A nurse is preparing to administer hydromorphone 2.5 mg. The available amount is 5 mg/5 mL elixir.

How many mL should the nurse administer?

Choice A rationale:

Administering the medications using a 3-mL medication syringe is not the best practice. While it is possible to use a 3-mL syringe for medication administration, it is not the most efficient or safest method. A larger syringe allows for easier administration and reduces the risk of creating too much pressure which could potentially damage the PEG tube.

Choice B rationale:

Applying firm pressure on the syringe’s piston to infuse the medication is not recommended. This can create too much pressure in the PEG tube and could potentially cause damage. It is generally advised to allow the medication to flow into the tube via gravity. Choice C rationale:

Flushing the tubing with 30 mL of saline after the medication has been given is the correct technique. This helps to ensure that all of the medication has been administered and also helps to keep the tube clear of any potential blockages.

Choice D rationale:

Using the barrel of the syringe, allowing the medication to flow via gravity into the tube is a common practice. However, it is not the only step in the process. It is also important to flush the tube before and after medication administration to ensure all medication is delivered and to maintain the patency of the tube.

The correct answer is Choice D.

Let’s go through the calculations step by step:

Step 1: Convert all the quantities to milliliters (mL), as the nurse needs to record the intake in mL. We know that 1 oz is approximately 29.5735 mL.

4 oz of juice = 4 × 29.5735 mL = 118.294 mL

6 oz of tea = 6 × 29.5735 mL = 177.861 mL 8 oz of broth = 8 × 29.5735 mL = 236.628 mL Step 2: Add all the quantities together:

118.294 mL (juice) + 177.861 mL (tea) + 100 mL (soda) + 150 mL (IV bolus) + 236.628 mL (broth) = 783.783 mL Step 3: Round off the total intake to the nearest whole number as required, which gives us 784 mL.

Therefore, the nurse should record 784 mL on the patient’s chart. However, this option is not available in the choices given. The closest option to this calculated value is 800 mL (Choice D).

Now, let’s discuss the rationales for each choice:

Choice A rationale:

500 mL would be an underestimate of the patient’s fluid intake. It does not account for all the fluids the patient consumed.

Choice B rationale:

600 mL, similar to Choice A, is an underestimate. It does not accurately represent the total volume of fluids the patient consumed. Choice C rationale:

700 mL is closer to the calculated intake but is still an underestimate. It does not fully account for all the fluids the patient consumed.

Choice D rationale:

800 mL is the closest option to the calculated intake of 784 mL. Although it’s slightly over the actual intake, it’s the best choice among the given options.