A nurse is planning care for a client who has a central venous access device for intermittent infusions.

Which of the following actions should the nurse include in the plan of care?

Use an aseptic technique when changing the dressing.

Cleanse the site with povidone-iodine.

Flush the catheter using a 10-mL syringe.

Change the dressing every 24 hours.

Answer and Explanation

The Correct Answer is A

The aseptic technique is important to prevent infection when changing the dressing of a central venous access device.
Choice B is not correct because povidone-iodine is not always the recommended cleansing agent for central venous access devices.
Choice C is not correct because a 10-mL syringe may generate too much pressure and damage the catheter.
Choice D is not correct because the dressing does not always need to be changed every 24 hours; the frequency of dressing changes depends on the type of dressing and the condition of the site.

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Correct Answer is A

Explanation

A decrease in the Glasgow Coma Scale (GCS) score indicates a decline in the client’s level of consciousness and neurological function.
This can be a sign of increased intracranial pressure or other complications related to the skull fracture.
Choice B is incorrect because an increase in WBC count may indicate an infection, but it is not as concerning as a decrease in GCS score.
Choice C is incorrect because a change in pulse pressure may indicate changes in cardiovascular function, but it is not as concerning as a decrease in GCS score.
Choice D is incorrect because a change in pupil diameter may indicate changes in neurological function, but it is not as concerning as a decrease in GCS score.

A. 33 mL/hr. B. 100 mL/hr. C. 200 mL/hr. D. 400 mL/hr.

Correct Answer is C

Explanation

Step 1: 100 mL ÷ 30 min

Step 2: (100 mL ÷ 30 min) × 60 min/hr

Step 3: 3.33 mL/min × 60 min/hr

Answer: 200 mL/hr

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A nurse is planning care for a client who has a central venous access device for intermittent infusions. Which of the following actions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client admitted with a skull fracture. Which of the following assessment findings should be of greatest concern to the nurse?

Correct Answer is A

Explanation

A nurse is preparing to administer piperacillin 3.375 g by intermittent IV bolus every 6 hr. Available in piperacillin 3.375 g in dextrose 5% in water (DsW) 100 mL to infuse over 30 min. The nurse should set the IV pump to deliver how many mL/hr?

Correct Answer is C

Explanation

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A nurse is planning care for a client who has a central venous access device for intermittent infusions.

Which of the following actions should the nurse include in the plan of care?