is a catecholamine, which is rapidly inactivated in alkaline solutions such as sodium bicarbonate. Therefore, connecting dopamine to the Y-site of a sodium bicarbonate infusion is contraindicated; a secondary IV line must be established. Additionally, dopamine is a potent vesicant that can cause severe tissue necrosis if extravasation occurs, so the peripheral site must be monitored meticulously. Second, the correct infusion rate must be calculated: Convert the weight (176 lbs÷2.2=80 kg176\text{ lbs} \div 2.2 = 80\text{ kg}), determine the dose (5 mcg×80=400 mcg/min5\text{ mcg} \times 80 = 400\text{ mcg/min}), calculate the concentration (400,000 mcg÷250 mL=1,600 mcg/mL400,000\text{ mcg} \div 250\text{ mL} = 1,600\text{ mcg/mL}), and determine the hourly rate (400÷1,600=0.25 mL/min×60 min/hr=15 mL/hr400 \div 1,600 = 0.25\text{ mL/min} \times 60\text{ min/hr} = 15\text{ mL/hr}).

Adım Adım Çözüm

1
Determine the physical and chemical compatibility of the prescribed medications.
Dopamine and sodium bicarbonate are chemically incompatible.
Dopamine is a catecholamine that undergoes chemical breakdown when exposed to highly alkaline solutions (like sodium bicarbonate). Therefore, a separate IV line is mandatory.
2
Convert the client's weight from pounds to kilograms.
176 lbs÷2.2=80 kg176\text{ lbs} \div 2.2 = 80\text{ kg}
Critical care continuous infusions are dosed based on the client's weight in kilograms.
3
Calculate the required dose per minute.
5 mcg/kg/min×80 kg=400 mcg/min5\text{ mcg/kg/min} \times 80\text{ kg} = 400\text{ mcg/min}
Determines the total amount of medication the client requires every minute to achieve the therapeutic effect.
4
Determine the concentration of the supplied dopamine solution.
400 mg=400,000 mcg400\text{ mg} = 400,000\text{ mcg}. Concentration = 400,000 mcg÷250 mL=1,600 mcg/mL400,000\text{ mcg} \div 250\text{ mL} = 1,600\text{ mcg/mL}
Standardizes the units (mcg to mcg) to prepare for volume calculation.
5
Calculate the final IV pump flow rate in mL/hr.
Rate = (400 mcg/min÷1,600 mcg/mL)×60 min/hr=15 mL/hr(400\text{ mcg/min} \div 1,600\text{ mcg/mL}) \times 60\text{ min/hr} = 15\text{ mL/hr}
IV infusion pumps must be programmed in milliliters per hour.

Anahtar Kavram

Chemical incompatibility of catecholamines with alkaline solutions and complex weight-based intravenous medication calculations.
Tahmini Süre:2m 30s
Soru 1115Soru →

A nurse is preparing to change a two-piece ostomy appliance for a client with a newly established descending colostomy. In which order should the nurse perform the following actions? Arrange the steps from first to last.

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Cevap

The correct sequence for changing an ostomy appliance is: removing the old appliance, cleaning and drying the skin, measuring the stoma, cutting the barrier to the appropriate size, and applying the new barrier and pouch.
The procedure for changing an ostomy pouch requires a logical progression focused on skin integrity and maintaining a proper seal. The nurse must first gently remove the old equipment by pushing the skin away from the adhesive to prevent epidermal stripping. Next, the skin is cleaned with warm water (avoiding soaps that leave residue) and thoroughly dried. Because the stoma size fluctuates, especially in the postoperative period, the nurse must measure it accurately after cleaning and drying the area. The wafer is then carefully cut approximately 1/8 inch larger than the stoma to ensure it does not compress the stomal tissue while still protecting the surrounding skin from effluent. Finally, the newly cut barrier and pouch are applied.

Adım Adım Çözüm

1
Remove the soiled appliance.
Exposes the stoma and peristomal skin.
Necessary to begin the care process while minimizing skin trauma.
2
Cleanse and dry the area.
Removes effluent and prepares a clean, dry surface.
Feces can cause severe skin breakdown, and moisture prevents the new adhesive from sticking properly.
3
Measure the stoma.
Provides the exact current dimensions of the stoma.
Stoma size changes over time, especially postoperatively, requiring accurate measurement during each change.
4
Cut the skin barrier 1/8 inch larger than the stoma.
Creates a customized opening in the wafer.
A correct fit prevents stoma strangulation and protects the surrounding skin from corrosive stool.
5
Apply the new barrier and pouch.
Secures the appliance to the client.
Completes the procedure, restoring the closed system for effluent collection.

Anahtar Kavram

Ostomy Care and Peristomal Skin Management
Soru 1116Soru →

A nurse is reviewing the medical record of a client who is scheduled for a computed tomography (CT) scan with intravenous (IV) iodinated contrast. Which finding is the most critical to report to the healthcare provider prior to the procedure?

Cevabı ve açıklamayı göster

Cevap: The client takes metformin for the management of type 2 diabetes mellitus.

Cevap

The client takes metformin for the management of type 2 diabetes mellitus.
IV iodinated contrast can cause acute kidney injury. If the kidneys are compromised by the contrast, metformin can accumulate in the body, leading to a life-threatening condition called lactic acidosis. Therefore, recognizing metformin use is the highest priority for risk reduction, and the medication must be temporarily discontinued.

Adım Adım Çözüm

1
Analyze the planned procedure and its physiological risks.
The client is scheduled for a CT scan with IV iodinated contrast, which carries a known risk of acute kidney injury.
Identifying the primary physiological risk of the procedure helps determine which assessment findings are most relevant.
2
Evaluate each assessment finding for its potential to increase procedural risk.
Metformin interacts with IV contrast to cause lactic acidosis. The ABG is normal, a pollen allergy is not a contrast risk, and an incorrect assessment sequence is not a physiological threat.
Systematically ruling out safe or low-priority findings isolates the critical safety hazard.
3
Select the finding that requires immediate clinical intervention.
The use of metformin is the finding that must be reported to the provider immediately.
The provider must order metformin to be held before and after the scan to prevent life-threatening complications.

Anahtar Kavram

Reduction of Risk Potential: Diagnostic Testing Preparations
Soru 1117Soru →

An older adult client with advanced Parkinson's disease and acute pancreatitis is receiving continuous enteral nutrition through a nasojejunal tube. The client suddenly becomes highly restless, pulls at the bedsheets, and attempts to climb over the side rails. Which nursing action demonstrates the most appropriate approach to this client's basic care and comfort?

Cevabı ve açıklamayı göster

Cevap: Keep the head of the bed elevated between 30 and 45 degrees, camouflage the enteral tubing under the client's gown, and assist the client with a urinal or bedpan.

Cevap

The most appropriate action is to keep the head of the bed elevated between 30 and 45 degrees, camouflage the tubing under the gown, and assist the client with toileting.
Clients receiving continuous enteral nutrition are at a high risk for aspiration and must remain with the head of the bed elevated at 30 to 45 degrees at all times, even during comfort care. Furthermore, acute restlessness in older adults is frequently an indicator of physiological distress, such as a full bladder or pain, rather than simple confusion. By camouflaging the tube under the gown, the nurse utilizes a least-restrictive safety measure to prevent dislodgement, while maintaining safe respiratory positioning and actively addressing a highly probable underlying cause of the agitation.

Adım Adım Çözüm

1
Analyze the client's presentation and medical history.
The client is an older adult with Parkinson's receiving continuous enteral feeding who is exhibiting acute, sudden restlessness.
Identifying acute changes helps differentiate between baseline cognitive deficits and acute physiological distress (delirium).
2
Evaluate the safety risks associated with the client's current treatments.
Continuous nasojejunal feeding carries a high risk of aspiration if the client is positioned incorrectly. The restlessness creates a secondary risk of tube dislodgement.
Nursing priorities must center on airway protection (preventing aspiration) and maintaining vital medical therapies.
3
Identify the safest and least restrictive interventions for agitation.
Restraints are contraindicated as a first step. Camouflaging the tube hides it from the client's line of sight, reducing pulling behaviors without restricting movement.
Standards of care mandate utilizing the least restrictive alternative to maintain client safety and comfort.
4
Address the most likely root causes of the sudden restlessness.
Acute agitation is often triggered by basic unmet needs such as a full bladder, unmanaged pain, or hypoxia. Assisting with a urinal addresses a primary physiological trigger.
Treating the underlying cause of delirium is more effective and safer than sedating or restraining the client.

Anahtar Kavram

Basic Care and Comfort for Enteral Nutrition and Agitation
Soru 1118Soru →

A nurse is preparing to safely transfer a client who has generalized weakness from the bed to a wheelchair. In what order should the nurse perform the following actions? Arrange the steps in the correct sequence from first to last.

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct sequence is: Position and lock the wheelchair, assist the client to sit on the edge of the bed, apply the transfer belt, assist the client to stand, and finally pivot to the wheelchair.
A safe bed-to-chair transfer prioritizes client stability and proper nursing body mechanics. First, the environment must be prepared by positioning the wheelchair on the client's strong side and locking the brakes to prevent movement. Next, the client is assisted to a dangling position to prevent orthostatic hypotension. The transfer belt is then applied while the client is seated to ensure a snug fit. Once secured, the nurse assists the client to stand. Finally, the nurse and client pivot together, allowing the client to reach for the wheelchair armrests and safely sit.

Adım Adım Çözüm

1
Position the wheelchair on the strong side and lock the brakes.
The equipment is safely prepared.
Ensures the wheelchair will not move during the transfer, preventing falls.
2
Assist the client to sit on the edge of the bed.
The client is seated upright.
Allows the client to stabilize and prevents injury from orthostatic hypotension (dizziness).
3
Apply the transfer belt securely.
The nurse has a safe grasping point.
Provides stability and allows the nurse to support the client's center of gravity without pulling on their arms.
4
Assist the client to a standing position.
The client is safely standing.
Transitions the client to a weight-bearing position using the support of the transfer belt.
5
Pivot and guide the client into the wheelchair.
The client is safely seated in the wheelchair.
Completes the transfer with minimal twisting of the nurse's spine and safe seating for the client.

Anahtar Kavram

Safe Client Transfer and Mobility
Soru 1119Soru →

A nurse is preparing to administer a prescribed dose of intravenous (IV) phenytoin to a client who is experiencing active seizure activity. The client has a single peripheral IV line with a continuous infusion of 5%5\% dextrose in water (D5W). Which of the following is the most appropriate action for the nurse to take?

Cevabı ve açıklamayı göster

Cevap: Stop the primary infusion and flush the IV line with 0.9%0.9\% sodium chloride before and after administering the medication.

Cevap

The nurse should pause the primary 5%5\% dextrose in water (D5W) infusion and flush the IV line with 0.9%0.9\% sodium chloride before and after giving the phenytoin to prevent crystallization.
Phenytoin is highly incompatible with dextrose-containing solutions and will rapidly precipitate if mixed. To safely administer the medication through an existing IV line infusing 5%5\% dextrose in water (D5W), the nurse must pause the primary infusion and flush the line thoroughly with 0.9%0.9\% sodium chloride (normal saline) before and after the IV push.

Adım Adım Çözüm

1
Identify the compatibility of the prescribed medication (phenytoin) with the continuous IV fluid (D5W).
Phenytoin is highly incompatible with all dextrose-containing solutions.
Mixing phenytoin with D5W causes the medication to immediately precipitate and form microcrystals in the IV tubing.
2
Determine the safest and most efficient method to administer the medication using the existing IV access.
The nurse must stop the primary D5W infusion and flush the line thoroughly with 0.9%0.9\% sodium chloride.
Flushing the line with normal saline clears the tubing of dextrose, creating a compatible environment for the phenytoin IV push without unnecessarily delaying treatment to start a new IV line.

Anahtar Kavram

Intravenous Medication Compatibility and Safe Administration
Tahmini Süre:1m 0s
Soru 1120Soru →

A client with a documented history of severe chronic obstructive pulmonary disease (COPD) is brought to the emergency department by a caregiver. The caregiver reports that the client has become increasingly lethargic and confused over the past four hours. The healthcare provider orders an arterial blood gas (ABG) analysis on room air. Which of the following ABG results indicates an acute loss of compensatory mechanisms requiring immediate airway management?

Cevabı ve açıklamayı göster

Cevap: pH 7.24, PaCO2PaCO_2 76 mm Hg, HCO3−HCO_3^- 29 mEq/L, PaO2PaO_2 52 mm Hg

Cevap

The ABG result showing pH 7.24, PaCO2PaCO_2 76 mm Hg, HCO3−HCO_3^- 29 mEq/L, and PaO2PaO_2 52 mm Hg indicates an acute loss of compensatory mechanisms.
The correct answer demonstrates acute-on-chronic respiratory acidosis. The client's pH is significantly acidotic (7.24) combined with severe hypercapnia (PaCO2PaCO_2 76 mm Hg). While the bicarbonate (HCO3−HCO_3^-) is slightly elevated (29 mEq/L), reflecting underlying chronic compensation from long-standing COPD, it is entirely insufficient to buffer the acute spike in carbon dioxide. This uncompensated state, combined with the clinical presentation of lethargy and confusion, strongly suggests carbon dioxide narcosis and impending respiratory arrest.

Adım Adım Çözüm

1
Analyze the client's clinical presentation and medical history.
The client has severe COPD (chronic CO2CO_2 retainer) and presents with new-onset lethargy and confusion.
Lethargy and confusion in a COPD client are classic signs of carbon dioxide narcosis, indicating an acute inability to ventilate adequately.
2
Evaluate the ABG options for signs of acute-on-chronic respiratory failure.
Identify the set of values showing a significantly acidotic pH and an acutely elevated PaCO2PaCO_2 that exceeds the buffering capacity of the chronically elevated HCO3−HCO_3^-.
A client with severe COPD typically operates in a state of fully compensated respiratory acidosis (normal pH, high PaCO2PaCO_2, high HCO3−HCO_3^-). An acute exacerbation causes a sudden spike in PaCO2PaCO_2, causing the pH to drop dramatically because the kidneys cannot increase HCO3−HCO_3^- fast enough to compensate.
3
Select the ABG matching the uncompensated acute decline.
The correct ABG shows a pH of 7.24 (acidemia), a PaCO2PaCO_2 of 76 mm Hg (severe hypercapnia), and an HCO3−HCO_3^- of 29 mEq/L (inadequate chronic compensation for the acute event).
This specific combination confirms a life-threatening respiratory failure requiring immediate intervention, distinguishing it from the client's expected baseline.

Anahtar Kavram

Interpretation of Arterial Blood Gases (ABGs) in Acute-on-Chronic Respiratory Failure
ÖncekiSayfa 56 / 98Sonraki
Physiological Integrity Alıştırma Soruları — NCLEX-RN — Sayfa 56 | Examkin