A client is to receive one liter of normal saline intravenously over six hours. The tubing delivers 15 drops per milliliter.
How many drops per minute should a nurse regulate the infusion to deliver?
42.
84.
100.
166.
The Correct Answer is B
To explain why, we need to use the formula for calculating the drip rate in drops per minute (dpm):
Volume of IV fluid (mL) x Drop Factor (drops/mL) / Time to run (h) x 60 (min/h) = Drip Rate (dpm)
In this question, the volume of IV fluid is one liter, which is equivalent to 1000 mL. The drop factor is 15 drops per mL, as given by the tubing.
The time to run is six hours, as ordered by the physician. Plugging these values into the formula, we get:
1000 mL x 15 drops/mL / 6 h x 60 min/h = 84 dpm
Therefore, the nurse should regulate the infusion to deliver 84 drops per minute.
Choice A is wrong because it gives a drip rate of 42 drops per minute, which is half of the correct answer.
This would result in delivering only 500 mL of normal saline in six hours, instead of one liter.
Choice C is wrong because it gives a drip rate of 100 drops per minute, which is more than the correct answer.
This would result in delivering 1.43 liters of normal saline in six hours, instead of one liter.
Choice D is wrong because it gives a drip rate of 166 drops per minute, which is almost double the correct answer.
This would result in delivering 1.99 liters of normal saline in six hours, instead of one liter.
Normal saline is a solution of 0.9% sodium chloride in water, which has the same osmolarity as blood plasma.
It is used to treat dehydration, shock, blood loss, and other conditions that require fluid replacement.
The normal range of sodium in blood is 135-145 mEq/L.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Irrigating the tube with 30 mL of sterile saline as needed. This prescription should be questioned by the nurse because it may cause trauma to the kidney or dislodge the tube. The nurse should only irrigate the tube if ordered by the health care provider and with a smaller amount of fluid.
Choice A is wrong because monitoring the urine’s color and odor is an appropriate intervention for a client with a nephrostomy tube. The urine may be bloody or cloudy initially, but it should gradually clear.
Choice B is wrong because recording the intake and output every eight hours is also an appropriate intervention for a client with a nephrostomy tube. The nurse should measure and document the amount and characteristics of urine drainage and report any changes or abnormalities.
Choice D is wrong because measuring the vital signs every four hours during the day is a reasonable prescription for a client with a nephrostomy tube. The nurse should monitor the client for signs of infection, bleeding, or obstruction.
Correct Answer is A
Explanation
“I will discard unused pills after six months after replacing it with a new vial.” This statement indicates that the client understands that nitroglycerin tablets lose their potency over time and need to be replaced regularly.
Choice B is wrong because nitroglycerin can cause headaches as a side effect, but the client should not stop taking it if they have chest pain. They can use Tylenol for pain relief.
Choice C is wrong because nitroglycerin can cause hypotension and dizziness, so the client should avoid lying down or changing positions suddenly after taking it. They should sit or stand still until the chest pain subsides.
Choice D is wrong because a tingling feeling on the tongue is a normal sensation when taking sublingual nitroglycerin and does not indicate an adverse reaction. It also confirms that the tablet is potent and effective.
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