PrepU Questions for 210 - Exam 2

The nurse is administering the first dose of an intravenous infusion of an antibiotic. Which statement made by the client is cause for concern? "I feel like I need to urinate." "I feel very tired." "I feel hungry." "I feel like my back and arms are itching."

"I feel like my back and arms are itching."

A nurse is administering a piggyback infusion to a client with second-degree burns. Which of the following describes the most important feature of a piggyback infusion? Medication locks are changed every 72 hours Primary IV solution is infused by gravity Medication is given all at one time as quickly as possible A parenteral drug is given in tandem with IV solution

A parenteral drug is given in tandem with IV solution

The nurse is preparing to administer a chemotherapy infusion to a client with esophageal cancer. The client has an implanted port that was last accessed 7 days ago. The insertion site is clean and dry and without erythema. Which is the appropriate action by the nurse? Access the port using a coring needle. Access the port using a Huber needle. Contact healthcare provider and write an incident report. Insert a peripheral line for the infusion.

Access the port using a Huber needle.

A nurse is preparing to assist a health care provider with a peripherally inserted central catheter. The nurse demonstrates understanding of this procedure by preparing which insertion site? Metacarpal vein Subclavian vein Jugular vein Basilic vein

Basilic vein

A client has just had a central venous catheter ordered and the nurse will take action to prevent the client from developing a central line associated bloodstream infection (CLABSI). Which action should the nurse take to achieve this goal? Ensure the catheter hub remains clean and protected at all times Maintain fluid infusion at a rate of at least 25 cc/hour at all times Advocate for a jugular or femoral insertion site Change the tubing no less frequently than every 48 hours

Ensure the catheter hub remains clean and protected at all times

The nurse is preparing to administer a medication through a peripheral intravenous line. What should the nurse do when administering the medication to ensure safe delivery? Select all that apply. Administer the medication rapidly so that faster absorption takes place. Flush the access device before the infusion is begun and after the infusion is completed. Don't start administering the medication until intravenous placement is confirmed. Observe for signs of infiltration or phlebitis prior to administration. Flush with small amounts of saline pushed through the device on a routine basis to ensure patency.

Flush the access device before the infusion is begun and after the infusion is completed. Flush with small amounts of saline pushed through the device on a routine basis to ensure patency. Don't start administering the medication until intravenous placement is confirmed. Observe for signs of infiltration or phlebitis prior to administration.

An emergency room nurse is ordered to administer nitroglycerin to a client being treated for acute pulmonary hypertension. Which means of drug administration would the nurse use to achieve rapid results in this emergency situation? Oral powder Subcutaneous injection Inhalation IV Infusion

IV Infusion

A nurse is preparing to perform site care for a client receiving IV therapy through a peripherally inserted central venous catheter. Using the steps below, place them in the order in which the nurse would complete them from first to last. 1Provide privacy. 2Apply mask to self and to client. 3Position the client comfortably. 4Perform hand hygiene. 5Identify the client.

Perform Hand Hygiene Identify the Client Provide privacy Position the client comfortably Apply mask to self and to patient

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? Remove the dressing, clean the site, and apply a new dressing. Remove the catheter, check for catheter integrity, and send the tip for culture. Notify the physician. Draw a circle around the moist spot and note the date and time.

Remove the dressing, clean the site, and apply a new dressing.

A client has just returned from having a central venous catheter placed and is prescribed I.V. solution to run at 100 ml/hr. What is the appropriate action by the nurse? Assess for blood return prior to administering the solution. Administer the I.V. solution as prescribed. Contact the healthcare provider to verify the prescription. Review the x-ray results to ensure correct catheter placement.

Review the x-ray results to ensure correct catheter placement.

A client has a central venous catheter inserted. The nurse understands that the tip of the catheter would be found at which location? Select all that apply. Basilic vein Median cubital vein Left ventricle Right atrium Superior vena cava

Right atrium Superior vena cava

A nurse who is administering a piggyback intermittent intravenous infusion of medication to a client observes that there is a cloudy, white substance forming in the IV tubing. Which actions should the nurse take in this situation? Select all that apply. Check literature regarding incompatibilities of medications after administering. Prime the secondary tubing by "backfilling" it. Stop the IV from flowing and stop administering the medication. Replace tubing on primary and secondary infusions. Clamp the IV at the site nearest to the client. Assess the IV site for signs of infiltration or phlebitis.

Stop the IV from flowing and stop administering the medication. Replace tubing on primary and secondary infusions. Clamp the IV at the site nearest to the client.

The nurse is preparing to access an implanted port when administering intravenous fluids and medications. What best practice should be used when accessing this port? The system is accessed with a noncoring needle and patency is maintained by periodic flushing. In general, a ½-in, 18-gauge needle is most frequently used. If the client has a significant amount of subcutaneous tissue, a longer length (1 or 1½ in) may be selected. When venous access is desired, the location of the injection port must be located via an x-ray. A smaller gauge (17-gauge) is preferred for administration of blood products.

The system is accessed with a noncoring needle and patency is maintained by periodic flushing.

graduate nurse is cleaning a central venous access device (CVAD) and is being evaluated by the preceptor nurse. The preceptor nurse makes a recommendation for relearning the skill when she notes the graduate nurse does the following action: Contaminates gloves and obtains a pair of sterile gloves for use Wipes catheter ports from distal end to insertion site Cleanses the insertion site with a chlorhexidine solution Uses a circular motion from insertion site outward

Wipes catheter ports from distal end to insertion site

The nurse is caring for children who are receiving IV therapy in the hospital setting. For which children would a central venous device be indicated? a child who is receiving a one-time dose of a medication a child who is receiving IV fluids for dehydration a child who is receiving chemotherapy for leukemia a child who is receiving an IV push

a child who is receiving chemotherapy for leukemia

A nurse needs to administer a prescribed medication to a client using IV push. In which way is the medication being administered to the client? electronic infusion device gravity infusion continuous drip bolus administration

bolus administration

The nurse is caring for a pediatric client who requires vitamins, minerals, lipids and amino acids through the circulatory system instead of the gastrointestinal tract. Which type of intravenous therapy is anticipated for long-term therapy? central venous catheter infusions intermittent fluids via a syringe pump use of a short line catheter and volume control chamber peripheral venous catheter infusions

central venous catheter infusions

A nurse is preparing to administer a medication by intravenous piggyback. Where will the piggyback container be placed? below the level of the patient's heart higher than the primary solution container at an equal height with the primary solution container lower than the primary solution container

higher than the primary solution container

The nurse administers medications by various routes of delivery. The nurse should use which route for a client who needs immediate effect of the medication? oral intravenous rectal transdermal

intravenous

A client has an order for an intermittent infusion of 250 mL of 0.9 normal saline. The nurse understands that this type of infusion is used for which situation? medications that are toxic if given over short periods medications that need to be infused over 20 to 60 minutes medications that are given over 1 minute for rapid therapeutic effect medications that can be given through a capped intravenous port

medications that need to be infused over 20 to 60 minutes

Which type of catheter is inserted so that the tip sits in the upper arm at or below the axillary line but is not useful to the nurse for blood draws due to inconsistent blood return? vascular implantable device (VID) peripherally inserted central catheter (PICC) midline catheter tunneled access device (TAD)

midline catheter

A client is to receive intravascular chemotherapy for 10 days. Which equipment should the nurse use for this procedure? peripherally inserted central catheter (PICC) central venous access in the femoral vein short peripheral catheter intravenous catheter insertion device

peripherally inserted central catheter (PICC)

When positioned properly, the tip of a central venous catheter should lie in the superior vena cava. basilic vein. subclavian vein. jugular vein.

superior vena cava.

A nurse flushes an intravenous lock before and after administering a medication. What is the rationale for this step? to dilute the infusion and maintain homeostasis to keep the inside of the needle or catheter sterile to facilitate client comfort and decrease anxiety to clear medication and prevent clot formation

to clear medication and prevent clot formation

Hickman and Groshong are examples of which type of central venous access device? nontunneled central catheters implanted ports tunneled central catheters peripherally inserted central catheters

tunneled central catheters