The practical nurse (PN) is preparing cefazolin 400 mg IM for a client with a gram-positive infection. The available vial is labeled, "Cefazolin 1 gram," and the instructions for reconstitution state, for IM use, add 2 mL sterile water for injection. Total volume after reconstitution is 2.5 mL. After reconstitution, how many mL should be administered to the client? (Enter numeric value only. If rounding is required, round to the whole number, nearest tenths/hundredth).

Choice A rationale:

Beginning continuous observation for transient episodes of neurologic dysfunction is important in the assessment and monitoring of the client's condition. However, in this scenario, the client is presenting with symptoms suggestive of a possible stroke or cerebrovascular event, and time is crucial. The nurse should prioritize actions that can lead to prompt diagnosis and treatment.

Choice B rationale:

Starting two large bore intravenous (IV) catheters and reviewing inclusion criteria for IV fibrinolytic therapy is the most urgent action. The client's symptoms, including sudden right-sided numbness, weakness, and facial droop, are indicative of a possible ischemic stroke. IV fibrinolytic therapy is time-sensitive and has a limited window of effectiveness. Establishing IV access and determining eligibility for this therapy should be the nurse's top priority to potentially improve the client's outcome.

Choice C rationale:

Administering aspirin to prevent further clot formation and platelet clumping is an important intervention in the treatment of ischemic stroke. However, it should not be the first action in this scenario. The priority is to assess for eligibility for IV fibrinolytic therapy, as this intervention has a more immediate impact on reversing the stroke's effects.

Choice D rationale:

Raising the head of the bed to 30 degrees and keeping the head and neck in neutral alignment is a reasonable nursing intervention to prevent complications such as aspiration and promote optimal cerebral blood flow. However, it is not the most urgent action in this case. The priority should be on assessing and potentially treating the stroke with IV fibrinolytic therapy.

To calculate the amount of darbepoetin alfa that the nurse should administer, you can use the following formula:

Dose (mL) = Amount prescribed (mcg) / Concentration (mcg/mL)

In this case:

Amount prescribed = 40 mcg
Concentration = 60 mcg/mL

Dose (mL) = 40 mcg / 60 mcg/mL = 2/3 mL

Now, you can convert 2/3 mL to decimal to make it easier to work with:

2/3 = 0.6667 mL

Rounded to one decimal place, the nurse should administer approximately 0.7 mL of darbepoetin alfa. So, the correct answer is 0.7 mL.