Chapter 13: Intravenous Therapuy

An client is receiving total parenteral nutrition. What type of IV fluid administration device would the nurse use for TPN administration? in-line filter medication lock vented tubing microdrip tubing

In-line filter

A nurse assessing the IV site of a patient observes swelling and pallor around the site and notes a significant decrease in the flow rate. The patient complains of coldness around the infusion site. What IV complication does this describe? Infiltration Thrombus Sepsis Speed shock

Infiltration

A nurse is assigned to care for a client who is bleeding severely following an accident and has been ordered transfusion of blood components. Which of the following should the nurse do to reduce the risk of septic reactions? Avoid infusing blood components within four hours of refrigeration. Keep the frozen blood components at room temperature for a longer duration. Immerse the refrigerated blood components in warm water before use. Refrigerate red blood cells and thawed fresh frozen plasma until use.

Refrigerate red blood cells and thawed fresh frozen plasma until use.

The nurse is caring for a healthy adult client who developed a gastrointestinal virus in the last 24 hours that has caused vomiting and diarrhea and now has a diagnosis of dehydration. The nurse should know that a health care provider's order to initiate intravenous therapy is given primarily for which reason(s)? Select all that apply. Replace electrolytes. Administer medications. Administer water-soluble vitamins. Replace blood or blood products. Replace fluids.

Replace fluids Replace electrolytes

Assessing a client at 4:00 PM, a nurse notes that 800 ml of normal saline solution has been infusing since it was hung at 4:00PM yesterday. What would be the nurse's next action? Replace the IV solution. Leave the IV solution until it completes. Write an incident report. Discontinue the IV site.

Replace the IV solution

A client is receiving a blood transfusion and reports a new onset of slight dyspnea. The nurse's rapid assessment reveals bilateral lung crackles and elevated BP. What is the nurse's most appropriate action? Slow the infusion rate and monitor the client closely. Discontinue the transfusion and begin resuscitation. Pause the transfusion and administer a 250 mL bolus of normal saline. Discontinue the transfusion and administer a beta-blocker, as prescribed.

Slow the infusion rate and monitor the client closely

A client receiving intravenous therapy is experiencing circulatory overload. Which of the following nursing actions is correct? Select all that apply. Slow the infusion rate. Discontinue any oxygen. Elevate the client's head. Apply warm compresses at the site. Contact the physician.

Slow the infusion rate. Elevate the client's head. Contact the physician.

The nurse is caring for an older adult client who is receiving intravenous therapy (IV). Which assessment data would indicate that the client is experiencing a complication of IV therapy? The client's respiratory rate has increased from 16/minute to 18/minute. The client complains of a stomachache. The client's jugular veins are distended. The client complains of aching joints.

The client's jugular veins are distended.

A client is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this client's adverse reaction? Antibodies to donor leukocytes remained in the blood. The donor blood was incompatible with that of the client. The client had a sensitivity reaction to a plasma protein in the blood. The blood was infused too quickly and overwhelmed the client's circulatory system.

The donor blood was incompatible with that of the client.

The nurse is supervising a new graduate nurse who is caring for a client receiving total parenteral nutrition for the last two weeks. The health care provider has just written an order to discontinue this therapy according to policy. What action by the new nurse would cause the supervising nurse to intervene in relation to intravenous therapy? The new graduate replaces the total parenteral nutrition intravenous solution with 0.9% saline. The new graduate first looks up the discontinuation policy related to total parenteral nutrition before going to the client's room. The new graduate completes a nutritional assessment of the client including skin turgor and current weight in relation to previous weight. The new graduate ensures that the client has bowel sounds and is aware that the total parenteral nutrition therapy is to be discontinued.

The new graduate replaces the total parenteral nutrition intravenous solution with 0.9% saline.

The nurse is preparing to administer a unit of blood to a client and should know that which is the FIRST action of the nurse prior to the administration? The nurse will obtain the client's vital signs. The nurse will connect the unit of blood to Y-administration set tubing. The nurse will check that the numbers of the client's wrist band and the unit of blood match and that this information is confirmed by another nurse. The nurse will explain to the client the symptoms associated with a transfusion reaction.

The nurse will check that the numbers of the client's wrist band and the unit of blood match and that this information is confirmed by another nurse

A client receiving intravenous therapy shows signs of swelling at the infusion site and says it is uncomfortable. The infusion is also slowing. Which of the following complications would the nurse most likely prepare to assist in managing? Infection Pulmonary embolus Thrombus formation Circulatory overload

Thrombus formation

A client is receiving total parenteral nutrition. The physician order includes lipid emulsion administration (contained in glass bottles) on Monday, Wednesday, and Friday. What type of IV tubing would the nurse select for the lipid administration? vented tubing unvented tubing macro drip tubing None of the options is correct.

Vented tubing

The IV solution for a client has infused, and the physician's order indicates that no more fluid is required. To discontinue IV therapy for this client, which nursing action would the nurse complete first? Clamp the tubing. Remove the tape holding the device in place. Don clean gloves. Remove the venipuncture device.

Don clean gloves

A client with ascites is receiving TPN until the condition clears. IV lipid emulsions would be contraindicated in a client with which condition? egg allergy sulfa allergy skin infection cardiac disease

Egg allergy

A client with type O blood and a history of anemia is scheduled for a blood transfusion. To avoid a transfusion reaction, this client must receive which blood type? O AB All blood types would work for this client. B

O

The physician has prescribed an IV of 3000 mL of 0.9% sodium chloride to be infused over the next 24 hours. The nurse uses IV tubing that has a drip factor of 10. How many drops per minute will deliver the correct amount of IV fluid? Record your answer using a whole number.

21 When infusing by gravity: Total volume in mL ÷ Total time in minutes × drop factor = gtt/minute 24 hours = 1440 minutes 3000 mL ÷ 1440 minutes × 10 = 20.83 gtt/minute Round up to 21 gtt/minute

A client is receiving IV fluid administration and consuming a rather large amount of fluids orally. In calculating the client's fluid intake for the past 24 hours, the nurse notes the amount and immediately notifies the physician of this finding. Notification of a physician regarding fluid intake should occur after exceeding how many milliliters in 24 hours? 3000 2500 1500 2000

3000

A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.

5

A physician orders an infusion of 250 mL of NS in 100 minutes. The set is 20 gtt/mL. What is the flow rate?

50 The flow rate (gtt/min) equals the volume (mL) times the drop factor (gtt/mL) divided by the time in minutes.

Which of the following clients would be a candidate for total parenteral nutrition? A client with diabetic ketoacidosis A postoperative appendectomy client A client with colitis and bloody diarrhea A client receiving intravenous antibiotics

A client with colitis and bloody diarrhea

A client has been a client in the ICU for 17 days, seriously ill. A multitude of medications are ordered for the client's treatment regimen, most of which are administered intravenously. What is an indication for the use of IV medications? Select all that apply. impaired gastrointestinal absorption restricted oral intake consistent therapeutic blood level desired All options are correct.

All options are correct

A client has hypertonic solution running via gravity at 100 mL/hour to decrease postoperative edema. Before transporting the client, the nurse sets the IV pole at the proper height to overcome the pressure within the client's veins. What is that height? at least 18 to 24 inches above infusion site no more than 18 to 24 inches above infusion site no more than 6 to 12 inches above infusion site at least 24 to 30 inches above infusion site

At least 18 to 24 inches above infusion site

An interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. What action has the greatest potential to reduce the risk of this transfusion reaction? Ensure that blood components are never infused at a rate greater than 125 mL/h. Administer prophylactic antihistamines prior to all blood transfusions. Establish baseline vital signs for all clients receiving transfusions. Be vigilant in identifying the client and the blood component.

Be vigilant in identifying the client and the blood component

A nurse needs to administer a prescribed dosage of antineoplastic drugs to a client with cancer. Which of the following pieces of medical equipment is used to administer antineoplastic drugs? Tuberculin injection Conventional syringe Central venous catheter Syringe with a large-bore needle

Central venous catheter

The nurse is preparing to administer the solution in the attached image to a client. Which of the following types of solution is the nurse going to administer? Isotonic Hypertonic Hypotonic Tonic-clonic

Isotonic

The RN is processing the physician's orders and recognizes that Mr. Chorn is to receive normal saline to keep vein open. The nurse is aware that normal saline solution is categorized as one of the following? Hypertonic solution. Hypotonic solution. Isotonic solution. Can create acidosis in clients.

Isotonic solution

A client has a history of congestive heart failure (CHF) and arthritis that causes significant discomfort. The physician has prescribed daily doses of NSAIDS to fight inflammation and pain. The client has developed a GI bleed as a result of the medication, and blood values indicate the need for a transfusion. Considering the client's history, which colloid solution would the nurse expect to be administered? packed cells whole blood blood products plasma expanders

Packed cells

A client receiving IV fluid therapy suddenly becomes anxious and exhibits an elevated blood pressure, a bounding pulse, and shortness of breath. Which nursing action(s) would be most appropriate to assist this client? Select all that apply. Slow the IV rate. Contact the physician. Lower the client's head. Provide oxygen to the client. Restart the IV.

Slow the IV rate. Contact the physician. Provide oxygen to the client.

A client has experienced a closed head injury causing cerebral edema. Which fluid would the nurse expect to see administered to decrease the client's cerebral edema? hypertonic solution hypotonic solution isotonic solution colloid solutions

hypertonic solution

The nurse is caring for a client who has experienced an isotonic fluid deficit caused by vomiting and expects the healthcare provider to order which intravenous fluid? 0.9% saline 3% saline 10% dextrose 5% dextrose in 0.45% saline

0.9% saline

A home healthcare client who is in a coma requires extended IV fluid therapy. Which peripheral access device would be most appropriate for administering this therapy? midline catheter butterfly needle over-the-needle catheter through-the-needle catheter

Midline catheter

Fresh-frozen plasma (FFP) has been prescribed for a hospital client. Prior to administration of this blood product, the nurse should prioritize what client education? Infection risks associated with FFP administration Physiologic functions of plasma Signs and symptoms of a transfusion reaction Strategies for managing transfusion-associated anxiety

Signs and symptoms of a transfusion reaction

A nurse needs to perform venipuncture on a client who has poor skin turgor. To prevent skin trauma at the venipuncture site, the nurse should: place a soft cloth between the tourniquet and the skin. not use a tourniquet on this older client. avoid using antiseptic on the client to prevent skin irritation. choose a vein in the client's foot as the venipuncture site.

Place a soft cloth between the tourniquet and the skin.

The nurse is preparing to initiate a peripheral intravenous infusion for an adult client and is having difficulty finding an appropriate site. The client asks the nurse, "Why don't you just put it in my foot? I'll be very careful when I get up to go to the bathroom." What is the nurse's best response to this client? "I'm sorry. Intravenous sites in the foot just never last very long." "I really don't think you want it there. It really hurts a lot more." "Intravenous sites in the foot and leg are avoided as much as possible because it increases the chances of a blood clot developing." "If that is where you want it, I will go and call your health care provider and ask permission to use that site."

"Intravenous sites in the foot and leg are avoided as much as possible because it increases the chances of a blood clot developing."

A client with aplastic anemia is going to receive a blood transfusion. In addition to taking vital signs and verifying that the unit of blood cells is matched to the client, what other assessments/actions would you take? Assess pain at the transfusion site and transfuse the packed blood cells over 5 hours to prevent fluid overload. Check the client regarding chills, low back pain, dyspnea, and skin itching during the transfusion. Ask the client about headaches; maintain bed rest during the transfusion, and reduce intake of fluids. Rapidly transfuse the blood for the first 15 minutes to detect transfusion reactions and allergic responses.

Check the client regarding chills, low back pain, dyspnea, and skin itching during the transfusion

A older adult client is admitted to the emergency department after being injured in a motor vehicle accident. The client has lost a significant amount of blood and requires a blood replacement product. Considering this client has a history of heart failure, the nurse expects the health care provider to order which blood product? Platelets Whole blood Fresh frozen plasma Packed cells

Packed cells

The nurse is caring for a client who has been NPO since admission two days ago and was admitted with vomiting as a primary symptom. The client has been receiving intravenous therapy at 100 mL/hr. since admission with Lactated Ringers (LR) as the intravenous solution. What nursing diagnosis is most appropriate for this client? Fluid overload R/T excess intravenous fluids Pain R/T intravenous insertion site Anxiety R/T extended hospitalization Altered Nutrition: Less than body requirements R/T lack of adequate caloric intake

Altered Nutrition: Less than body requirements R/T lack of adequate caloric intake

When you complete the initial postoperative assessment for a client aged 55 years, you note that his IV is on time and infusing at 33 gtts/min (administration set - 10 gtts/ml). You check the order, which reads: "IV of 1000 cc D5S to infuse over 8 hours." What actions would you take? Continue infusing the IV at 33 gtts/min; check for pulmonary congestion. Change the rate to 21 gtts/min and observe for fluid overload. Reduce the rate to 150 ml/hr and observe for increased urine output. Check the IV site and ask the client who adjusted the flow rate last; clarify with that person.

Change the rate to 21 gtts/min and observe for fluid overload.

A nursing responsibility in managing IV therapy is to monitor the fluid infusions and to replace the fluid containers as needed. Which of the following is an accurate guideline for IV management that the nurse should consider? The nurse should use new tubing when attaching additional IV solutions As one bag is infusing, the nurse should prepare the next bag so it is ready for a change when less than 10 mL of fluid remains in the original container. It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order. Generally, the nurse should change the administration sets of simple IV solutions every 24 hours.

It is the responsibility of the nurse to provide ongoing verification of the IV solution and the infusion rate with the physician's order.

The nurse is caring for a client who has been receiving intravenous therapy via a central venous catheter inserted through the subclavian vein. Suddenly after the tubing to the intravenous solution is changed, the client develops shortness of breath, chest pain, and tachycardia. What should be the PRIORITY action of the nurse at this time? Place the bed in Trendelenburg position with the client on the left side. Place the bed in reverse Trendelenburg position with the client on the right side. Elevate the head of the bed to 75° and place the client in the supine position. Position the bed completely flat and place the client in the fetal position.

Place the bed in Trendelenburg position with the client on the left side

A client needs an IV started. What nursing interventions would the nurse follow to prepare the client? Select all that apply. Verify the identity of the client using multiple methods. Bring the IV equipment into the client's room first. Refer the client to the physician if there are any questions. Explain how long the procedure is expected to take. Give the client an idea of how much discomfort the procedure will cause.

Verify the identity of the client using multiple methods. Explain how long the procedure is expected to take. Give the client an idea of how much discomfort the procedure will cause.

A client requires a blood transfusion, and the nurse is preparing the blood transfusion equipment. Which item will the nurse need? Y-administration tubing 22-gauge catheter primary tubing pressure infusion sleeve

Y-administration tubing