NCLEX: Chapter 12 Intravenous Therapy and Blood Administration Questions

The nurse is making a worksheet and listing the tasks that need to be performed for assigned adult clients during the shift. The nurse writes on the plan to check the intravenous (IV) of the assigned client who is receiving fluid replacement therapy how frequently?

Every hour

A client who was receiving a blood transfusion has experienced a transfusion reaction. The nurse sends the blood bag that was used for the client to which area?

The blood bank

The nurse is assisting with caring for a client who has received a transfusion of platelets. The nurse determines that the client is benefiting most form this therapy if the client exhibits which finding?

A decrease in oozing from puncture sites and gums

Which of these clients is/are most likely to develop fluid (circulatory) overload?

A premature infant; A 101-year old man; A client with heart failure; A client receiving renal dialysis

The nurse is assigned to care for a client with a peripheral intravenous (IV) infusion. The nurse is providing hygiene care to the client and should avoid which changing the client's hospital gown?

Disconnecting the IV tubing from the catheter in the vein

The nurse is preparing an intravenous (IV) solution and tubing for a client who requires IV fluids. While preparing to prime the tubing, The tubing drops and hits the top of the medication cart. The nurse should plan to take which action?

Change the IV tubing

A client has prescription to receive 1,000 mL of 5% dextrose in 0.45% sodium chloride. After gathering the appropriate equipment, the nurse takes which action first before spiking the IV bag with tubing?

Close the roller clamp on the IV tubing

A client who is receiving a blood transfusion pushes the call light for the nurse. When entering the room, the nurse notes that the client is flushed, dyspneic, and complaining of generalized itching. How should the nurse correctly interpret these findings?

Fluid Overload

The nurse is doing a routine assessment of a client's peripheral intravenous (IV) site. The nurse notes that the site is cool, pale, and swollen and that the IV has stopped running. The nurse determines that which has probably occurred?

Infiltration

The nurse is checking the insertion site of a peripheral intravenous (IV) catheter. The nurse notes the site to be reddened, warm, painful, and slightly edematous in the area of the vein proximal to the IV catheter. The nurse interprets that this is likely the result of which?

Phlebitis if the vein

The nurse has been instructed to remove an intravenous (IV) line. The nurse removes the catheter by withdrawing the catheter while applying pressure to the site with which item?

Sterile 2 x 2 gauze

The nurse takes a client's temperature before giving a blood transfusion. The temperature is 100 degrees F orally. The nurse reports the finding to the RN and anticipates that which action will take place?

The blood will be held, and the primary health care provider (PHCP) will be notified

The nurse is assisting with caring for a client who will receive a unit of blood. Just before the infusion, it is most important for the nurse to check which item?

Vital Signs

A client is going to be transfused with a unit of packed red blood cells (PRBCs). The nurse understands that it is necessary to remain with the client for what time period after the transfusion is started?

15 minutes

The nurse is assisting with caring for a client who is receiving a unit of packed red blood cells (PRBCs). The nurse should tell the client that it is most important to report which sign immediately?

Chills, itching, or rash