A.Q. Ch 13

A patient with a history of cancer is prescribed an intravenous (IV) infusion of chemotherapeutic agents through a peripherally inserted central catheter (PICC). The primary health care provider instructs the nurse to flush the catheter before and after medication administration. What solution should be used for flushing?

10 mL of sterile saline

The primary health care provider prescribes rapid fluid resuscitation to a patient with severe blood loss from a motor vehicle collision. Which gauge of peripheral catheter should the nurse use for this patient?

14-gauge

Approximately how many punctures can the port body of an implanted port tolerate when it is placed in the chest?

2000

What should be the approximate flow rate of a blood transfusion when a 22-gauge peripheral catheter is used? Record your answer using a whole number.

38

A diabetic patient who suffered an acute myocardial infarction is in the hospital during recovery. The physician orders an IV drip of regular human insulin with regular blood glucose monitoring. In addition to the IV drip, what other insulin should be given?

A priming volume of 20 mL of insulin solution should be given before starting the IV drip.

The nurse is admitting patients to the same-day surgery unit. Which insertion site for routine peripheral venous catheters does the nurse choose most often?

Cephalic vein of the forearm

Which central vascular access device (CVAD) is placed in arteries, epidural space, and the peritoneal cavity?

Implanted ports

Which central venous access device (CVAD) is indicated in patients who require IV therapy for more than a year?

Implanted ports

Which is a complication of intraosseous (IO) infusion therapy?

Osteomyelitis

What is hypodermoclysis?

Slow infusion of isotonic fluids into the subcutaneous tissues

The nurse has received a prescription for infusion therapy for a patient. What does the nurse look for in the prescription to determine its completeness?

Specific type of fluid Rate of administration Specific dose of drug to be added

A patient with a body mass index of 42 is scheduled to receive hypodermoclysis. What consideration should the nurse take into account when administering hypodermoclysis to this patient?

The fluids from the treatment will be more readily absorbed because of the presence of large amounts of adipose tissue.

A patient reports blistering, sloughing, and tissue necrosis from the site after an IV drug infusion. Which drug is likely to have caused this condition?

Vinblastine

After surgery to remove pancreatic cancer, the surgeon inserted an epidural catheter for patient-controlled opioid administration. Several hours after surgery during a routine nursing assessment, the patient indicated a pain level of 7 but had not yet self-administered pain medication. When the nurse asked why, the patient expressed concern about opioid addiction. What should the nurse tell the patient?

"Addiction to opioids rarely results from short-term use of opioids for pain relief, and patients heal faster and can be taken off the drugs sooner if they use adequate amounts of drug to control pain."

The nurse is teaching a hospitalized patient who is being discharged about how to care for a peripherally inserted central catheter (PICC) line. Which patient statement indicates a need for further education?

"I can continue my 20-mile running schedule as I have for the past 10 years."

The registered nurse (RN) is training a student nurse on the use of peripheral vascular access devices (VADs). The RN states that one patient is receiving IV antibiotics to treat a lower respiratory infection, but because he has severe lower extremity edema, they are administering the antibiotics intermittently. Which statement by the student nurse indicates an understanding of peripheral VADs?

"That means that the VAD should have a saline lock on it."

A student nurse notes that a patient who has just been admitted to the hospital has a hemodialysis catheter. The physician asks the registered nurse who is supervising the student nurse to draw some blood and start an IV antibiotic. Which statement by the student nurse indicates that additional teaching is needed about the use of hemodialysis catheters?

"We can draw blood and inject the drugs through the hemodialysis catheter to avoid additional needle sticks for the patient."

The nurse is preparing a child for a tonsillectomy. Which peripheral catheter does the nurse anticipate the anesthesiologist will use?

20-gauge

What is the osmolarity of a hypotonic infusate?

250 mOsm/L

A physician has ordered that a patient be infused with a hypertonic solution to correct fluid and electrolyte imbalances. The solution will be infused through a peripheral IV line. Which solution does the nurse administer to this patient?

A solution that has an osmolarity of 400 mOsm/L

Patients with which disorders or conditions may better benefit from intraosseous therapy?

Cardiac arrest Diabetic ketoacidosis

What is the expected risk for a patient who had a total parenteral nutrition (TPN) solution with an osmolarity of 1500 mOsm/L infused peripherally?

Decreased perfusion

What is a local complication of intravenous therapy?

Ecchymosis

When is intraosseous (IO) infusion therapy contraindicated?

Fracture Osteoporosis Osteogenesis imperfecta

Which detail is the least important factor to be considered for a patient who is prescribed peripherally inserted central catheters (PICC) for peripheral infusion therapy?

Gender of the patient

Which condition indicates infiltration?

Leakage of nonvesicant intravenous (IV) solution into extravascular fluids

Which catheter type is usually chosen for intravenous therapy in older adults?

Midline catheters

The nurse is monitoring a patient in the instillation phase of intraperitoneal infusion therapy for a pancreatic tumor. What common side effect should the nurse be prepared for during this time?

Nausea and vomiting

Which catheter is preferred in emergency or trauma situations?

Nontunneled percutaneous central venous catheters

A patient with severe pneumonia has been admitted to the hospital, and the physician ordered ciprofloxacin to be administered by IV infusion. Because the patient is frail and immunocompromised due to chemotherapy treatments, the entire 10-day course of antibiotics will be administered parenterally. Which type of infusion system would be best for this patient?

Peripherally inserted central catheter

A patient with severe hyponatremia has been prescribed 3% hypertonic saline. What must the nurse clarify with the prescribing provider before administering the hypertonic saline by IV infusion?

Rate of infusion Length of infusion Route of administration

The novice nurse is inserting a short peripheral catheter into a patient's median vein. The nurse is having trouble finding the vein, and when he pulls the catheter and needle out, he accidentally sticks the needle into his fingertip. What is the nurse required to do to report this incident?

Record the incident in the sharps injury log.

The nurse is monitoring a patient receiving morphine via subcutaneous infusion therapy. After three days of therapy, the nurse notices redness at the infusion site. Which is the appropriate immediate response by the nurse?

Remove the infusion needle and start the infusion at a new site with a new needle.

A nurse who plans to give a drug through an implanted port makes several observations. Which observation would require the nurse to stop injection of the drug?

There is no blood return when the needle is inserted through the septum.

The nurse is attending to a patient with a peripherally inserted central catheter (PICC). What action does the nurse take to maintain patency of the PICC?

Use 10-mL barrel syringes to flush all PICC lines.

A registered nurse is teaching a student nurse about midline intravenous (IV) catheters. Which statement made by the student nurse indicates the need for further teaching?

"Midline catheters are indicated for the administration of vesicant medications."

The registered nurse is teaching a student nurse about the use of short peripheral catheters. Which statement made by the student nurse indicates a need for further teaching?

"Short peripheral catheters can be inserted into veins in the lower extremities of adults."

Which statement made by the nurse about IV peripheral catheters needs correction?

"Small gauge peripheral catheters pose an increased risk of phlebitis."

A patient is admitted to the emergency department with severe injuries to the neck and upper body from a motor vehicle accident. The physician has ordered the registered nurse to insert a catheter to infuse fluids and antibiotics. The student nurse who is trailing the registered nurse suggests inserting a nontunneled percutaneous central venous catheter (CVC). What should the registered nurse tell the student nurse?

"The CVC is not appropriate for this patient because trauma to the neck or chest prohibits the use of these devices due to injury of the insertion site."

A female patient in the hospital is receiving IV antibiotics in sterile saline to treat bacterial meningitis. The patient's husband is concerned about DEHP from the plastic IV bags leaking into the fluids and harming his wife. What facts can the nurse tell the husband about DEHP that might calm his fears?

"The FDA has found that the amount of DEHP released from IV bags will not cause harm to most patients." "DEHP has the most serious effects on the development of the male reproductive system, so females are not at high risk for severe side effects."

A patient who used to work as a nurse asks, "Why is the hospital using a 'fancy new IV' without a needle? That seems expensive." How does the nurse respond?

"They minimize health care workers' exposure to contaminated needles."

A registered nurse and student nurse are monitoring a patient who has just received an intra-arterial infusion pump for fibrinolytic treatment of ischemic stroke. Which statement by the student nurse indicates a need for further teaching regarding intra-arterial infusion pumps?

"This patient would benefit from an implanted port rather than the external catheter."

A patient with severe traumatic brain injury enters the hospital in a coma. Because of the severity and location of the injury, the physician suspects that the patient may never recover from the coma. However, the patient's family insists on full medical treatment. Therefore, the physician orders insertion of a tunneled central venous catheter to support long-term total parenteral nutrition. A family member approaches the nurse with concerns that long-term catheter insertion will cause an infection that may speed the patient's death. How should the nurse respond?

"Tunneled central venous catheters have a low rate of infection and are the best catheters to use for long-term intravenous treatment."

The student nurse is teaching about the activities of daily life (ADLs) for a patient with a peripherally inserted central catheter. Which teachings made by the student nurse would need a correction?

"You can walk for exercise."

What is the pore size (in microns) of a filter for removing all particles and bacteria in infusion systems?

0.2

A patient with cerebral palsy has severe muscle spasticity that is being treated with a surgically implanted intrathecal port for delivery of baclofen. During each doctor visit, the nurse provides skin care to the implanted port pocket. Which antiseptic cleanser should the nurse use for this task?

10% Povidone-iodine solution

A patient was admitted to the hospital after a motor vehicle accident. The primary health care provider instructed the nurse to provide rapid infusion of fluids peripherally. What could be the possible size of the catheter used for infusion?

16 gauge

The health care provider instructs the nurse to administer 0.8 L of 5% dextrose over 5 hours. What would be the infusion rate in mL/hr? Record your answer using a whole number.

160

A 22-year-old patient is seen in the emergency department (ED) with acute right lower quadrant abdominal pain, nausea, and rebound tenderness. It appears that surgery is imminent. What gauge catheter does the ED nurse choose when starting this patient's intravenous (IV) solution?

18

A patient with anemia is admitted to the hospital. The primary health care provider instructs the nurse to arrange for a blood transfusion using peripheral catheters. What is the most appropriate catheter size and approximate rate of flow?

22 gauge with 2280 mL/hr

Following the administration of IV fluids, the patient reports peripheral edema and fluid overload. What might be the serum osmolarity of the infusate?

280 mOsm/L

Which would be the approximate flow rates for a 22-gauge peripheral intravenous catheter?

38 mL/min

A patient with renal failure has to use a hemodialysis catheter. What concentration of heparin is used to lock the catheter?

5000 units/mL

What would be the osmolarity of fluids and medications that are infused through a midline catheter?

575 mOsm/L

A patient has received an external arterial catheter to deliver a short term infusion of chemotherapy agents. What is the maximum number of days the patient should use the catheter? Record your answer using a whole number.

7

An active 14-year-old male patient has recently been diagnosed with type I diabetes. He says that he would like to use an insulin pump rather than having to take multiple injections of insulin every day. In order for the patient to remain active, which infusion site should the nurse recommend?

Abdomen

Two days after intraperitoneal therapy for colorectal cancer, a patient complains of abdominal pain. Upon a physical assessment, the nurse finds that the patient has an oral temperature of 102.5 °F and abdominal rigidity. What follow-up treatment may the nurse need to administer to this patient?

Antibiotics

A patient is being admitted to the burn unit from another hospital. The patient has an intraosseous IV that was started 2 days ago, according to the patient's medical record. What does the admitting nurse do first?

Anticipate an order to discontinue the intraosseous IV and start an epidural IV.

A patient has returned from having an intra-arterial infusion catheter inserted into a femoral artery. What adjunct therapy should the nurse recommend for this patient?

Antiembolic stockings

What would be the line of treatment for a female patient receiving chemotherapeutic agents for ovarian cancer through an implanted peritoneal catheter who has complications?

Antimicrobials

What point should the nurse keep in mind to ensure skin antisepsis prior to venipuncture in older adults?

Apply chlorhexidine for maximum antiseptic action.

The nurse is starting a peripheral IV catheter on a recently admitted patient. What actions does the nurse perform before insertion of the line?

Apply povidone-iodine to clean skin, dry for 2 minutes. Clean the skin around the site. Prepare the skin with 70% alcohol or chlorhexidine.

A patient with chronic severe back pain recently had an intrathecal catheter inserted for continuous dosing of morphine. During discharge instructions, the nurse told the patient to immediately report symptoms including headache, stiff neck, and fever. What complication is the nurse concerned about?

Bacterial meningitis

The nurse is inserting a peripherally inserted central catheter (PICC) into a patient. When identifying the insertion site, which site is the nurse most likely to use?

Basilic vein in the upper arm

Which method of administration should be used to prevent complications in a patient with cystic fibrosis who was prescribed an infusion of intravenous (IV) fluids with an osmolarity of 1200 mOsm/L and a pH of 4.3?

Central intravenous infusion

The nurse is attending to an older patient who cannot tolerate oral medication. The patient is prescribed subcutaneous therapy for infusion of isotonic solutions. What action does the nurse take during hypodermoclysis?

Choose the area under the clavicle or abdomen.

What are the causes of phlebitis after the venous puncture? .

Improper antiseptic technique Improper catheter securement devices Osmolarity and pH of the medication used

A nurse has been asked to insert a short peripheral venous catheter in an elderly patient. The patient is right handed and has had a mastectomy and lymph nodes removed on her left side. Where is the best site for the nurse to insert the catheter?

In the median vein of the right arm

A patient receiving intrathecal therapy reports a headache, stiff neck, high grade fever, and swelling at the exit site. Based on these symptoms, what should the nurse suspect?

Infection

What manifestations of catheter-related complications does the nurse observe in a patient undergoing intraspinal infusion therapy?

Infection Bleeding

A nurse is monitoring two patients. One patient is receiving pain medication via traditional IV access. The other patient is receiving chemotherapeutic treatment of liver tumors via intra-arterial infusion therapy. Which complications will the nurse need to monitor for in both patients?

Infection Catheter migration

The nurse inserts an intravenous (IV) line in a patient requiring fluid infusion. Which condition would the nurse document if the IV solution leaks into tissues around the vein?

Infiltration

Which devices allow the visualization of a vein for a patient who is prescribed infusion therapy?

Infrared Laser beam Transilluminator

Which infusion therapy route is often used in the administration of chemotherapeutic agents into arterial blood flow?

Intra-arterial

Which type of infusion therapy can be used to treat trauma and burn victims?

Intraosseous infusion therapy

A tunneled central venous catheter (CVC) is used for lifetime parenteral nutrition. Which are commercial trade names of the catheters that are available?

Leonard Hickman

Needleless connection devices are used for reducing the risk of exposure to contaminated needles. Which interventions can be included to reduce the risk of infection?

Maintaining hand hygiene Avoiding taped connections Cleaning the needleless devices

A patient who takes corticosteroids daily for rheumatoid arthritis requires insertion of an IV catheter to receive IV antibiotics for 5 days. Which type of IV catheter does the nurse teach the new graduate nurse to use for this patient?

Midline catheter

A patient is receiving long-term intra-arterial infusion therapy of methotrexate through the carotid artery. Which assessment is most important for the nurse to include?

Neurological assessment

Which central catheter insertion requires the patient to be in the Trendelenburg position for catheter insertion?

Nontunneled percutaneous central venous catheter

The nurse is monitoring a trauma patient receiving fluids and pain medication via intraosseous therapy in the proximal tibia. During routine assessments, which complications should the nurse assess for related to the intraosseous therapy?

Osteomyelitis Compartment syndrome

Two patients sustained trauma in a motor vehicle collision, were admitted to the hospital reporting similar symptoms, and were prescribed different treatments. What could be the reason behind the different prescriptions?

Patient 2 had compartment syndrome.

The nurse needs to begin fluid resuscitation for four critically ill patients. Which patient is least likely to receive intraosseous infusion of fluids?

Patient C

The nurse is inserting vascular access devices in four patients. Which patient is most likely to receive a midline catheter

Patient D

A nurse has been tasked with administering packed red blood cells to a trauma patient. The nurse has confirmed the patient's identification using two patient identifiers. What else must the nurse do before beginning the blood transfusion process?

Perform strict evidence-based handwashing techniques for infection control. Receive positive patient identification from a second qualified health care professional. Confirm that the four components listed on the label of the blood are correct for the patient.

The health care provider prescribes IV ciprofloxacin to a patient who presents with a systemic infection via a peripheral intravenous catheter. Which complication would most likely occur in this patient?

Phlebitis

What is the expected complication for a patient with an intra-abdominal infection is prescribed long-term treatment of antimicrobial agents to be infused via a peripheral intravenous catheter?

Phlebitis

The nurse has been asked to start intraosseous therapy for a severely burned patient. Assuming that all the bones are intact, which site would be the preferred site for intraosseous therapy?

Proximal tibia

Which cadre of nurses is trained and certified in administering infusion therapy?

Registered nurse (RN)

Which nursing interventions will bring relief to a patient reporting tingling, feeling pins and needles in the extremities, and numbness during vein puncture? .

Removing the catheter Choosing a new site for the catheter insertion Stopping the intravenous insertion procedure immediately

A patient reports pain at the intravenous (IV) therapy site, and the nurse finds redness at the site and inflammation along the length of the vein. Which nursing interventions relieve the patient's pain?

Removing the catheter Using warm compresses to relieve pain Reinserting a new catheter in opposite extremity

Paramedics arrived to a 911 call to find the patient in cardiac arrest. After the patient was revived, the paramedics were unsuccessful in getting IV access, so they started intraosseous therapy for fluid administration and delivered the patient to the hospital. What is the priority action the nurse takes in regards to the intraosseous therapy when caring for the patient in the hospital?

Replacing the intraosseous therapy with traditional IV therapy within 24 hours

A palliative care patient receiving home care is scheduled to start subcutaneous infusion therapy of 1,000 mL of isotonic fluids per day. What teaching points should the nurse use when teaching the patient and caregiver how to use the subcutaneous infusion set?

The needle should be inserted in an area of skin free from infection, inflammation, and bruising. If redness, warmth, swelling, leakage, bruising, or pain is seen around the infusion site, the infusion site should be changed.

A patient on intravenous (IV) therapy reports shortness of breath and cough. The nurse finds that the patient has elevated blood pressure, puffiness around eyes, and distended neck veins. What does the nurse infer about the patient's condition?

The patient is showing signs of circulatory overload.

A patient is receiving opioid pain medications via intrathecal infusion. Within an hour of the treatment start, the patient complains of severe pruritus. The patient's respiratory rate gradually falls to four breaths per minute and the patient becomes lethargic with decreased awareness within two hours of treatment start. What is the most probable explanation for this?

The patient was given a dose of medication appropriate for epidural infusion rather than intrathecal infusion.

The nurse is providing discharge instructions for a patient who is being sent home with an ambulatory pump that will dispense regulated amounts of pain medication. What is a teaching point the nurse should include that may not apply to other types of IV pumps?

The patient will need to be taught how to replace or recharge the battery.

What may be a serious complication of peripherally inserted central catheter (PICC)?

Thrombophlebitis

A physician is planning to insert a nontunneled percutaneous central venous catheter into a patient in preparation for surgery. The nurse has been asked to provide patient education about the insertion procedure. During the patient teaching session, the nurse should include information about which of the following positions?

Trendelenburg position

Which parameters of intravenous therapy should the nurse document?

Vein that was used for insertion Date and time of the vascular access device insertion Name of the nurse who inserted the vascular access device

Which device is most commonly used to assist in the placement of short peripheral catheters?

Vein transilluminator

What are the precautionary measures to be followed while inserting a peripheral catheter? .

Wearing clean gloves Performing hand hygiene Applying antiseptic agent