A nurse is caring for a client who weighs 68 kg and has a new prescription for nitroprusside 0.3 mcg/kg/min by continuous IV infusion. The prescription says to increase the dose by 0.3 mcg every 5 min to maintain systolic UP at 100 to 200 mm Hg. Available is nitroprusside 50 mg in dextrose 5% in water 250 mL. Five min after starting the infusion, the client's 8P is 208/150 mm Hg. How many mute should the nurse administer now? (Round the to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
The Correct Answer is ["12.2"]
Understanding the Problem
Initial Order: Nitroprusside 0.3 mcg/kg/min
Client Weight: 68 kg
Dose Increase: 0.3 mcg/kg/min every 5 minutes
Current BP: 208/150 mmHg (Indicates need for dose increase)
Available Solution: Nitroprusside 50 mg in 250 mL of D5W
Desired Rate: mL/hr
Step 1: Calculate the Initial Dose
Initial Dose: 0.3 mcg/kg/min
Client Weight: 68 kg
Initial Total Dose: 0.3 mcg/kg/min x 68 kg = 20.4 mcg/min
Step 2: Determine the New Dose After Increase
Increase: 0.3 mcg/kg/min
Client Weight: 68 kg
Total Increase: 0.3 mcg/kg/min x 68 kg = 20.4 mcg/min
New Total Dose: 20.4 mcg/min (initial) + 20.4 mcg/min (increase) = 40.8 mcg/min
Step 3: Convert the New Dose to Milligrams (mg)
1 mg = 1000 mcg
New Dose in mg/min: 40.8 mcg/min / 1000 mcg/mg = 0.0408 mg/min
Step 4: Calculate the New Dose in mg/hr
New Dose in mg/min: 0.0408 mg/min
Minutes in an Hour: 60 min
New Dose in mg/hr: 0.0408 mg/min x 60 min/hr = 2.448 mg/hr
Step 5: Determine the Concentration of the Nitroprusside Solution
Available Nitroprusside: 50 mg
Solution Volume: 250 mL
Concentration: 50 mg / 250 mL = 0.2 mg/mL
Step 6: Calculate the Infusion Rate in mL/hr
New Dose in mg/hr: 2.448 mg/hr
Concentration: 0.2 mg/mL
Infusion Rate: 2.448 mg/hr / 0.2 mg/mL = 12.24 mL/hr
Step 7: Round to the Nearest Tenth
The calculated rate is 12.24 mL/hr.
Rounded to the nearest tenth: 12.2 mL/hr
Answer: 12.2 mL/hr
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["8"]
Explanation
Convert the Client's Weight from Pounds to Kilograms:
1 kg = 2.205 lbs
Weight in kg = 180 lbs / 2.205 lbs/kg
Weight in kg ≈ 81.63 kg
Calculate the Insulin Dose in Units/hr:
Dose = 0.1 units/kg/hr x 81.63 kg
Dose ≈ 8.163 units/hr
Calculate the Insulin Concentration in Units/mL:
Available concentration = 500 units / 500 mL
Concentration = 1 unit/mL
Calculate the Infusion Rate in mL/hr:
Infusion Rate (mL/hr) = Dose in units/hr / Concentration (units/mL)
Infusion Rate (mL/hr) = 8.163 units/hr / 1 unit/mL
Infusion Rate (mL/hr) ≈ 8.163 mL/hr
Round to the Nearest Whole Number:
8 mL/hr
Correct Answer is A
Explanation
A) Digoxin 25 mcg/kg via IV bolus every 8 hr x 2 doses: This prescription should be clarified. Digoxin is typically prescribed in micrograms (mcg), but the dose of 25 mcg/kg is very high and could lead to toxicity. For a client with heart failure, the usual dosage for digoxin is 0.125–0.25 mg daily, not 25 mcg/kg per dose, which is excessive and potentially dangerous. Therefore, this order should be clarified with the provider.
B) Dobutamine 15 mcg/kg via continuous IV infusion: This is an appropriate dose for dobutamine, which is commonly used in heart failure for its inotropic effects. Dobutamine is typically dosed between 2–20 mcg/kg/min for continuous IV infusion, so 15 mcg/kg/min is within a safe range.
C) Bumetanide 0.1 mg/kg via IV bolus every 12 hr: Bumetanide is a loop diuretic used in heart failure, and the prescribed dose of 0.1 mg/kg every 12 hours is an appropriate dosing regimen for this medication. It is within the typical dosing range, and the interval is also reasonable for managing fluid overload in heart failure.
D) Dextrose 5% in 0.45% sodium chloride with 20 mEq KCl via continuous IV infusion at 50 mL/hr: This IV fluid prescription is generally appropriate. The combination of dextrose and sodium chloride with potassium is commonly used to maintain hydration and electrolyte balance in clients, particularly in the context of heart failure management. The infusion rate of 50 mL/hr is a typical rate for continuous IV infusions.
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