8:1-3 IV Meds

Which of the following is a correct sequence for administering an IV piggyback through a saline lock? Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing and document. Cleanse the port with alcohol. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline. Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline.

Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline. The nurse should flush the port with normal saline prior to administering the IV piggyback to verify patency and flush any blood from the access device. After the piggyback solution has infused, the nurse should again flush the access device with normal saline to clear the port of any medication and maintain patency of the saline lock. In the other sequences critical steps were missed. The nurse failed to assess for patency by aspirating for blood return or flushing the access device in one and in the other the nurse failed to flush the access device after the IV piggyback had infused. This may result in medication being left in the access device and clotting of the catheter.

What additional supplies are required for administering a medication by IV bolus through a saline lock versus an existing infusion of IV fluids? Two syringes with 2 to 3 mL of normal saline. Nonsterile gloves. A watch. The necessary supplies are the same regardless of whether a medication is administered by IV bolus through a saline lock or through an existing infusion of IV fluids.

Two syringes with 2 to 3 mL of normal saline. Two syringes with 2 to 3 mL of normal saline are necessary for flushing the saline lock before and after medication administration.

Which are the advantages and disadvantages of administering medications by intravenous (IV) bolus. Ability to maintain a patient on a strict fluid restriction. Avoids possible discomfort with highly alkaline medications compared with the subcutaneous or intramuscular (IM) route. Amount of time allowed for correcting errors. Time it takes to achieve constant therapeutic drug levels. Possibility of irritation to the lining of blood vessels. Quick route of administration in an emergency; rapid response.

Ability to maintain a patient on a strict fluid restriction. Advantage Avoids possible discomfort with highly alkaline medications compared with the subcutaneous or intramuscular (IM) route. Advantage Amount of time allowed for correcting errors. Disadvantage Time it takes to achieve constant therapeutic drug levels. Advantage Possibility of irritation to the lining of blood vessels. Disadvantage Quick route of administration in an emergency; rapid response. Advantage

Which of the following is a correct sequence for administering a medication by IV bolus through a saline lock? Clean injection port, insert syringe of normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended period, withdraw syringe, clean port, and flush port with normal saline at same rate as medication administration. Clean injection port, insert syringe of medication, pinch tubing above port and aspirate for a blood return, release the tubing and administer the medication at the recommended rate, remove syringe, and verify infusion rate. Clean injection port with antiseptic swab, insert syringe with normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended time period, withdraw syringe, clean port, discard gloves, and document. Clean injection port with antiseptic swab, insert syringe containing prepared medication into port, and inject over recommended time period. Remove syringe, clean port, and flush port with normal saline at same rate as medication administration.

Clean injection port, insert syringe of normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended period, withdraw syringe, clean port, and flush port with normal saline at same rate as medication administration. The correct sequence is clean injection port, insert syringe of normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended period, withdraw syringe, clean port, and flush port with normal saline at same rate as medication administration.

Identify advantages of administering medication by the IV route. (Select all that apply.) Less risk of an allergic response. Establishes therapeutic blood levels. Causes less discomfort with highly alkaline medications that are irritating to subcutaneous or intramuscular tissue. Onset of therapeutic action is delayed. Requires less knowledge and skill. Delivers medication quickly in an emergency.

Establishes therapeutic blood levels. Causes less discomfort with highly alkaline medications that are irritating to subcutaneous or intramuscular tissue. Delivers medication quickly in an emergency. The advantages of administering medication by the IV route are that it provides a route for administering medication when the drug must be delivered quickly, it is the preferred route when it is necessary to establish constant therapeutic blood levels, and it causes less discomfort with highly alkaline and irritating medications than the subcutaneous or intramuscular route. After a medication enters the bloodstream, it begins to act immediately. If the patient is allergic to the medication, the reaction will be more prompt. Administering medications by the IV route requires more knowledge and skill to prevent negative outcomes.

Identify nursing precautions to ensure safe patient care when administering IV medications. (Select all that apply.) Having the antidote available, if the medication has one. Adding IV medications to IV bags that are already hanging. Being knowledgeable of the desired action and side effects of the medication. Informing assistive personnel how to assess for fluid overload and evaluate medication effectiveness. Following the six rights of medication administration. Verifying the rate of administration with a drug reference or pharmacist. Observing for symptoms of adverse reactions. Assessing vital signs before, during, and after infusion with potent medications.

Having the antidote available, if the medication has one. Being knowledgeable of the desired action and side effects of the medication. Following the six rights of medication administration. Verifying the rate of administration with a drug reference or pharmacist. Observing for symptoms of adverse reactions. Assessing vital signs before, during, and after infusion with potent medications. The nurse takes special care to avoid errors in dose calculation and preparation because once the dose enters the bloodstream, it begins to act immediately and there is no way to stop its action. The nurse uses the six rights of medication administration to verify that the right dose of the right medication is given by the right route to the right patient at the right time and then documented accurately. The nurse verifies the prescribed rate of administration with a drug reference or pharmacist before giving any IV medication so that the medication is given over the appropriate amount of time. Patients may experience severe adverse reactions if IV medications are administered too quickly. The nurse is aware of the desired therapeutic effect and potential side effects for accurate observation and evaluation of the medication therapy. The nurse continuously observes the patient for symptoms of adverse reactions so that early intervention may be implemented. This includes having an antidote available if the medication has one. When administering potent medications, the nurse assesses vital signs before, during, and after administration to assess for any alteration in the patient's status. It is inappropriate to delegate nursing assessment and evaluation to assistive personnel. Only add medications to new IV fluid containers as ordered by the health care provider, and administer solutions and medications prepared and dispensed from the pharmacy or as commercially prepared when possible.

Match the six rights of medication administration, plus three additional rights when administering IV push medications, by matching the appropriate "right" to the example. The nurse: Right documentation Right dose Right drug Right time Right monitoring Right route Right flush or dilution Right patient Right speed - calculated and prepared the amount of medication as necessary according to orders. - compared the order with the medication label on the vial. - administered the medication at the prescribed frequency. - administered the medication intravenously according to orders. - observed the patient during and after medication administration. - verified compatibility with the drug and IV fluids. - asked the patient to state his name and birthdate and looked at his identification bracelet. - calculated the amount of time necessary to push the medication according to a drug reference. - recorded medication administration.

Match the six rights of medication administration, plus three additional rights when administering IV push medications, by matching the appropriate "right" to the example. The nurse: Right documentation - recorded medication administration. Right dose - calculated and prepared the amount of medication as necessary according to orders. Right drug - compared the order with the medication label on the vial. Right time - administered the medication at the prescribed frequency. Right monitoring - observed the patient during and after medication administration. Right route - administered the medication intravenously according to orders. Right flush or dilution - verified compatibility with the drug and IV fluids. Right patient - asked the patient to state his name and birthdate and looked at his identification bracelet. Right speed - calculated the amount of time necessary to push the medication according to a drug reference. The others listed are not rights. Leave them blank.

The nurse is administering vancomycin (Vancocin) 500 mg by IV piggyback over 60 minutes. An hour later the nurse returns to find that approximately half of the infusion has been administered and the IV site appears swollen, pale, and is cool to the touch. What is the appropriate action to be taken for this unexpected outcome? Select all that apply. Provide extravasation care. Provide an extra blanket for the patient. Discontinue the IV. Stop the infusion. Increase the flow rate. Recheck the patient for an allergy to vancomycin.

Provide extravasation care. Discontinue the IV. Stop the infusion. These are signs of infiltration. The infusion will have to be stopped and the IV access device discontinued. Some IV medications are extremely harmful to subcutaneous tissue. The nurse should provide IV extravasation care (e.g., injecting phentolamine around the IV infiltration site) as indicated by agency policy, use a medication reference, or consult a pharmacist to determine appropriate follow-up care. If continuation of therapy is indicated, a new IV site, preferably in the other extremity, will have to be started. Increasing the rate of flow would only make the infiltration worsen. Providing the patient with a blanket may provide comfort but will fail to resolve the problem. These symptoms are not indications of an allergic response.

When preparing to administer an IV medication, a nurse checks the health care provider's order with the medication administration record (MAR) and the label on the medication vial. The nurse verifies the IV route for administration. Next the nurse computes the correct dosage and withdraws the medication according to the MAR using the appropriate dilution. The nurse administers the medication intravenously at the time ordered and at the correct rate. Which of the six rights of medication administration did the nurse fail to demonstrate? (Select all that apply.) Right date of expiration. Right patient. Right documentation. Right tubing. Right concentration.

Right patient. Right documentation. The nurse failed to identify the right patient by comparing the MAR to the patient's identification bracelet and asking the patient to state his or her name and birth date. Also the nurse is not described as recording the medication administration on completion of the procedure. Although the right concentration is excluded from the six rights of medication administration, the nurse did demonstrate the right dose by calculating the dosage and preparing it according to the medication order. Right tubing and right date of expiration also are not identified as among the six rights of medication administration. The nurse did verify the right drug by looking at the medication label on the vial and comparing it with the MAR. The nurse would also check the expiration date on the medication label at this time.

A patient with a saline lock has the following order: hydromorphone 2 mg IV push q3h prn pain. The drug book states: Hydromorphone: Dilute with at least 5 mL of sterile water or 0.9% NaCl for injection. Administer slowly, at a rate not to exceed 2 mg over 3 to 5 minutes. Which of the following actions if performed by the nurse would require correction? (Select all that apply.) The nurse injects the IV medication over 4 minutes using a watch to time administration. The nurse cleans the injection port with an antiseptic swab, flushes the IV lock, and inserts the needleless tip of prepared medication syringe through injection port of IV lock. The nurse dilutes the hydromorphone in 5 mL of normal saline 0.9% and labels the syringe with the patient's name, generic drug name and dosage in syringe. The nurse observes the IV site above the catheter while flushing the IV site with normal saline prior to medication administration. The nurse flushes the IV injection port with 2 to 3 mL of normal saline over 30 seconds following medication administration.

The nurse cleans the injection port with an antiseptic swab, flushes the IV lock, and inserts the needleless tip of prepared medication syringe through injection port of IV lock. The nurse flushes the IV injection port with 2 to 3 mL of normal saline over 30 seconds following medication administration. The nurse should clean the injection port with an alcohol swab and allow it to dry prior to entering the IV port every time. The nurse should have cleaned the port again prior to inserting the needleless tip of the prepared medication. The nurse should have pulled back on the plunger prior to the initial flush to check for blood return to verify IV catheter is in vein. Following medication administration, the nurse should flush the IV injection port at the same rate as the medication was administered. The nurse flushed the port too fast following medication administration. All other actions were appropriate.

Which of the following are advantages of volume-controlled intravenous (IV) infusions? (Select all that apply.) There is less risk of rapid-dose infusion (as compared with IV push) because medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes). It is the preferred method in an emergency. The risk of side effects is minimal because this is the safest method of administering IV medications. It allows for administration of medications (e.g., antibiotics) that are stable for a limited time in solution.

There is less risk of rapid-dose infusion (as compared with IV push) because medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes). It allows for administration of medications (e.g., antibiotics) that are stable for a limited time in solution. Using volume-controlled infusions has several advantages: It reduces the risk of rapid-dose infusion by IV push. Medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes). It allows for administration of medications (e.g., antibiotics) that are stable for a limited time in solution. It allows for control of IV fluid intake. The risk of side effects still remains; the safest method of administering IV medications is by large-volume infusions. IV bolus is the preferred method in an emergency when quick-acting medications are needed.

A nurse takes precautions to prevent an undesirable outcome when administering medications by the IV route. Which of the following actions may produce an undesirable outcome? The nurse: adds piggyback infusion of an antibiotic to main line IV of parenteral nutrition. explores patient's cultural beliefs regarding use of alcohol, herbal remedies, and dietary preferences. administers solutions and medications prepared and dispensed from pharmacy when possible. verifies prescribed dilution and rate of administration for medication.

adds piggyback infusion of an antibiotic to main line IV of parenteral nutrition. The nurse should never administer IV medications through tubing that is infusing blood, blood products, or parenteral nutrition solutions because the medications may cause the blood cells to clump or cause clotting. Cultural assessment yields information about dietary preferences, tobacco and alcohol use, and use of herbal remedies that affect drug action and response. Patients may experience severe adverse reactions if IV medications are administered too quickly. Verify the rate of administration with a drug reference or a pharmacist before giving any IV medication to ensure medication is given over the appropriate time in the appropriate concentration. For risk reduction, the nurse should administer solutions and medications prepared and dispensed from the pharmacy or as commercially prepared when possible.

The nurse is planning to administer an IV medication with a mini-infusion pump. The nurse has performed hand hygiene; verified the medication, dose, route, and time with the order; and explained the medication therapy to the patient. The nurse uses two patient identifiers to verify the right patient. The nurse connects the prefilled syringe to the mini-infusion tubing and places the syringe into the mini-infuser pump. The nurse connects the mini-infusion tubing to the main IV line and hangs the pump on the IV pole alongside the primary IV. The nurse set the pump to deliver the medication within the recommended time while allowing the primary line to continue to infuse. The nurse observes the patient for any signs of adverse reactions. What steps have not been completed? The nurse needs to: (Select all that apply.) gently push the plunger and fill the tubing with medication. turn off the main IV line while the mini-infuser pump is running. hang the mini-infusion pump on an IV pole by itself. press the button on the mini-infusion pump to begin the infusion. check that the syringe was secure in the mini-infuser pump. wipe off the port with an alcohol swab before connecting the mini-infusion tubing to the main IV line.

gently push the plunger and fill the tubing with medication. press the button on the mini-infusion pump to begin the infusion. check that the syringe was secure in the mini-infuser pump. wipe off the port with an alcohol swab before connecting the mini-infusion tubing to the main IV line. The correct sequence for administering an IV medication with a mini-infusion pump is as follows: Check the patient's identification bracelet and ask the patient to state his or her name and one other identifier (identification of the patient is required before any medication administration); connect the prefilled syringe to mini-infusion tubing (tubing must be attached to syringe for infusion); carefully apply pressure to the syringe plunger, allowing the tubing to fill with medication (infusion tubing should be fluid filled and free of air bubbles to prevent air embolism); place the syringe into the mini-infuser pump and be sure the syringe is secure (to facilitate proper administration); wipe off the port with an alcohol swab (to reduce the transmission of microorganisms); connect the mini-infusion tubing to the main IV line and hang the infusion pump with syringe on the IV pole alongside the main IV bag (prevents delay in flushing after completion of infusion, maintaining patency of device); set the pump to deliver medication within the time recommended (for IV medication to be delivered at recommended rate); press button on the pump to begin the infusion. The main IV infusion normally continues to flow while medication infuses; after the medication has infused, check the flow regulator on the primary infusion, and regulate as needed (prevents infusion of excess fluid); observe the patient for signs of adverse reactions (early identification of a medication reaction or complications enables prompt intervention).

The nurse is preparing to administer a medication by the IV route. Which of the following actions indicates further instruction is needed? The nurse: (Select all that apply.) stops the infusion when the patient complains of itching and difficulty breathing and the NAP reports the patient's pulse is 110 and blood pressure is 80/60. fills the Volutrol with the desired amount of fluid, cleans the port, adds the medication, gently rotates, and labels the Volutrol chamber. notes the time the piggyback is started on the pump in order to return at time of completion to turn the primary infusion back on. removes the piggyback bag and tubing from the primary line after the piggyback has infused to prevent bacterial growth. assesses the IV insertion site for signs of infiltration or phlebitis before initiating the infusion and frequently evaluates the site for complications.

notes the time the piggyback is started on the pump in order to return at time of completion to turn the primary infusion back on. removes the piggyback bag and tubing from the primary line after the piggyback has infused to prevent bacterial growth. The piggyback should be left in place with the tubing for future medication administration unless it is time to change the tubing. Establishment of a secondary line produces a route for microorganisms to enter the main line. Repeated changes in tubing increase the risk of infection transmission. (Check facility policy.) It is unnecessary to turn the primary infusion back on as it will automatically start when the piggyback infusion is completed. The nurse should determine patency and assess the IV site frequently for complications. The Volutrol should be gently rotated to ensure mixing and labeled to identify type and amount of medication added. If the patient is hypotensive, tachycardic, and complaining of itching and difficulty breathing, an allergic reaction should be suspected. The nurse should turn off the IV, follow facility policy for response to an allergic reaction, and notify the health care provider.