Chapter 13: Nursing Care and Complications of IV therapy

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 nurse is inserting a peripheral intravenous (IV) catheter. Which patient statement is of greatest concern during this procedure?

"My hand tingles when you poke me."

Which statement made by a student nurse regarding the guidelines published by the Occupational Safety and Health Administration (OSHA) on needleless connection devices indicates a need for further education?

"The goal of the guidelines is to limit the transmission and spread of airborne pathogens."

Which principles from the catheter-related bloodstream infection prevention bundle (CRBSI) are important to remember when assisting with the placement of a central line? Select all that apply.

- Perform hand hygiene before touching the line. - Use a checklist during the insertion of the central line. - Drape the patient head to toe with a sterile barrier prior to line insertion. - Everyone in the room during the insertion procedure should wear a mask.

A patient is prescribed intravenous antibiotics for 4 weeks. How often should the nurse change the gauze dressing?

48 hours

The nurse is transfusing blood to a patient. Which components should the nurse be sure to check on the blood label? Select all that apply.

ABO group and Rh factor Product code Lot number

The nurse who is starting the shift finds a patient with an IV that is leaking all over the bed linens. What does the nurse do initially?

Assess the insertion site.

Which type of intravenous therapy-acquired infection is most responsible for increased death rates?

Catheter-related bloodstream

Which veins are most appropriate for common peripheral catheter placement? Select all that apply.

Cephalic Basilic Median

Which veins may lead to nerve damage if used for intravenous therapy? Select all that apply.

Cephalic vein near the wrist Veins on the palmar side of the wrist

The nurse is administering a drug to a patient through an implanted port. Before giving the medication, what does the nurse do to ensure safety?

Check for blood return.

A patient is prescribed intravenous antibiotics for four weeks. What is the most important assessment the nurse should perform after the peripherally inserted central catheter (PICC) is inserted in the brachial vein to prevent complications?

Check for signs of phlebitis in the patient's upper chest

The nurse checking an IV fluid order questions its accuracy. What does the nurse do first?

Contacts the health care provider who ordered it

What should the nurse document after inserting a venous catheter?

Date and time of the insertion

A patient with a central venous catheter reports back pain between the shoulder blades. What should be the immediate nursing intervention in this situation?

Discontinuing all infusions and flushing the central venous line

An older adult patient receiving intravenous steroid therapy reports swelling, pain, and tenderness at the insertion site. Which immediate complication may the patient develop?

Ecchymosis

Which complication may happen if the tourniquet applied during the intravenous (IV) catheter insertion is left on an older patient's arm?

Ecchymosis

The nurse is to administer a unit of whole blood to a postoperative patient. What does the nurse do to ensure the safety of the blood transfusion?

Ensures that another qualified health care professional checks the unit before administering

The nurse is caring for a patient with a peripherally inserted central catheter (PICC). What could cause this catheter to become dislodged?

Excessive physical activity

Which is the least preferred site for peripherally inserted central catheters (PICC)?

Femoral vein

A patient is seen in the emergency department (ED) with pain, redness, and warmth of the right lower arm. The patient was in the ED last week after an accident at work. On the day of the injury, the patient was in the ED for 12 hours receiving IV fluids. On close examination, the nurse notes the presence of a palpable cord 1 inch in length and streak formation. How does the nurse classify this patient's phlebitis?

Grade 3

Which complication is common in both thrombophlebitis and phlebitis?

Inflammation

The nurse is preparing to administer a blood transfusion to a patient. Which vein is selected for a midline catheter?

Median antecubital

While the nurse is attempting to remove a midline catheter from a patient, the patient develops venospasms. Which technique does the nurse use to facilitate the removal of the catheter in this patient?

Medication administration

Which regulation or act requires every health care facility to maintain a sharps injury log with details of each incident?

Needlestick Safety and Prevention Act

A patient receiving intravenous therapy reports tingling and numbness at the insertion site. What could be the possible complication?

Nerve damage

Which catheter types are more likely to cause venospasms when removed forcefully? Select all that apply.

Peripherally inserted central Midline

The nurse is reviewing assessment data of a patient and observes a hard, cordlike vein. Which complication of the intravenous (IV) therapy does the patient manifest?

Phlebitis

A severely dehydrated patient requires a rapid infusion of normal saline and needs a midline IV placed. Which staff member does the emergency department (ED) charge nurse assign to complete this task?

RN with certified registered nurse infusion (CRNI) certification who is assigned to the ED for the day

The primary health care provider instructs the nurse to change the dressing of a patient's catheter insertion site. Which action made by the nurse would lead to the dislodgement of the catheter?

Removing the dressing by pulling it away from the insertion site

Which statement is true about the special needs of older adults receiving IV therapy?

Skin integrity can be compromised easily by the application of tape or dressings.

A 70-year-old patient with severe dehydration is ordered an infusion of an isotonic solution at 250 mL/hr through a midline IV catheter. After 2 hours, the nurse notes that the patient has crackles throughout all lung fields. Which action does the nurse take first?

Slow the rate of the IV infusion.

When flushing a patient's central line with normal saline, the nurse feels resistance. Which action does the nurse take first?

Stop flushing and try to aspirate blood from the line.

Which nursing intervention is the most appropriate when meeting resistance during the flushing of a peripheral catheter?

Stop flushing the catheter.

A patient receiving intravenous therapy has developed a swollen extremity and engorged peripheral veins of the ipsilateral chest. Which complication should the nurse suspect?

Thrombosis

How will the nurse document the intravenous (IV) therapy complication of a blood clot inside the vein?

Thrombosis