Labs & Acid-Base /IV therapy

Which of the following statements about solutes in diffusion is accurate? a. They move from an area of lower concentration to an area of higher concentration. b. They move against the concentration gradient. c. They move from an area of higher concentration to an area of lower concentration.

c. In diffusion, solutes move from an area of higher concentration to an area of lower concentration.

Which of the following electrolytes maintains cell electroneutrality? a. magnesium b. chloride c. potassium

c. Potassium maintains cell electroneutrality.

An 89-year-old patient with a history of heart failure has an I.V. solution infusing through microdrip tubing. Microdrip tubing delivers how many drops per minute? a. 20 gtt/minute b. 60 gtt/minute c. 80 gtt/minute

b. Microdrip tubing delivers 60 gtt/minute.

Which of the following types of medications has a potential for damaging tissue? a. irritants b. vesicants c. nonvesicants

b. Vesicants can cause a reaction so severe that blisters form and tissue is damaged or destroyed.

A client with the recent diagnosis of myocardial infarction and impaired renal function is recuperating on the step-down cardiac unit. The client's blood pressure has been borderline low and intravenous (IV)fluids have been infusing at 100 mL/hour via a central line catheter in the right internal jugular for approximately 24 hours to increase renal output and maintain the blood pressure. Upon entering the client's room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is most likely experiencing which complication of IV therapy? 1. Hematoma 2. Air embolism 3. Systemic infection 4. Circulatory overload

4 Circulatory (fluid) overload is a complication of intravenous therapy. Signs include rapid breathing, dyspnea, a moist cough, and crackles. When circulatory overload is present, the client's blood pressure also increases.

A 39-year-old patient returns from the OR after undergoing a right thoracotomy. An I.V. solution of 5% dextrose in 0.45% sodium chloride solution is infusing. Which type of I.V. solution is the patient receiving? a. isotonic b. hypotonic c. hypertonic

c. Dextrose 5% in 0.45% sodium chloride solution is a hypertonic I.V. solution.

True or false: a hypotonic solution such as D5W may be needed for a patient on dialysis when diuretic therapy dehydrates the cells True False

False

A health care provider has written a prescription to discontinue an intravenous (IV) line. The nurse should obtain which item from the unit supply area for applying pressure to the site after removing the IV catheter? 1. Elastic wrap 2. Betadine swab 3. Adhesive bandage 4. Sterile 2 × 2 gauze

Option 4 is correct answer. Rationale: A dry sterile dressing such as a sterile 2 × 2 is used to apply pressure to the discontinued IV site. This material is absorbent, sterile, and nonirritating. A Betadine swab would irritate the opened puncture site and would not stop the blood flow. An adhesive bandage or elastic wrap may be used to cover the site once hemostasis has occurred.

The nurse is inserting an intravenous line into a client's vein. After the initial stick, the nurse would continue to advance the catheter in which situation? 1. The catheter advances easily. 2. The vein is distended under the needle. 3. The client does not complain of discomfort. 4. Blood return shows in the backflash chamber of the catheter.

Option 4 is correct answer. Rationale: The IV catheter has entered the lumen of the vein successfully when blood backflash shows in the IV catheter. The vein should have been distended by the tourniquet before the vein was cannulated. Client discomfort varies with the client, the site, and the nurse's insertion technique and is not a reliable measure of catheter placement. The nurse should not advance the catheter until placement in the vein is verified by blood return.

Low plasma PaCO2 a)Metabolic Acidosis b)Respiratory Alkalosis c)Metabolic Alkalosis d)Respiratory Acidosis

b)

Which of the following should not be done in the event of an allergic reaction to an IV medication? a)Slow the IV rate b)Discontinue the IV and remove the solution c)Leave the catheter in place d)Monitor ABCs and vital signs

a)

You received a report on a 65-year-old patient who underwent resection of an abdominal aortic aneurysm. The nurse told you that he has lactated Ringer's solution infusing at 150 ml/hour. When you enter his room to perform your assessment, you note that he's in respiratory distress. You check his blood pressure and find that it's elevated. You also note bilateral jugular vein distension. This patient is most likely experiencing a. circulatory overload. b. hypersensitivity. c. systemic infection.

a. Jugular vein distension, respiratory distress, and increased blood pressure, along with crackles and a positive fluid balance, are signs of circulatory overload.

High plasma PaCO2 a)Metabolic Acidosis b)Respiratory Alkalosis c)Metabolic Alkalosis d)Respiratory Acidosis

d)

An 85-year-old patient with a history of abdominal aortic aneurysm resection is admitted to the ED with dehydration. Which of the following contraindicates insertion of an I.V. catheter in his arm? a. hemodialysis arteriovenous (AV) fistula b. previous I.V. site c. nondominant arm or hand

a. Never insert an I.V. catheter in an arm with an AV fistula.

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to insert the spike end of the IV tubing into the IV bag, the tubing drops and the spike end hits the top of the medication cart. The nurse should take which action? 1. Obtain a new IV bag. 2. Obtain new IV tubing. 3. Wipe the spike end of the tubing with Betadine. 4. Scrub the spike end of the tubing with an alcohol swab.

Option 2 is correct answer. Rationale: The nurse should obtain new IV tubing because contamination has occurred and could cause systemic infection to the client. There is no need to obtain a new IV bag because the bag was not contaminated. Wiping with Betadine or alcohol is insufficient and is contraindicated because the spike will be inserted into the IV bag.

The nurse has a prescription to hang a 1000-mL intravenous (IV) bag of 5% dextrose in water with 20 mEq of potassium chloride and needs to add the medication to the IV bag. The nurse should plan to take which action immediately after injecting the potassium chloride into the port of the IV bag? 1. Rotate the bag gently. 2. Attach the tubing to the client. 3. Prime the tubing with the IV solution. 4. Check the solution for yellowish discoloration.

Option 1 is correct answer. Rationale: After adding a medication to a bag of IV solution, the nurse should agitate or rotate the bag gently to mix the medication evenly in the solution. The nurse should then attach a completed medication label. The nurse can then prime the tubing. The IV solution should have been checked for discoloration before the medication was added to the solution. The tubing is attached to the client last.

The nurse notes that the site of a client's peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. After taking appropriate steps to care for the client, the nurse should document in the medical record that the client experienced which condition? 1. Phlebitis of the vein 2. Infiltration of the IV line 3. Hypersensitivity to the IV solution 4. Allergic reaction to the IV catheter material

Option 1 is correct answer. Rationale: Phlebitis at an IV site can be distinguished by client discomfort at the site and by redness, warmth, and swelling proximal to the catheter. If phlebitis occurs, the nurse should discontinue the IV line and insert a new IV line at a different site. Coolness at the site would be noted if the IV catheter was infiltrated. An allergic reaction produces a rash, redness, and itching. A major reaction, such as hypersensitivity, can cause dyspnea, a swollen tongue, and cyanosis.

A client had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 3 PM. The nurse making rounds at 3:45 PM finds that the client is complaining of a pounding headache and is dyspneic, is experiencing chills, and is apprehensive, with an increased pulse rate. The intravenous (IV) bag has 400 mL remaining. The nurse should take which action first? 1. Slow the IV infusion. 2. Sit the client up in bed. 3. Remove the IV catheter. 4. Call the health care provider (HCP).

Option 1 is correct answer. Rationale: The client's symptoms are compatible with circulatory overload. This may be verified by noting that 600 mL has infused in the course of 45 minutes. The first action of the nurse is to slow the infusion. Other actions may follow in rapid sequence. The nurse may elevate the head of the bed to aid the client's breathing, if necessary. The nurse also notifies the HCP. The IV catheter is not removed; it may be needed for the administration of medications to resolve the complication.

A client involved in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates that which intravenous (IV) solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume, and increase blood pressure? 1. 5% dextrose in lactated Ringer's 2. 0.33% sodium chloride (⅓ normal saline) 3. 0.225% sodium chloride (¼ normal saline) 4. 0.45% sodium chloride (½ normal saline)

Option 1 is correct answer. Rationale: The goal of therapy with this client is to expand intravascular volume as quickly as possible. The 5% dextrose in lactated Ringer's (hypertonic solution) would increase intravascular volume and immediately replace lost fluid volume until a transfusion could be administered, resulting in an increase in the client's blood pressure. The solutions in the remaining options would not be given to this client because they are hypotonic solutions and, instead of increasing intravascular space, the solutions would move into the cells via osmosis.

The nurse provides a list of instructions to a client being discharged to home with a peripherally inserted central catheter (PICC). The nurse determines that the client needs further instructions if the client made which statement? 1. "I need to wear a Medic-Alert tag or bracelet." 2. "I need to restrict my activity while this catheter is in place." 3. "I need to have a repair kit available in the home for use if needed." 4. "I need to keep the insertion site protected when in the shower or bath."

Option 2 is correct answer. Rationale: The client should be taught that only minor activity restrictions apply with this type of catheter. The client should protect the site during bathing and should carry or wear a Medic-Alert identification. The client should have a repair kit in the home for use as needed because the catheter is for long-term use.

The nurse is making initial rounds on the nursing unit to assess the condition of assigned clients. The nurse notes that a client's intravenous (IV) site is cool, pale, and swollen, and the solution is not infusing. The nurse concludes that which complication has occurred? 1. Infection 2. Phlebitis 3. Infiltration 4. Thrombosis

Option 3 is correct answer. Rationale: An infiltrated IV is one that has dislodged from the vein and is lying in subcutaneous tissue. Pallor, coolness, and swelling are the results of IV fluid being deposited in the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of the IV solution will stop. The corrective action is to remove the catheter and start a new IV line at another site. Infection, phlebitis, and thrombosis are likely to be accompanied by warmth at the site, not coolness.

A client has just undergone insertion of a central venous catheter at the bedside. The nurse would be sure to check which results before initiating the flow rate of the client's intravenous (IV) solution at 100 mL/hour? 1. Serum osmolality 2. Serum electrolyte levels 3. Portable chest x-ray film 4. Intake and output record

Option 3 is correct answer. Rationale: Before beginning administration of IV solution, the nurse should assess whether the chest radiograph reveals that the central catheter is in the proper place. This is necessary to prevent infusion of IV fluid into pulmonary or subcutaneous tissues. The other options represent items that are useful for the nurse to be aware of in the general care of this client, but they do not relate to this procedure.

A client rings the call bell and complains of pain at the site of an intravenous (IV) infusion. The nurse assesses the site and determines that phlebitis has developed. The nurse should take which action(s) in the care of this client? Select all that apply. 1. Notify the health care provider (HCP). 2. Remove the IV catheter at that site. 3. Apply warm moist packs to the site. 4. Start a new IV line in a proximal portion of the same vein. 5. Document the occurrence, actions taken, and the client's response.

Options 1,2,3,5 are correct answers. Rationale: Phlebitis is an inflammation of the vein that can occur from mechanical or chemical (medication) trauma or from a local infection and can cause the development of a clot (thrombophlebitis). The nurse should remove the IV at the phlebitic site and apply warm moist compresses to the area to speed resolution of the inflammation. Because phlebitis has occurred, the nurse also notifies the HCP about the IV complication. The nurse should restart the IV in a vein other than the one that has developed phlebitis. Finally, the nurse documents the occurrence, actions taken, and the client's response.