Chapter 14- Medication Administration qqq
48. The use of O-negative blood in the prehospital setting is impractical because: A) it expires in 24 hours. B) it requires refrigeration. C) not everyone can receive O-negative blood. D) the blood cannot be typed and cross-matched.
B
53. Once an IV solution is removed from its protective sterile plastic bag, it must be used: A) immediately. B) within 24 hours. C) within 36 hours. D) within 48 hours.
B
55. A microdrip administration set: A) allows 10 or 15 drops per milliliter. B) delivers 1 mL for every 60 drops. C) should be used when patients need fluid replacement. D) does not contain a needlelike orifice in its drip chamber.
B
60. When selecting a vein for cannulation, you should avoid areas of the vein that: A) are straight. B) pass over joints. C) are firm and springy. D) appear to be straight.
B
65. In contrast to butterfly catheters, over-the-needle catheters: A) are more likely to rupture the vein due to excessive movement of the patient. B) allow for greater patient movement without the need to immobilize the entire limb. C) are more difficult to insert and are more cumbersome to secure in place effectively. D) may cause blood cell damage when drawing blood through the Teflon catheter.
B
66. Through which of the following over-the-needle catheters can you infuse the greatest amount of fluid over the shortest period of time? A) 16 gauge, 1 ¼ B) 14 gauge, 1 ¼ C) 18 gauge, 2 ¼ D) 14 gauge, 2 ¼
B
7. Which of the following statements regarding electrolytes is correct? A) Electrolytes are nonreactive and relatively harmless if they are left to circulate in the body. B) Electrolytes are also called ions and dissociate into charged components when placed in water. C) Electrolytes help to regulate muscular contraction, but have no effect on cardiac function. D) Electrolyte charges are stabilized by blood so that they can aid in the body's metabolic functions.
B
71. After attaching the prepared IV line to the hub of the IV catheter and removing the constricting band, you should: A) set the IV flow rate to keep the vein open (KVO). B) open the IV line and observe for swelling or infiltration. C) apply a sterile gauze pad directly over the venipuncture site. D) secure the catheter and tubing in place with a commercial device.
B
74. The first step in discontinuing an IV line is to: A) stabilize the catheter as you remove the tape. B) shut off the flow of fluid with the roller clamp. C) remove the tubing from the hub of the catheter. D) ensure that all of the fluid has been administered.
B
76. Prior to cannulating an external jugular vein, it is MOST important to: A) cleanse the puncture site. B) palpate for the carotid pulse. C) turn the patient's head to the side. D) occlude the vein distal to the puncture site.
B
8. Cations are electrolytes that have an overall __________ charge, and anions are electrolytes that have an overall ___________ charge. A) negative, neutral B) positive, negative C) neutral, positive D) negative, positive
B
81. When determining whether an occluded IV line should be reestablished, you should: A) attempt to improve the IV flow rate by applying a pressure infuser device around the IV bag. B) infuse 10 mL of normal saline through the injection port to attempt to disrupt the occlusion. C) lower the IV bag below the level of the patient's heart and observe for blood return in the IV tubing. D) apply manual pressure to the IV bag while observing for a sudden increase in the IV flow rate.
B
82. Vein irritation during IV therapy is usually caused by: A) the formation of a thrombus. B) an infusion rate that is too rapid. C) contaminants in the IV solution. D) IV solutions that are not warmed.
B
88. Pyrogenic reactions can be largely avoided by: A) determining if the patient has any allergies. B) inspecting the IV solution carefully before use. C) premedicating the patient with 1 gram of acetaminophen. D) keeping the piercing spike sterile after it is exposed.
B
89. The MOST common cause of circulatory overload in the prehospital setting is: A) overestimating the patient's baseline hydration level and giving too much IV fluid. B) failure to readjust the drip rate after flushing the IV line immediately after insertion. C) not using a Volutrol administration set when administering IV fluids to the elderly. D) administering excessive crystalloid solutions to patients with hypovolemic shock.
B
93. The signs and symptoms that occur when an IV catheter is sheared and becomes a free-floating segment in the circulatory system MOST closely resemble: A) pneumothorax. B) an air embolus. C) left-sided heart failure. D) right-sided heart failure.
B
94. A lavender-topped blood tube: A) contains a preservative to help determine blood-clotting factors. B) is used to determine a patient's hematocrit and hemoglobin levels. C) contains no additives and is intended to clot if blood typing is needed. D) is filled with heparin and is used to evaluate electrolyte and glucose levels.
B
97. The IO space collectively comprises the ________ bone of the ________ and the medullary cavity of the ________. A) tibial, upper leg, diaphysis B) cancellous, epiphysis, diaphysis C) diaphyseal, epiphysis, proximal tibia D) epiphyseal, diaphysis, cancellous bone
B
1. Approximately ___% of an adult male's weight is constituted by water. A) 40 B) 50 C) 60 D) 70
C
100. Which of the following IO devices is NOT used in children? A) EZ-IO B) Jamshedi needle C) FAST1 D) Bone Injection Gun (BIG)
C
11. The milliequivalent (mEq) represents the chemical combining power of the ion and is based on the: A) percentage of sodium in a given electrolyte solution. B) ability to unite with an electrolyte with the same charge. C) number of available ionic charges in an electrolyte solution. D) ratio of positively and negatively charged ions.
C
16. Hyperkalemia would MOST likely result in: A) abnormal gastrointestinal function. B) decreased skeletal muscle function. C) hyperstimulation of neural cell transmission. D) severe bradycardia due to increased vagal tone.
C
18. The chemical sign for sodium bicarbonate is: A) NaCl. B) H2CO3. C) NaHCO3. D) KCl.
C
2. Intracellular fluid: A) is the fluid that bathes the cells. B) transports red and white blood cells. C) is the water contained inside the cells. D) accounts for about 15% of body weight.
C
23. Osmosis occurs when: A) water moves from an area of higher solute concentration to an area of lower solute concentration. B) solutes move from an area of lower water concentration to an area of higher water concentration. C) water moves from an area of lower solute concentration to an area of higher solute concentration. D) solutes move from an area of higher water concentration to an area of lower water concentration.
C
27. A healthy person loses approximately ___ to ___ liters of fluid daily through urine output, through exhalation, and through the skin. A) 0.5, 1 B) 1, 1.5 C) 2, 2.5 D) 3, 4
C
33. IV fluids introduced into the circulatory system: A) are only effective if the patient is experiencing renal insufficiency. B) will always cause a fluid shift out of the intracellular compartment. C) can affect the tonicity of the extracellular fluid and can be harmful. D) usually do not cause a fluid shift into or out of the intracellular space.
C
38. Lactated Ringer's (LR) solution may be beneficial to patients who have lost large amounts of blood because: A) it takes less LR to effectively expand the intravascular compartment than any other isotonic solution. B) LR has the ability to carry oxygen and can maintain cellular perfusion until the patient receives definitive care. C) the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis. D) the likelihood of causing acute circulatory overload is minimal relative to other hypertonic solutions.
C
40. Hypotonic solutions: A) include normal saline and lactated Ringer's solution. B) draw fluid from the cells and into the vascular space. C) hydrate the cells while depleting the vascular compartment. D) are the preferred solutions to use in patients with head trauma.
C
44. How much isotonic crystalloid solution should you administer to a patient who weighs 65 kg and who has signs and symptoms of internal bleeding? A) Boluses of up to 1,625 mL each B) 10 to 20 mL/kg every 5 to 10 minutes C) An amount adequate to maintain perfusion D) Enough to increase blood pressure to a normal level
C
5. A composition of dissolved elements and water is called a(n): A) solute. B) solvent. C) solution. D) electrolyte.
C
50. The MOST important point to remember about IV therapy is to: A) locate the largest vein. B) wear two pairs of gloves. C) keep the IV equipment sterile. D) prepare all supplies ahead of time.
C
51. Which of the following questions does the paramedic generally NOT ask himself or herself when determining the most appropriate IV solution to use on a patient? A) Is the patient's condition critical? B) Will the patient need medications? C) Has the patient had IV therapy before? D) Will the patient need fluid replacement?
C
56. When a patient needs rapid fluid replacement, you should: A) use a microdrip administration set because you can deliver more precise volumes of IV fluid. B) choose an administration set that delivers the least amount of volume per the most number of drops. C) select an administration set that contains a large opening between the piercing spike and drip chamber. D) use a microdrip administration set in order to avoid inadvertently overloading the patient with fluid.
C
58. Blood tubing is a: A) special type of microdrip administration set that contains an inline filter designed to cleanse transfused blood of impurities. B) macrodrip administration set that is designed to be used exclusively with 1,000-mL bags of type O-negative blood. C) macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or a combination of IV fluids and blood. D) special administration set with dual piercing spikes that allows the paramedic to administer IV fluids to two critically ill or injured patients at the same time.
C
62. Large protruding arm veins in an otherwise healthy adult can be difficult to cannulate because they often: A) are covered by thick skin that bends the IV catheter. B) constrict in response to insertion of the IV catheter. C) roll from side to side during the cannulation attempt. D) rupture spontaneously when punctured with the needle.
C
67. If an adult patient does NOT require fluid replacement, which of the following over-the-needle catheters is usually an appropriate size to use? A) 14 or 16 gauge B) 16 or 18 gauge C) 18 or 20 gauge D) 22 or 24 gauge
C
72. In the prehospital setting, saline locks are used primarily for patients who: A) have cancer and require continuous infusions of chemotherapy. B) are in compensated shock and only require small IV fluid boluses. C) do not need additional fluids but may need rapid medication delivery. D) have fragile veins that are easily infiltrated by rapid IV fluid boluses.
C
78. Edema at the IV catheter site and continued IV flow after occlusion of the vein above the insertion site are signs of: A) phlebitis. B) infection. C) infiltration. D) thrombophlebitis.
C
79. Thrombophlebitis is MOST commonly caused by: A) abuse of IV drugs. B) long-term IV therapy. C) lapses in aseptic technique. D) any type of hypotonic solution.
C
85. Damage to nerves, tendons, or ligaments would MOST likely occur during venipuncture if: A) the patient has diabetes. B) the patient moves suddenly. C) the selected IV site is near a joint. D) a small vein in the hand is cannulated.
C
90. Signs and symptoms of circulatory overload include: A) diarrhea. B) headache. C) hypertension. D) collapsed jugular veins.
C
95. Which of the following blood tubes contains the preservative EDTA and is used to determine a patient's prothrombin time (PT) and partial thromboplastin time (PTT)? A) Red top B) Green top C) Blue top D) Lavender top
C
15. Potassium: A) helps stimulate the release of insulin. B) is found predominantly outside the cell. C) is a bivalent cation that tends to follow water. D) plays a major role in neuromuscular function.
D
21. The antidiuretic hormone (ADH) prevents the loss of water from the kidneys during the process of: A) osmosis. B) dialysis. C) diffusion. D) filtration.
D
25. The tonicity of a solution is determined by the: A) velocity with which potassium ions shift outside of the cell and sodium ions shift inside the cell. B) permeability of the cell and the ability of sodium and potassium to actively move across its membrane. C) amount of antidiuretic hormone the body produces and the volume of water that is reabsorbed in the tubules of the kidneys. D) concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell.
D
30. Overhydration occurs when: A) a patient experiences prolonged periods of severe hyperventilation. B) the left side of the heart fails and blood backs up into the systemic circulation. C) the intracellular compartment becomes engorged due to a decrease in vascular volume. D) fluid is forced from the engorged interstitial compartment into the intracellular compartment.
D
35. A solution of water with 0.9% sodium chloride is: A) hypotonic until it is introduced into the body. B) capable of carrying oxygen when it is infused. C) of minimal value in expanding the vascular space. D) also called normal saline and is an isotonic solution.
D
37. Lactated Ringer's (LR) solution should not be given to patients with liver problems because: A) LR is a hypertonic solution and cannot be metabolized by the liver. B) the lactate contained within LR can cause necrosis of the liver tissue. C) patients with liver disease commonly experience renal insufficiency. D) the liver cannot metabolize the lactate in the solution.
D
43. Administering large amounts of an isotonic crystalloid solution to a patient with internal bleeding would MOST likely: A) expand the vascular space and improve systemic perfusion. B) cause acute hypotension as fluid is drawn from the vascular space. C) change the ratio of hemoglobin and red blood cells. D) increase the severity of internal bleeding by interfering with hemostasis.
D
46. All of the following are examples of colloid solutions, EXCEPT: A) dextran. B) hetastarch. C) Plasmanate. D) lactated Ringer's.
D
52. In the prehospital setting, the MOST commonly used IV solutions are: A) colloid solutions. B) hypotonic crystalloids. C) hetastarch and saline. D) isotonic crystalloids.
D
57. When preparing an IV administration set, you should NOT: A) invert the bag if the drip chamber contains too much fluid. B) run IV fluid through the administration set to flush air out. C) fill the drip chamber of the administration set with IV fluid. D) cleanse the piercing spike before inserting it into the IV bag.
D
6. Solutes are defined as: A) atoms that carry an electrical charge. B) solutions that exclusively carry electrolytes. C) solutions that contain dissolved components. D) the dissolved particles contained in a solvent.
D
61. When initiating an IV line in the upper extremity of a stable patient, you should: A) always use the antecubital vein. B) look at the anterior forearm first. C) start proximally and work distally. D) start distally and work proximally.
D
64. When selecting the most appropriate IV catheter, you should routinely consider all of the following, EXCEPT: A) the age of the patient. B) the purpose of the IV. C) the location of the IV. D) the patient's gender.
D
69. Regardless of the technique you use to start an IV, you should always: A) apply a tight constricting band proximal to the selected vein for approximately 5 minutes. B) use an over-the-needle catheter that features an automatic needle retraction system for added safety. C) obtain blood samples for emergency department staff by attaching a syringe to the hub of the IV catheter. D) keep the beveled side of the catheter up during insertion and maintain adequate traction on the vein during cannulation.
D
70. After observing a flash of blood in the IV catheter's flash chamber, you should: A) remove the proximal constricting band and then slide the catheter off the needle and into the vein. B) carefully raise the angle of the catheter to approximately 45° and thread the catheter off of the needle. C) apply pressure to the vein just proximal to the end of the indwelling catheter and remove the needle. D) immediately drop the angle of the catheter to about 15° and advance the catheter a few more centimeters.
D
75. Common risks associated with cannulation of the external jugular vein include all of the following, EXCEPT: A) an air embolism. B) carotid artery damage. C) a rapidly expanding hematoma. D) cannulation of the subclavian vein.
D
80. The first sign(s) of IV occlusion is/are: A) a varying flow rate when the IV catheter is manipulated. B) local tissue swelling and a progressively slowing drip rate. C) point tenderness and an abrupt cessation of the IV flow rate. D) a decreasing drip rate or the presence of blood in the IV tubing.
D
86. To avoid inadvertently cannulating an artery, you should: A) routinely cannulate veins on the anterior aspect of the arm. B) refrain from attempting to cannulate an external jugular vein. C) recall that most patients' veins and arteries are transpositioned. D) always check for a pulse in any vessel you intend to cannulate.
D
9. Major cations of the body include all of the following, EXCEPT: A) sodium. B) calcium. C) potassium. D) bicarbonate.
D
92. A vasovagal reaction is the result of: A) acute bradycardia. B) sudden hypertension. C) massive vasoconstriction. D) dilation of the vasculature.
D
99. If a manually inserted IO needle is placed properly in an adult, it should: A) not require a pressure infuser. B) be easily movable in the bone. C) rest at a 45° angle to the bone. D) rest at a 90° angle to the bone.
D
49. All of the following are peripheral veins, EXCEPT the: A) subclavian vein. B) external jugular vein. C) veins of the hand. D) lower extremity veins.
A
54. Once the pigtail is removed from the sterile access port of an IV solution, the solution must be used: A) immediately. B) within 24 hours. C) within 36 hours. D) within 48 hours.
A
59. The purpose of a Volutrol (Buretrol) administration set is to: A) avoid inadvertent fluid overload. B) deliver large volumes of IV fluid. C) facilitate piggyback medication infusions. D) deliver a maximum of 50 mL of IV solution.
A
63. "Track marks" along the course of a patient's vein are usually a sign of: A) sclerosis caused by frequent cannulation. B) numerous one-way valves inside the vein. C) small vein rupture caused by hypertension. D) multiple thromboses deep within the vein.
A
68. If an adult patient is in hypovolemic shock, you should attempt to insert a(n) ______ over-the-needle catheter into the _______. A) 14-gauge, antecubital vein B) 16-gauge, metacarpal vein C) 14-gauge, metacarpal vein D) 18-gauge, external jugular vein
A
73. When changing an IV bag, it is important to: A) ensure that fluid remains in the drip chamber. B) attach a new fluid administration set to the bag. C) ensure that the tubing is completely depleted of fluid. D) allow the bag to become completely depleted of fluid.
A
77. If you discover that an IV is not flowing sufficiently, you should: A) check the height of the IV bag. B) reapply the constricting band. C) discontinue the IV infusion. D) pull back on the IV catheter.
A
83. Pain, tenderness, and blood rapidly pooling around the IV site are MOST indicative of: A) hematoma. B) phlebitis. C) vein occlusion. D) thrombophlebitis.
A
84. Which of the following conditions or situations is associated with the HIGHEST risk of vein rupture during IV cannulation? A) Diabetes B) Hypertension C) Ibuprofen use D) Atherosclerosis
A
87. The MOST prominent clinical indicator of a pyrogenic reaction is: A) fever. B) nausea. C) a headache. D) vascular collapse.
A
91. During IV therapy, the presence of shortness of breath, unequal breath sounds, and cyanosis despite administration of high-flow oxygen should make you MOST suspicious for: A) an air embolus. B) circulatory overload. C) acute pulmonary edema. D) spontaneous pneumothorax.
A
96. IO infusion is a technique of administering IV fluids and medications into: A) the IO space of a long bone. B) the diaphysis of the femur or humerus. C) the epiphysis of the proximal tibia. D) a large vein that lies deep within the neck.
A
98. Which of the following statements regarding IO cannulation and infusion is correct? A) The IO space remains patent, even when peripheral veins have collapsed. B) The IO route is reserved for select medications and certain blood products. C) IO infusion should only be attempted in children younger than 6 years of age. D) Medication absorption occurs more slowly through the IO space than through the IV route.
A
10. Which of the following electrolytes is NOT a cation? A) Chloride B) Calcium C) Potassium D) Magnesium
A
12. Sodium is a ________ cation and can react completely with _______. A) monovalent, 1 mEq of a singly charged anion B) bivalent, 2 mEq of a doubly charged cation C) monovalent, 2 mEq of a singly charged anion D) bivalent, 1 mEq of a doubly charged cation
A
13. Which of the following statements regarding calcium is correct? A) Calcium is needed for bone growth and proper blood clotting. B) Patients with ataxia should be suspected of being hypocalcemic. C) Calcium can react completely with 1 mEq of a singly charged anion. D) Abdominal cramps are a sign of an increased level of serum calcium.
A
17. The primary buffer used in all circulating body fluids is: A) bicarbonate. B) phosphorus. C) potassium. D) magnesium.
A
22. Pumping sodium out of the cell and potassium into the cell has the added benefit of: A) moving glucose into the cell at the same time. B) transiently decreasing serum levels of calcium. C) facilitating water reabsorption in the renal tubules. D) expending minimal levels of adenosine triphosphate.
A
28. Which of the following statements regarding dehydration is correct? A) It is often a chronic condition in elderly patients and may take days to manifest. B) During early dehydration, a profound loss of interstitial fluid occurs in the body. C) In younger patients, dehydration is typically caused by an acute loss of more than 50 mL of blood. D) During dehydration, fluid shifts from the extracellular compartment to the intracellular compartment.
A
29. Signs and symptoms of dehydration include all of the following, EXCEPT: A) bradypnea. B) flushed, dry skin. C) postural hypotension. D) dry mucous membranes.
A
32. Signs and symptoms of overhydration include: A) edema. B) oliguria. C) weight loss. D) wheezing.
A
34. Which of the following statements regarding isotonic solutions is correct? A) Isotonic solutions have almost the same osmolarity as bodily fluids. B) D5W becomes an isotonic solution once it is introduced into the body. C) Normal saline is the only isotonic solution used in the prehospital setting. D) Isotonic solutions expand the vascular space by shifting fluid from other compartments.
A
39. Once D5W is infused into the body: A) the body metabolizes the dextrose quickly and the solution becomes hypotonic. B) it causes fluid to shift from the intracellular space into the vascular space. C) cellular uptake of dextrose occurs and the solution quickly becomes isotonic. D) it rapidly expands the vascular space and effectively increases blood pressure.
A
4. In a 175-lb man, intravascular fluid accounts for approximately ____ lb. A) 8 B) 9 C) 10 D) 12
A
45. Colloid solutions: A) contain proteins that are too large to pass out of the capillary membranes, so the solutions remain in the vascular compartment. B) include solutions such as lactated Ringer's and normal saline and rapidly expand the intravascular compartment. C) are safe to use in the prehospital setting because they rapidly and effectively expand the intravascular compartment. D) do not contain large molecules and are therefore ineffective in expanding the intravascular compartment.
A
41. A hypertonic solution has an osmolarity higher than that of serum, meaning that the solution: A) may cause the cells to expand and rupture due to the increased intracellular osmotic pressure exerted by the solution. B) has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. C) contains high concentrations of proteins and can result in fluid overloading in patients with impaired cardiac function or renal insufficiency. D) has a lower ionic concentration than serum and pulls fluid and electrolytes from the intravascular compartment into the intracellular and interstitial compartments.
B
42. Which of the following statements regarding isotonic crystalloid solutions is correct? A) You should infuse 1 mL of isotonic crystalloid solution for every 3 mL of estimated blood loss. B) Approximately two thirds of infused isotonic crystalloid solution will leave the vascular space within 1 hour. C) Isotonic crystalloids, such as normal saline, have the ability to carry and deliver oxygen to the body's cells. D) The ability of isotonic crystalloids to cross membranes and alter fluid levels makes them dangerous to use for fluid replacement.
B
14. The principal extracellular cation that regulates the distribution of water throughout the body is: A) calcium. B) sodium. C) chloride. D) phosphorus.
B
19. Which of the following electrolytes plays the MOST active role in metabolism? A) Potassium B) Magnesium C) Bicarbonate D) Phosphorus
B
20. The movement of compounds or charges across a cell membrane to an area of lower concentration is called: A) osmosis. B) diffusion. C) filtration. D) selective permeability.
B
24. The net effect of osmosis is to: A) balance the concentration of water on both sides of the cell wall. B) equalize solute concentrations on both sides of the cell membrane. C) utilize ATP to actively move solutes across the cell membrane. D) maintain a higher concentration of solutes outside of the cell.
B
26. The internal environment's resistance to change is called: A) hemostasis. B) homeostasis. C) hypertonicity. D) hypotonicity.
B
3. Cerebrospinal fluid and intraocular fluid are types of: A) plasma. B) interstitial fluid. C) intracellular fluid. D) intravascular fluid.
B
31. A common cause of overhydration is: A) hypertension. B) kidney failure. C) gastrointestinal drainage. D) prolonged hyperventilation.
B
36. It is MOST important to exercise caution when administering isotonic solutions to patients with: A) hypotension and severe hypovolemia. B) hypertension and congestive heart failure. C) dehydration secondary to excessive diarrhea. D) a history of insulin-dependent diabetes mellitus.
B
47. Which of the following statements regarding synthetic blood substitutes is correct? A) Type O-negative blood is a synthetic blood substitute. B) They have the ability to carry oxygen to the body's cells. C) They do not possess the ability to carry and deliver oxygen. D) Hespan is the most commonly used synthetic blood substitute.
B
