Before leaving the room of a client who is confused, the nurse observes that a half bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed frame. Which action should the nurse take before leaving the room?

Ensure that the restraints are snug against the client's wrists.

Ensure that the knot can be quickly released.

Tie the knot with a double turn or square knot.

Move the ties so the restraints are secured to the side rails.

Answer and Explanation

The Correct Answer is B

A.   Restraints should be secure but not too tight to prevent injury or impaired circulation.
B.   Ensuring the knot can be quickly released is critical for the client's safety in case of emergency.
C.   A double turn or square knot would make the restraint difficult to remove quickly, posing a safety risk.
D.   Restraints should never be tied to side rails as this can cause injury if the rails are moved.

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Correct Answer is A

Explanation

A. An ionized calcium level significantly above the reference range can lead to cardiac dysrhythmias and requires immediate attention to assess cardiac function.
B. While urine output and characteristics are important indicators of renal function, cardiac assessment takes priority due to the potential cardiac effects of hypercalcemia.
C. Assessment of deep tendon reflexes is relevant since hypercalcemia can lead to muscle weakness and diminished reflexes. However, this should be done after assessing for any cardiac dysrhythmias.
D. Comparing muscle strength bilaterally is important for assessing neurological integrity but is not the priority when hypercalcemia is suspected.

Correct Answer is ["1.3"]

Explanation

To calculate the dosage of amoxicillin for the infant, first convert the weight from pounds to kilograms, knowing that 1 kilogram equals 2.2 pounds. The infant weighs 22 pounds, which is equivalent to 10 kilograms (22 lb / 2.2 lb/kg). The prescription is for 20 mg/kg/day, so the total daily dosage is 200 mg (10 kg * 20 mg/kg). This total daily dosage is divided into three doses, as it is to be administered every 8 hours, resulting in

66.7 mg per dose (200 mg / 3). The medication is supplied as 250 mg per 5 mL, so to find out how many mL per dose, set up a proportion: 250 mg is to 5 mL as 66.7 mg is to X mL. Solving for X gives us 1.334 mL (66.7 mg * 5 mL / 250 mg), which rounds to 1.3 mL when rounded to the nearest tenth.

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Before leaving the room of a client who is confused, the nurse observes that a half bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed frame. Which action should the nurse take before leaving the room?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When assessing a client with an ionized calcium level of 17 mg/dL (4.25 mmol/L), which intervention is most important for the nurse to implement? Reference Range lonized Calcium [Adult 4.6 to 5.1 mg/dL (1.15 to 1.35 mmol/L)]

Correct Answer is A

Explanation

Correct Answer is ["1.3"]

Explanation

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