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.)

The correct answer is choiceB. Confirm that the gown is tied securely at the neck and waist.

Choice A rationale:

Reminding the UAP to wash hands frequently while in the room is important for infection control, but it is not the immediate priority in this scenario. The UAP has already donned gloves, which are part of the personal protective equipment (PPE) required for contact precautions. Hand hygiene is crucial before and after patient contact and after removing gloves, but ensuring the gown is properly secured takes precedence to prevent contamination.

Choice B rationale:

Confirming that the gown is tied securely at the neck and waist is essential to ensure that the UAP is fully protected from potential contamination.A properly secured gown prevents the UAP’s clothing from coming into contact with the patient or contaminated surfaces, which is critical in maintaining effective contact precautions.

Choice C rationale:

Assisting the UAP with the application of a face mask or face shield is necessary for droplet or airborne precautions, not specifically for contact precautions.Since the scenario involves contact precautions, the focus should be on the gown and gloves.

Choice D rationale:

Helping the UAP reposition the gown sleeve over the glove edges is not necessary because the UAP has already secured the tops of the gloves over the gown sleeves.This method is appropriate as it prevents the sleeves from becoming contaminated.

Clinical Rationale

Choice B (Correct): To ensure a proper seal and maintain the prescribed $FiO_2$, the mask must be secured over the bridge of the nose first, then pulled down to cover the mouth and chin. A snug fit prevents oxygen from leaking toward the eyes, which can cause irritation, and ensures the client receives the full benefit of the oxygen therapy.

Choice A (Incorrect): Simple face masks used in acute care are generally disposable, single-patient-use items. Cleaning them with soap and water is not standard practice and could introduce contaminants or moisture that compromises the equipment.

Choice C (Incorrect): A client with an oxygen saturation of 89% is hypoxic and requires continuous supplemental oxygen. Taking frequent "breaks" would cause the saturation to drop further, potentially leading to respiratory distress or cardiac strain.

Choice D (Incorrect): For an oxygen mask to be effective, it must cover both the nose and the mouth. Leaving the nose exposed allows the client to inhale room air (21% oxygen), which dilutes the supplemental oxygen and fails to reach the desired therapeutic level.

Choice E (Incorrect): Oxygen is a medication that requires a provider's order. While a nurse may titrate oxygen based on specific standing orders (e.g., "titrate to keep $SpO_2$ > 92%"), a nurse cannot unilaterally "adjust" levels without a protocol or direct order in place.