Capstone Intravenous; Module 8

At 1300, the nurse is documenting the receipt of a unit of packed blood cells at the hospital blood bank. The nurse calculates that the transfusion must be started by which time?

1330

The health care provider prescribes 2000 mL of 5% dextrose and normal saline 0.45% for infusion over 24 hours. The drop factor is 15 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round to the nearest whole number). __

21 gtts/mL

Disulfiram is prescribed for a client. Which questions does the nurse make a priority of asking the client before administering this medication? Select all that apply.

"Do you have a history of thyroid problems?" "When was your last drink of alcohol?"

A nurse is caring for a group of adult clients on an acute care nursing unit. Which clients does the nurse recognize as the most likely candidates for total parenteral nutrition (TPN)? Select all that apply.

A client with a severe exacerbation of ulcerative colitis A client with severe sepsis A client with pancreatitis Rationale: TPN is indicated in the client whose gastrointestinal tract is not functional or who cannot tolerate an enteral diet for extended periods. The client with sepsis is very ill and may require TPN. Other candidates include clients who have undergone extensive surgery, sustained multiple fractures, or have advanced cancer or AIDS. The client who has undergone hiatal hernia repair is not a candidate, because this client would resume a normal diet within a relatively short period after the hernia repair. The client with renal calculi also is not a candidate because the client would be able to eat.

Akathisia

A state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs.

A nurse discontinues an infusion of a unit of packed red blood cells (RBCs) because the client is experiencing a transfusion reaction. After discontinuing the transfusion, which action should the nurse take next?

Contact the health care provider

Trigeminal neuralgia

Episodes of severe, shooting, or jabbing pain that may feel like an electric shock. Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking, or brushing teeth. Attacks of pain lasting from a few seconds to several minutes. Pain that occurs with facial spasms.

Carbamazepine is prescribed for a client with trigeminal neuralgia. Which side/adverse effects does the nurse instruct the client to report to the health care provider? Select all that apply.

Fever Sore throat Mouth sores

A nurse is preparing a plan of care for a client who will be receiving meperidine hydrochloride. Which side/adverse effects does the nurse make a note of needing to be alert to in the plan of care? Select all that apply.

Hypotension Urine retention Constipation Respiratory depression

Meperidine hydrochloride

Meperidine hydrochloride is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, tremors, constipation, urinary retention, nausea, vomiting.

A nurse is caring for a client with histoplasmosis who is receiving intravenous amphotericin B . Which is the most critical observation for the nurse to make while the medication is being administered?

Monitor the client's urine output

Baclofen is prescribed for a client with a spinal cord injury who is experiencing muscle spasms. While providing instructions to the client, which side effect does the nurse tell the client is possible?

Photosensitivity

A nurse notes that the site of a client's peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous near the insertion point of the catheter. On the basis of this assessment, the nurse should take which action first?

Remove the catheter

A client receiving total parenteral nutrition (TPN) requires fat emulsion (lipids), which will be piggybacked to the TPN solution. On obtaining a bottle of fat emulsion, the nurse notes that fat globules are floating at the top of the solution. Which action should the nurse take?

Request a new bottle from the pharmacy

A client who is taking bupropion in an attempt to stop smoking tells a nurse that he has been doubling the daily dose to make it easier to resist smoking. The nurse warns the client that doubling the daily dosage is dangerous. Of which adverse effect of the medication does the nurse warn the client?

Seizures

A nurse is changing the central line dressing of a client receiving total parenteral nutrition (TPN). The nurse notes moisture under the dressing covering the catheter insertion site. What should the nurse assess next?

Tightness of the tubing connections

Metoprolol has been prescribed for a client with hypertension. For which common side effects of the medication does the nurse monitor the client? Select all that apply.

Weakness Fatigue Erectile dysfunction

A home care nurse has been assigned a client who has been discharged home with a prescription for total parenteral nutrition (TPN). Which parameters does the nurse plan to check at each visit as a means of identifying complications of the TPN therapy? Select all that apply.

Weight Temperature Glucose test

The nurse is preparing to change the solution bag and intravenous tubing of a client receiving total parenteral nutrition (TPN) through a left subclavian central venous line. Which essential action does the nurse ask the client to perform just before switching the tubing?

Ask patient to hold their breath at the end of expiration before the last 15cm of the PICC is removed. During inspiration, negative intrathoracic pressure can encourage air to enter the exit site and cause an air embolism.

A nurse is caring for a client with myasthenia gravis who is exhibiting signs of cholinergic crisis. Which medication does the nurse ensure is available to treat this crisis?

Atropine sulfate. Rationale: The treatment for cholinergic crisis is atropine sulfate. Protamine sulfate is the antidote for heparin, and acetylcysteine is the antidote for acetaminophen (Tylenol). Pyridostigmine bromide is an anticholinesterase agent used in the treatment of myasthenia gravis to improve muscle strength. An overdose of this medication can cause cholinergic crisis.

A client has been given a prescription to begin using nitroglycerin transdermal patches for the management of angina pectoris. What should the nurse tell the client about the medication?

Apply the patch at the same time each day and leave it in place for 12 to 16 hours as directed

A client is receiving total parenteral nutrition (TPN) with fat emulsion (lipids) piggybacked to the TPN solution. For which signs of an adverse reaction to the fat emulsion should the nurse monitor the client? Select all that apply.

Chills Headache Nausea & vomiting Chest and back pain Rationale: Signs of an adverse reaction to fat emulsion include chest and back pain, chills, fever, dyspnea, cyanosis, diaphoresis, flushing, headache, nausea and vomiting, pressure over the eyes, vertigo, and thrombophlebitis at the infusion site.

A client with a peripheral intravenous (IV) line in place has a new prescription for infusion of parenteral nutrition (PN), a solution containing 25% glucose.

Questioning the healthcare provider about the prescription Rationale: TPN solutions containing as much as 10% glucose can be infused through peripheral vessels. A TPN solution containing 25% glucose is hypertonic. The nurse should question the prescription in the absence of a central venous catheter or a peripherally inserted central catheter. Diluting the solution with sterile water to half-strength and hanging the IV solution as prescribed are both inappropriate. The nurse must not alter a prescribed solution independently.