Chapter 8- Vascular Access and Medication Administration

After starting an IV on a patient, you set the flow at a "KVO" rate. How many drops per minute does this rate deliver?

8 to 15

One deciliter (dL) is equivalent to:

100mL

A 42-year-old man was splashed in the eye by a corrosive substance. Medical control orders you to irrigate the patient's eye with 2 liters of sterile saline. How many milliliters is this?

2,000

What is the MOST significant drawback to cannulating a scalp vein in a child with a butterfly catheter?

It does not allow for rapid fluid administration.

What role does phosphorus play in the body?

It is an important component in the formation of adenosine triphosphate.

Why should five percent dextrose in water (D5W) be avoided in patients with severe brain trauma?

It may increase intracranial pressure.

Which of the following statements regarding subcutaneous injections is correct?

Subcutaneous injections are usually given with a 24-gauge to 26-gauge needle

What physiologic response causes a vasovagal reaction?

Vasodilation and a decrease in blood pressure

When attaching an administration set to a bag of IV fluid and priming the IV tubing, you should ensure that the drip chamber is:

one half full.

When attaching an administration set to a bag of IV fluid and priming the IV tubing, you should ensure that the drip chamber is:

one-half full.

Compounds or charges concentrated on one side of a cell membrane will move across it to an area of lower concentration to maintain balance on both sides of the cell wall. This process is called:

diffusion

A hypertonic solution is one that:

draws fluid and electrolytes out of the cell.

As an AEMT, the MOST commonly inhaled medication you will administer is:

oxygen

Contraindications for intraosseous infusion include all of the following, EXCEPT:

patients who are in cardiac arrest or status epilepticus.

An example of intravascular fluid is:

plasma.

A glass drug cartridge and syringe are components of a/an:

prefilled syringe.

You are performing an interfacility transport of a patient that will take approximately 15 minutes. The patient has an IV line of normal saline set at a rate of 125 mL/hr. What is the approximate total fluid amount this patient will receive during the transport?

30 mL

How many grams are present in 25 mL of 50% dextrose (D50)?

12.5 g

Which of the following is a systemic complication associated with IV therapy?

Air embolus

Which of the following is a major anion in the body?

Chloride

Which of the following is the smallest unit of weight?

Microgram

Reconstituting a drug, such as glucagon, involves:

injecting liquid from one vial into another vial that already contains powder.

Prior to administering an oral medication to a patient, you must:

take standard precautions

There is 0.5 mg/10 mL of epinephrine in an auto-injector. How many milligrams (mg) would you deliver if you administered 5 milliliters (mL)?

0.25

If you have an epinephrine concentration of 0.1 mg/mL, how many milligrams would be present in 5 mL?

0.5 mg

500 micrograms (µg) is equal to:

0.5 mg.

The concentration of sodium in the cells of the body is approximately:

0.9%

One milliliter (mL) is the equivalent of:

1 cubic centimeter

Which of the following represents a "standard" drug dose?

1 mg

How many pounds does a 90-kg patient weigh?

198 lb

Which of the following electrolytes determines whether the body is acidotic or alkalotic?

Bicarbonate

An ion that has an overall positive charge is called a/an:

cation

Sclerosis of a vein is caused by:

frequent cannulation.

An anion is an:

ion with an overall negative charge.

Following administration of an amiodarone bolus, your paramedic partner begins a continuous infusion. This is necessary in order to:

maintain a therapeutic blood level of the drug.

An isotonic solution is one that causes:

no change in the shape of the cell.

Intraosseous lines require full and careful immobilization because:

they rest at a 90° angle to the bone and are easily dislodged.

You have a prefilled syringe containing 25g of dextrose in 50 mL of volume. How many milligrams of dextrose are present in each milliliter?

500 mg

Which of the following routes is the quickest for getting medication into the central circulation?

Intravenous

Factors that can cause an insufficient or absent flow of fluid through an IV line include:

an IV bag that is placed too low.

After starting an IV on a patient in shock, the AEMT accidentally gets stuck with the IV needle. This is referred to as a/an:

contaminated stick.

After removing the stylet from the IV catheter, you should next:

dispose of the needle in the appropriate container.

When administered to a normally hydrated patient, normal saline will:

stay in the intravascular space.

A stable patient requires an IV line in the event that medication therapy is needed. When selecting the appropriate vein, you should first attempt to cannulate the:

vein on the hand

If used in pediatric patients, butterfly catheters are commonly placed in the:

veins of the scalp

Once the protective wrap is removed from a bag of IV fluid, the fluid must be used:

within 24 hours

Minimum documentation following IV therapy includes all of the following, EXCEPT:

your certification level.

During an attempted resuscitation of a 9-year-old boy in cardiac arrest, your paramedic partner asks you to prepare epinephrine in a dose of 0.01 mg/kg. The child's mother tells you that he weighs approximately 65 pounds. You have a prefilled syringe of epinephrine containing 1 mg in 10 mL. How many milliliters should be administered to this child?

3 mL

You have set an IV to deliver 250 mL of normal saline over three hours using microdrip tubing. How much fluid are you delivering every 30 minutes?

42 mL

What percentage of water accounts for the total body weight?

60%

You respond to a residence where a 5-year-old male has ingested an unknown substance. Upon arrival at the scene, the child's mother tells you that her son swallowed approximately 20 Tylenol capsules. What is the MOST logical way of determining how much this child weighs?

Ask the mother if she knows the weight of her son.

During the IV procedure, when is it MOST appropriate to apply the constricting band?

Before you cleanse the venipuncture site.

You are transporting an elderly man to the hospital because of complications associated with his congestive heart failure. Approximately 20 minutes after starting an IV of normal saline on the patient, he begins to complain of shortness of breath. You auscultate his lungs and hear rales in all lung fields. What should you do?

Check the flow rate of the IV line.

An intraosseous line should be inserted in a critical patient if:

IV access is unsuccessful after three attempts.

You respond to a call for an unresponsive diabetic female. Upon arrival, you find a 23-year-old female unresponsive on her couch. During your assessment, you determine that her blood glucose level is 38 mg/dL. You attempt to start an IV, but are unsuccessful after several attempts. Which of the following routes could be used as a last resort to administer 50% dextrose?

Rectal

You respond to a call for an unresponsive diabetic. Upon arrival, you find a 23-year-old female unresponsive on her couch. During your assessment, you determine that her blood glucose level is 38 mg/dL. You attempt to start an IV, but are unsuccessful after several attempts. Which of the following routes could be used as a last resort to administer 50% dextrose?

Rectal

You are transporting a patient with an IV of D5W. Which of the following signs would be atypical of infiltration?

Redness around the IV site

A 66-year-old male with congestive heart failure presents with pulmonary edema and difficulty breathing. His blood pressure is 180/90 mm Hg and his pulse rate is 110 beats/min and irregular. When starting an IV, which of the following, if available, would be MOST appropriate for this patient?

Saline lock

Which of the following electrolytes is essential for the distribution of water throughout the body?

Sodium

The term "bolus" is defined as:

administering a drug in one mass of volume.

Third spacing is defined as:

an abnormal fluid shift into the serous linings of the body.

Major cations in the body include all of the following, EXCEPT:

bicarbonate.

Butterfly catheters are MOST useful for adult patients who require:

blood drawing only.

Severe hyperkalemia can result in:

hyperstimulation of neural transmission.

Before you can calculate an IV drip rate, you must know all of the following information, EXCEPT:

the gauge of the IV catheter you will use.

Which of the following IV catheters would deliver the largest volume of fluid?

1 ¼" 14-gauge cathete

The MOST appropriate administration set to use for a patient who requires rapid fluid replacement is one that delivers 1 mL of IV fluid per:

10 drops

A 7-year-old child has swallowed a bottle of aspirin. Medical control orders you to give the child 0.5 g/kg of activated charcoal. Based on the child's weight of 45 pounds, how much charcoal will you administer?

10 g

A 44-year-old man is experiencing a ventricular dysrhythmia. Medical control orders your paramedic partner to administer 1.5 mg/kg of lidocaine to the patient, who weighs 185 pounds. Lidocaine is supplied in a concentration of 100 mg/10mL. How many milliliters should your partner administer to this patient?

12.6 mL

A 30-year-old construction worker lacerated his brachial artery and has lost a significant amount of blood. His blood pressure is 70/40 mm Hg and his pulse rate is 130 beats/min. Which of the following IV catheters would be MOST appropriate for this patient?

14 gauge

Prior to administering oral glucose to your diabetic patient, you look at the dosage, which reads 15g. How many milligrams is this equivalent to?

15,000

A severely injured patient has lost approximately 750 mL of blood. What is the appropriate volume of crystalloid solution to administer to the patient?

2,250 mL

You have been requested to infuse 1,000 mL of lactated ringers over six hours. You have macrodrip (10 gtts/mL) tubing and a 16-gauge IV catheter. At how many drops per minute will you set the IV flow rate?

28

Medical control has ordered you to start an IV on a dehydrated patient and administer normal saline at a rate of 200 mL/hr. Using macrodrip (10 gtts/mL) tubing and an 18-gauge catheter, how many drops per minute will you set the flow rate at?

33

You receive an order from medical control to start an IV of lactated ringers and administer 150 mL/hr. Using macrodrip (15 gtts/mL) tubing, how many drops per minute will you set the flow rate at?

38

A 40-year-old female requires a medication to decrease her heart rate. The medication to be administered is supplied in a prefilled syringe in a concentration of 6 mg/2 mL. How many milliliters are required to achieve a dose of 12 mg?

4 mL

You respond to an apartment complex for an unconscious male. When you arrive, the patient's friend tells you that he overdosed on heroin. Following your local protocol, you administer 2 mg of naloxone. You have 1 mL ampules of naloxone that contain 0.4 mg per ampule. How many ampules will you have to use?

5

A 68-year-old female with unstable bradycardia requires 0.5 mg of atropine. Your paramedic partner opens a prefilled syringe of atropine containing 1 mg/10mL. How many milliliters should be administered to the patient?

5 mL

A microdrip administration set features a small, needle-like orifice inside the drip chamber and delivers:

60 gtts/mL.

During a long distance transport, you initiate an IV of normal saline and infuse 125 mL over 2 hours. Using microdrip tubing, how many drops per minute (gtts/min) is your IV flow rate set at?

63 gtts/min

What is the approximate weight in kilograms of a 155 lb patient?

70 kg

Which of the following medications or solutions can be administered through an intraosseous line?

Anything that you can administer via an IV

Which of the following techniques is appropriate when cannulating a vein?

Apply traction to the vein and insert the needle with the bevel side up at a 45° angle.

Which of the following electrolytes determines whether or not the body is acidotic or alkalotic?

Bicarbonate

Which of the following statements regarding intraosseous infusion is correct?

Compared to an IV line, fluid does not flow well into the bone because of resistance

What is the difference between a crystalloid and a colloid solution?

Crystalloids do not contain large protein molecules.

A 70-year-old man presents with generalized weakness and dizziness. His blood pressure is 110/70 mm Hg when he is sitting and 96/56 mm Hg when he is standing. His heart rate is 120 beats/min, and his skin is flushed and dry. What is the MOST likely cause of this patient's signs and symptoms?

Dehydration

A 70-year-old man presents with generalized weakness and dizziness. His blood pressure is 110/70 mm Hg when he is sitting, 96/56 mm Hg when he is standing. His heart rate is 120 beats/min and his skin is flushed and dry. What is the MOST likely cause of this patient's signs and symptoms?

Dehydration

Which of the following formulas is correct for converting a patient's weight in pounds to his or her weight in kilograms?

Divide the patient's weight in pounds by 2 and subtract 10%.

Which of the following would be LEAST likely to result in overhydration?

Excessive GI drainage

A patient with congestive heart failure requires medication administration. Which of the following IV solutions would be MOST appropriate to use?

Five percent dextrose in water

Which of the following is the MOST significant complication associated with IV therapy in geriatric patients?

Fluid overloading.

Although painful and difficult to manage, what is the location of choice for starting IVs in pediatric patients?

Hand vein

In addition to administering supplemental oxygen, what is the MOST appropriate management for a patient with circulatory overload caused by excessive IV fluid administration?

Head elevated, medical control notified

A 70-year-old female presents with generalized muscle weakness; lethargy; and hot, flushed skin. Which of the following electrolyte disturbances should you suspect?

Hypercalcemia

A 50-year-old patient complains of abdominal muscle cramps and spasms of his hands. Which of the following electrolyte disturbances does this patient MOST likely have?

Hypocalcemia

Which of the following steps for drawing medication from a vial is NOT necessary when drawing medication from an ampule?

Injecting air into the container before withdrawing the drug.

A 29-year-old female experiences shortness of breath, urticaria, and bilateral wheezing shortly after you started an IV of normal saline. How should you manage this situation?

Leave the catheter in place and remove the solution.

Which of the following formulas would you use to convert a larger unit of weight to a smaller one?

Multiply the larger unit of weight by 1,000.

Which of the following potential complications of IV therapy are you LEAST likely to encounter in the prehospital setting?

Phlebitis

How does lactated ringers solution help combat intracellular acidosis associated with severe blood loss?

The lactate is metabolized by the liver to form bicarbonate.

Which of the following represents the correct formula for determining how many drops (gtts) per minute to set your IV at?

Volume in milliliters, multiplied by the gtts/mL of the administration set, divided by the total number of minutes over which the fluid will be infused

Which of the following is NOT a crystalloid?

Whole blood

After inserting the needle into the injection port of a saline lock, you pull back on the plunger and observe blood return in the syringe. You should next:

administer the medication and observe for infiltration.

A breakable glass container that is designed to carry a single medication dose is called a/an:

ampule

An over-the-needle catheter is commonly referred to as a/an:

angiocath

A 60-year-old man is in cardiac arrest. As emergency medical responders are performing CPR, your partner is managing the patient's airway. After preparing your IV set, you should FIRST attempt to cannulate the:

antecubital vein.

When starting an IV on an elderly patient, you should be aware that:

certain medications can create fragile skin and veins.

A 52-year-old man complains of chest pressure. He is diaphoretic and has a blood pressure of 110/90 mm Hg. He has a prescription for nitroglycerin (NTG), but has not taken any. After administering oxygen to the patient you should:

contact medical control for permission to administer the NTG.

A 52-year-old man complains of chest pressure. He is diaphoretic and has a blood pressure of 110/90 mm Hg. He has a prescription for nitroglycerin (NTG), but has not taken any. After administering oxygen to the patient, you should:

contact medical control for permission to administer the NTG.

When selecting the most appropriate site for IV cannulation, you should avoid veins that:

cross or lie over joints.

When replacing lost volume with crystalloids, it is important to remember that:

crystalloids do not have the capacity of carrying oxygen.

After inserting an IV catheter into a vein, you should:

decrease the angle of the catheter to 15° and insert the catheter a few mm farther.

Substances that become charged particles when they disassociate in water are called:

electrolytes.

You have inserted an IV catheter into a vein in a patient's hand and have secured the IV line appropriately. You assess the flow of the IV and note that it is not flowing. You should FIRST:

ensure that the constricting band has been released.

Signs and symptoms of an air embolus include all of the following, EXCEPT:

facial flushing.

A potential complication of intraosseous infusion is compartment syndrome. This occurs when:

fluid leaks out of the bone and into the osteofascial compartment.

Perfusion occurs in the capillaries as a result of __________ hydrostatic pressures and __________ in the capillary beds

high, osmosis

A solution that has a greater concentration of sodium than does the cell is referred to as being:

hypertonic

A solution that has a greater concentration of sodium than does the cell is referred to as being:

hypertonic.

A solution that hydrates the cells while depleting the vascular compartment is referred to as being:

hypotonic

A solution that results in water flowing into a cell, causing it to burst, is referred to as being:

hypotonic

Once the "pigtail" that covers the access port of a bag of IV fluid has been removed, the fluid must be used:

immediately

The purpose of a constricting band when starting an IV is to:

increase vascular pressure at the puncture site.

The purpose of a constricting band when starting an IV is to:

increase venous pressure at the puncture site.

Actions taken after administering a medication to a patient include all of the following, EXCEPT:

inquiring about drug allergies.

When inserting an IV into the external jugular vein, you should:

insert the catheter with the tip pointing toward the shoulder.

When administering nitroglycerin via the sublingual route, you should:

instruct the patient not to chew or swallow the medication.

__________ fluid accounts for approximately 16% of the body's total weight.

interstitial

The majority of the body's potassium is found within the:

intracellular fluid.

Five percent dextrose in water (D5W) is an isotonic solution until it:

is administered to a patient

The most commonly carried IV solutions in the prehospital setting are:

isotonic crystalloids.

Compared to a 16-gauge catheter, a 22-gauge catheter would be more appropriate for an elderly patient because:

it reduces the risk of fluid extravasation.

Filtration, a type of diffusion, is commonly used to clean the blood via the:

kidneys

When choosing an IV site on an elderly patient, you should:

know that varicose veins allow minimal circulation.

You have attempted to cannulate a vein in a patient's hand; however, shortly after inserting the IV catheter, the vein infiltrates. You should:

look for a vein that is proximal to the infiltrated vein.

The term applied to the practice of preventing contamination of the patient when performing an invasive procedure is called:

medical asepsis.

To calculate a drug dosage, you must know the weight of the drug present in each:

milliliter.

Osmosis is defined as the:

movement of water across a semipermeable membrane.

In order to prevent catheter shear when starting an IV, you should:

never rethread the needle into the catheter.

Shortly after starting an IV on a patient with a possible femur fracture, the patient experiences a sudden onset of shortness of breath and develops cyanosis. After reassessing airway patency and breathing adequacy, you should position the patient:

on the left side with the head down.

Other than oxygen, prior to administering any medication to a patient, you must take standard precautions and then:

perform a careful assessment of the patient.

The cell membrane is a ______________ bilayer, which is an important barrier to fluid movement and the acid-base balance.

phospholipid

After inserting the needle into the injection port of an IV line, but before administering the medication, you should:

pinch off the tubing proximal to the injection port.

The MOST common site for intraosseous cannulation is the:

proximal tibia.

While starting an IV on a patient, you see bright red blood quickly traveling up the IV tubing. You should:

remove the catheter and apply direct pressure.

You are attempting to start an IV in a vein on the back of your patient's hand. As you insert the catheter, the patient complains of sudden, severe shooting pain followed by numbness in the extremity. You should:

remove the catheter and choose another site.

Following insertion of a needle into a patient's skin to administer an intramuscular injection, you pull back on the plunger and note the presence of blood in the syringe. You should:

remove the needle and apply pressure to the site.

Medical control has ordered your paramedic partner, via two-way radio, to administer 40 mg of Lasix to a patient with congestive heart failure. You should anticipate that your partner will first:

repeat the drug order to the physician as she heard it.

When discontinuing an IV line, you should FIRST:

shut off the flow from the IV with the roller clamp.

When administering a medication via the intramuscular route, you should:

stretch the skin over the area and insert the needle at a 90° angle.

Unlike IM or SC injections, intravenously administered drugs rapidly affect the body because:

they bypass most barriers to drug absorption.

When administering a medication via the intranasal route with a mucosal atomizer device, it is important to remember that:

you must spray half of the medication dose into each nostril.