Mr. Kirby has developed third-degree heart block and is receiving 250 ml D5W with 1 mg isoproterenol IV every 5 hours. A microdrip administration set is being used and delivers 60 gtt./ml. At the start of your shift in evaluating whether or not Mr. Kirby is receiving the ordered amount of fluid, you know that the flow rate in drops per minute should be

Correct Answer: C

Rationale: In this scenario, the correct answer is option C) 50 gtt./min. To understand why this is the correct flow rate, we need to consider the components of the question. Mr. Kirby is receiving 250 ml of D5W with 1 mg of isoproterenol every 5 hours. The administration set delivers 60 gtt./ml. To calculate the flow rate in drops per minute, we need to consider the total volume to be infused over 5 hours and the drip factor of the administration set. First, we need to calculate the total volume to be infused in 5 hours: 250 ml every 5 hours = 50 ml/hour Next, we convert ml/hour to drops per minute using the drip factor: 1 ml = 60 gtt. 50 ml = 50 * 60 gtt. = 3000 gtt. Since the total volume is to be infused over 5 hours, and we need to find the flow rate in drops per minute: 3000 gtt. / 300 minutes = 10 gtt./min Therefore, the correct flow rate is 50 gtt./min, as option C states. Option A) 5 gtt./min, Option B) 10 gtt./min, and Option D) 1 gtt./min are incorrect because they do not accurately calculate the flow rate based on the information provided in the question. In an educational context, understanding how to calculate intravenous flow rates is crucial for nurses and healthcare professionals to ensure accurate medication administration and patient safety. This question challenges learners to apply their knowledge of drip factors, volume calculations, and time conversions to determine the appropriate flow rate for intravenous therapy. Mastering these calculations is essential in providing quality patient care and preventing medication errors.

Correct Answer: B

Rationale: In the acute phase of pernicious anemia, nursing care should focus on addressing the symptoms and complications of the condition. Bed rest with range-of-motion exercises is the correct option because it helps prevent complications like deep vein thrombosis and promotes circulation without exerting excessive energy that the patient may lack due to anemia. Option A is incorrect as placing limits on food, fluids, and activity can worsen the patient's condition by restricting essential nutrients and preventing necessary movement. Option C, preparation for blood transfusion, is incorrect because pernicious anemia is primarily due to vitamin B12 deficiency, not necessarily a lack of blood that would require a transfusion. Option D, providing a heating pad, is incorrect as warmth does not address the underlying cause or symptoms of pernicious anemia. Educationally, understanding the rationale behind the correct answer emphasizes the importance of tailored nursing care for patients with pernicious anemia. It highlights the need for interventions that address the specific needs and symptoms of the condition to promote optimal patient outcomes. This question also reinforces the significance of knowledge in providing evidence-based care to individuals with hematologic disorders.

Correct Answer: A

Rationale: In understanding why option A is the correct answer in this question about hemophilia A, it is crucial to grasp the pathophysiology of the condition. Hemophilia A is a genetic disorder characterized by a deficiency in clotting factor VIII, leading to impaired blood clotting. Due to this deficiency, bleeding in individuals with hemophilia A is often delayed after trauma because the clotting process is disrupted. This delayed bleeding is a hallmark feature of hemophilia A and distinguishes it from other bleeding disorders. Regarding why the other options are incorrect: - Option B: Hemarthrosis, or bleeding into joint spaces, is actually a common and significant complication in individuals with hemophilia A due to their impaired clotting mechanism. - Option C: In hemophilia A, coagulation and bleeding time are prolonged, not severely prolonged, due to the deficiency in factor VIII. - Option D: Client education plays a crucial role in managing hemophilia A by empowering individuals to recognize symptoms early, seek appropriate care, and prevent complications. Therefore, stating that client education is ineffective is inaccurate. Educational context: Understanding the key clinical manifestations and complications of hemophilia A is essential for healthcare professionals working in hematology and oncology. By grasping the nuances of this condition, clinicians can provide optimal care and support to individuals with hemophilia A, emphasizing the importance of early recognition, prompt treatment, and ongoing education to prevent complications and improve outcomes.

Correct Answer: D

Rationale: The correct answer is option D) resting the joint when painful or swollen. Hemarthrosis, which is bleeding into joint spaces, is a common issue in individuals with hemophilia due to impaired blood clotting. Resting the joint when painful or swollen helps prevent further damage and allows the body to naturally reabsorb the blood, reducing pain and inflammation. Option A) restricting the individual's activity is incorrect because complete restriction may lead to joint stiffness and muscle weakness without addressing the immediate need for joint rest. Option B) applying heat at the first indication of pain or swelling is incorrect as heat can exacerbate bleeding by dilating blood vessels, increasing blood flow to the joint, and worsening the condition. Option C) giving frequent intramuscular injections of analgesics is incorrect as it does not address the underlying cause of hemarthrosis and can potentially lead to further bleeding complications. In an educational context, teaching families about the importance of recognizing early signs of hemarthrosis and the appropriate management, such as resting the joint, can help prevent complications and improve the quality of life for individuals with hemophilia. Encouraging open communication with healthcare providers for timely interventions is also crucial in managing hemarthrosis effectively.

Correct Answer: D

Rationale: In the scenario presented, the correct answer is D) ecchymoses. Ecchymoses are large, non-elevated bruises caused by the leakage of blood into the skin due to damaged blood vessels. This is a common manifestation in conditions such as thrombocytopenia or coagulopathies, where there is a decreased ability to clot blood, leading to easy bruising. Option A) erythropoiesis refers to the process of red blood cell production and is not directly related to bruising. Option B) leukoplakia is a condition affecting the mucous membranes, characterized by white patches, and is not associated with bruising. Option C) megakaryocytic hyperplasia is an increase in the production of platelet precursor cells, which would actually lead to increased platelet count and reduced bruising tendency. In an educational context, understanding the clinical significance of different types of bruising can help healthcare providers in diagnosing underlying conditions such as hematological disorders or coagulopathies. Recognizing ecchymoses can prompt further investigations to determine the cause and initiate appropriate management, highlighting the importance of keen observation and clinical assessment skills in patient care.