The nurse is preparing to apply the client’s scheduled fentanyl transdermal patch. The nurse notes the previously applied patch is intact on the client’s upper back and the client reports no pain. Which action should the nurse take?

Remove the patch and consult with the healthcare provider about the client’s pain resolution.

Place the patch on the client’s shoulder and leave both patches in place for 12 hours.

Apply the new patch in a different location after removing the original patch.

Administer an oral analgesic and evaluate its effectiveness before applying the new patch.

Answer and Explanation

The Correct Answer is C

A) Remove the patch and consult with the healthcare provider about the client’s pain resolution: While it’s essential to assess the need for continued pain management, removing the patch without replacing it could lead to inadequate pain control, especially if the client still requires opioid analgesia. Additionally, fentanyl patches are typically left in place for their prescribed duration, and removing them prematurely could disrupt the pain management plan.

B) Place the patch on the client's sh’ulder and leave both patches in place for 12 hours: Applying a new patch without removing the previous one could result in a higher-than-intended dose of fentanyl, increasing the risk of opioid toxicity. Leaving both patches in place simultaneously is not recommended.

C) Apply the new patch in a different location after removing the original patch: This is the correct action. Applying the new patch in a different location helps prevent skin irritation and ensures consistent drug absorption. Rotating patch sites according to the manufacturer's in’tructions is important for optimal medication delivery.

D) Administer an oral analgesic and evaluate its effectiveness before applying the new patch: While oral analgesics may provide temporary relief, they may not be as effective as transdermal fentanyl for managing chronic pain, especially if the client has been on a stable regimen of fentanyl patches. Additionally, delaying the application of the new patch could lead to inadequate pain control.

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Correct Answer is B

Explanation

A) A serum creatinine level of 1.0 mg/dL falls within the reference range (0.5 to 1.1 mg/dL) and does not indicate immediate action by the nurse. Creatinine levels within the reference range suggest normal kidney function.

B) A platelet count of 100,000/mm3 (100 x 10^9/L) is below the lower limit of the reference range (150,000 to 400,000/mm3). Thrombocytopenia, or low platelet count, increases the risk of bleeding complications, especially when administering anticoagulants like enoxaparin. Therefore, a platelet count of 100,000/mm3 requires immediate action by the nurse to assess for bleeding and notify the healthcare provider.

C) A hematocrit of 45% (0.45 volume fraction) falls within the reference range (42% to 52%) and does not indicate immediate action by the nurse.

D) A blood urea nitrogen (BUN) level of 20 mg/dL (7.1 mmol/L) falls within the reference range (10 to 20 mg/dl) and does not indicate immediate action by the nurse.

Correct Answer is ["100"]

Explanation

Since the client weighs 90 kg, let’s first convert their weight to pounds to determine the appropriate cefazolin dosage:

Conversion factor: 1 kg = 2.205 pounds

Client weight (pounds) = 90 kg x 2.205 pounds/kg = 198.45 pounds (rounded to two decimals)

Now, comparing the client’s weight (198.45 pounds) to the weight threshold (265.5 pounds):

Client weight is less than the threshold (198.45 pounds < 265.5 pounds).

Therefore, the appropriate dosage is:

Cefazolin 2 grams/100 mL 0.9% normal saline over 1 hour.

The pump rate is determined by the total volume of the IV fluid and the infusion time.

We are not given the specific bag size, but typically these come in 100 mL or 500 mL volumes.

Assuming a 100 mL bag (which aligns with the concentration provided):

Total volume of IV bag: 100 mL

Infusion time: 1 hour

Calculation:

Pump rate (mL/hr) = Total volume (mL) / Infusion time (hr)

Pump rate (mL/hr) = 100 mL / 1 hour = 100 mL/hr

Therefore, the nurse should program the pump to deliver 100 mL/hr.

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The nurse is preparing to apply the client’s scheduled fentanyl transdermal patch. The nurse notes the previously applied patch is intact on the client’s upper back and the client reports no pain. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

Correct Answer is ["100"]

Explanation

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