Question

A nurse is caring for a client who has schizophrenia and is experiencing hallucinations. The provider prescribes chlorpromazine 50 mg 1M every 4 hr as needed. Available is chlorpromazine injection 25 mg/mL. How many mL should the nurse administer per dose?

(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Answer 1

Correct Answers:

2

Rationale :

To calculate the volume (mL) to administer per dose, use the formula: Volume to administer=Desired dose/Available concentration Desired dose = 50 mg Available concentration = 25 mg/mL 50 mg/25 mg/mL=2 mL

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Answer 2

Correct Answers:

Reporting laboratory findings to a member of the client's family

Rationale :

Client confidentiality is a fundamental principle in healthcare, ensuring that personal health information is protected and shared only with those who are authorized. This includes respecting the rights of the patient to have control over who is privy to their health data. In this case, reporting laboratory findings to a member of the client's family without the patient's consent constitutes a violation of confidentiality. Confidential information should be disclosed only to individuals who have been explicitly authorized by the patient or those who have a legal right to the information, such as certain healthcare professionals involved in the patient’s care. In most cases, sharing health information with a family member would require prior written consent from the patient, unless the patient is unable to provide consent due to their medical condition and the information is required for the safety or well-being of the patient.

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Answer 3

Correct Answers:

Hospital ethics committee

Rationale :

When there is a disagreement among family members regarding the care of a client, it can create a challenging ethical dilemma. In such cases, the hospital ethics committee is the appropriate group to consult. The ethics committee is composed of healthcare professionals, including doctors, nurses, social workers, and sometimes legal experts, who specialize in resolving complex ethical issues. They can assist in navigating disputes over medical decisions, especially when there is conflict among family members about the best course of action for the patient’s care.

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Answer 4

Correct Answers:

Prior to administering each medication
After each medication
After giving multiple medications

Rationale :

The nurse should instill 15 to 30 mL of warm water prior to administering each medication, after each medication, and after giving multiple medications to maintain tube patency and prevent clogs. Flushing before and after each medication ensures the tube is clear of residual formula or medications, allowing for effective delivery and minimizing the risk of obstruction. After giving multiple medications, a final flush helps ensure that all medications are cleared from the tube and the entire dose is delivered to the stomach.

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Answer 5

Correct Answers:

250

Rationale :

To calculate the IV flow rate in mL/hr, use the formula: Flow rate (mL/hr)=Total volume (mL)/Time (hr) Total volume = 2000 mL Time = 8 hr Flow rate=2000mL/8 hr=250 mL/hr

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Answer 6

Correct Answers:

Surgeon

Rationale :

The surgeon is responsible for obtaining informed consent for a surgical procedure. This process includes explaining the nature of the procedure, potential risks, benefits, and alternatives to the surgery. The patient must understand this information and voluntarily agree to the surgery by signing the consent form. Although other healthcare professionals, like the nurse, may provide education or clarify questions, it is the surgeon who is legally and ethically responsible for ensuring that the patient fully understands the procedure before consent is obtained.

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Answer 7

Correct Answers:

Malpractice

Rationale :

Malpractice refers to professional negligence, where a healthcare provider fails to provide the standard of care expected in their profession, resulting in harm to the patient. In this case, administering the wrong medication, which caused a severe allergic reaction and prolonged hospitalization, is a clear example of negligence in the nurse's professional duties. This could lead to a malpractice lawsuit because the nurse did not adhere to the standard of care expected when administering medications, resulting in harm to the client.

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Answer 8

Correct Answers:

"Documentation is a communication tool for the interprofessional health care team.'

Rationale :

The primary purpose of documentation in the electronic health record (EHR) is to serve as a communication tool for the entire healthcare team. It ensures that all members of the team—nurses, doctors, specialists, and other healthcare professionals—have access to accurate and up-to-date information about the patient’s care, treatment, and progress. This allows for coordinated care, reduces the risk of errors, and improves patient outcomes. While documentation can also be used for legal, financial, and auditing purposes, its main role is facilitating communication among the healthcare providers.

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Answer 9

Correct Answers:

Drop prescribed amount of medication into the conjunctival sac.

Rationale :

When administering eye drops, the nurse should drop the prescribed amount of medication directly into the conjunctival sac, which is the space between the lower eyelid and the eyeball. This ensures the medication is properly delivered to the area it needs to act on.

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Answer 10

Correct Answers:

Assigning tasks to an assistive personnel (AP)

Rationale :

Indirect nursing care involves activities that support direct patient care but do not involve directly interacting with the patient. Assigning tasks to assistive personnel (AP) is considered indirect care because the nurse is delegating responsibilities to others to ensure that client care tasks are completed, allowing for more efficient patient care delivery.

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NUR 104 Fundamentals Final~Exam

No.

2 : A nurse is giving a presentation about client confidentiality to a group of newly licensed nurses. Which of the following actions is an example of a violation of confidentiality?

3 : A nurse is caring for a client whose family is in a state of disagreement over the care of their family member. The nurse should report the situation to which of the following facility personnel?

4 : A nurse is administering several medications via a client's gastrostomy tube. At which of the following times should the nurse instill 15 to 30 mL of warm water? (Select all that apply.)

5 : A nurse is preparing to administer 045% sodium chloride (NaCl) 2000 mL IV to infuse over 8 hr The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number.

Use a leading zero if it applies. Do not use a trailing zero.)

6 : A nurse is caring for a client who has a hip fracture that requires surgical repair. Which of the following health care professionalsis responsible for obtaining informed consent from the client for the procedure?

7 : A nurse accidentally administers the wrong medication to a client, which results in a severe allergic reaction and prolongs the client's hospitalization. The client could rightfully sue the nurse for which of the following?

8 : A nurse is orienting a newly licensed nurse about documentation of a client's information in the electronic health record. Which of the following statements by the newly licensed nurse indicates understanding of the purpose of documentation?

9 : A nurse is administering timolol eye drops to a client who has glaucoma. Which of the following actions should the nurse take?

10 : A nurse is implementing direct nursing care for a group of clients in an acute care facility. Which of the following actions by the nurse is considered an indirect nursing care activity?

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NUR 104 Fundamentals Final~Exam

No.

2 : A nurse is giving a presentation about client confidentiality to a group of newly licensed nurses. Which of the following actions is an example of a violation of confidentiality?

3 : A nurse is caring for a client whose family is in a state of disagreement over the care of their family member. The nurse should report the situation to which of the following facility personnel?

4 : A nurse is administering several medications via a client's gastrostomy tube. At which of the following times should the nurse instill 15 to 30 mL of warm water? (Select all that apply.)

5 : A nurse is preparing to administer 045% sodium chloride (NaCl) 2000 mL IV to infuse over 8 hr The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number.Use a leading zero if it applies. Do not use a trailing zero.)

6 : A nurse is caring for a client who has a hip fracture that requires surgical repair. Which of the following health care professionalsis responsible for obtaining informed consent from the client for the procedure?

7 : A nurse accidentally administers the wrong medication to a client, which results in a severe allergic reaction and prolongs the client's hospitalization. The client could rightfully sue the nurse for which of the following?

8 : A nurse is orienting a newly licensed nurse about documentation of a client's information in the electronic health record. Which of the following statements by the newly licensed nurse indicates understanding of the purpose of documentation?

9 : A nurse is administering timolol eye drops to a client who has glaucoma. Which of the following actions should the nurse take?

10 : A nurse is implementing direct nursing care for a group of clients in an acute care facility. Which of the following actions by the nurse is considered an indirect nursing care activity?

5 : A nurse is preparing to administer 045% sodium chloride (NaCl) 2000 mL IV to infuse over 8 hr The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number.

Use a leading zero if it applies. Do not use a trailing zero.)