The MD orders Flagyl 150mg in 100 mL of NS to infuse over 60 minutes.

Calculate the flow rate in mL/hr? (ROUND TO WHOLE NUMBER: LABEL CORRECTLY TO RECEIVE CREDIT)

Choice A rationale

A bruit is an abnormal vascular sound, typically a loud, whooshing, or blowing murmur, caused by turbulent blood flow through a narrowed or partially obstructed artery. It is best auscultated with the bell of the stethoscope, which is more effective at detecting low-pitched sounds due to its larger surface area and ability to transmit vibrations from a broader area of contact. The turbulence creates vibratory patterns indicative of compromised blood flow.

Choice B rationale

A high-pitched tinkling sound is not characteristic of a bruit and is more commonly associated with bowel sounds in cases of intestinal obstruction, indicating fluid and gas movement within the bowel. The diaphragm of the stethoscope is indeed used for high-pitched sounds, but this specific sound quality does not align with the pathophysiology of a vascular bruit.

Choice C rationale

A soft, trickling, pulsatile sound does not describe a bruit. While pulsatile, the "soft, trickling" quality suggests a very low-flow state or venous hum rather than the turbulent arterial flow responsible for a true bruit. The bell is appropriate for low-pitched sounds, but the character of the sound is inconsistent with a bruit.

Choice D rationale

A low gurgling sound is generally associated with gastrointestinal motility, such as normal bowel sounds, and is not indicative of a vascular bruit. While low-pitched sounds can be detected with the bell, the diaphragm is used for higher-pitched sounds, and the "gurgling" description is inappropriate for arterial turbulence.

Choice A rationale

A 15-degree angle is typically used for intradermal injections, where the medication is deposited just beneath the epidermis to form a bleb, not for subcutaneous injections which target the adipose tissue layer. Taut skin is also incorrect for subcutaneous.

Choice B rationale

For an average-sized client receiving a subcutaneous injection, a 45-degree angle facilitates optimal medication deposition into the subcutaneous adipose tissue layer. Pinching the skin helps to elevate the subcutaneous tissue away from underlying muscle, reducing the risk of intramuscular injection.

Choice C rationale

A 90-degree angle is typically used for intramuscular injections in most adults, aiming to deposit medication deep into muscle tissue. Stretching the skin is generally more appropriate for intramuscular injections rather than subcutaneous.

Choice D rationale

Z-tracking is a technique primarily used for intramuscular injections of irritating medications to prevent leakage back into subcutaneous tissue. It is not a standard technique for subcutaneous injections, which use a different angle and skin manipulation.