NUR 337 - Week 1: IV Catheter Insertion
How can the nurse ensure that a patient's IV tubing will not tug on the infusion catheter after a transparent dressing is applied to an infusion site on the arm? A. Encircle the arm with tape. B. Secure the tubing and catheter hub with tape. C. Secure the tubing in two different locations on the arm. D. Label the dressing with the date and time of application.
C. Secure the tubing in two different locations on the arm.
The nurse is assessing the patient for signs and symptoms of fluid volume excess. Which of the following would indicate the patient is experiencing this complication and should be reported? (Select all that apply. A. Skin turgor good and capillary refill less than 3 seconds B. Decreased urine output and dry mucous membranes C. Shortness of breath and crackles in lungs D. Elevated blood pressure and edema
C. Shortness of breath and crackles in lungs D. Elevated blood pressure and edema
What might the nurse do to improve a patient's cooperation during the removal of an IV access device? A. Describe the entire procedure to the patient. B. Assure the patient that you will remove the IV catheter quickly. C. Assure the patient that the procedure will take only about 5 minutes. D. Tell the patient that the procedure will cause only a slight burning sensation.
A. Describe the entire procedure to the patient.
What is the primary danger related to a broken catheter tip? A. Embolus B. Infection C. Pain D. Phlebitis E. Hematoma formation
A. Embolus
How might the nurse prepare a patient to anticipate some discomfort when inserting a venous access device? A. Instruct the patient to expect a sharp, quick stick. B. Insert the access device as quickly as possible. C. Apply a topical anesthetic to the area before inserting the device. D. Promise that the procedure will not hurt once the device has been inserted.
A. Instruct the patient to expect a sharp, quick stick.
Which of the following situations indicates discontinuation of peripheral IV access? (Select all that apply.) A. The patient is being discharged to home on PO medications. B. The health care provider has ordered normal saline at 100 mL per hour and the patient's bag of IV fluids is empty. C. The patient is drinking fluids well postoperatively and has an order for morphine IV every 3 hours as needed. D. The electronic infusion pump alarm keeps sounding, indicating 'occlusion' on its screen and the nurse is unable to flush the IV. E. The patient's arm is swollen and cool to the touch; the patient complains of pain at the IV site. F. The patient's arm appears reddened and is tender to the touch. G. The IV access site is dated 4 days ago.
A. The patient is being discharged to home on PO medications. D. The electronic infusion pump alarm keeps sounding, indicating 'occlusion' on its screen and the nurse is unable to flush the IV. E. The patient's arm is swollen and cool to the touch; the patient complains of pain at the IV site. F. The patient's arm appears reddened and is tender to the touch. G. The IV access site is dated 4 days ago.
How will the nurse minimize the risk for infection when changing a patient's IV catheter site dressing? A. Use aseptic technique throughout the process. B. Pull the tape toward the insertion site. C. Remove both the gauze dressing and the tape one layer at a time. D. Explain the process to the patient.
A. Use aseptic technique throughout the process.
Which of the following would be consistent with infiltration? (Select all that apply.) A. Redness B. Cool to touch C. Warm to touch D. Swelling around insertion site E. With or without pain
B. Cool to touch D. Swelling around insertion site E. With or without pain
An elderly patient is receiving 0.9% normal saline at 125 mL/hr. The NAP reports the patient is complaining of feeling short of breath. The nurse determines the patient is experiencing fluid volume excess. What other symptoms would lead the nurse to this conclusion? (Select all that apply.) A. Decreased skin turgor B. Crackles in lungs C. Peripheral edema D. Hypotension E. Dyspnea
B. Crackles in lungs C. Peripheral edema E. Dyspnea
Which action would the nurse take if an intravenous (IV) insertion site appeared red, warm, and swollen? A. Assess for blood return. B. Discontinue the infusion. C. Change the existing dressing. D. Secure the tubing with more tape.
B. Discontinue the infusion.
Which of the following would be consistent with phlebitis? (Select all that apply.) A. Grade 0 on phlebitis scale B. Pain C. Redness D. Numbness E. Coolness
B. Pain C. Redness
What would the nurse do to assess a patient's risk for embolus when removing a venous access device? A. Inspect the site for redness. B. Visualize the tip of the IV device. C. Palpate the site for possible edema. D. Ask the patient to rate any pain at the site.
B. Visualize the tip of the IV device.
Which action minimizes the patient's risk for injury when inserting a venous access device into the arm? A. Wearing clean gloves during the procedure B. Using a larger vein found on the palmar (ventral) side of the wrist C. Checking for a radial pulse once the tourniquet has been applied D. Priming the extension tubing after attaching it to the newly placed venous access device
C. Checking for a radial pulse once the tourniquet has been applied
Which of the following sites should be avoided for IV insertion? (Select all that apply.) A. Dorsal surface of the hand of a middle-aged adult B. Inner arm C. Foot of an adult D. Site distal to a previous venipuncture site E. Inner wrist F. Areas of venous bifurcation G. Foot of a child
C. Foot of an adult D. Site distal to a previous venipuncture site E. Inner wrist F. Areas of venous bifurcation
The nurse is inserting an over-the-needle catheter into a newly admitted patient. What will the nurse do after confirming blood return? A. Loosen or remove the tourniquet. B. Advance the catheter 1 inch into the vein. C. Lower the catheter until it is flush with the skin. D. Thread the catheter into the vein up to the hub.
C. Lower the catheter until it is flush with the skin.
The nurse is preparing to insert a venous access device into a newly admitted 75-year-old patient. Which vein is not an inappropriate choice for IV insertion in this patient? A. Basilic vein B. Cephalic vein C. Superficial dorsal vein D. Median cubital vein
C. Superficial dorsal vein
Which instruction might the nurse give to nursing assistive personnel (NAP) regarding the care of a patient with an intravenous (IV) site dressing? A. "Assess the IV site frequently for signs of inflammation." B. "Be sure not to obscure the insertion site with the dressing." C. "If the gauze dressing looks damp, replace it with a dry 4 × 4 gauze." D. "Be sure to notify me if the patient reports that the IV site is painful or swollen."
D. "Be sure to notify me if the patient reports that the IV site is painful or swollen."
When should the tourniquet be released a second time during the procedure for insertion of a peripheral intravenous device? A. After the catheter is secured with tape or a transparent dressing B. Immediately after the catheter punctures the skin C. Immediately after observing a "flashback" of blood in the catheter D. After a "flashback" of blood is observed and the catheter has been advanced off the stylet
D. After a "flashback" of blood is observed and the catheter has been advanced off the stylet
Which of the following technique(s) is/are best for minimizing a patient's risk for injury when inserting a venous access device? A. Inserting the needle with the bevel up B. Using a vein on the dorsal surface of the arm C. Holding the skin taut directly below the site D. All of the above
D. All of the above
Which technique is most accurate in identifying an appropriate vein site for IV catheter insertion into the arm? A. Remove any clothing that is covering the arm. B. Apply a warm washcloth to the arm at the proposed site. C. Elevate the selected arm on a pillow for 2 to 3 minutes. D. Apply a tourniquet to the selected arm 4 to 6 inches above the proposed site.
D. Apply a tourniquet to the selected arm 4 to 6 inches above the proposed site.
What will the nurse do to prevent possible complications after removing an IV access device in a patient on anticoagulant therapy? A. Instruct the patient to report immediately any sign of bleeding on the site dressing. B. Perform hand hygiene and wear clean gloves while removing the device. C. Encourage the patient to keep a cold compress on the site for 15 minutes. D. Apply firm pressure to the site with sterile gauze for 10 minutes.
D. Apply firm pressure to the site with sterile gauze for 10 minutes.
The student nurse is watching the staff nurse discontinue a peripheral IV. The staff nurse removes the catheter and then looks at it. The student asks the nurse what she is looking for. The correct response by the nurse is "I am: A. looking to see if there is any clot formation on the tip." B. looking for exudate at the catheter tip." C. noting the gauge of the catheter so I can document removal accurately." D. inspecting the catheter for intactness."
D. inspecting the catheter for intactness."
An adult patient developed a complication with his IV and it had to be removed, yet continued IV fluids were needed. Which site would be most appropriate for the nurse to choose? A. Proximal to the previous IV site. B. Distal to the previous IV site. C. In the antecubital fossa. D. In the foot.
Proximal to the previous IV site.
Match the correct catheter size to the appropriate patient situation. (A) Adult patient scheduled for major surgery (B) Older adult requiring IV medications (C) Infant requiring IV fluids (D) Young adult requiring fluid maintenance (1) 18- gauge (2) Butterfly needle (3) 20-gauge (4) 22-gauge
(A) Adult patient scheduled for major surgery - 18-gauge (B) Older adult requiring IV medications - 22-gauge (C) Infant requiring IV fluids - Butterfly needle (D) Young adult requiring fluid maintenance - 20-gauge
Match the correct type of tourniquet to the appropriate patient situation. (A) Reusable tourniquet (B) Blood pressure cuff (C) Rubber band (D) Single-use tourniquet (1) Infant (2) Older adult (3) Adult
(A) Reusable tourniquet - Never use (B) Blood pressure cuff - Older adult (C) Rubber band - Infant (D) Single-use tourniquet - Adult
At what angle should an IV catheter puncture the skin and vein during insertion in a middle-aged adult? A. 10- to 30-degree angle B. 45-degree angle C. 90-degree angle D. 5- to 10-degree angle
A. 10- to 30-degree angle
Which action would the nurse perform to best ensure effective insertion of a venous access device into a patient's arm? A. Anchor the vein by placing a thumb 1 to 2 inches below the site. B. Insert the device tip at a 45-degree angle distal to the proposed site. C. Place the patient's left arm in a dependent position for 5 minutes before assessment. D. Apply a tourniquet to the left antecubital fossa 8 to 12 inches above the proposed site.
A. Anchor the vein by placing a thumb 1 to 2 inches below the site.
A patient has been receiving IV antibiotics and as a result has had several IV site locations. What action can the nurse take to promote venous distention in the patient? (Select all that apply.) A. Apply a warm pack to the arm for several minutes. B. Elevate the arm 10 to 30 degrees. C. Teach the patient relaxation techniques. D. Use the side of paralysis to avoid a vasoconstriction response to catheter insertion. E. Choose a site distal to the previous IV site. F. Rub or stroke the patient's arm. G. Tap the patient's veins multiple times.
A. Apply a warm pack to the arm for several minutes. F. Rub or stroke the patient's arm.
The nurse is concerned that a confused patient's erratic movements may compromise the intravenous (IV) insertion site. Which action can the nurse take to protect the patient and the site from injury? A. Apply an IV site-protection device over the site, such as House UltraDressing. B. Apply restraints to the patient. C. Check the patient frequently. D. Instruct the patient to avoid dislodging the IV catheter.
A. Apply an IV site-protection device over the site, such as House UltraDressing.
When preparing to insert a venous access device, how can the nurse encourage patient compliance with the procedure? A. Assess the patient's understanding of the placement of the device. B. Insert the access device as quickly as possible. C. Ask the patient to select the arm preferred for access. D. Apply a topical anesthetic to the area before inserting the device.
A. Assess the patient's understanding of the placement of the device.
Which action will best minimize the patient's risk for vein injury when removing an IV access device from a patient's arm? A. Keep the hub parallel to the skin. B. Cleanse the site with an antibacterial swab. C. Cut the dressing to facilitate its removal. D. Turn the IV tubing roller clamp to the "off" position.
A. Keep the hub parallel to the skin.
The nurse notices failure of flow in the drip chamber with the roller clamp open and an absence of swelling at the insertion site. What should the nurse do? (Select all that apply.) The nurse should: A. Attempt forceful flushing to achieve catheter patency without having to relocate the IV. B. Determine patency by aspirating for a blood return. C. Inject heparin flush solution into the nearest port of the catheter. D. Apply a warm pack to the IV site. E. Check for kinking of IV tubing.
B. Determine patency by aspirating for a blood return. E. Check for kinking of IV tubing.
Which of the following sites should be avoided when initiating an intravenous infusion? (Select all that apply.) A. The foot of a child B. The left arm of a patient who has a history of a left mastectomy C. An area of venous bifurcation or palpation of valves D. Site proximal to a previous venipuncture site E. The antecubital fossa F. Sclerosed or hardened cordlike veins G. Inner wrist H. Inner arm I. Dorsal surface of the hand in an adult J. Side of paralysis K. Extremity with a dialysis shunt
B. The left arm of a patient who has a history of a left mastectomy C. An area of venous bifurcation or palpation of valves E. The antecubital fossa F. Sclerosed or hardened cordlike veins G. Inner wrist J. Side of paralysis K. Extremity with a dialysis shunt
Which instruction might the nurse give to nursing assistive personnel (NAP) when caring for a patient whose IV access device is to be removed? A. "Remember to wear gloves to minimize the risk for infection." B. "Be sure to keep pressure on the site for at least 2 to 3 minutes." C. "Let me know if you notice any bleeding on the site dressing." D. "Make sure the patient knows to notify me if the IV site becomes painful."
C. "Let me know if you notice any bleeding on the site dressing."
Which instruction might the nurse give to nursing assistive personnel (NAP) regarding the care of a patient with an intravenous access device? A. "Assess the IV site frequently for signs of inflammation." B. "Be sure not to obscure the insertion site with the dressing." C. "Let me know when you notice that the IV bag contains less than 100 milliliters." D. "Explain the symptoms of infection to the patient."
C. "Let me know when you notice that the IV bag contains less than 100 milliliters."
The nurse is preparing an IV infusion prior to initiating an IV. The nurse removes the protective sheath covering the tubing insertion spike and accidentally touches the spike. What is the nurse's best action at this time? A. Wipe the insertion spike with an alcohol swab, allow to dry, and insert into opening of IV bag. B. Insert spike into opening of IV bag and compress the drip chamber and release, allowing it to fill to one-half full. C. Discard IV tubing and obtain a new one. D. Discard IV tubing and fluids and obtain new supplies.
C. Discard IV tubing and obtain a new one.
The nurse is using chlorhexidine to prepare the site before inserting a venous access device into the median cubital vein of a 60-year-old patient. Which action is correct? A. Wash the site with soap and water. B. Allow the site to dry 1 to 2 minutes after cleansing it with chlorhexidine. C. Cleanse the site using a circular motion, starting at the insertion site and working outward. D. Cleanse the area by first swabbing horizontally, then vertically with the applicator for about 30 seconds.
D. Cleanse the area by first swabbing horizontally, then vertically with the applicator for about 30 seconds.
The nurse knows to monitor the patient's IV site for signs of phlebitis. Why is it most important to discontinue the IV site if phlebitis is evident? A. Because it will cause the patient pain. B. In order to prevent the spread of infection to the other extremity. C. Phlebitis will eventually result in infiltration. D. Phlebitis can be dangerous because blood clots can occur.
D. Phlebitis can be dangerous because blood clots can occur.
