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The nurse must give 25 micrograms of fentanyl IVP X1 dose. Fentanyl is available in an ampule 100 micrograms per 2m How many mL will the nurse give for the correct dose?

round to the nearest tenth. Use a preceding zero if necessary. Do not use trailing zeros.

Answer and Explanation

The Correct Answer is ["0.5"]

Step 1: Identify the available concentration of fentanyl.

The ampule contains 100 micrograms of fentanyl in 2 mL.

Step 2: Determine the dose required.

The nurse needs to give 25 micrograms of fentanyl.

Step 3: Calculate the volume (mL) needed for the required dose.

Use the formula: (Dose required ÷ Dose available) × Volume of available dose.

Step 4: Substitute the values into the formula.

(25 micrograms ÷ 100 micrograms) × 2 mL

Step 5: Perform the division.

25 micrograms ÷ 100 micrograms = 0.25

Step 6: Perform the multiplication.

0.25 × 2 mL = 0.5 mL

Result: The nurse will give 0.5 mL for the correct dose.

Final Answer: 0.5 mL

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Correct Answer is B

Explanation

Choice B Reason: Assess for environmental triggers and potential unmet needs.

Choice A Reason:

Consulting the interdisciplinary team regarding behavior modification techniques is important for long-term management of behavioral problems in clients with major neurocognitive disorder. However, it is not the immediate priority when a client is exhibiting acute behavioral escalation. Immediate assessment and intervention are necessary to address the current situation and ensure the client’s safety.

Choice B Reason:

Assessing for environmental triggers and potential unmet needs is the priority in this scenario. Clients with major neurocognitive disorder often exhibit behavioral problems due to unmet needs or environmental factors that they cannot communicate effectively. Identifying and addressing these triggers can help de-escalate the situation and prevent further agitation. This approach aligns with evidence-based practice, which emphasizes understanding the underlying causes of behavioral issues to provide appropriate interventions.

Choice C Reason:

Assessing for potential injury to the client’s arms, legs, and back is crucial, especially if the client is on the ground and exhibiting aggressive behavior. However, this assessment should follow the initial step of identifying and addressing environmental triggers and unmet needs. Ensuring the client’s immediate safety by understanding the cause of their behavior is the first priority.

Choice D Reason:

Anticipating the behavior and physically restraining the client when pacing begins is not recommended as the first line of action. Physical restraint should be a last resort due to the potential for causing harm and increasing the client’s agitation. Instead, non-pharmacological interventions, such as identifying triggers and unmet needs, should be prioritized to manage the behavior safely and effectively.

A. Have a poor prognosis. B. Are not improving and may be getting worse. C. Are questioning the hallucination and want reassurance from the nurse. D. Will begin to enter the manic phase of their illness.

Correct Answer is C

Explanation

Choice A Reason: Have a poor prognosis

A poor prognosis in schizophrenia is typically associated with persistent and severe symptoms, lack of response to treatment, and significant functional impairment. While the client’s statement about hearing voices is concerning, it does not necessarily indicate a poor prognosis on its own. Prognosis in schizophrenia is multifactorial and depends on various factors, including the duration of untreated psychosis, adherence to treatment, and the presence of supportive social networks.

Choice B Reason: Are not improving and may be getting worse

This choice suggests that the client’s condition is deteriorating. While the presence of hallucinations can indicate a lack of improvement, it is important to consider the context. The client’s ability to question the hallucination and seek reassurance from the nurse suggests a level of insight that is often associated with better outcomes. Insight into one’s condition is a positive prognostic factor in schizophrenia.

Choice C Reason: Are questioning the hallucination and want reassurance from the nurse

This is the correct answer. The client’s question indicates that they are aware that the voices might not be real and are seeking reassurance from the nurse. This level of insight is crucial in managing schizophrenia, as it can lead to better adherence to treatment and improved outcomes. Insight into the nature of hallucinations and delusions is often a sign of a more favorable prognosis.

Choice D Reason: Will begin to enter the manic phase of their illness

Mania is characterized by elevated mood, increased activity, and other symptoms such as decreased need for sleep and grandiosity. It is more commonly associated with bipolar disorder than schizophrenia. The client’s statement about hearing voices predicting their death does not align with the typical presentation of mania. Therefore, this choice is not applicable in this context.

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The nurse must give 25 micrograms of fentanyl IVP X1 dose. Fentanyl is available in an ampule 100 micrograms per 2m How many mL will the nurse give for the correct dose? round to the nearest tenth. Use a preceding zero if necessary. Do not use trailing zeros.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client diagnosed with major neurocognitive disorder is exhibiting behavioral problems. At the change of shift, the client’s behavior escalates from pacing in the hallway to screaming and waving their arms while on the ground. Which of the following represents a priority for the nurse?

Correct Answer is B

Explanation

After being in the hospital for one month, a client with schizophrenia states that voices are telling them they will die tonight. The client asks the nurse if this is true. The client’s statement and question indicate that they:

Correct Answer is C

Explanation

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The nurse must give 25 micrograms of fentanyl IVP X1 dose. Fentanyl is available in an ampule 100 micrograms per 2m How many mL will the nurse give for the correct dose?

round to the nearest tenth. Use a preceding zero if necessary. Do not use trailing zeros.