A client weighing 198 lbs is prescribed Dopamine hydrochloride IV at 2 mcg/kg/minute to promote renal perfusion.

The pharmacy provides a pre-mixed bag of dopamine containing 400 mg in 250 mL dextrose 5% in water (D5W). An IV pump that provides a precision infusion rate to a tenth of a mL is available.

How many mL/hour should the IV pump be set to deliver? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

Answer and Explanation

The Correct Answer is ["6.8"]

Step 1: Convert the client’s weight from lbs to kg. 1 kg is approximately 2.2 lbs. So, 198 lbs ÷

2.2 = 90 kg (rounded to the nearest whole number).

Step 2: Calculate the total mcg of Dopamine needed per minute. The prescription is for 2 mcg/kg/minute. So, 90 kg × 2 mcg/kg/minute = 180 mcg/minute.

Step 3: Convert the total mcg of Dopamine in the bag to mcg/mL. The bag contains 400 mg of Dopamine in 250 mL. 1 mg is equal to 1000 mcg. So, 400 mg × 1000 = 400,000 mcg. Therefore, the concentration is 400,000 mcg ÷ 250 mL = 1600 mcg/mL.

Step 4: Calculate the mL of Dopamine needed per minute. So, 180 mcg/minute ÷ 1600 mcg/mL

= 0.1125 mL/minute.

Step 5: Convert mL/minute to mL/hour. There are 60 minutes in an hour. So, 0.1125 mL/minute × 60 = 6.75 mL/hour. The IV pump should be set to deliver 6.8 mL/hour (rounded to the nearest tenth).

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Correct Answer is A

Explanation

Choice A rationale
Testing the fluid on the dressing for glucose is the immediate action the nurse should take. Clear fluid could be cerebrospinal fluid (CSF), which is often released following spinal surgery. CSF contains glucose, so a positive glucose test would confirm it is CSF.
Choice B rationale
Replacing the dressing using a compression bandage is not the immediate action the nurse should take. While it is important to manage the drainage and prevent infection, the nurse first needs to identify what the clear fluid is.
Choice C rationale
Marking the drainage area with a pen and continuing to monitor is not the immediate action the nurse should take. While this can be part of ongoing wound care and monitoring, the nurse first needs to identify what the clear fluid is.

Choice D rationale
Documenting the findings in the electronic medical record is an important step, but it should not be the immediate action. The nurse first needs to identify what the clear fluid is, as it could indicate a complication from the surgery.

A. Maintain nasal packing. B. Monitor intake and output. C. Provide frequent oral care. D. Keep the head of the bed elevated to 30 degrees.

Correct Answer is D

Explanation

Choice A rationale
Maintaining nasal packing is important after a hypophysectomy, especially if the surgery was performed through the nose (transnasal). However, it is not the most important intervention for a patient with Cushing’s disease in the post-anesthesia care unit (PACU)4.
Choice B rationale
Monitoring intake and output is a standard nursing intervention in the PACU. It helps assess the patient’s fluid balance and kidney function. However, it is not the most important intervention for a patient with Cushing’s disease following a hypophysectomy.
Choice C rationale
Providing frequent oral care is important for patient comfort and prevention of infections, but it is not the most important intervention for a patient with Cushing’s disease in the PACU following a hypophysectomy.

Choice D rationale
Keeping the head of the bed elevated to 30 degrees is the most important intervention for a patient with Cushing’s disease in the PACU following a hypophysectomy. This position helps reduce swelling, decreases the risk of aspiration, and promotes effective breathing and drainage.

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Naxlex Comprehensive Predictor Exams

The nurse notices the presence of clear fluid on the surgical dressing of a patient who has just returned to the unit following lumbar spinal surgery. What immediate action should the nurse take?

Correct Answer is A

Explanation

The nurse is monitoring a patient with Cushing’s disease in the post-anesthesia care unit (PACU) following a hypophysectomy. Which intervention is most important for the nurse to include in the patient’s plan of care?

Correct Answer is D

Explanation

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The nurse is preparing a client with breast cancer for BRCA1 and BRCA2 genetic testing. Which pathophysiological process should the nurse use to support client teaching?

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Restricted activity is prescribed for a client with Crohn’s disease. What is the primary purpose of the activity restriction?

A nurse notices clear fluid on the surgical dressing of a patient who has just returned from lumbar spinal surgery. What should be the nurse’s immediate course of action?