Problem 104 - Cliffs Test Prep NCLEX-RN

Question

. The physician orders 1000 milliliters of D5NS for a patient. The nurse will hang: 1\. 5 percent dextrose in 0.9 percent sodium chloride. 2\. isotonic sodium chloride with 5 grams of dextrose added to the liter bag by the pharmacy. 3\. normal saline after she has added 5 grams of dextrose to a liter bag. 4\. 5 percent dextrose in any saline solution concentration.

Step-by-Step Solution

Answer

Option 1: 5 percent dextrose in 0.9 percent sodium chloride.

Step 1: Understanding the Options

First, let's decode what each of the given options means by examining the provided solutions. 1. "5 percent dextrose in 0.9 percent sodium chloride" means a solution where 5% of the solution's weight is dextrose (glucose), and it contains 0.9% sodium chloride, which matches D5NS as ordered. 2. "Isotonic sodium chloride with 5 grams of dextrose added to the liter bag by the pharmacy" implies a normal saline (0.9% sodium chloride) solution with 5 grams of dextrose added. 3. "Normal saline after she has added 5 grams of dextrose to a liter bag" suggests adding dextrose to a standard 0.9% saline solution to achieve a similar concentration. 4. "5 percent dextrose in any saline solution concentration" indicates a dextrose concentration of 5% in an unspecified saline solution.

Step 2: Identifying the Correct Option

The order specifies D5NS, which is "5% dextrose in 0.9% normal saline". We need to match this exact requirement with one of the options. - Option 1 correctly states "5 percent dextrose in 0.9 percent sodium chloride", which is precisely the D5NS solution required. - Option 2 involves modifying a 0.9% saline solution by adding 5 grams of dextrose, creating the required mixture but not in the specified form. - Option 3 similarly results in the correct mixture but involves nurse preparation. - Option 4 allows for any saline concentration, which does not specifically ensure 0.9% sodium chloride as required.

Step 3: Final Decision

Since we need to meet the exact order of D5NS (5% dextrose in 0.9% normal saline), Option 1 meets this requirement exactly without any modification or ambiguity.

Key Concepts

Intravenous Solutions

Intravenous (IV) solutions are fluids administered directly into a patient's bloodstream. They are essential in providing hydration, electrolytes, and nutrients to patients who cannot consume them orally. An understanding of the different types of IV solutions is crucial for nurses in creating appropriate clinical care plans. These solutions are categorized based on their components and osmolarity, which is the measure of solute concentration.

Common categories include:

• Isotonic Solutions: Mimic the body's natural osmolarity, e.g., 0.9% sodium chloride (normal saline) or Lactated Ringer’s solution.
• Hypotonic Solutions: Have lower osmolarity than bodily fluids, e.g., 0.45% sodium chloride.
• Hypertonic Solutions: Contain higher osmolarity, e.g., 5% dextrose in 0.9% sodium chloride (D5NS).

IV solutions like D5NS introduce both glucose and electrolytes simultaneously, making them valuable in managing hydration and energy levels. Understanding their composition allows nurses to choose suitable solutions for patients requiring specific fluid therapies.

Clinical Decision Making

In nursing, clinical decision making is a critical skill enabling nurses to interpret data accurately and apply knowledge effectively in patient care. Decisions encompass selecting appropriate interventions, such as choosing the right IV solution.

To make informed decisions, nurses rely on various factors, including:

• Patient Assessment: Evaluating vital signs, laboratory results, and clinical history to identify needs.
• Evidence-Based Practice: Using current research and best practices to guide choices.
• Collaboration: Consulting with healthcare teams and pharmacists for accurate solution preparation.

In the exercise, selecting the correct IV solution involves recognizing that "5% dextrose in 0.9% sodium chloride" aligns precisely with the doctor's order, as it does not require any alterations or formulations by the nurse.

Nurse Responsibilities

A nurse's responsibilities are diverse and encompass patient safety, accurate drug preparation, and delivery of care. When administering intravenous solutions, nurses must ensure the right solution is given, as prescribed, to avoid complications.

Key duties include:

• Verification of Orders: Double-checking physician orders for clarity and correctness.
• Preparation and Administration: Ensuring sterile technique during IV setup and connecting it to the patient.
• Monitoring: Observing patients for adverse reactions and ensuring therapeutic effects.

In the exercise example, ensuring D5NS is correctly administered involves verification of the IV bag’s label, preparation according to best practices, and monitoring for patient response. Thus, nurses play a pivotal role in maintaining high standards of patient care and safety.