A nurse is calculating the fluid intake for an infant at the end of an 8-hr shift. For oral intake, the infant had 10 mL of medication, 3 oz of formula, and 2 oz of juice. In addition, the infant had IV fluid infusing at 20 mL/hr via an IV pump. The nurse should record how many mL of intake on the clients record? (Round the answer to the nearest whole number.)
310 mL
390 mL
320 mL
180 mL
The Correct Answer is C
To calculate:
1. Convert units:
1 oz = 30 mL
3 oz formula = 3 oz x 30 mL/oz = 90 mL
2 oz juice = 2 oz x 30 mL/oz = 60 mL
2. Calculate total oral intake:
Total oral intake = 10 mL (medication) + 90 mL (formula) + 60 mL (juice) = 160 mL
3. Calculate IV fluid intake:
IV fluid intake = 20 mL/hr x 8 hr = 160 mL
4. Calculate total fluid intake:
Total fluid intake = 160 mL (oral) + 160 mL (IV) = 320 mL
Answer: 320 mL
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Gamma globulin
Gamma globulin is a blood product used to provide passive immunity by supplying antibodies to prevent or treat certain infections. It is not used for digitalis toxicity, so A is incorrect.
B) Cardizem
Cardizem (diltiazem) is a calcium channel blocker primarily used for controlling heart rate and treating conditions such as atrial fibrillation or angina. It is not used as an antidote for digoxin toxicity, so B is incorrect.
C) Protamine
Protamine is a medication used to reverse the effects of heparin, an anticoagulant. It works by neutralizing the anticoagulant activity of heparin, but it is not used to treat digitalis (digoxin) toxicity, so C is incorrect.
D) Digoxin immune fab
Digoxin immune fab is the specific antidote for digoxin toxicity. It consists of antibodies that bind to digoxin molecules, thereby neutralizing their toxic effects on the heart. This antidote is used when a patient exhibits severe symptoms of digoxin toxicity, such as arrhythmias or life-threatening effects on the heart. Therefore, D is the correct answer.
Correct Answer is C
Explanation
A) Bradycardia
Bradycardia (a slow heart rate) is not the most common response to nitroglycerin (NTG). While NTG can affect heart rate in some individuals, its primary action is related to blood vessels, and it typically leads to vasodilation, which more commonly results in reflex tachycardia (an increased heart rate), rather than bradycardia.
B) Tachycardia
Tachycardia (an increased heart rate) can occur as a compensatory mechanism when nitroglycerin causes vasodilation and a decrease in blood pressure. However, this is more of a secondary effect. The primary action of nitroglycerin is to lower blood pressure (by dilating blood vessels), and in response to the lowered blood pressure, the body may try to compensate by increasing the heart rate.
C) Hypotension
The most common and primary response to nitroglycerin (NTG) administration is hypotension. Nitroglycerin works by relaxing smooth muscle in blood vessels, leading to vasodilation (widening of blood vessels). This reduces the amount of work the heart has to do and lowers the overall blood pressure. Hypotension is expected as part of the therapeutic effect of NTG, especially with a larger dose or rapid administration (e.g., sublingual NTG).
D) Dry mouth
While many medications can cause dry mouth (especially anticholinergic drugs), nitroglycerin is not typically associated with this issue. Its primary action is vasodilation, and while it can cause other symptoms like headaches, dizziness, and hypotension, dry mouth is not considered a common or significant effect.
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