The healthcare provider decreased the ordered dose of fentanyl to 25 mcg/hr transdermal patch. The pharmacy delivers a 50 mcg/hr patch to the nurse when the next dose is scheduled. What is the best action by the nurse?

Cut the 50 mcg/hr patch in half to obtain 25 mcg/hr dosing

Ask pharmacy to send a 25 mcg/hr transdermal patch

Contact the healthcare provider and request to increase the dose to 50 mcg/hr

Remove the previous patch and apply the 50 mcg/hr patch in a different location

Answer and Explanation

The Correct Answer is B

A) Cut the 50 mcg/hr patch in half to obtain 25 mcg/hr dosing: Cutting a fentanyl patch in half is not recommended because it can lead to inconsistent dosing. The patches are designed to release medication at a controlled rate, and cutting them could cause the medication to be released too quickly or unevenly, which could result in overdose or insufficient relief of pain. It’s essential to follow the manufacturer's guidelines and avoid altering the patch.

B) Ask pharmacy to send a 25 mcg/hr transdermal patch: The best course of action is to ask the pharmacy to send the correct 25 mcg/hr transdermal patch. This ensures that the patient receives the prescribed dose in the most accurate and safe manner. The 25 mcg/hr patch is formulated to deliver the correct amount of medication, and it will avoid any risk associated with altering the patch.

C) Contact the healthcare provider and request to increase the dose to 50 mcg/hr: Requesting an increase in the dose is premature without a clear justification from the healthcare provider. The healthcare provider decreased the dose to 25 mcg/hr for a reason, possibly due to side effects, effectiveness, or other clinical factors. Altering the prescribed dose without a proper review would be inappropriate. The nurse should follow the current prescribed dose and resolve the issue by requesting the correct patch from the pharmacy.

D) Remove the previous patch and apply the 50 mcg/hr patch in a different location: Switching to the 50 mcg/hr patch without approval could lead to administering an incorrect dose of fentanyl, which can increase the risk of overdose or severe side effects like respiratory depression. The nurse should adhere to the prescribed 25 mcg/hr dose and request the correct patch from the pharmacy rather than substituting with a higher dose patch.

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Correct Answer is B

Explanation

A) Ask the client what prescribed medications are taken at home: While obtaining information about the client's home medications is important, this action does not address the specific issue of the unclear order. It is not an appropriate substitute for clarifying the medication order that the nurse is having difficulty transcribing.

B) Contact the prescriber to clarify the order: This is the best action for the nurse to take. If the nurse is unsure about the order due to illegible handwriting, the safest and most effective way to clarify the order is to directly contact the prescriber. This ensures that the nurse administers the correct medication and dose, reducing the risk of medication errors.

C) Wait until the prescriber makes rounds again to clarify the order: Waiting for the prescriber to make rounds is not an appropriate or timely solution. Medication administration should not be delayed due to unclear orders, as it could lead to treatment delays or potential harm to the patient. Immediate clarification is necessary.

D) Ask a colleague what the order says: While consulting a colleague might be helpful, it is not the most reliable or safe course of action. The nurse should not rely on others to interpret unclear orders, as there may be different interpretations or misunderstandings. Contacting the prescriber directly ensures the order is clarified accurately and safely.

Correct Answer is ["20"]

Explanation

Identify the total units of heparin in the bag:

The IV bag contains 25,000 units of heparin in 250 mL.

Identify the desired hourly dose:

The client is ordered to receive 2,000 units of heparin per hour.

Calculate the mL containing 2,000 units:

We can set up a proportion:

(25,000 units) / (250 mL) = (2,000 units) / (x mL)

Solving for x, we get:

x = (2,000 units x 250 mL) / 25,000 units x = 20 mL

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The healthcare provider decreased the ordered dose of fentanyl to 25 mcg/hr transdermal patch. The pharmacy delivers a 50 mcg/hr patch to the nurse when the next dose is scheduled. What is the best action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a period of time when the computerized medication order system was down, the prescriber wrote admission the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber's handwriting. Which is the best action for the nurse to take at this time?

Correct Answer is B

Explanation

A client is to be started on a heparin intravenous infusion at 2,000 units per hour. On hand is an IV bag labeled 25,000 units/ 250 mL. At what rate (mL/hour) will the nurse set the pump? (Answer to the nearest whole number)

Correct Answer is ["20"]

Explanation

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