A nurse is preparing to administer hydrocortisone 100 mg IM daily to a client. Available is hydrocortisone 250 mg/2 mL. How many mL should the nurse administer per dose?

(Round the answer to the nearest tenth number. Use a leading zero if it applies. Do not use a trailing zero.)

Answer and Explanation

The Correct Answer is ["0.8"]

To calculate the amount of mL to administer, the nurse should use the following formula:

(mg ordered / mg available) x mL available = mL to administer

Substituting the values from the question, the nurse should do the following:

(100 mg / 250 mg) x 2 mL = 0.8 mL

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Correct Answer is B

Explanation

Suctioning is the priority observation in the client's care, as it prevents airway obstruction and respiratory distress caused by blood, mucus, or secretions. The client has a permanent tracheostomy and cannot cough or clear the airway eﬀectively. The nurse should assess the need for suctioning frequently and perform it as needed, using sterile technique and maintaining oxygenation.

a) Patency of the intravenous line is important, but not the priority observation in the client's care. The intravenous line provides ﬂuids, electrolytes, and medications to the client, but it does not aﬀect the airway patency or oxygenation.
c) Integrity of the dressing is important, but not the priority observation in the client's care. The dressing protects the surgical site from infection and bleeding, but it does not aﬀect the airway patency or oxygenation.
d) Level of pain is important, but not the priority observation in the client's care. The pain can be managed with analgesics and nonpharmacological measures, but it does not aﬀect the airway patency or oxygenation.

A. A client who has had radiation therapy for head and neck cancer B. A client who has had prolonged diarrhea C. A client who has had a cerebrovascular accident D. A client who has lactose intolerance E. A client who is 4 hr postoperative following a leg amputation with general anesthesia

Correct Answer is ["A","C","E"]

Explanation

These clients have impaired swallowing, gag reﬂex, or level of consciousness, which increase their risk of aspiration while eating.

The other options are not correct because:

b. A client who has had prolonged diarrhea does not have a direct risk factor for aspiration, as diarrhea aﬀects the lower gastrointestinal tract and not the upper airway or esophagus.

d. A client who has lactose intolerance does not have a risk factor for aspiration, as lactose intolerance causes abdominal cramps, bloating, gas, or diarrhea when consuming dairy products, but does not aﬀect the ability to swallow or protect the airway.

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A nurse is preparing to administer hydrocortisone 100 mg IM daily to a client. Available is hydrocortisone 250 mg/2 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth number. Use a leading zero if it applies. Do not use a trailing zero.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client following a total laryngectomy. Which of the following is the priority observation in the client's care?

Correct Answer is B

Explanation

A nurse is caring for a group of clients. Which of the following clients should the nurse identify as having an increased risk of aspiration while eating? (Select all that apply)

Correct Answer is ["A","C","E"]

Explanation

A nurse is caring for a client with a tracheostomy. The client's partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client's discharge?

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A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. Which of the following actions should the nurse take?

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A nurse is caring for a client who has a three-chamber closed chest tube system. Which of the following actions should the nurse take after noticing a rise in the water seal chamber with client inspiration?

A nurse is teaching a client who has tuberculosis and is to start medication therapy with isoniazid, rifampin, and pyrazinamide. Which of the following instructions should the nurse include?

A nurse is providing discharge teaching to a client who has asthma and a new prescription for ﬂuticasone/salmeterol. For which of the following adverse eﬀects should the nurse instruct the client to report to the provider?

A nurse is caring for a client who has just developed a pulmonary embolism. Which of the following medications should the nurse anticipate administering?

A nurse is preparing to administer hydrocortisone 100 mg IM daily to a client. Available is hydrocortisone 250 mg/2 mL. How many mL should the nurse administer per dose?

(Round the answer to the nearest tenth number. Use a leading zero if it applies. Do not use a trailing zero.)