Ch 12 Intravenous Route

What minimal rate of infusion is maintained for a "to keep open" (TKO) IV infusion? A. 10 mL/hr B. 20 mL/hr C. 30 mL/hr D. 40 mL/hr

A. 10 mL/hr. Hospital policy for the definition of TKO may vary among facilities, but the minimal infusion rate is usually interpreted to be at 10 mL/hr and should infuse less than 500 mL/24 hr.

Which items are identified as tunneled central venous catheters? (Select all that apply.) A. Broviac B. PICC C. Hickman D. Groshong E. Huber

A. Broviac C. Hickman Correct D. Groshong Correct Broviac, Hickman, and Groshong catheters are types of tunneled central venous catheters. A peripherally inserted central catheter (PICC) is a type of midline catheter. A Huber is a 90 degree noncoring needle.

Which fluid is an example of a hypotonic solution? A. D5W B. 0.9% normal saline C. D10W D. Ringer's lactate

A. D5W D5W has lower osmolality than vascular fluid, which makes it a hypotonic solution. Ringer's lactate and 0.9% normal saline have the same osmolality as vascular fluid and are thus considered isotonic. D10W has more osmolality than vascular fluid and is thus considered hypertonic.

Which statements are true about IV administration of medications? (Select all that apply.) A. IV administration is the most rapid of all parenteral routes. B. Large volumes of fluids can be rapidly infused into a vein. C. IV medications can only be given continuously. D. All nurses are eligible to perform IV therapy. E. The nurse should always check for drug allergies before administration.

A. IV administration is the most rapid of all parenteral routes. Correct B. Large volumes of fluids can be rapidly infused into a vein. Correct E. The nurse should always check for drug allergies before administration. IV administration bypasses all barriers to drug absorption and is therefore the most rapid of all parenteral routes. An advantage of IV infusion is that large volumes of fluids can be rapidly administered into the vein with less irritation. The nurse should always check for drug allergies and drug reactions before administering an IV medication. IV administration is a rapid route, and if the patient has a drug allergy, it will become more difficult to treat an allergic reaction or drug reaction. IV medications may be given by direct injection, intermittently, or by continuous infusion. Before a nurse is eligible to perform IV therapy, he or she must meet the institutional guidelines pertaining to infusion therapy.

Which are causes of thrombophlebitis? (Select all that apply.) A. Irritation of the vein by the catheter B. Infection C. Chemical irritation from medication D. TKO rate of infusion E. Use of glass IV bottles

A. Irritation of the vein by the catheter B. Infection C. Chemical irritation from medication Irritation of the vein by the catheter may cause thrombophlebitis, particularly when the IV catheter is too large for the vein or there is improper insertion of the IV device. Infection may be caused by improper aseptic technique during routine IV care or from the IV insertion, thereby causing thrombophlebitis. Chemical irritation may be due to a solution being infused too rapidly or too large a volume for the vein, and thrombophlebitis may develop. TKO rate of infusion is not a primary cause of thrombophlebitis. The type of IV bags that are used, whether glass or plastic, does not cause thrombophlebitis.

A patient receiving IV vincristine for treatment of acute leukemia develops extravasation. Which action does the nurse take? A. Removes the IV catheter B. Applies heat to the affected site Correct C. Places the affected extremity in a dependent position D. Keeps the IV infusion at a keep vein open rate

B. Applies heat to the affected site. When extravasation occurs, protocol dictates that the IV infusion be stopped, the extremity elevated, ice or heat applied to the site, and the occurrence documented. Vincristine requires heat rather than cold to be applied to the IV site. The IV solution should be stopped but the IV catheter should be left in place. With authorization from the health care provider, attempts may be made to aspirate the medication. The affected extremity should be elevated. The IV infusion should be stopped to prevent further damage.

Which devices are used for intravenous (IV) therapy lasting from 2 to 4 weeks? A. Peripheral devices B. Midline catheters C. Central venous devices D. Implantable venous infusion ports

B. Midline catheters. Midline catheters are used over 2 to 4 weeks. They are inserted into intermediate sized veins and advanced into larger vessels. Peripheral devices are for short term use in peripheral veins in the hand or forearm, and are usually changed every 72 hours. Central venous devices are inserted into intermediate sized vessels and advanced into central veins for maximum mixing. They are indicated for long term therapy or when peripheral sites have been exhausted from repeated use, or the condition of veins for access is poor. Implantable venous infusion ports are placed into central veins for long term therapy.

What is a winged needle also known as? (Select all that apply.) A. Midline B. Mediport C. Butterfly D. Scalp E. Port A Cath

C. Butterfly D. Scalp Winged needles, also known as butterfly or scalp needles, are short sharp tipped needles used for venipuncture of small veins in infants and elderly patients. Midline catheters are flexible, 3 to 8 inches long, and are inserted at the antecubital fossa into the cephalic or basilic vein and advanced to the distal subclavian vein. A mediport is an implantable infusion port for long term therapy and for intermittent access of the central vein. A Port A Cath is an implantable infusion port for long term therapy and for intermittent access of the central vein.

A PICC line is a: A. Peripheral device. B. Midline catheter. C. Central device.

C. Central device.

A patient is prescribed morphine to be administered through a patient controlled analgesia (PCA) pump. Which infusion control device is used for administration? A. Negative pressure pump B. Nonvolumetric IV controller C. Syringe pump Correct D. Volumetric IV controller

C. Syringe pump. A PCA pump is a syringe pump that holds a prefilled amount of morphine, delivering a specific volume of medication over a set time. Syringe pumps are used when small volumes need to be administered. There is no such thing as a negative pressure pump. Syringe pumps apply positive pressure to a plunger. Nonvolumetric IV controllers monitor only the gravity infusion rate by counting the drops that drip through the chamber; this would not be an appropriate infusion control device to use for a patient receiving PCA. A volumetric IV controller is a pump that applies external pressure to the administration set tubing to squeeze the solution through the tubing at a specific rate. These pumps may be used when larger volumes of fluid may be administered. It does not hold a prefilled syringe or prefilled amount of medication.

Which fluid may be used to maintain vascular volume in a patient who is hypovolemic and hypotensive? A. D5W B. 0.45% normal saline C. D5/0.2% normal saline D. 0.9% normal saline

D. 0.9% normal saline. A 0.9% normal saline is an isotonic solution and may be used for a hypovolemic and hypotensive patient. D5W is a hypotonic solution; the fluid is drawn from the intravascular space into other compartments, thus increasing hypovolemia. A 0.45% normal saline is also a hypotonic solution. Over time, the dextrose in this solution is metabolized and it becomes a hypotonic solution, which causes the fluid to be drawn from the intravascular space into other compartments, thus increasing hypovolemia. D5/0.2% normal saline should not be used to maintain vascular volume in this patient.

A patient who is hemorrhaging is admitted to the emergency department after a head on car collision. Which IV fluid does the nurse anticipate will be prescribed for this patient? A. D5W B. 0.45% sodium chloride C. D10W D. Lactated Ringer's

D. Lactated Ringer's. Lactated Ringer's solution is an isotonic solution that is an ideal replacement fluid for patients who are hemorrhaging; it helps increase vascular volume. D5W is a hypotonic solution used to treat cellular dehydration. If administered too rapidly, it may cause a fluid shift from the intravascular space into other compartments. A 0.45% sodium chloride is a hypotonic solution used to treat cellular dehydration. If administered too rapidly, it may also cause a fluid shift from the intravascular space into other compartments. D10W is a hypertonic solution that has the potential to pull fluid from the intracellular and interstitial compartments into the intravascular compartment, causing cellular dehydration and vascular volume overload.

Which measure does the nurse include in a care plan for a patient receiving IV therapy? A. Changing the IV site every 24 hours B. Applying a topical antibiotic cream to the IV site to prevent infection C. Changing the IV solution every 48 hours D. Monitoring the patient's intake and output

D. Monitoring the patient's intake and output. The patient's intake and output should be monitored to assess fluid volume status. The IV site is generally changed every 72 hours; changing the site every 24 hours may increase the patient's risk for infection. Applying a topical antibiotic cream may increase the potential of developing fungal infections and antimicrobial resistance. IV solution should be changed every 24 hours to minimize the development of new infections.