Administering IV medications

You just hung a piggyback infusion of cefazolin sodium (Ancef) to be completed in 30 minutes. Which of the following is an appropriate instruction for NAP? (Select all that apply.) a) "When this infusion is complete, let me know so that I can turn the primary line back on." b) "Please report to me if the patient has any discomfort at the infusion site." c) "Please instruct the patient about the purpose and side effects of this medication." d) "Be sure to notify me if the patient develops a rash, itching, difficulty breathing, hypotension, or any other unusual symptoms."

b) "Please report to me if the patient has any discomfort at the infusion site." d) "Be sure to notify me if the patient develops a rash, itching, difficulty breathing, hypotension, or any other unusual symptoms."

You assess the IV site before administering a medication by IV bolus and determine that the site appears to be infiltrated. You inform the patient that the IV will have to be discontinued and restarted in another location before the medication is administered. The patient states that he doesn't want to be "stuck" again and requests that you use the present IV site. What is your best response? a) "Okay, but you may experience more discomfort as the medication infuses." b) "The puffiness at the IV site indicates that the catheter is not in the vein." c) "Sometimes you have to put up with a little pain to get well." d) "Okay, as long as there is not any redness or warmth at the IV site."

b) "The puffiness at the IV site indicates that the catheter is not in the vein." Rationale: Because the IV has infiltrated, the IV will have to be relocated to avoid tissue damage.

Order: Haloperidol (Haldol) 2 mg, IV, q4h, prn Drug available: Haldol 5 mg per mL, Drug Reference: IV maximum infusion rate 1 mg per minute? a) 5 mL, 10 minutes b) 0.4 mL, 2 minutes c) 0.2 mL, 5 minutes d) 2 mL, 4 minutes

b) 0.4 mL, 2 minutes 2mg/5mg x 1mL = 0.4mL 2mg/1mg x 1 min = 2 min.

The patient has the following order: Vancomycin (Vancocin) 500 mg IV q6h. The pharmacy prepared Vancomycin 500 mg in 250 mL of D5W with instructions to infuse over 1 hour. Identify relevant expected outcomes for this patient. (Select all that apply.) a) The prescribed infusion will complete in 60 minutes. b) Patient's IV site remains free of phlebitis or infiltration. c) The nurse will maintain sterility of IV medication. d) Patient's laboratory values of therapeutic drug monitoring reveal desired response without renal toxicity. e) Patient or family is able to explain purpose and side effects of medication. f) Patient fails to show evidence of hypersensitivity, allergic reaction, or other side effects to IV medication.

b) Patient's IV site remains free of phlebitis or infiltration. d) Patient's laboratory values of therapeutic drug monitoring reveal desired response without renal toxicity. e) Patient or family is able to explain purpose and side effects of medication. f) Patient fails to show evidence of hypersensitivity, allergic reaction, or other side effects to IV medication.

You are administering a medication by IV bolus. The patient states, "Wow! That is really burning!" What is your best initial response? a) Stop delivering the medication immediately and discontinue the IV site. b) Slow the rate of infusion. c) Provide the patient with an ice pack. d) Initiate extravasation care.

b) Slow the rate of infusion. Rationale: Some medications are more irritating than others to the vessel lining. Slowing the rate of flow may help reduce the burning sensation. Also, the next time you administer the medication, you should consider diluting the medication further.

The nurse is preparing to administer a medication by IV bolus. In addition to following the six rights of medication administration, what other considerations should the nurse make when administering a medication specific to this method? (Select all that apply.) a) The nurse administers all IV bolus medications over 1 minute. b) The nurse checks the drug reference for the right rate of pushing the medication. c) The nurse does not dilute the medication unless recommended by the manufacturer or reference literature. d) The nurse has the pharmacist prepare the medication for administration. e) The nurse monitors the patient during and after the medication is administered for any adverse reaction.

b) The nurse checks the drug reference for the right rate of pushing the medication. c) The nurse does not dilute the medication unless recommended by the manufacturer or reference literature. e) The nurse monitors the patient during and after the medication is administered for any adverse reaction.

What additional supplies are required for administering a medication by IV bolus through a saline lock versus an existing infusion of IV fluids? a) The necessary supplies are the same regardless of whether a medication is administered by IV bolus through a saline lock or through an existing infusion of IV fluids. b) Two syringes with 2 to 3 mL of normal saline. c) A watch. d) Nonsterile gloves.

b) Two syringes with 2 to 3 mL of normal saline. Rationale: Two syringes with 2 to 3 mL of normal saline are necessary for flushing the saline lock before and after medication administration.

Order: Protamine sulfate 50 mg, IV, STAT, Drug available: 50mg vial 10mg/mL), Drug Reference: IV maximum infusion rate 5 mg per minute a) 10 mL, 10 minutes b) 5 mL, 5 minutes c) 5 mL, 10 minutes d) 10 mL, 5 minutes

c) 5 mL, 10 minutes 50mg/10mg x 1mL = 5mL 50mg/5mg x 1 min = 10 min.

Which of the following is a correct sequence for administering a medication by IV bolus through a saline lock? a) Clean injection port with antiseptic swab, insert syringe containing prepared medication into port, and inject over recommended time period. Remove syringe, clean port, and flush port with normal saline at same rate as medication administration. b) Clean injection port with antiseptic swab, insert syringe with normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended time period, withdraw syringe, clean port, discard gloves, and document. c) Clean injection port, insert syringe of normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended period, withdraw syringe, clean port, and flush port with normal saline at same rate as medication administration. d) Clean injection port, insert syringe of medication, pinch tubing above port and aspirate for a blood return, release the tubing and administer the medication at the recommended rate, remove syringe, and verify infusion rate.

c) Clean injection port, insert syringe of normal saline, aspirate for blood return, and flush with saline. Remove syringe, clean port, administer medication over recommended period, withdraw syringe, clean port, and flush port with normal saline at same rate as medication administration.

Order: Morphine sulfate 6 mg, IV push, q3h, prn Medication available: 10 mg/mL Drug Reference: Maximum infusion rate 10 mg per 5 minutes The 6 mg of morphine sulfate (morphine) should be administered over ____minutes.

3 minutes 6mg/10mg x 5min = 3 minutes

Solve the problem. Order: Lorazepam (Ativan) 6 mg, IV, q6h, as needed. Medication available: Lorazepam (Ativan) 4 mg per mL Drug reference: IV maximum infusion rate 2 mg per minute At what rate should this medication be administered? IV over minutes.

3 minutes Feedback: 6mg/2mg x 1 min = 3 min.

Order: Oxacillin (Bactocil) 400 mg, IV, q6h. Medication available: 400 mg oxacillin (Bactocil) in 100 mL of D5W. Instruction: Infuse over 40 minutes. Micro-drip tubing (60 gtts/mL) is being used. The infusion pump should be set to mL per hour.

150 mL/hr Calculation: 100mL/40min x 60min/hr = 150mL/per

Order: Ranitidine (Zantac) 50 mg, IV, q6h Set: infusion pump; micro drip (60 gtt per mL) tubing Medication available: premixed drug in bag (Zantac 50 mg in 50 mL 0.45% NaCl) Drug Reference: Infuse over 15 minutes Infusion pump rate is ______ mL per hour.

200mL/hr 60min per hr/15min x 50mL = 200mL per hr

Order: Morphine sulfate (Morphine) 6 mg, IV push, q3h, prn Medication Available: 10 mg/mL Morphine sulfate Drug Reference: Maximum infusion rate 10 mg per 5 minutes How much medication would you administer? ______ mL

0.6 mL 6mg/10mg x 1mL = 0.6mL

Solve the problem. Order: Lorazepam (Ativan) 6 mg, IV, q6h, as needed Medication available: Lorazepam (Ativan) 4 mg per mL Drug reference: IV maximum infusion rate 2 mg per minute How much medication would you administer in mL?

1.5 Feedback: 6mg/4mg x 1mL = 1.5mL

The health care provider has ordered levofloxacin (Levaquin) 250 mg in 50 mL to be infused over 1 hour.How many gtt/min will you set the rate on a gravity flow if the drop factor is 15?

13 gtt/min Calculation: 50mL/60min x 15 gtt per mL = 12.5 = 13gtt per min

Order: Ranitidine (Zantac) 50 mg, IV, q6h Drug available: premixed drug in bag (Zantac 50 mg in 50 mL 0.45% NaCl) Drug Reference: Infuse over 15 minutes. If 15 gtt per mL macro drip tubing were used, what is the correct drip rate? ______ gtt per minute

50gtt/min 50mL/15min x 15gtt per mL = 50gtt per min

The health care provider has ordered levofloxacin (Levaquin) 250 mg in 50 mL to be infused over 1 hour. Micro-drip tubing (60 gtts/mL) is being used.The nurse should set the infusion pump at mL/hr.

50mL/hr Calculation: 50mL to be infused in 1hr = 50mL per hr

Ordered: 150 mL of IV antibiotic to infuse over 40 minutes. At how many drops/min should the nurse set the rate, if the drop factor is 15 gtt/mL?

56gtt/min Calculation: 150mL/40min x 15gtt per mL = 56.25 = 56gtt per min

After receiving report, which of the following patients should the nurse see first? A) A patient who is receiving an IV piggyback antibiotic and is complaining of shortness of breath and itching. B) A patient who is unable to explain the purpose and side effects of the medication. C) A patient who complained of "stinging" at the IV site when the previous nurse administered an IV push medication. D) A patient with IV fluids infusing without difficulty, but was reported to have no blood return upon aspiration.

A) A patient who is receiving an IV piggyback antibiotic and is complaining of shortness of breath and itching.

Which of the following are assessment measures the nurse should make before administering an IV medication? (Select all that apply) A) Patency and appearance of IV site B) Length of time patient has had IV therapy C) History of allergies or diseases D) Patient's understanding of medication therapy E) Assistive personnel's ability to monitor infusion F) Drug information and compatibility G) Rate of infusion H) Lab values

A) Patency and appearance of IV site C) History of allergies or diseases D) Patient's understanding of medication therapy F) Drug information and compatibility G) Rate of infusion H) Lab values

The nurse is to administer 5 mg of Morphine sulfate IV push. The drug is available as 10 mg/mL. What is the nurse's best action? A) Assess the patient's IV site for patency, and administer 2 mL of morphine sulfate. B) Dilute the amount of morphine sulfate to be given in 5 to 10 mL of 0.9% sodium chloride and administer at the correct rate. C) Administer 0.5 mL of morphine sulfate at the correct rate by IV push without further dilution. system. D) Flush the IV line with 1 mL of normal saline, administer the correct amount of morphine sulfate at the correct rate, and flush with 2 to 3 mL of normal saline.

B) Dilute the amount of morphine sulfate to be given in 5 to 10 mL of 0.9% sodium chloride and administer at the correct rate.

The nursing instructor is reviewing IV medication administration with the nursing students. Which of the following statements, if made by a student, indicates further instruction is needed? A) "The nurse should never administer IV medications through tubing that is infusing blood, blood products, or parenteral nutrition solutions." B) "The 6 rights of medication administration include the right medication, the right dose, the right patient, the right route, the right time, and the right documentation." C) "The three additional rights for administering a medication by IV bolus are the right flush or dilution, the right syringe, and the right monitoring." D) "The administration of hyperosmolar drugs by the intravenous route increases the risk of phlebitis."

C) "The three additional rights for administering a medication by IV bolus are the right flush or dilution, the right syringe, and the right monitoring."

Which of the following is a correct sequence for administering an IV piggyback through an existing IV infusion that uses a needleless system? A) Connect infusion tubing to medication bag and prime tubing, hang piggyback medication bag at same level as primary fluid bag, wipe off lower Y-port of primary infusion line with an alcohol swab and insert tip of piggyback infusion tubing, then regulate flow rate of IV piggyback. B) Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach appropriate IV tubing to the saline lock, and administer the medication via piggyback. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline. C) Connect infusion tubing to medication bag and prime tubing, hang piggyback medication bag above level of primary fluid bag, wipe off upper Y-port of primary infusion line with an alcohol swab and insert tip of piggyback infusion tubing, regulate flow rate of IV piggyback.

C) Connect infusion tubing to medication bag and prime tubing, hang piggyback medication bag above level of primary fluid bag, wipe off upper Y-port of primary infusion line with an alcohol swab and insert tip of piggyback infusion tubing, regulate flow rate of IV piggyback.

The nurse is planning to administer medication by IV bolus through a saline lock. After the medication is delivered, why is it necessary to flush the port with 2 to 3 mL of normal saline at the same rate as the medication was delivered? A) In order to ensure patency of the IV site while observing for puffiness. B) To prevent dislodging a blood clot into the bloodstream. C)To ensure that any medication remaining within the IV is delivered at the correct rate. D) To avoid causing circulatory compromise from fluid volume excess.

C)To ensure that any medication remaining within the IV is delivered at the correct rate.

The nurse needs to administer an IV push medication for a patient who is complaining of pain. The medication is incompatible with the IV fluid that is infusing. What is the nurse's best initial action? A) Initiate a saline lock in a different location (proximal to the present IV site) to be used for IV push medications. B) Wait until the infusion is complete and then administer the pain medication. C) Contact the physician and request the pain medication be given by a different route, or request a different pain medication that would be compatible with the IV fluids. D) Stop the infusion, flush with 10 mL of 0.9% sodium chloride, give the IV pain medication over the appropriate amount of time, flush with another 10 mL of 0.9% sodium chloride at the same rate as the medication was administered, and restart the IV fluids.

D) Stop the infusion, flush with 10 mL of 0.9% sodium chloride, give the IV pain medication over the appropriate amount of time, flush with another 10 mL of 0.9% sodium chloride at the same rate as the medication was administered, and restart the IV fluids.

The nurse wants to take appropriate precautions when administering IV medications in order to provide safe and effective nursing care. Which of the following indicate misunderstanding and may impede the nurse from reaching the goal of safe, effective care? A) The nurse is aware the presence of diseases that impair drug absorption, metabolism, or excretion increase the risk of an adverse drug reaction. B) Clean gloves are worn during administration of an IV bolus. C) The nurse adds medications to new IV fluid containers only. D) The nurse continues a large volume infusion containing medication on a patient with crackles, dyspnea, and an elevated blood pressure and pulse rate.

D) The nurse continues a large volume infusion containing medication on a patient with crackles, dyspnea, and an elevated blood pressure and pulse rate.

The IV bolus, or "push," is the most dangerous method of administering medications. True or False

True Rationale: Because there is no time to correct errors.

The nursing instructor is reviewing with the nursing students how to administer a medication by IV push through a saline lock. Which statements made by the nursing students reveal accurate comprehension? (Select all that apply.) a) "Disposable gloves should be worn." b) "All IV medications should be administered over 5 minutes for safety." c) "A saline flush should be administered before and after medication administration." d) "The saline flush administered after the medication should be given at the same rate as the medication." e) "If less than 1 mL of medication is given, it should be diluted in 5 to 10 mL of normal saline or sterile water."

a) "Disposable gloves should be worn." c) "A saline flush should be administered before and after medication administration." d) "The saline flush administered after the medication should be given at the same rate as the medication."

Which of the following are examples of expected outcomes for administering medication by IV bolus? (Select all that apply.) a) Absence of phlebitis or infiltration at IV site. b) Nurse relocates IV insertion site according to agency protocol. c) Patient verbalizes understanding of purpose and side effects of medication. d) Absence of adverse reactions or negative side effects of medication.

a) Absence of phlebitis or infiltration at IV site. c) Patient verbalizes understanding of purpose and side effects of medication. d) Absence of adverse reactions or negative side effects of medication.

Which of the following is a correct sequence for administering an IV piggyback through a saline lock? a) Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline. b) Cleanse the port with alcohol. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline. c) Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing and document.

a) Cleanse the port with alcohol and assess the patency of the IV line by flushing it with 2 to 3 mL of sterile normal saline. Attach IV piggyback tubing to the saline lock, and administer the medication per order. When the infusion is completed, disconnect the tubing, cleanse the port with alcohol, and flush the IV line with 2 to 3 mL sterile normal saline.

Identify nursing precautions to ensure safe patient care when administering IV medications. (Select all that apply.) a) Observing for symptoms of adverse reactions. b) Following the six rights of medication administration. c) Being knowledgeable of the desired action and side effects of the medication. d) Adding IV medications to IV bags that are already hanging. e) Assessing vital signs before, during, and after infusion with potent medications. f) Verifying the rate of administration with a drug reference or pharmacist. g) Informing assistive personnel how to assess for fluid overload and evaluate medication effectiveness. h) Having the antidote available, if the medication has one.

a) Observing for symptoms of adverse reactions. b) Following the six rights of medication administration. c) Being knowledgeable of the desired action and side effects of the medication. e) Assessing vital signs before, during, and after infusion with potent medications. f) Verifying the rate of administration with a drug reference or pharmacist. h) Having the antidote available, if the medication has one. Rationale: The nurse takes special care to avoid errors in dose calculation and preparation because once the dose enters the bloodstream, it begins to act immediately and there is no way to stop its action. The nurse uses the six rights of medication administration to verify that the right dose of the right medication is given by the right route to the right patient at the right time and then documented accurately. The nurse verifies the prescribed rate of administration with a drug reference or pharmacist before giving any IV medication so that the medication is given over the appropriate amount of time. Patients may experience severe adverse reactions if IV medications are administered too quickly. The nurse is aware of the desired therapeutic effect and potential side effects for accurate observation and evaluation of the medication therapy. The nurse continuously observes the patient for symptoms of adverse reactions so that early intervention may be implemented. This includes having an antidote available if the medication has one. When administering potent medications, the nurse assesses vital signs before, during, and after administration to assess for any alteration in the patient's status. It is inappropriate to delegate nursing assessment and evaluation to assistive personnel. Only add medications to new IV fluid containers as ordered by the health care provider, and administer solutions and medications prepared and dispensed from the pharmacy or as commercially prepared when possible.

When preparing to administer an IV medication, a nurse checks the health care provider's order with the medication administration record (MAR) and the label on the medication vial. The nurse verifies the IV route for administration. Next the nurse computes the correct dosage and withdraws the medication according to the MAR using the appropriate dilution. The nurse administers the medication intravenously at the time ordered and at the correct rate. Which of the six rights of medication administration did the nurse fail to demonstrate? (Select all that apply.) a) Right patient. b) Right documentation. c) Right concentration. d) Right tubing. e) Right date of expiration.

a) Right patient. b) Right documentation. Rationale: The nurse failed to identify the right patient by comparing the MAR to the patient's identification bracelet and asking the patient to state his or her name and birth date. Also the nurse is not described as recording the medication administration on completion of the procedure. Although the right concentration is excluded from the six rights of medication administration, the nurse did demonstrate the right dose by calculating the dosage and preparing it according to the medication order. Right tubing and right date of expiration also are not identified as among the six rights of medication administration. The nurse did verify the right drug by looking at the medication label on the vial and comparing it with the MAR. The nurse would also check the expiration date on the medication label at this time.

The nurse is administering vancomycin (Vancocin) 500 mg by IV piggyback over 60 minutes. An hour later the nurse returns to find that approximately half of the infusion has been administered and the IV site appears swollen, pale, and is cool to the touch. What is the appropriate action to be taken for this unexpected outcome? (Select all that apply.) a) Stop the infusion. b) Recheck the patient for an allergy to vancomycin. c) Provide extravasation care. d) Increase the flow rate. e) Provide an extra blanket for the patient. f) Discontinue the IV.

a) Stop the infusion. c) Provide extravasation care. f) Discontinue the IV. Rationale: These are signs of infiltration. The infusion will have to be stopped and the IV access device discontinued. Some IV medications are extremely harmful to subcutaneous tissue. The nurse should provide IV extravasation care (e.g., injecting phentolamine around the IV infiltration site) as indicated by agency policy, use a medication reference, or consult a pharmacist to determine appropriate follow-up care. If continuation of therapy is indicated, a new IV site, preferably in the other extremity, will have to be started. Increasing the rate of flow would only make the infiltration worsen. Providing the patient with a blanket may provide comfort but will fail to resolve the problem. These symptoms are not indications of an allergic response.

Which of the following are advantages of volume-controlled intravenous (IV) infusions? (Select all that apply.) a) There is less risk of rapid-dose infusion (as compared with IV push) because medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes). b) It allows for administration of medications (e.g., antibiotics) that are stable for a limited time in solution. c) The risk of side effects is minimal because this is the safest method of administering IV medications. d) It is the preferred method in an emergency.

a) There is less risk of rapid-dose infusion (as compared with IV push) because medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes). b) It allows for administration of medications (e.g., antibiotics) that are stable for a limited time in solution. Rationale: Using volume-controlled infusions has several advantages: It reduces the risk of rapid-dose infusion by IV push. Medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes). It allows for administration of medications (e.g., antibiotics) that are stable for a limited time in solution. It allows for control of IV fluid intake. The risk of side effects still remains; the safest method of administering IV medications is by large-volume infusions. IV bolus is the preferred method in an emergency when quick-acting medications are needed.

The patient's IV piggyback has infused completely. To determine the outcome of administration of IV medication by IV piggyback, you should evaluate which of the following? (Select all that apply.) a) Time of completion b) IV site c) Lab reports for therapeutic drug levels, if applicable d) Length of time tubing is left hanging connected to primary infusion e) Patient for adverse reaction f) Patient's ability to verbalize understanding of drug therapy

a) Time of completion b) IV site c) Lab reports for therapeutic drug levels, if applicable e) Patient for adverse reaction

A nurse takes precautions to prevent an undesirable outcome when administering medications by the IV route. Which of the following actions may produce an undesirable outcome? The nurse: a) adds piggyback infusion of an antibiotic to main line IV of parenteral nutrition. b) explores patient's cultural beliefs regarding use of alcohol, herbal remedies, and dietary preferences. c) verifies prescribed dilution and rate of administration for medication. d) administers solutions and medications prepared and dispensed from pharmacy when possible.

a) adds piggyback infusion of an antibiotic to main line IV of parenteral nutrition. Rationale: The nurse should never administer IV medications through tubing that is infusing blood, blood products, or parenteral nutrition solutions because the medications may cause the blood cells to clump or cause clotting. Cultural assessment yields information about dietary preferences, tobacco and alcohol use, and use of herbal remedies that affect drug action and response. Patients may experience severe adverse reactions if IV medications are administered too quickly. Verify the rate of administration with a drug reference or a pharmacist before giving any IV medication to ensure medication is given over the appropriate time in the appropriate concentration. For risk reduction, the nurse should administer solutions and medications prepared and dispensed from the pharmacy or as commercially prepared when possible.

The nurse is planning to administer an IV medication with a mini-infusion pump. The nurse has performed hand hygiene; verified the medication, dose, route, and time with the order; and explained the medication therapy to the patient. The nurse uses two patient identifiers to verify the right patient. The nurse connects the prefilled syringe to the mini-infusion tubing and places the syringe into the mini-infuser pump. The nurse connects the mini-infusion tubing to the main IV line and hangs the pump on the IV pole alongside the primary IV. The nurse set the pump to deliver the medication within the recommended time while allowing the primary line to continue to infuse. The nurse observes the patient for any signs of adverse reactions. What steps have not been completed? The nurse needs to: (Select all that apply.) a) gently push the plunger and fill the tubing with medication. b) check that the syringe was secure in the mini-infuser pump. c) wipe off the port with an alcohol swab before connecting the mini-infusion tubing to the main IV line. d) hang the mini-infusion pump on an IV pole by itself. e) turn off the main IV line while the mini-infuser pump is running. f) press the button on the mini-infusion pump to begin the infusion.

a) gently push the plunger and fill the tubing with medication. b) check that the syringe was secure in the mini-infuser pump. c) wipe off the port with an alcohol swab before connecting the mini-infusion tubing to the main IV line. f) press the button on the mini-infusion pump to begin the infusion.

The nurse is preparing to administer a medication by the IV route. Which of the following actions indicates further instruction is needed? The nurse: (Select all that apply.) a) removes the piggyback bag and tubing from the primary line after the piggyback has infused to prevent bacterial growth. b) assesses the IV insertion site for signs of infiltration or phlebitis before initiating the infusion and frequently evaluates the site for complications. c) notes the time the piggyback is started on the pump in order to return at time of completion to turn the primary infusion back on. d) fills the Volutrol with the desired amount of fluid, cleans the port, adds the medication, gently rotates, and labels the Volutrol chamber. e) stops the infusion when the patient complains of itching and difficulty breathing and the NAP reports the patient's pulse is 110 and blood pressure is 80/60.

a) removes the piggyback bag and tubing from the primary line after the piggyback has infused to prevent bacterial growth. c) notes the time the piggyback is started on the pump in order to return at time of completion to turn the primary infusion back on. Rationale: The piggyback should be left in place with the tubing for future medication administration unless it is time to change the tubing. Establishment of a secondary line produces a route for microorganisms to enter the main line. Repeated changes in tubing increase the risk of infection transmission. (Check facility policy.) It is unnecessary to turn the primary infusion back on as it will automatically start when the piggyback infusion is completed. The nurse should determine patency and assess the IV site frequently for complications. The Volutrol should be gently rotated to ensure mixing and labeled to identify type and amount of medication added. If the patient is hypotensive, tachycardic, and complaining of itching and difficulty breathing, an allergic reaction should be suspected. The nurse should turn off the IV, follow facility policy for response to an allergic reaction, and notify the health care provider.

Identify advantages of administering medication by the IV route. (Select all that apply.) a) Less risk of an allergic response. b) Onset of therapeutic action is delayed. c) Delivers medication quickly in an emergency. d) Establishes therapeutic blood levels. e) Causes less discomfort with highly alkaline medications that are irritating to subcutaneous or intramuscular tissue. f) Requires less knowledge and skill.

c) Delivers medication quickly in an emergency. d) Establishes therapeutic blood levels. e) Causes less discomfort with highly alkaline medications that are irritating to subcutaneous or intramuscular tissue. Rationale: The advantages of administering medication by the IV route are that it provides a route for administering medication when the drug must be delivered quickly, it is the preferred route when it is necessary to establish constant therapeutic blood levels, and it causes less discomfort with highly alkaline and irritating medications than the subcutaneous or intramuscular route. After a medication enters the bloodstream, it begins to act immediately. If the patient is allergic to the medication, the reaction will be more prompt. Administering medications by the IV route requires more knowledge and skill to prevent negative outcomes.

The nurse added a medication to the Volutrol and applied a label identifying the name of the medication, dosage, total volume including diluent, and time of administration. What is the purpose of labeling? a) Writing on the label is preferred because writing on the bag smears the ink. b) For accountability purposes, it identifies the nurse who administered the medication. c) It alerts nurses to medication being infused. d) It informs patient of planned therapies.

c) It alerts nurses to medication being infused. Rationale: Proper labeling prevents other medications from being added to the Volutrol.

A patient with a saline lock has the following order: hydromorphone 2 mg IV push q3h prn pain. The drug book states: Hydromorphone: Dilute with at least 5 mL of sterile water or 0.9% NaCl for injection. Administer slowly, at a rate not to exceed 2 mg over 3 to 5 minutes. Which of the following actions if performed by the nurse would require correction? (Select all that apply.) a) The nurse dilutes the hydromorphone in 5 mL of normal saline 0.9% and labels the syringe with the patient's name, generic drug name and dosage in syringe. b) The nurse observes the IV site above the catheter while flushing the IV site with normal saline prior to medication administration. c) The nurse cleans the injection port with an antiseptic swab, flushes the IV lock, and inserts the needleless tip of prepared medication syringe through injection port of IV lock. d) The nurse injects the IV medication over 4 minutes using a watch to time administration. e) The nurse flushes the IV injection port with 2 to 3 mL of normal saline over 30 seconds following medication administration.

c) The nurse cleans the injection port with an antiseptic swab, flushes the IV lock, and inserts the needleless tip of prepared medication syringe through injection port of IV lock. e) The nurse flushes the IV injection port with 2 to 3 mL of normal saline over 30 seconds following medication administration. Rationale: The nurse should clean the injection port with an alcohol swab and allow it to dry prior to entering the IV port every time. The nurse should have cleaned the port again prior to inserting the needleless tip of the prepared medication. The nurse should have pulled back on the plunger prior to the initial flush to check for blood return to verify IV catheter is in vein. Following medication administration, the nurse should flush the IV injection port at the same rate as the medication was administered. The nurse flushed the port too fast following medication administration. All other actions were appropriate.

As an evaluation measure, the nurse will ________ the IV site before and after administering medication by IV bolus. a) change b) and adverse reaction c) assess d) resistance

c) assess

The nurse will observe the patient for signs of ________ to the medication during the injection and afterward. a) assess b) resistance c) change d) an adverse reaction

d) an adverse reaction