Physiological Integrity

A client with a systemic fungal infection has a double-lumen peripherally inserted central catheter (PICC). The proximal lumen is dedicated to a continuous total parenteral nutrition (TPN) infusion. The distal lumen is infusing 0.9% sodium chloride with 20 mEq of potassium chloride at 75 mL/hr. The healthcare provider prescribes a daily intermittent intravenous (IV) infusion of amphotericin B deoxycholate. Which of the following actions by the nurse demonstrates the correct technique for administering this medication?

A nurse is caring for a client with acute decompensated heart failure who weighs $198 \text{ lbs}$. The healthcare provider prescribes a continuous intravenous (IV) infusion of milrinone at $0.375 \text{ mcg/kg/min}$. The pharmacy supplies milrinone as $20 \text{ mg}$ in $100 \text{ mL}$ of $5\% \text{ Dextrose}$ in water (D5W). At what rate, in $\text{mL/hr}$, should the nurse set the IV infusion pump? (Record answer to the nearest tenth.)

The charge nurse on a medical-surgical unit is reviewing the electronic health records of four assigned clients. Which client requires the most immediate assessment to reduce the risk of severe physiological deterioration?

A nurse is evaluating a $65$-year-old client admitted for a severe acute exacerbation of chronic obstructive pulmonary disease (COPD). The client is currently prescribed oxygen at $2$ L/min via nasal cannula. During the latest assessment, the nurse discovers that the client is extremely lethargic, difficult to arouse, and breathing at a shallow rate of $10$ breaths/min. The results of a stat arterial blood gas (ABG) draw are as follows:

* pH: $7.22$
* PaCO $_2$: $74$ mm Hg
* PaO $_2$: $58$ mm Hg
* HCO $_3^-$: $29$ mEq/L

To mitigate the risk of impending physiological decompensation, which of the following is the priority nursing action?

An adult client receiving volume-controlled mechanical ventilation suddenly exhibits profound clinical deterioration. The ventilator triggers continuous high peak airway pressure alarms. Simultaneously, the cardiac monitor displays a heart rate of $142$ beats per minute, and the arterial line shows a precipitous blood pressure drop to $68/38 \text{ mmHg}$. Arrange the following emergency nursing actions in the correct chronological sequence for managing this acute crisis.

A client receiving an intravenous infusion of vincristine reports severe pain and burning at the peripheral intravenous site. The nurse observes swelling and blanching around the insertion site. Arrange the following nursing actions in the correct sequence.

An $78$-year-old client with a history of heart failure is receiving a continuous intravenous (IV) infusion of furosemide and is scheduled for an intermittent IV push dose of digoxin. During the morning assessment, the client reports nausea, anorexia, and seeing "yellow halos" around the lights in the room. The nurse assesses an irregular apical heart rate of $52 \text{ beats/min}$. Based on these findings, which of the following is the priority nursing action?

A nurse is caring for a client with a confirmed pulmonary embolism who is receiving a continuous intravenous (IV) infusion of heparin at $18 \text{ units/kg/hr}$ through a single-lumen peripheral venous catheter. The healthcare provider prescribes a scheduled dose of IV levofloxacin $500 \text{ mg}$ to infuse over $60 \text{ minutes}$ for a concurrent bacterial pneumonia. Upon reviewing a pharmacological reference, the nurse discovers that heparin and levofloxacin are physically incompatible. Which of the following is the most appropriate action by the nurse?

A pediatric client with otitis media is prescribed amoxicillin $250 \text{ mg}$ by mouth every $8$ hours. The pharmacy dispenses an oral suspension labeled $125 \text{ mg} / 5 \text{ mL}$. Based on this information, how many milliliters ($\text{mL}$) should the nurse administer for each individual dose?

A nurse is monitoring a client who is receiving a transfusion of packed red blood cells. Ten minutes after the transfusion begins, the client reports sudden chills, severe lower back pain, and shortness of breath. Arrange the following nursing actions in the correct priority order to manage this situation from first to last.

A nurse is caring for a client with a T4 spinal cord injury. The client suddenly reports a severe, pounding headache, and the nurse notes profound facial flushing and diaphoresis above the level of the injury. The client's current blood pressure is 218/114 mm Hg. Arrange the following nursing interventions in the priority order they should be performed, from first to last.

A nurse is preparing to administer an intermittent intravenous (IV) antibiotic piggyback to a client who is receiving a continuous IV infusion of 0.9% sodium chloride. Which of the following nursing actions are required for safe administration? Select all that apply.

A nurse is providing care for a client who has just returned to the nursing unit following a lumbar puncture. Which of the following actions should the nurse take to reduce the risk of post-procedure complications?

A client in septic shock is receiving a continuous intravenous infusion of norepinephrine. The medication is formulated as $4 \text{ mg}$ of norepinephrine in $250 \text{ mL}$ of $5\%$ dextrose in water ($\text{D}_5\text{W}$) and is currently infusing via a peripheral intravenous line at $15 \text{ mL/hr}$. The client's mean arterial pressure (MAP) drops to $52 \text{ mm Hg}$. The healthcare provider prescribes an immediate dose titration to $8 \text{ mcg/min}$. During the assessment, the nurse observes that the peripheral intravenous insertion site is cool, pale, and edematous. Which of the following is the priority nursing action?

A registered nurse is developing a plan of care for an older adult client who is on strict bed rest due to a severe exacerbation of rheumatoid arthritis. The client has recently developed urinary incontinence and exhibits extremely dry, itchy skin on the upper extremities. Which of the following nursing interventions should be included in the basic care and comfort plan? Select all that apply.

A nurse is preparing to transfer a client who has left-sided hemiparesis from the bed to a wheelchair. In which order should the nurse perform the following actions? (Arrange the steps from first to last.)

A healthcare provider prescribes a continuous intravenous (IV) infusion of aminophylline at a rate of $0.5 \text{ mg/kg/hr}$ for a client experiencing a severe exacerbation of asthma. The client weighs $75 \text{ kg}$. The pharmacy supplies an IV bag containing aminophylline $500 \text{ mg}$ in $250 \text{ mL}$ of $0.9\% \text{ sodium chloride}$. At what rate, in $\text{mL/hr}$, should the nurse set the IV infusion pump? Record your answer rounding to the nearest tenth.

A nurse preceptor is observing a newly licensed nurse prepare and administer parenteral medications. Which of the following actions by the newly licensed nurse indicate a safety hazard and require the preceptor to intervene? Select all that apply.

While conducting hourly rounds, a nurse observes that the intravenous administration set has completely disconnected from a client's central venous catheter hub. The client abruptly exhibits severe dyspnea, a dry cough, and grasps their chest in distress. In which sequence must the nurse execute the following interventions? (Arrange the actions in order of clinical priority, from first to last.)

A client presents to the emergency department with a severe asthma exacerbation. The initial assessment reveals tachypnea with a respiratory rate of $34$ breaths/min and diffuse wheezing. An initial arterial blood gas (ABG) shows a pH of $7.52$, $PaCO_2$ of $28$ mm Hg, and $HCO_3^-$ of $24$ mEq/L. Two hours later, the client appears drowsy, wheezing is diminished, and the respiratory rate has decreased to $14$ breaths/min. A repeat ABG reveals a pH of $7.31$, $PaCO_2$ of $56$ mm Hg, and $HCO_3^-$ of $24$ mEq/L. Based on these findings, what is the most accurate clinical conclusion?