A nurse is instructing a patient who has been newly prescribed sumatriptan tablets for the treatment of migraine headaches.
Which instructions should the nurse include?

Step 1: Determine the amount of medication needed. The order is for 20 mEq of potassium chloride. The available amount is 10 mEq/mL.

Step 2: Calculate the volume of medication to administer. Volume = Ordered dose ÷ Available concentration Volume = 20 mEq ÷ 10 mEq/mL = 2 mL So, the nurse should administer 2 mL of potassium chloride suspension.

Choice A rationale

While it is within the nurse’s scope of practice to communicate with the doctor regarding the patient’s condition, applying restraints should not be the first course of action when a patient frequently tries to remove their IV catheter. Restraints should only be used as a last resort when all other interventions have failed and the patient’s safety is at risk.

Choice B rationale

This is the correct response. Covering the catheter so the patient can’t see it may help to reduce the patient’s urge to remove it. This is a non-invasive intervention that respects the patient’s autonomy while also ensuring their safety.

Choice C rationale

Waiting until nighttime to see if the patient continues the behavior may not be the best course of action. If the patient is frequently trying to remove their IV catheter, it is important to address the issue promptly to prevent potential harm.

Choice D rationale

Applying restraints immediately is not the best course of action. Restraints should only be used as a last resort when all other interventions have failed and the patient’s safety is at risk.