After a Whippie procedure for cancer of the pancreas, a client is to receive the following intravenous (IV) fluids over 24 hours; 1000 ml D5W; 0.5 liter normal saline; 1500 ml D5NS. In addition, an antibiotic piggyback in 50 ml D5W is ordered every 8 hours. The nurse calculates that the clients IV fluid intake Tor 24 hours will be:

Correct Answer: C

Rationale: The correct answer is C) 3200 ml. To calculate the total IV fluid intake over 24 hours, we add up the volumes of the different fluids. D5W 1000 ml + normal saline 500 ml + D5NS 1500 ml = 3000 ml. Adding the antibiotic piggyback in 50 ml D5W every 8 hours, we get 150 ml in 24 hours. Therefore, the total IV fluid intake is 3000 ml + 150 ml = 3200 ml. Option A) 3150 ml is incorrect because it does not include the additional 50 ml of antibiotic piggyback every 8 hours, making the total less than 3200 ml. Option B) 3650 ml is incorrect because it includes the incorrect calculation of adding the antibiotic piggyback every 8 hours multiple times, leading to an inflated total volume. Option D) 3750 ml is incorrect as it overestimates the total IV fluid intake by including incorrect calculations and multiple counts of the antibiotic piggyback volume. Understanding IV fluid calculations is crucial for pediatric nursing as precise administration is vital for patient safety. Nurses must accurately calculate and monitor IV fluid intake to prevent dehydration or fluid overload in pediatric patients undergoing treatments like the Whippie procedure for cancer of the pancreas.

Correct Answer: C

Rationale: Chronic respiratory acidosis is a condition where there is an excess of carbon dioxide (CO2) in the blood due to inadequate exhalation of CO2. This typically occurs as a result of hypoventilation, which is characterized by breathing at an abnormally slow rate or shallow depth. In patients with long-standing lung disease, the ability to effectively exchange gases in the lungs is compromised, leading to a buildup of CO2 in the bloodstream and subsequent respiratory acidosis. Hyperventilation, on the other hand, would result in a decrease in CO2 levels in the blood, while the loss of acid or base by the kidneys is related to metabolic acidosis or alkalosis, not respiratory acidosis. Therefore, in this case, the primary problem causing chronic respiratory acidosis is hypoventilation.

Correct Answer: C

Rationale: 1. Setting up a visit from a well-adjusted laryngectomee should be the first priority. This action will provide emotional support and guidance from someone who has gone through a similar experience, which can be extremely beneficial for the new laryngectomee in adjusting to their new situation and learning coping strategies.

Correct Answer: B

Rationale: IV morphine is the most appropriate choice among the options provided for quickly reducing shortness of breath (SOB) in a crisis situation for a patient with end-stage respiratory disease. Morphine is commonly used in palliative care for symptom management in patients with severe respiratory distress. It acts as a respiratory depressant by reducing the perception of breathlessness, which can help alleviate the distressing symptoms of dyspnea. The rapid onset of action of IV morphine makes it an effective option for immediate relief in emergency situations for patients experiencing significant SOB due to end-stage respiratory disease. Oral cortisone, IM meperidine (Demerol), and IV propranolol (Inderal) are not primary choices for quickly reducing SOB in this context.

Correct Answer: C

Rationale: The erythrocyte sedimentation rate (ESR) is an important diagnostic test that can help identify inflammation in the body, including inflammation in the heart. Elevated ESR levels may indicate the presence of an underlying condition that could potentially lead to cardiac complications if left untreated. Regular monitoring of ESR levels can help in the early detection and prevention of cardiac issues. The other options (A. Chest x-ray examination, B. Throat culture, and D. White blood cell count) are not specific diagnostic tests for assessing cardiac complications.