Calculation:

Total volume to be infused = 250 mL.

Infusion time = 2 hr.

• Calculate the infusion rate in milliliters per hour (mL/hr).

Infusion rate (mL/hr) = Total volume (mL) / Infusion time (hr)

= 250 mL / 2 hr

= 125 mL/hr.

A. Taking a telephone prescription about a client who is to be transferred from PACU: While receiving a PACU transfer report is important for care continuity, it is not the most urgent need. The transfer can wait until any potentially life-threatening issues with other clients are addressed.

B. Reassuring the partner of a client who sustained a closed head injury: Providing emotional support is an important aspect of nursing care, but it is not a higher priority than assessing a client with signs suggestive of a possible thromboembolic event.

C. Assessing a client who experiences unilateral calf pain when ambulating: Unilateral calf pain during ambulation may indicate deep vein thrombosis (DVT), which poses a risk for pulmonary embolism—a life-threatening condition. Prompt assessment and intervention are critical to prevent serious complications.

D. Reinforcing a client's dressing for the surgical site of an above-the-knee amputation: Reinforcing a dressing is important to prevent infection and maintain wound integrity, but unless there is active bleeding or signs of dehiscence, it is not more urgent than potential DVT symptoms.

Calculation:

Desired dose = 5 mg.

Available concentration = 1 mg/mL.

• Calculate the volume to administer.

Volume (mL) = Desired dose (mg) / Available concentration (mg/mL)

= 5 mg / 1 mg/mL

Calculation:

Desired dose = 5 mg.

Available concentration = 20 mg/mL.

• Calculate the volume to administer.

Volume (mL) = Desired dose (mg) / Available concentration (mg/mL)

= 5 mg / 20 mg/mL

= 0.25 mL.

A. Obtain a venous duplex ultrasound: This is the most appropriate diagnostic test to confirm or rule out deep vein thrombosis (DVT). It is non-invasive, reliable, and widely used to visualize blood flow and detect clots in the veins, particularly when symptoms like redness, warmth, and tenderness are present.

B. Obtain impedance plethysmography: Although it can be used to detect DVT by measuring changes in blood volume in the legs, it is less specific and sensitive than venous duplex ultrasound. It is typically used only when ultrasound is unavailable or inconclusive.

C. Apply cold therapy to the affected leg: Cold therapy is generally not recommended for suspected DVT because it may cause vasoconstriction and worsen venous stasis. Elevation and warm compresses are sometimes used but diagnostic testing is the priority.

D. Monitor Homan's sign: Homan's sign, which involves dorsiflexing the foot to elicit calf pain, is no longer considered reliable or safe due to poor sensitivity and the risk of dislodging a clot.

A. "Would you like to speak to a therapist after treatment?": While this offers a helpful resource, it does not address the client’s immediate emotional expression. Delaying support until after treatment misses the chance to explore current distress and ensure safety in the moment.

B. "If you do not like your medications, would you like to try an alternative?": This shifts focus away from the client’s emotional statement and assumes the issue is medication-related without first validating or exploring the client’s feelings of hopelessness and loss.

C. "You would like more information. I will get that for you right away.": This response misinterprets the client’s emotional expression as a request for information, missing an opportunity to reflect and support the client through a serious psychological concern.

D. "You feel like you have no remaining options and are struggling to find a solution.": This therapeutic response reflects and validates the client’s emotions, helping the client feel heard and opening the door for further exploration of suicidal ideation or other serious concerns.

A. Ascites:Ascites is fluid accumulation in the abdominal cavity, typically associated with liver failure or severe right-sided heart failure. It is not a hallmark finding of pulmonary edema, which affects the lungs rather than the abdomen.

B. Jugular vein distention:JVD indicates increased central venous pressure, often resulting from left-sided heart failure progressing to right-sided overload. It is a common sign in pulmonary edema due to fluid backup in the circulation.

C. Pink frothy sputum:This is a classic and critical indicator of pulmonary edema. It results from fluid leaking into the alveoli, mixing with air and blood. It signifies severe fluid overload and impaired gas exchange in the lungs.

D. Edema of the extremities:Peripheral edema reflects fluid retention and increased hydrostatic pressure. It commonly accompanies pulmonary edema, especially when heart failure is the underlying cause, due to systemic volume overload.

E. Tachypnea:Rapid breathing occurs as a compensatory response to impaired oxygenation. In pulmonary edema, fluid-filled alveoli reduce gas exchange efficiency, leading to hypoxia and increased respiratory rate.

F. Atelectasis:Atelectasis is the collapse of alveoli and can occur with many respiratory conditions, but it is not specific to pulmonary edema. Pulmonary edema is more characterized by alveolar flooding than alveolar collapse.

A. Monitor the client for headache: While headache could suggest hypoxia or other neurological involvement, it is not the most urgent concern. The client’s acute chest pain and dyspnea suggest a possible fat embolism, requiring immediate respiratory support.

B. Check the client for a positive Chvostek's sign: Chvostek’s sign assesses for hypocalcemia and is unrelated to the client’s acute respiratory and cardiovascular symptoms. Evaluating for this sign does not address the emergent nature of the client's presentation.

C. Administer an IV vasopressor medication: Vasopressors may be indicated if the client becomes hemodynamically unstable, but this is not the first action. The immediate priority is ensuring adequate oxygenation due to the suspected fat embolism.

D. Provide high-flow oxygen: Sudden chest pain and dyspnea after a long bone fracture are hallmark signs of fat embolism syndrome. The first action should be to support oxygenation with high-flow oxygen to prevent hypoxemia and further complications while awaiting further interventions.

A. Metabolic acidosis: Metabolic acidosis presents with a low pH and low bicarbonate. In this case, the bicarbonate is within the normal range (22–26 mEq/L), ruling out a metabolic origin. The elevated PaCO₂ indicates a respiratory rather than metabolic problem.

B. Metabolic alkalosis: This condition is characterized by a high pH and high bicarbonate levels, which are not present in the client’s ABG results. The pH is acidic, not alkaline, and bicarbonate is within normal limits, making this diagnosis unlikely.

C. Respiratory acidosis: A pH of 7.22 (low) and PaCO₂ of 68 mm Hg (elevated) indicate hypoventilation and CO₂ retention. This supports a diagnosis of respiratory acidosis, especially in a low respiratory rate of 7/min, which impairs adequate CO₂ elimination.

D. Respiratory alkalosis: Respiratory alkalosis occurs with low PaCO₂ and high pH due to hyperventilation. This client is hypoventilating with elevated PaCO₂ and decreased pH, making respiratory alkalosis inconsistent with the data provided.

A. Barrel chest:A barrel chest reflects chronic hyperinflation typical of COPD and is not an acute indicator of decompensation. It does not require urgent follow-up.

B. Lung sounds:The progression from diminished to wheezing with accessory muscle use indicates worsening airflow obstruction. This clinical change signals acute deterioration and warrants prompt intervention.

C. Shortness of breath:Increased dyspnea and use of the orthopneic position suggest respiratory fatigue and declining gas exchange, requiring immediate clinical attention.

D. Oxygen saturation:An SpO₂ of 83% is critically low and indicates severe hypoxemia. This requires urgent oxygen therapy or ventilatory support to prevent organ damage.

E. Electrocardiogram results:While helpful in identifying hypoxia-related arrhythmias, the ECG showed sinus rhythm and no urgent findings. It supports care but is not the top priority here.

F. Arterial blood gas results:The ABG reveals severe hypoxemia and elevated CO₂ with compensated respiratory acidosis, confirming acute respiratory compromise. This demands immediate follow-up.