When entering a client's room to administer an 0900 IV antibiotic, the nurse finds that the client is engaged in sexual activity with a visitor. Which action should the nurse implement?

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. Provide only distilled water. Providing only distilled water is not appropriate in this situation.
The client's weight gain and electrolyte imbalance indicate the need for careful monitoring and intervention, but restricting fluid intake to distilled water alone may not address the underlying issues adequately.
B. Document abdominal girth. Documenting abdominal girth is important to assess for signs of ascites, which can occur in hepatic failure. A sudden weight gain and elevated blood pressure may indicate fluid retention, and documenting abdominal girth can provide additional information about fluid accumulation in the abdomen.
C. Offer a high protein diet. While nutritional support is important for clients with hepatic failure, offering a high protein diet may not be appropriate if the client has an electrolyte imbalance. Protein intake should be balanced and monitored carefully to avoid exacerbating the imbalance.
D. Use a cushion when sitting. Using a cushion when sitting may be beneficial for comfort, but it does not directly address the identified issues of electrolyte imbalance, elevated blood pressure, and weight gain. The priority is to assess and address these concerns through appropriate
interventions such as documenting abdominal girth and addressing fluid retention.