Client is admitted following cerebrovascular accident (CVA). Client is alert and oriented. Heart rate regular. Respirations rapid and non-labored. Wheezing auscultated in upper lobes of the lungs. Client is receiving 2 U/min of oxygen via nasal cannula. Right upper and lower extremities flaccid with decreased muscle tone and strength.

Client sitting up in a chair for lunch. Client states they are right-handed and are having difficulty feeding themselves.

For which of the following interprofessional team members should the nurse anticipate a provider's referral?

Select all that apply.

Case manager

Respiratory therapist

Diabetes nurse educator

Physical therapist

Occupational therapist

Answer and Explanation

Correct Answer : D,E

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Correct Answer is C

Explanation

A.Medications and blood should never be mixed in the same line because it can cause reactions, interference with the blood product, and complications for the client. Medications should be administered through a separate IV line or a port further away from the client.

B.Blood transfusions should typically be completed within 2 to 4 hours to reduce the risk of bacterial contamination and ensure that the blood does not exceed a safe infusion duration.

C.Y tubing is commonly used for blood transfusions, where one arm of the Y is used for the packed RBCs and the other is for normal saline. Normal saline is used to flush the line before and after administering blood, ensuring the infusion is free of air and that the blood flows smoothly without clotting.

D.The drip chamber should not be completely filled with blood. It should have a small amount of blood for monitoring the infusion rate, but the filter within the drip chamber is designed to filter any clots or debris. A completely filled chamber with blood can make it difficult to assess the flow rate, and could indicate that the blood is not flowing properly.

Correct Answer is ["125"]

Explanation

To determine the mL/hr rate for the IV pump, we need to calculate the infusion rate of the

potassium chloride solution. Given:

Potassium chloride concentration: 40 mEq in 500 mL Infusion rate: 10 mEq/hr

We can set up a proportion to find the mL/hr rate:

(40 mEq / 500 mL) = (10 mEq / x mL) Cross-multiplying the equation:

40 mEq * x mL = 500 mL * 10 mEq Simplifying:

40x = 5000

Dividing both sides by 40:

x = 5000 / 40

x ≈ 125

Therefore, the nurse should set the IV pump to deliver approximately 125 mL/hr.

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Naxlex Comprehensive Predictor Exams

A nurse is monitoring a client who is receiving packed RBCs. The nurse identifies which of the following as an expected finding?

Correct Answer is C

Explanation

A nurse is preparing to administer 40 mEq of potassium chloride in 45% sodium chloride (NaCl) 500 mL IV to infuse 10 mEq/hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["125"]

Explanation

A nurse is organizing interprofessional team members to meet the needs of a client. Which of the following roles is the nurse taking?

A nurse is reviewing a client's laboratory values and discovers the client has a serum potassium of 6.2 mEq/L. Which of the following interventions should the nurse anticipate?

A nurse is caring for four hospitalized clients. Which of the following clients should the nurse identify as being at risk for fluid volume deficit?

A nurse is monitoring a client who is receiving a blood transfusion. Which of the following findings indicates an allergic transfusion reaction?

A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply.)

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?

A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply.)

A nurse is reviewing the arterial blood gas values for a client. The pH is 7.32, PaCO2 48 mm Hg and the HCO, is 23 mEq/L. The nurse should recognize that these findings indicate of which of the following acid base balances?