Exhibits here

The nurse is implementing solutions to provide care.

Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.

The nurse determines that the client's is still having an adverse reaction resulting in symptoms of

Step-by-step Calculation:

1. We need to find the volume (in mL) of teriparatide that contains the desired dose of 60 mcg.
2. Set up the proportion:

dose (mcg) / concentration (mcg/mL) = volume (mL)

1. Fill in the known values:
   • Dose (mcg): 60 mcg (as given in the problem)
   • Concentration (mcg/mL): 750 mcg/2.4 mL (from the medication label)
2. Solve for the volume:
   • Multiply both sides of the proportion by the concentration to isolate the volume on the left:
   • dose (mcg) = volume (mL) concentration (mcg/mL)
   • Substitute the known values:
   • 60 mcg = volume (mL) (750 mcg / 2.4 mL)
3. Calculate the volume:
   • Divide both sides by the concentration to solve for the volume:
   • volume (mL) = 60 mcg / (750 mcg / 2.4 mL)
   • Simplify:
   • volume (mL) = (60 mcg 2.4 mL) / 750 mcg
   • volume (mL) = 0.192 mL (approximately)
4. Rounding (optional): The problem specifies rounding to the nearest tenth. Since 0.192 is closer to 0.2 than 0.1, the rounded volume is:
5. volume (mL) = 0.2 mL (rounded to one decimal place)

Therefore, the nurse should administer 0.2 mL of teriparatide.

A. Increase the fractional concentration of Inspired oxygen: As the partial pressure of oxygen (PaO) has decreased to 64 mm Hg from 99 mm Hg, and the oxygen saturation may drop, it's necessary to increase the fraction of inspired oxygen (FiO2) to maintain adequate oxygenation.
B. Change the ventilator settings to continuous positive airway pressure (CPAP): CPAP is not typically used in patients who are intubated. CPAP is a non-invasive ventilation mode used for patients with respiratory distress who are breathing spontaneously. In this case, the patient is intubated and requires mechanical ventilation, so CPAP is not appropriate.
C. Increase the respiratory rate: While the respiratory rate has decreased from 15 to 13 breaths/minute, it's important to maintain a careful balance when adjusting ventilator settings. Increasing the respiratory rate may not be necessary at this point, especially if the patient is still oxygenating adequately. Moreover, the primary concern appears to be hypoxemia rather than hypoventilation.
D. Continue weaning the ventilator as ordered: While weaning the patient off the ventilator is a goal, it may not be appropriate at this time, especially with the worsening blood gas values
indicating respiratory insufficiency. Continuing the weaning process could potentially exacerbate respiratory failure.

E. Decrease the tidal volume: Decreasing the tidal volume could worsen ventilation-perfusion matching and exacerbate hypoxemia. This approach might be considered in certain cases of acute respiratory distress syndrome (ARDS) or in patients with severe lung injury, but it's not typically indicated in this scenario without further assessment.

F. Alert the provider of the blood gas values: The nurse should inform the provider about the changes in blood gas values, especially the decrease in PaO2 and the increase in PaCO2, which indicate worsening respiratory status and potential respiratory acidosis.

G. Switch the ventilator to pressure control: Given the deterioration in respiratory status with an increase in PaCO2 and decrease in PaO2, switching to pressure control ventilation may provide better control over the patient's ventilation and oxygenation, especially in cases of acute
respiratory failure.