When the nurse enters the room of a male client who was admitted for a fractured femur, his cardiac monitor displays a normal sinus rhythm (NSR), but he has no spontaneous respirations and his carotid pulse is not palpable. Which intervention should the nurse implement?

Here are the steps you can follow to calculate the infusion pump flow rate:

Step 1: Calculate the prescribed dose in mcg/min

1. Dose per weight: 2 mcg/kg/min * 60 kg = 120 mcg/min

Step 2: Convert the concentration in the IV bag to mcg/mL

1. Convert mg to mcg: 200 mg * 1000 mcg/mg = 200,000 mcg
2. Concentration: 200,000 mcg / 250 mL = 800 mcg/mL

Step 3: Calculate the flow rate in mL/min

1. Flow rate: 120 mcg/min / 800 mcg/mL = 0.15 mL/min

Step 4: Convert the flow rate to mL/hour

1. Hour conversion: 0.15 mL/min * 60 min/hour = 9 mL/hour

Therefore, the nurse should program the infusion pump to deliver 9 mL/hour.

The correct answer is Choice D

Choice A rationale: Repeating information may reinforce understanding but does not address the core barrier in unilateral hearing loss, which is sound localization and clarity. Auditory input from one ear limits binaural processing, making it harder to distinguish speech from background noise. Repetition without visual cues or proper orientation may still result in misinterpretation. Effective communication requires compensating for the sensory deficit, not merely reiterating content. Thus, repetition alone is insufficient for optimal education delivery.

Choice B rationale: Writing on a whiteboard provides visual support but lacks the dynamic interaction necessary for patient education. While visual aids help reinforce concepts, they do not allow for immediate clarification or emotional engagement. Pain management education involves nuanced discussion of pharmacologic options, side effects, and patient preferences. Relying solely on written communication may hinder comprehension, especially if literacy or cognitive load is a concern. It should supplement, not replace, direct verbal and visual interaction.

Choice C rationale: Speaking loudly into the affected ear is counterproductive and may distort sound further. In unilateral hearing loss, the affected ear has reduced or absent auditory function, and increasing volume does not restore clarity. Loud speech can also be perceived as aggressive or uncomfortable. Effective communication requires engaging the functional ear and using visual cues to enhance comprehension. Loudness does not compensate for neural deficits in auditory processing and may worsen patient experience.

Choice D rationale: Facing the client allows for optimal use of visual cues such as lip reading, facial expressions, and gestures, which are critical in compensating for unilateral auditory deficits. This technique engages the functional ear while supporting multimodal communication. It respects the neurophysiological limitations of monaural hearing and enhances speech perception through visual-auditory integration. Direct face-to-face interaction also fosters trust and allows for immediate feedback, making it the most scientifically sound approach for patient education.