A Nurse is preparing to start a heparin drip on a client with acute coronary syndrome. Ordered: Give Heparin 1000 units per hour, standard dilution of 25,000 units in 250 mL of normal saline. What is the correct drip setting for the pump in mL/hr?

Answer and Explanation

The Correct Answer is ["10"]

Determine the heparin concentration:
- You have 25,000 units of heparin in 250 mL of normal saline.
- Concentration = 25,000 units / 250 mL = 100 units/mL
Calculate the mL/hr rate:
- The order is for 1,000 units/hour.
- Drip rate (mL/hr) = 1,000 units/hour / 100 units/mL = 10 mL/hour

Answer = 10mL/hr

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

Explanation

A. Assessing for acute pain is unnecessary. Sinus bradycardia is not typically associated with acute pain unless another condition, such as myocardial infarction, is present.
B. Monitoring fluid volume excess is incorrect. Sinus bradycardia is not directly related to fluid overload; however, fluid status may need to be monitored in clients with underlying cardiac conditions.
C. Prevention of falls is correct. Bradycardia can lead to dizziness, hypotension, and syncope, increasing the risk of falls.
D. Monitoring heart rate and rhythm is correct. Continuous monitoring is essential to detect any worsening bradycardia or associated arrhythmias.
E. Assessing for neurologic changes is correct. Bradycardia can reduce cerebral perfusion, leading to symptoms such as confusion, dizziness, or syncope.

A. Amiodarone administration B. Defibrillation C. Epinephrine administration D. Synchronized Cardioversion

Correct Answer is B

Explanation

A. Amiodarone is an antiarrhythmic medication used after defibrillation and CPR in persistent ventricular fibrillation (VF) or ventricular tachycardia (VT). However, it is not the first priority.
B. Defibrillation is the immediate priority in a pulseless client with ventricular fibrillation. Early defibrillation increases the chances of survival. The shock should be delivered as soon as possible.
C. Epinephrine is given after the first defibrillation and CPR cycle, not before.
D. Synchronized cardioversion is inappropriate because it is used for unstable tachyarrhythmias with a pulse, not pulseless VF.

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A Nurse is preparing to start a heparin drip on a client with acute coronary syndrome. Ordered: Give Heparin 1000 units per hour, standard dilution of 25,000 units in 250 mL of normal saline. What is the correct drip setting for the pump in mL/hr?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has undergone diagnostic testing and received a diagnosis of sinus bradycardia. Which interventions are most appropriate and should be included in the client's plan of care? (SELECT ALL THAT APPLY)

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

Explanation

A nurse is caring for a client with chest pain who becomes unresponsive. The client is pulseless and apneic. The code team places the client on the monitor, which indicates ventricular fibrillation. What is the next priority action?

Correct Answer is B

Explanation

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