The healthcare provider (HCP) prescribes diazepam 8 mg IM every 4 hours PRN for muscle spasms for a client with a fractured femur. The available vial is labeled "Diazepam Injection, USP 10 mg/2 mL." How many mL should the nurse administer to the client?

(Enter numerical value only. If rounding is required, round to the nearest tenth.)

Choice A reason: Administering medications as prescribed is a critical intervention for this client experiencing an acute asthma exacerbation. The prescribed medications, including albuterol and ipratropium bromide via nebulizer, act to relieve bronchospasm and improve airflow. Albuterol, a beta-2 adrenergic agonist, works by relaxing smooth muscles in the airway, while ipratropium, an anticholinergic, reduces mucus production and further enhances bronchodilation. Prednisone, a corticosteroid, reduces airway inflammation and prevents progression of the attack. Administering these medications promptly addresses the underlying pathophysiology of the asthma attack, improves oxygenation, and reduces the risk of complications like hypoxemia or respiratory failure. This is an essential and time-sensitive step in the client’s care.

Choice B reason: Providing client teaching is essential to address both immediate and long-term care needs. Education should focus on the correct use of inhalers, the importance of monitoring expiration dates, and adherence to prescribed medications. The nurse should explain proper inhalation techniques, the role of maintenance medications in preventing exacerbations, and the importance of identifying and avoiding triggers such as outdoor allergens and exercise without premedication. Additionally, discussing early signs of asthma worsening and when to seek medical attention can empower the client to better manage their condition and prevent severe exacerbations in the future. This intervention ensures the client has the tools to reduce recurrence and improve quality of life.

Choice C reason: Notifying the healthcare provider of the client's need for intubation is unnecessary at this stage based on the assessment data. While the client is in respiratory distress, indicated by increased respiratory rate and low oxygen saturation, they remain alert and responsive, with expiratory wheezes present—a sign that air is moving through the lungs. Intubation is reserved for clients in severe respiratory failure who are unable to maintain oxygenation or ventilation despite aggressive interventions. Administering nebulized medications and corticosteroids should stabilize the client and resolve the acute symptoms, making this action premature and inappropriate.

Choice D reason: Placing the client in the Trendelenburg position is contraindicated in asthma management and respiratory distress. The Trendelenburg position involves lowering the head of the bed and elevating the feet, which could worsen breathing by increasing pressure on the diaphragm, reducing lung expansion, and exacerbating hypoxemia. The preferred position for clients in respiratory distress is a high Fowler’s position, which promotes optimal lung expansion and improves oxygenation. The Trendelenburg position is used for specific conditions like shock or hypotension but has no role in managing asthma exacerbations.

Choice E reason: Asking the client for a list of current medications is a vital step in obtaining an accurate medication history and identifying potential factors contributing to the asthma exacerbation. An expired rescue inhaler suggests possible gaps in medication adherence or management. Understanding the client’s current medications, including any maintenance inhalers or allergy treatments, helps the healthcare team adjust the treatment plan effectively. Additionally, this step ensures that new prescriptions do not conflict with existing medications, reducing the risk of adverse interactions. It also highlights any missed preventive measures, such as maintenance therapy with inhaled corticosteroids, which can significantly reduce the frequency and severity of asthma attacks.

Condition:

Postoperative infection

2 Actions:

1. Administer prescribed antibiotics.
2. Culture wound drainage.

2 Parameters:

1. Temperature.
2. White blood cell count.

Rationale for correct condition:

A postoperative infection is the most likely condition because the patient has elevated white blood cell count (11,000/mm³) and a slightly elevated temperature (99.8°F). These findings suggest a systemic inflammatory response, potentially from infection. The presence of a recent surgical wound increases the risk of bacterial contamination. The absence of redness or drainage does not rule out deeper tissue infection. The patient’s symptoms align with early signs of an infectious process.

Rationale for the two correct actions:

1. Administer prescribed antibiotics: Antibiotics target potential bacterial infection, which is critical to prevent further complications such as systemic infection or sepsis.
2. Culture wound drainage: This identifies the causative organism and guides appropriate antibiotic therapy. Even if the wound appears clean externally, culturing can confirm or rule out deeper infection.

Rationale for parameters to monitor:

1. Temperature: Monitoring temperature helps identify trends in fever, a common sign of infection progression or resolution.
2. White blood cell count: Elevated levels are a marker of infection or inflammation. Monitoring changes in WBC count can indicate if treatment is effective.

Rationale for incorrect conditions:

1. Surgical rash: A rash is not indicated in the notes, and the elevated WBC count and temperature do not suggest a dermatologic issue.
2. Contractures: No evidence suggests reduced mobility or positioning problems causing contractures.
3. Deep vein thrombosis (DVT): The client’s normal vital signs and lack of redness or swelling in the residual limb make DVT less likely.

Rationale for incorrect actions to take:

1. Request NPO prescription: There is no evidence of gastrointestinal issues or surgery requiring this intervention.
2. Elevate residual limb to reduce swelling: While useful in managing swelling, there is no current sign of significant limb edema requiring elevation.
3. Educate on incentive spirometer use: This is preventive for respiratory complications but unrelated to infection management.

Rationale for incorrect parameters to monitor:

1. Adherence to activity prescription: While important for recovery, it does not directly address infection.
2. Residual limb redness or swelling: Although relevant to infection, there is no current evidence of redness or swelling in the notes.
3. Pain intensity and characteristics: Pain is already being managed with morphine, and its current level (5/10) does not directly indicate infection.