Chapter 15 - Concepts of Infusion Therapy

A medical-surgical nurse is concerned about the incidence of complications related to IV therapy, including bloodstream infection. Which intervention will the nurse suggest to the management team to make the biggest impact on decreasing complications? a. Initiate a dedicated team to insert access devices. b. Require additional education for all nurses. c. Limit the use of peripheral venous access devices. d. Perform quality control testing on skin preparation products.

A

A new nurse is caring for a client receiving drug therapy via a smart pump. What statement by the new nurse demonstrates the need for more instruction on this technology? a. "I don't need to manually calculate IV infusion rates with smart pumps." b. "Responding to IV pump alarms is a high priority for client safety." c. "The hospital can preprogram the pumps for high-alert drug limits." d. "These pumps have a system to prevent fluids from free-flowing into the client."

A

What is the best place for the nurse to add a filter to a client's IV administration set? A. As close as possible to the catheter hub B. Immediately below the infusion pump C. As close to the solution container as possible D. At any convenient connection point unlikely to be disconnected

A

What is the nurse's best action when a client receiving IP therapy reports nausea and vomiting? A. Reduce the IP flow rate and administer antiemetics. B. Help the client move from side to side to distribute the fluid evenly. C. Flush the catheter with normal saline after the fluid has drained. D. Notify the health care provider and obtain a prescription for abdominal x-ray.

A

What is the nurse's first action(s) when a client who is receiving IV chemotherapy through a PICC line develops infiltration into the tissue and redness is observed? A. Stop the infusion and disconnect the IV line from the administration set. B. Apply pressure and elevate the site of swelling and redness. C. Aspirate the drug from the intravenous access device. D. Check vital signs, monitor the client, and document the incident.

A

What is the priority nursing responsibility when a client is receiving IV therapy through an infusion pump? A. Monitor the client's infusion site and rate. B. Program the correct amount of fluid into the pump. C. Position the container for gravity flow. D. Check the equipment at the end of the infusion

A

What would the nurse do when caring for an older adult client receiving IV fluids through a central line at 150 mL/hr, who becomes short of breath, develops puffiness around the eyes, and now has a cough? A. Place the client in an upright position, administer oxygen, slow the IV fluids, and notify the health care provider. B. Notify the health care provider, place the client in Trendelenburg position, and administer urokinase to unclot the catheter. C. Assess for patency of the central line catheter, change the tubing, and resume the IV fluids. D. Remove the central line, apply pressure, notify the health care provider, and place the client in a semi-Fowler's position.

A

Which client is the nurse most likely to teach about placement of a tunneled central venous catheter? A. Client in wheelchair to receive IV antibiotics for 16 weeks B. Client with trauma from a motor vehicle crash C. Client in need of fluid replacement for dehydration D. Client with acute renal failure and decreased urine output

A

Which criteria must the nurse follow before using a newly established peripherally inserted central catheter (PICC) to start IV therapy for a client? A. Wait for the results of a chest x-ray indicating that the tip resides in the lower superior vena cava (SVC). B. Check the client's chart to ensure that sterile technique is used for insertion to reduce the risk for catheter-related blood-stream infection (CRBSI). C. Review the purpose of the PICC line and check the pH or osmolality of fluids to be infused through the line. D. Check patency of the PICC line by flushing with 20 mL of sterile normal saline.

A

Which instruction will the nurse be sure to give the assistive personnel (AP) when checking the blood pressure of a client receiving IV therapy? A. "Avoid taking blood pressure in an extremity with any type of IV catheter in place." B. "Put the pump on hold while you take the client's blood pressure, then restart it." C. "Remind the phlebotomist to draw blood from the extremity without an IV catheter." D. "You can check blood pressure with a short peripheral catheter, but not with a midline catheter."

A

Which priority concept concerns the nurse when performing infusion therapy for any client? A. Fluid and electrolyte balance B. Tissue integrity C. Acid-base imbalance D. Perfusion

A

While assessing a client's peripheral IV site, the nurse observes a streak of red along the vein path and palpates a 1.5 inch (4-cm) venous cord. How will the nurse document this finding? a. "Grade 3 phlebitis at IV site" b. "Infection at IV site" c. "Thrombosed area at IV site" d. "Infiltration at IV site"

A

A nurse teaches a client who is being discharged home with a peripherally inserted central catheter (PICC). Which statement will the nurse include in this client's teaching? a. "Avoid carrying your grandchild with the arm that has the central catheter." b. "Be sure to place the arm with the central catheter in a sling during the day." c. "Flush the peripherally inserted central catheter line with normal saline daily." d. "You can use the arm with the central catheter for most activities of daily living."

AA

Which type of intravenous (IV) access would the nurse use to administer a client's chemotherapy treatment? Select all that apply. A. Intra-arterial catheter B. Peripherally inserted central catheter (PICC) C. Implanted port D. Short peripheral catheter E. Dialysis catheter F. Midline catheter

ABC

Which teaching would the nurse provide for the client and family on prevention of catheter-related bloodstream infection (CRBSI) before the IV catheter was inserted? Select all that apply. A. The type of catheter to be inserted B. Hand hygiene C. Aseptic technique for care of the catheter D. Activity limitations E. Signs and symptoms of complications F. Alternatives to catheter and therapy

ABCDEF

Which activities would be performed by infusion nurses for clients requiring infusion therapy? Select all that apply. A. Provide education about infusion therapy for staff, families, and clients. B. Monitor client outcomes with infusion therapy. C. Develop evidence-based policies and procedures. D. Consult on product selection and purchasing decisions. E. Develop new products for more effective infusion therapy. F. Insert and maintain peripheral, midline, and central venous catheters.

ABCDF

When the nurse is providing care for a client with a midline catheter, which key points are true? Select all that apply. A. Midline catheters are inserted in the upper arm, most commonly in the median antecubital vein. B. Midline catheters are used for hydration and for IV drug therapy up to 14 days. C. Strict sterile techniques are used for insertion and for dressing changes for mid-line catheters. D. Midline catheters can be used for the infusion of vesicant medications. E. All parenteral nutrition formulas may be infused through a midline catheter. F. When using a double-lumen midline catheter, do not administer incompatible drugs.

ABCF

A nurse assists with the insertion of a central vascular access device. Which actions will the nurse ensure are completed to prevent a catheter-related bloodstream infection? (Select all that apply.) a. Include a review for the need of the device each day in the client's plan of care. b. Remind the primary health care provider to perform hand hygiene prior to insertion if he or she forgets. c. Cleanse the preferred site with alcohol and let it dry completely before insertion. d. Ask everyone in the room to wear a surgical mask during the procedure. e. Plan to complete a sterile dressing change on the device every day. f. Minimal client draping and barrier precautions as blood loss are minimal.

ABD

A nurse prepares to administer a blood transfusion to a client, and checks the blood label with a second registered nurse using the International Society of Blood Transfusion (ISBT) universal bar-coding system to ensure the right blood for the right client. Which components must be present on the blood label in bar code and in eye-readable format? (Select all that apply.) a. Unique facility identifier b. Lot number related to the donor c. Name of the client receiving blood d. ABO group and Rh type of the donor e. Blood type of the client receiving blood f. Signature line for 2-person verification

ABD

Which key points would the nurse teach a client about intraosseous (IO) therapy? Select all that apply. A. The only absolute contraindication is a fracture in the bone to be used as a site. B. The IO route is for short term use and should not be used for more than 24 hours. C. The most common site accessed for IO therapy is the distal femur. D. The same fluids and drugs given IV can be given IO. E. During the IO procedure, most clients rate the pain as a 2 or 3 on a scale of 0 to 10. F. For access, 12-or 14-gauge needles specifically designed for IO therapy are preferred.

ABDE

Which specific actions will the nurse take when assessing a client's IV site? Select all that apply. A. Look for redness, swelling, hardness, or drainage. B. Check integrity of the dressing to make sure it is clean, dry, and adherent to the skin on all sides. C. Ensure that all connections are taped to prevent disconnection and leaking of fluids. D. Check the rate and amount of fluid that has infused. E. Be sure that the correct type of fluid is being infused.F. Check the skin around the dressing for medical adhesive-related skin injury (MARSI).

ABDE

What information must the nurse know before giving any IV drug to a client? Select all that apply. A. Indications and proper dosage B. Contraindications and precautions C. Percentage of adverse events for the drug D. Compatibility with other IV medications E. Rate of infusion and osmolarity F. Potential for irritant and vesicant effects

ABDEF

Which substances does the nurse understand are not compatible with plastic containers when administering IV therapy to clients? Select all that apply. A. Insulin B. Nitroglycerin C. Propranolol D. Lorazepam E. Furosemide F. Fat emulsion

ABDF

A nurse prepares to insert a short peripheral venous catheter. What actions will the nurse take to use best practices? (Select all that apply.) a. Choose a distal site on the client's nondominant arm. b. Verify that the prescription is appropriate for peripheral infusion. c. Place the venous catheter near an area of joint flexion. d. Wear a surgical mask during the catheter insertion procedure. e. Perform hand hygiene before inserting the catheter. f. Limit unsuccessful attempts by up to three clinicians to one attempt each.

ABE

A registered nurse (RN) occasionally delegates client care to licensed practical nurses (LPNs) or technicians. What information does the RN consider when delegating components of IV therapy? (Select all that apply.) a. Each state's Nurse Practice Act will regulate who can perform care related to IVs. b. The nurse would check the facility's Policies and Procedures manual. c. The LPN's level of experience primarily guides the decision. d. Technicians cannot participate in any part of caring for IV infusions. e. The RN remains accountable for all aspects of IV care and delegated actions. f. The Infusion Nurses Society has guidelines and standard of IV therapy competency

ABEF

Which statements does the nurse recognize as true when providing care for a client receiving intraperitoneal (IP) infusions? Select all that apply. A. IP infusion therapy involves the administration of chemotherapy agents into the peritoneal cavity. B. An IP catheter has large internal lumens with multiple side-holes along the catheter length to allow for delivery of large quantities of fluid. C. Clean techniques are used when handling IP access and supplies. D. IP therapy is used for clients who are receiving medications for diagnostic tests E. IP therapy includes three phases: the installation phase; the dwell phase, usually 1 to 4 hours; and the drain phase. F. Strict aseptic techniques are used when handling the IP access and supplies.

ABEF

A nurse assesses a client who has a peripherally inserted central catheter (PICC). For which common complications will the nurse assess? (Select all that apply.) a. Phlebitis b. Pneumothorax c. Thrombophlebitis d. Excessive bleeding e. Extravasation f. Pneumothorax g. Infiltration

AC

Which major components and precautions of the catheter-related bloodstream infection (CRBSI) prevention bundle must the specially trained nurse follow when inserting a PICC line into a client? Select all that apply. A. Measuring upper arm circumference as a baseline before insertion B. Betadine skin antisepsis C. Proper aseptic hand hygiene D. Maximal barrier precautions on insertion E. Optimal catheter site selection F. Daily review of line necessity with prompt removal of unnecessary lines

ACDEF

Which nursing actions are implemented when caring for a client with an implanted port? Select all that apply. A. Before giving a drug through the port, always check for a blood return. B. De-access the port using a 5-mL syringe and 5 mL of heparin 5 units/mL. C. Before puncturing a port, palpate the port and locate the septum. D. Use a non-coring needle to access the implanted port. E. Flush the implanted port at least once monthly between courses of therapy F. Use a topical anesthetic cream to decrease the pain of accessing the port.

ACDEF

or which conditions does the nurse consider intrathecal infusion appropriate for a client? Select all that apply. A. Traumatic brain injury B. Leukemia C. Multiple sclerosis D. Cancer of the central nervous system E. Cerebral palsy F. Chronic pain

ACDEF

What information must be included with each prescription for IV therapy for the nurse to administer it safely to a client? Select all that apply. A. Frequency of drug administration B. Specific type of administration equipment C. Rate of administration D. Specific type of solution E. Method for diluting drugs for the solution F. Specific drug to be added to the solution

ACDF

Which techniques will the nurse use to prevent air emboli when changing the IV administration set or connectors for a client with a central venous catheter? Select all that apply. A. Placing the client flat or in Trendelenburg so that the catheter site is below the heart B. Using sterile technique when handling the IV set and connectors C. Asking the client to perform the Valsalva maneuver by holding his or her breath and bearing down D. Timing the IV set change to the expiratory cycle if the client is spontaneously breathing E. Having an assistive personnel (AP) apply pressure at the insertion site F. Timing the IV set change to the inspiratory cycle when the client is receiving positive-pressure mechanical ventilation

ACDF

A home care nurse prepares to administer intravenous medication to a client. The nurse assesses the site and reviews the client's chart prior to administering the medication and notes it to have been inserted 4 months ago. The site has no redness, warmth, or swelling and flushes easily. What action does the nurse take? a. Notify the primary health care provider. b. Administer the prescribed medication. c. Discontinue the PICC. d. Switch the medication to the oral route.

B

A nurse is caring for a client who has just had a central venous access line inserted. What action will the nurse take next? a. Begin the prescribed infusion via the new access. b. Ensure that an x-ray is completed to confirm placement. c. Check medication calculations with a second RN. d. Make sure that the solution is appropriate for a central line.

B

A nurse is caring for a client who is receiving an epidural infusion for pain management. Which assessment finding requires immediate intervention from the nurse? a. Redness at the catheter insertion site b. Report of headache and stiff neck c. Temperature of 100.1° F (37.8° C) d. Pain rating of 8 on a scale of 0-10

B

A nurse is caring for a client with a peripheral vascular access device who is experiencing pain, redness, and swelling at the site. After removing the device, what action will the nurse take to relieve pain? a. Administer topical lidocaine to the site. b. Place warm compresses on the site. c. Administer prescribed oral pain medication. d. Massage the site with scented oils.

B

At what rate would the nurse set the infusion when a client is to receive 0.45% normal saline, 1000 mL over 15 hours? A. 50 mL/hr B. 67 mL/hr C. 75 mL/hr D. 83 mL/hr

B

What is the nurse's priority action when attempting to insert a short peripheral catheter (SPC) and the client reports a feeling of "pins and needles"? A. Ask the client to wiggle the fingers to stimulate circulation. B. Stop immediately, remove the catheter, and choose a new site. C. Change to a short-winged butterfly needle. D. Pause the procedure and gently massage the fingers.

B

Which factor increases the likelihood that a client who comes into the emergency department (ED) after a serious motor crash is a candidate for intraosseous (IO) therapy? A. Endotracheal intubation is difficult to accomplish. B. IV access cannot be established within a few minutes. C. Client is an older adult and very thin. D. Client has a history of chronic renal failure.

B

Which intervention would the nurse use to reduce the risk of infection when a client is receiving IV drugs by way of a needleless system? A. Always use a hand scrub when entering a client's room. B. Clean all needleless system connections with an antimicrobial agent for 10-15 seconds before connecting infusion sets. C. Use tape to assure that secondary IV sets remain attached to primary IV sets. D. Disconnect secondary IV sets after each dose of IV drug is completed.

B

Which intravenous (IV) fluid would the nurse infuse for a client when the health care provider prescribes a hypotonic solution? A. 0.9% NaCl B. 0.45% NaCl C. Lactated Ringer's solution D. 5% dextrose with 0.9% saline

B

Which nursing action is essential when a client is receiving infusion therapy through an intra-arterial catheter placed in the carotid artery? A. Monitor respirations for rate and regularity. B. Perform frequent neurologic and cognitive status assessments. C. Assess the extremities for sensation and peripheral pulses. D. Place antiembolic stockings on client's lower extremities.

B

Which statement by a client to a nurse indicates the need for additional teaching regarding care of a PICC line? A. "My PICC line has a lumen size 4 French so blood samples can be drawn from it." B. "I will be able to rejoin my soccer team as long as I protect the PICC with padding." C. "My PICC line will work for IV antibiotics even up to 14 days." D. "I will be careful to use sterile technique when I change the dressing."

B

Which are among the most common reasons for a nurse to administer infusion therapy to a client? Select all that apply. A. Keep a line open for surgery B. Administer medications C. Maintain electrolyte or acid-base balance D. Maintain fluid balance or correct fluid imbalance E. Chemotherapy for cancer clients F. Correct electrolyte or acid-base imbalance

BCDF

Which actions must the nurse follow to remove a short peripheral catheter (SPC) when a client is ready for discharge to home? Select all that apply. A. Flush the SPC before removal. B. Remove the SPC dressing. C. Explain the procedure to the client. D. Rapidly withdraw the catheter from the skin. E. Immediately cover the puncture site with dry gauze. F. Hold pressure until hemostasis is achieved. G. Assess the catheter tip to ensure it is intact and completely removed. H. Document catheter removal and appearance of the site.

BCEFGH

A nurse teaches a client who is prescribed a central vascular access device and is transferring to a skilled facility for long-term treatment. Which statement will the nurse include in this client's teaching? a. "You will need to wear a sling on your arm while the device is in place." b. "There is no risk of infection because sterile technique will be used during insertion." c. "Ask all providers to vigorously clean the connections prior to accessing the device." d. "You will not be able to take a bath with this vascular access device."

C

For which potential problem does the nurse assess the client after receiving epidural therapy when symptoms of headache, stiff neck, or temperature higher than 101°F (38.3°C) develop? A. Allergic reaction B. Leakage of cerebrospinal fluid C. Meningitis D. Catheter migration

C

What is the RN generalist's role for a client in need of infusion therapy? A. Placement of a peripherally inserted central catheters (PICC) B. Changing dressing on all intravenous sites every 48 hours C. Insertion of short peripheral catheters (SPC) D. Providing services such as hypodermoclysis and intraosseous infusions

C

What is the minimum gauge of short peripheral catheter (SPC) through which a nurse can infuse a unit of packed RBCs for a client? A. 18 gauge B. 20 gauge C. 22 gauge D. 24 gauge

C

What solution and volume does the nurse typically use to flush a client's short peripheral catheter IV saline lock? A. 3 mL heparinized saline B. 5 mL bacteriostatic saline C. 3 mL normal saline D. 5 mL heparin solution

C

What would the nurse's first action(s) be when a client's IV site demonstrates slowed flow rate, skin tightness, discomfort at the site (e.g., burning, tenderness), and leakage around the site? A. Apply a cold pack and elevate the extremity. B. Place a sterile dressing over the site if weeping from the tissue occurs. C. Stop the solution and remove the intravenous access. D. Insert a new IV catheter above the site of the old one.

C

Which client condition influences the nurse's choice of right versus left forearm placement when a short peripheral catheter (SPC) needs placement? A. Myocardial infarction with pain radiating down the left arm B. Pneumothorax with a chest tube on the right side C. Regular renal dialysis with a shunt on the left forearm D. Right hip fracture with immobilization and traction in place

C

Which grade of infiltration (based on Infusion Nurses Society [INS] criteria) would the nurse document after observing a client's IV site to have skin that is blanched and translucent, gross edema more than 6 inches in any direction, area cool to touch, moderate pain, and site numbness? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

C

Which site will the nurse choose for a client who is to receive hypodermoclysis treatment for palliative care? A. Anterior forearm B. Lateral aspect of the upper arm C. Area under the clavicle D. Posterior tibial area

C

Which technique will the nurse use to access a client's implanted port for chemotherapy? A. Palpate the port, scrub the skin, and access port with a butterfly needle. B. Scrub the port with alcohol and access the port with a needleless device. C. Palpate the port, scrub the skin, and access the port with a non coring needle. D. Scrub the port with betadine and flush using saline in a 10-mL syringe.

C

Which type of equipment decreases the risk of disconnection or leakage when a nurse attaches an administration set to a client's central venous catheter? A. Slip lock connector B. Extension set C. Luer-Lok connector D. Needleless connector

C

A nurse assesses a client who had an intraosseous catheter placed in the left leg. Which assessment finding is of greatest concern? a. The catheter has been in place for 20 hours. b. The client has poor vascular access in the upper extremities. c. The catheter is placed in the proximal tibia. d. The client's left lower extremity is cool to the touch.

D

A nurse assesses a client who has a radial artery catheter. Which assessment will the nurse complete first? a. Amount of pressure in fluid container b. Date of catheter tubing change c. Type of dressing over the site d. Skin color and capillary refill

D

A nurse assesses a client who was started on intraperitoneal therapy 5 days ago. The client reports abdominal pain and "feeling warm." For which complication of this therapy will the nurse assess the client? a. Allergic reaction b. Bowel obstruction c. Catheter lumen occlusion d. Infection

D

A nurse assesses a client's peripheral IV site, and notices edema and tenderness above the site. What action will the nurse take next? a. Apply cold compresses to the IV site. b. Elevate the extremity on a pillow. c. Flush the catheter with normal saline. d. Stop the infusion of intravenous fluids.

D

A nurse delegates care to an assistive personnel (AP). Which statement will the nurse include when delegating hygiene for a client who has a vascular access device? a. "Provide a bed bath instead of letting the client take a shower." b. "Use sterile technique when changing the dressing." c. "Disconnect the intravenous fluid tubing prior to the client's bath." d. "Use a plastic bag to cover the extremity with the device."

D

A nurse is assessing clients who have intravenous therapy prescribed. Which assessment finding for a client with a peripherally inserted central catheter (PICC) requires immediate attention? a. The initial site dressing is 3 days old. b. The PICC was inserted 4 weeks ago. c. A securement device is absent. d. Upper extremity swelling is noted.

D

A nurse prepares to flush a peripherally inserted central catheter (PICC) line with 50 units of heparin. The pharmacy supplies a multidose vial of heparin with a concentration of 100 units/mL. Which of the syringes shown below will the nurse use to draw up and administer the heparin? a. 1mL syringe b. 3mL syringe c. 5mL syringe d. 10mL syringe

D

How often would the nurse routinely change the transparent dressing on a client's central venous IV site? A. Every 24 hours B. Every 48 hours C. Every 3 days D. Every 5 to 7 days

D

What complication does the nurse suspect when a client receiving IV antibiotic therapy over the past 3 days develops chills, headache, and an elevated temperature? A. Fluid volume overload B. Allergic reaction to antibiotics C. Phlebitis with infiltration D. Catheter-related bloodstream infection (CRBSI)

D

Where would the nurse insert an IV short peripheral catheter (SPC) in an active client with a prescription for IV therapy? A. Wrist B. Hand C. Antecubital area D. Forearm

D

Which technique is recommended by the Infusion Nurses Society (INS) for the nurse to maintain a PICC line for a client receiving IV antibiotic therapy every 4 hours? A. Flush the catheter with 10 mL heparinized saline after each dose of antibiotic. B. Flush the catheter every 12 hours using a 5-mL syringe. C. Avoid flushing the catheter with heparinized saline more than twice a week. D. Use 10 mL of sterile saline to flush before and after each dose of antibiotic.

D

nurse prepares to insert a peripheral venous catheter in an older adult. What action will the nurse take to protect the client's skin during this procedure? a. Lower the extremity below the level of the heart. b. Apply warm compresses to the extremity. c. Tap the skin lightly and avoid slapping. d. Place a washcloth between the skin and tourniquet.

D