NUR270 EXAM 2

IV med order checks

right patient, right specfic drug in solution, right dose, right route, right time, right type of solution, right rate/duration of admin

highest med is primary or secondary with gravity flow

secondary

isotonic

similar to osmolarity of serum; 230-375 mOsm/L

IV tubing procedure - and when is asepsis/sterility required

spike: sterile, aseptic clamp tubing drip chamber: squeeze to fill - 1/3-1/2 full open clamp and make sure fluid is flowing through tubing with no air if air, flick out or use pump to back prime leur lok: maintain sterility

colloid solutions

stay in the bloodstream and provide nutrients to help patients regain strength

pump disadvantages

can't use free flow

IV infusions/meds: primary/continuous infusion

maintenance, electrolyte replacement

IV med nursing responsibilities

(safety interventions/assessments) eval effectiveness monitor for side effects assess IV site every 4 hrs minimum documentation educate client/family document education

A nurse is preparing to administer dextrose 5% in water (D5W) 250 mL IV to infuse over 30 min. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how man gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

125 gtt/min

limit unsuccessful attempts to __ per clinicial and no more than __ total

2, 4

fluids and meds with ph <___ and >___ with osmolarity >___ mOsm/L best infused in central lines

5, 9, 600

A nurse is preparing to administer 0.9% sodium chloride (0.9% NaCI) 1.5 L IV to infuse over 6 hr. The drop factor of the manual IV tubing is 20 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

83 gtt/min

peripheral IV size and indications with approximate flow rate: 20G

Adequate for all therapies Most providers of anesthesia prefer not to use a smaller size than this for surgery cases approx. flow rate: 65mL/min (3900mL/hr)

peripheral IV size and indications with approximate flow rate: 14G-16G

For trauma and surgical patients requiring rapid fluid resuscitation Needs to be in a vein that can accommodate it approx. flow rate: over 200mL/min (12,000mL/hr)

intraosseous

In bone that can tolerate a lot of fluid administration - often tibia or humerus

circulatory overload signs and symptoms

Increase in heart rate Shortness of breath JVD (distended neck veins) Cough Crackles auscultated Elevated RR Dyspnea on exertion Peripheral edema/weight gain

peripheral IV size and indications with approximate flow rate: 18G

Preferred size for surgery Vein needs to be large enough to accommodate the catheter approx. flow rate: 110mL/min (6600mL/hr)

extravasation signs and symptoms

Similar to infiltration Extensive pain Burning, stinging of tissue Skin blanching Deep tissue sloughing Blistering

speed shock

Systemic reaction of rapid infusion of substance unfamiliar to circulatory system (drug reaches toxic level quickly); usually associated with central line; too much too fast or meds don't react well together

T/F: all IV fluids must have an order (including NS)

T

secondary IV

Used to infuse intermittent medications, boluses, or electrolyte replacement Tubing must be changed per policy/protocol Connected to the Y-site above the tubing cassette Pump determines secondary bag placement

intraosseous indications for use

When have no other access Usually during an emergency For large, rapid fluid administration; large blood transfusions, etc

A nurse is assessing a client who has a peripheral IV with a continuous infusion. Which of the following findings is a manifestation of phlebitis? Select all that apply a. erythema b. damp dressing c. throbbing d. warmth at insertion site e. streak formation

a, c, d, e

air embolism

air in vasculature; pump should alarm if air in tubing

infection of IV site causes

break in asepsis technique during insertion improper maintenance

A nurse is assessing a client who is receiving 0.9% sodium chloride IV at 125 mL/hr. Which of the following should the nurse recognize as a possible complication related to the IV therapy? a. Petechiae is present over the IV site b. The skin is cool over the IV site c. Client reports coughing and shortness of breath d. Client's blood pressure is lower than normal

c, client reports coughing and shortness of breath, coughing and SOB

air embolism treatment

call for help/rapid response; place in Trendelenburg position on left side, administer O2, monitor VS

tonicity catergorized by?

comparison of normal blood plasma as osmolarity

a nurse is attempting to flush the IV saline loc for a client. the client reports pain above the catheter site. which of the following actions should the nurse take? a. inject the solution more slowly while flushing the IV saline lock b. apply a warm compress to the IV site c. apply firm pressure to the plunger of the syringe during the IV flush to improve patency d. remove the IV saline lock

d, remove the IV saline lock

phlebitis - what is it, signs and symptoms

inflammation of vein pain along vein above insertion site redness along vein warm to touch hard or cord-like feeling swelling slow/sluggish infusion

power cath

midline cath

infiltration causes

puncture of vein during insertion dislodgement of IV catheter poorly secured/loose dressings high volume of infusions/high rate of admin/high pressure excessive manipulation/movement

infection signs and symptoms - and each - systemic (S) or local (L)

redness - L pain - L swelling - L foul-smelling drainage - L, could become S fever - S elevated WBC - S

when can you not use an arm for IV site location

side of a mastectomy, lymph node dissection, arteriovenous shunt or fistula, paralysis

IV assessment

site, dressing, connections, infusion rate, labeling (name, date, time changed, and sticker for when it needs to be changed next)

what type of CVC can nurses never remove

tunneled

for adults, choose a site for placement in ______________. DO NOT use ______

upper extremity; wrist

midline catheters

used longer-term than peripheral; longer catheter associated with them

normal blood serum

275-295 mOsm/kg (chart) 270-300 mOsm/L (ppt)

"large gauge"

larger lumen, smaller number

IV sites - open-ended or valved

peripheral = open ended central = usually valved/closed

hypotonic fluid movement

pulls water from intravascular compartment into interstitial

central venous access devices indications for use

Total parental nutrition (TPN) Chemotherapy Infusion of vesicants/irritants Frequent blood product transfusions Hemodialysis

A nurse is preparing to administer dextrose 5% in water (D5W) 250 mL IV to infuse over 4 hr. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

63 gtt/min

a nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

75 mL/hr

A nurse has just inserted a peripheral IV catheter. Which of the following actions should the nurse take to secure the catheter? a. Apply an IV securement device b. Wrap tape around the circumference of the client's arm c. Tape the IV catheter's hub securely to the client's skin d. Place a piece of paper tape over the insertion site

a, apply an IV securement device, securement device

what access site should be used for TPN? a. left antecubital vein b. right subclavian vein c. right femoral artery d. left arm radial artery

b, right subclavian vein

NS lock needle/catheter sizes

26G-14G, 1/4 in to 1 1/4 in length

what should the nurse do for phlebitis

Stop infusion Discontinue IV site Initially apply cold compress Warm, moist soaks to affected area Follow facility protocol Restart in opposite arm

A nurse is preparing to administer an IV medication to a client. The nurse should identify that which of the following is a disadvantage of administering IV medications? a. IV medications are irreversible. b. IV medications have a slow onset. c. IV medications bypass the liver. d. IV medications have less bioavailability.

a, IV medications are irreversible, irreversible

A nurse is discontinuing a peripheral IV catheter. Upon removal, the nurse should assess the catheter for which of the following? a. An intact catheter tip b. Catheter erosion c. Blood within the catheter d. Discoloration of the catheter

a, an intact catheter tip, intact cath tip

infiltrate

leaking of IV fluid into surrounding tissue

extravasation

leaking of vesicant or irritant into surrounding tissue

peripheral catheters

short term use, usually on arms, start distal to proximal

thrombosis signs and symptoms

slowed or stopped infusion, localized warmth, inability to restart flow of IV

peripheral IV size and indications with approximate flow rate: 24G-26G

smallest, shortest not ideal for viscous infusions expect blood transfusion to take longer preferred for infants and small children approx. flow rate: 24mL/min (1440 mL/hr)

implanted port-a-cath "port" location, type of access, needle to access, # of lumens, infection risk, insertion procedure

subclavian or internal jugular self-sealing SQ reservoir for access accessed with Huber needle double or single lumen lowest risk of infection surgical insertion

how are tunneled CVCs placed and removed

surgery

A nurse is inserting a peripheral IV catheter and observes a blood return in the flashback chamber after puncturing the skin and selected vein. Which of the following actions should the nurse perform next? a. Secure the catheter to the skin with a transparent dressing. b. Advance the catheter into the vein with the finger hub. c. Release the tourniquet from the client's arm. d. Attach a primed piece of extension tubing to the catheter.

b, advance the catheter into the vein with the finger hub, advance with finger hub

A nurse is caring for a client who is receiving 0.9% sodium chloride IV at 75 mL/hr through a triple lumen central venous access device. The IV pump alarm sounds, indicating that there is an occlusion. Which of the following actions should the nurse take first? a. Call the provider who inserted the catheter. b. Check the line at or above the hub for kinked tubing that's creating resistance to flow c. Flush the line with a 10-mL syringe of heparin. d. Reposition client

b, check the line at or above the hub for kinked tubing that's creating resistance to flow, check line for kinked tubing

midline needle/catheter size

3F-5F, 3-8 in length

a nurse is preparing to administer clindamycin 300 mg by intermittent IV bolus over 30 min to a client who has a staphylococci infection. Available is clindamycin premixed in 50 mL 0.90% sodium chloride (NaCl). The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

100 mL/hr

A nurse is preparing to administer lactated Ringer's 1 L to infuse over 2 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

125 gtt/min

butterfly needle

22G

angio-cath

plastic part that stays in place in peripheral IVs

admin of IV push meds

Confirm order Check compatibility if IVF's infusing Syringe appropriate for medication volume and type of line (>/=10mL syringe for PICC lines) Appropriate flush (Saline vs. Heparin) Appropriate size flush syringe Aseptic cleansing wipe (alcohol or CHG) Gloves

infiltration signs and symptoms

Coolness at site Inflammation/taunt skin Discomfort Pallor of skin at/around site Slow/sluggish IV infusion

example of med that is no longer given due to causticity

IV phenergan - was used for nausea, can cause extravasation

prevention of air embolism

Remove air bubbles from syringes prior to IV use Tighten IV connections Flush IV's appropriately Prime IV tubing appropriately/remove air bubbles Don't ignore IV pump alarms

implanted central venous devices

access chamber surgically implanted in subcu tissue often flushed with heparin

thrombosis/thrombophlebitis

clot formation at insertion site

colloid

contains large molecular weight particles such as proteins or hydroxyethyl starches (HES) suspended in a crystalloid solution; 2 types - natural and synthetic

A nurse is preparing to administer cefuroxime 750 mg by intermittent IV bolus everv 8 hr. Available is cefuroxime injection 750 mg in 0.9% sodium chloride (0.9% NaCI) 50 mL to infuse over 15 min. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

200 mL/hr

A nurse is preparing to administer lactated Ringer's 2 L to infuse over 16 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

21 gtt/min

A nurse is preparing to administer 0.9% sodium chloride (0.9% NaCI) 500 mL IV to infuse over 2 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

42 gtt/min

colloid examples

5% albumin 25% albumin Hetastarch Hespan Low-molecular weight dextran High-molecular weight dextran natural: whole blood, plasma, concentrated albumin solutions synthetic: include gelatins, starches, dextrans, and complex polysaccharides

hypertonic

higher osmolarity than serum; >300 mOsm/L

pH measured by? & range

acidity or alkalinity 3.5-6.2

IV infusions/meds: IV Push

antiemetic, pain, cardia, emergent, steroid

crystalloid

aqueous solution composed of water and small solutes such as electrolytes and glucose; hypotonic, hypertonic, and isotonic solutions are examples

a nurse is preparing to administer ampicillin and gentamicin sulfate via IV indusion. which of the following resources should the nurse consult first regarding the medication compatibility? a. nurse manager b. hospital pharmacist c. health care provider d. medication sales rep

b, hospital pharmacist, pharmacist

A nurse is caring for a client who was admitted to the hospital for same day surgery and has a new prescription for continuous IV therapy. Which of the following actions should the nurse take when administering the IV therapy? a. Place a cold compress over the vein. b. Inspect the IV solution for fluid color, clarity, and expiration date. c. Apply a tourniquet 1 to 2 inches above the selected insertion site. d. Secure an armboard to the client's extremity.

b, inspect the IV solution for fluid color, clarity, and expiration date, inspect solution

a charge nurse is teaching a new nurse how to initiate IV access on a client. which of the following actions by the new nurse indicates an understanding of the teaching? a. Shaves the selected insertion site with a razor prior to the procedure b. Washes hands with soap and water before the procedure c. Applies sterile gloves prior to starting the IV catheter d. Applies the tourniquet 1 inch above the selected insertion site

b, washes hands with soap and water before the procedure, washes hands

how often should IV sites be assessed - oriented & alert patients? other patients?

every 4 hrs (if patient is alert) every 1-2 hrs (for other patients)

isotonic solution uses (& LR specific uses)

hypotension, hypovolemia/blood loss; dehydration, maintenance fluid, surgery LR is also used for extensive burns, severe injuries or major loss of blood

speed shock signs and symptoms

lightheaded dizziness, chest discomfort, flushed face, irregular pulse

infection treatment

monitor vitals, blood cultures if ordered, culture of drainage/CVC tip if ordered, antibiotics if ordered

which arm should be used (when possible)

non-dominant

can RNs remove central venous catheters

only specialty trained nurses

free-flowing

open clamp full way to infuse med as quickly as possible

"large gauge needle"

small needle/lumen, higher number

infusion fluids are classified by?

tonicity/concentration/osmolarity

examples of hypotonic solutions

0.45% NS 0.33% NaCl 0.225% NaCl D2.5W

A provider prescribes dextrose 5% in water IV to infuse at 100 mL/hr. The drop factor on the manual IV tubing is 60 gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min? (Round the answer to the nearest whole number.)

100 gtt/min

A nurse is preparing to administer dextrose 5% in 0.45% sodium chloride (D50.45% NaCI) 1,500 mL to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

188 mL/hr

examples of hypertonic solutions

3% NaCl 5% NaCl 10% Dextrose (D10W) (in central line if possible; do not use in same line as blood products) D20W (in central line if possible) D50W (in central line; for severe hypoglycemia) TPN D5LR D5 0.9% NS D5 0.45% NS

A nurse is preparing to administer dextrose 5% in water (D5W) to infuse at 125 mL/hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

31 gtt/min

a client is to receive a 1,000 mL bag of 5% dextrose in lactated Ringer's over 8 hr. Using tubing with a drop factor of 15 gtt/mL, the nurse should regulate the fluid to infuse at how many drops per minute? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

31 gtt/min

A nurse is preparing to administer ceftriaxone 1 g in 100 mL IV over 30 min. The drip rate is 10 gtt/mL. The nurse should set the infusion rate to administer how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

33 gtt/min

A nurse is removing a client's IV catheter. Which of the following actions should the nurse take? a. Apply firm pressure over the vein b. Leave the roller clamp slightly open c. Pull the catheter straight back from the insertion site d. Lift the hub slightly upward away from the skin

c, pull the catheter straight back from the insertion site

multiple lumen cath

multiple tubes; usually central line access

examples of isotonic solution

0.9% NaCl (NSS) Lactated Ringer's (LR) D5W (in bag) Ringer's

A nurse is calculating the intake of a client during the past 9 hr. The client's intake includes lactated Ringer's IV at 150 mL/hr, cefazolin 2 g IV intermittent bolus in 100 mL of 0.9% sodium chloride, two units of packed RBCs of 275 mL and 250 mL; two IV bolus infusions of 250 mL of 0.9% sodium chloride, famotidine 20 mg IV intermittent bolus in 50 mL of 0.9% sodium chloride. How many mL of intake should the nurse record?

2525 mL

A nurse is preparing to administer clindamycin 300 mg by intermittent IV bolus every 8 hr. Available is clindamycin injection 300 mg in 0.9% sodium chloride (0.9% NaCI) 50 mL to infuse over 45 min. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

67 mL/hr

a patient receives their 3rd dose of IV penicillin, and 10 mins into the infusion, the client reports that the IV site itches, he feels SOB, and he's dizzy. which of the following actions should the nurse take? a. stop the infusion b. call the client's provider c. elevate the head of the bed d. auscultate the client's breath sounds

a, stop the infusion

TPN requires what kind of intravenous line

central line

site to infuse hypertonic solutions

central line (recommended due to solution being vesicant)

isotonic fluid movement

fluids remain in intravascular compartment; water doesn't move in and out of cells

isotonic solutions are used to...

increase the extracellular fluid volume

NS lock types

angio, power, multiple lumen

IV infusions/meds: secondary infusion/piggyback

antibiotic, pain, electrolyte replacement

infiltration/extravasation treatment

Stop infusion immediately/remove IV Administer antidote if appropriate (know if vesicant) Elevate arm if swollen Apply cold compress for inflammation Warm, moist pack for comfort Restart IV in opposite arm or more proximal site Follow facility protocol

TPN

Contains proteins, carbs, electrolytes, vitamins and minerals Used only if normal digestion is not an option or is not sufficient Requires central access, close monitoring Infusion rate gradually increased/decreased to avoid drastic blood chemistry changes

air embolism signs and symptoms

Decreased blood pressure/dizziness (BP can become high or low though) Itchy skin Irregular heart rhythm (likely tachycardia) Respiratory (rate likely increase) Neurological changes-confusion or loss of consciousness (change in mental status) Chest pain Anxiety/dyspnea Pain in joints/muscles

caring for IV sites

Maintain sterility Dressing changes Catheter/tubing/pump changes when needed Flushing Patient restrictions Scrub hubs Possibly apply mitts to keep from people from pulling out IV

IV med order example

NSS 1000mL over 8 hours 40 mEq KCL (potassium chloride) in 1000mL NSS @ 125mL/hr; D5 0.45% NSS @ 67mL/hr

hemodialysis catheters

Perm-caths - floor RNs won't touch them Surgically placed for hemodialysis Patients are frail, and that is their lifeline Surgical fistulas placed

circulatory overload treatment

Slow or discontinue IV infusions check client and notify physician keep client warm may have diuretics ordered Place in high fowler's position Assess client/notify provider Monitor vital signs administer O2 if needed administer diuretics as ordred strict I's & O's, daily weight

pump advantages

alarms to avoid air embolism

proper maintenance of IV sites

clean hub pre-flush/med admin limiting disconnection of tubing limit manipulation of IV device secure dressing

thrombosis treatment

discontinue site apply cold compress if site is warm and tender assess circulation

gravity flow secondary IV location

higher than primary

gravity flow

higher you hang it, faster it injects

circulatory overload prevention

monitor IV infusions/rate check every hour limit fluid boluses never play catch-up with fluids unless ordered split blood bags monitor VS and breath sounds thorough cardiopulmonary assessments

extremes of both ___ and ___ can damage veins

osmolarity; pH

circulatory overload

too much fluid in body

hypotonic solution uses

hyperglycemic condition-high glucose levels draw fluid out of cells into vascular and interstitial compartments diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia hypernatremia (high Na) dehydration (especially D2.5W)

IV solutions classified by?

tonicity (concentration) and pH

A nurse is preparing to administer clindamycin 900 mg by intermittent IV bolus over 45 min. Available is clindamycin 900 mg in 100 mL dextrose 5% (D5W). The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

133 mL/hr

A nurse is preparing to administer dextrose 5% in water (D5W) 1 L IV to infuse over 12 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

21 gtt/min

A nurse is preparing to administer dextrose 5% in water (D5W) 250 mL via IV bolus to infuse over 45 min. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

333 mL/hr

peripheral IV size and indications with approximate flow rate: 22G

Adequate for most therapies; blood can infuse without damage approx. flow rate: 38mL/min (2280mL/hr)

complications of IV therapy

Infection (CRBSI/CLABSI) Phlebitis Extravasation/Infiltration Thrombosis Deep Vein Thrombosis (DVT) Circulatory Overload Air Embolism Speed shock

RN responsibilities of CVAD's

Maintain asepsis Prevent backflow of blood Flush catheter before and after med and routinely-protocol Assess site every 4 hrs. minimum Assess dressing integrity every 4 hrs. minimum Monitor infusions rates Review necessity and discuss with care team Dressing changes per protocol and prn

While assessing a client who is receiving continuous IV therapy via his left forearm, a nurse notes that the site is red, swollen, and painful and that the surrounding tissues are hard. Which of the following actions should the nurse take? a. Discontinue the existing IV line b. Initiate a new IV line in the other extremity c. Apply a hot pack to the irritated site d. Determine if the client needs to continue IV therapy

a, discontinue the existing IV line, discontinue

A nurse administers the first dose of a client's prescribed antibiotic via intermittent IV bolus. During the first 10 to 15 min of administration, which of the following assessments is the nurse's priority? a. Assess the IV site for redness or swelling. b. Assess the client for a systemic allergic reaction. c. Assess the IV dressing for signs of leakage. d. Assess the client's limb for signs of discomfort.

b, assess the client for a systemic allergic reaction, allergic reaction

peripherally inserted central catheter (PICC)

considered a central catheter can be inserted by IV teams and Nurse Practitioners done at the bedside; can be discontinued at the bedside sterile procedure; patient and nurse wear masks small lumen catheter - needs special care

A nurse has just initiated an IV infusion and is teaching the client about possible complications. The nurse should include that which of the following findings is an indication of early infiltration? a. Moisture b. Bruising c. Tingling d. Coolness

d, coolness

A nurse has just initiated a new peripheral IV infusion with 5% dextrose in water for continuous infusion. How often should the nurse plan to replace the primary infusion tubing? a. every 24 hrs b. every 48 hrs c. every 72 hrs d. every 96 hrs

d, every 96 hrs

tunneled central venous access devices

dwell time: months to years exit site typically on chest less risk of infection

chemical phlebitis causes

infusion of irritating solutions and rapid infusion rates

central venous access - inserted by who and types

inserted by physician/surgeon, CRNP, or PA tunneled or non-tunneled implanted port hemodialysis catheter

non-tunneled central venous access devices

inserted in subclavian, jugular, or femoral vein dwell time: up to 1 month increased risk of infection

mechanical phlebitis causes

inserting catheter in an area of flexion, using an excessively large IV catheter, inadequately stabilizing catheter after insertion

D5W osmolarity

isotonic in bag becomes hypotonic in body; 253 mOsm/L

hypotonic

less osmolarity of serum <250 mOsm/L (chart) <270 mOsm/L (ppt)

phlebitis causes

mechanical, chemical, or bacterial irritation

hypertonic fluid movement

moves water/fluids/electrolytes out of intracellular and interstitial compartments and into intravascular compartment

hypertonic solution uses

severe hyponatremia cerebral edema hypovolemia replace electrolytes

hypertonic solution causes cells to...

shrink

central venous access devices

sterile insertion tip is threaded into caval-atrial junction short or long term use single or multiple lumen; if multiple, color-coded named based on exit point

central venous catheters - blood draws

stop infusion withdraw 10 mL "waste" withdraw blood sample flush per protocol

hypotonic solution causes cells to...

swell

A nurse is caring for a client who experienced an infection at the insertion site of her intravenous catheter. Which of the following findings should the nurse expect? a. The client reports numbness at the site b. Purulent drainage is noted from the site c. The vein appears cord-like d. Skin over the site is sloughing

b, purulent drainage is noted from the site, drainage

bacterial phlebitis causes

break in asepsis during insertion and break in integrity of dressing covering the insertion site

common peripheral IV sites

cephalic vein, brachial vein, basilic vein, median cubital vein, dorsal metacarpals

A nurse is caring for a client who is in early stage renal failure and has a prescription for the infusion of IV fluids. Which of the following IV fluids does the nurse anticipate a prescription for and why? a. 10% dextrose in water because it pulls fluid from the cells and increases vascular volume b. 0.45% sodium chloride because it dilutes extracellular fluid and rehydrates the cells c. 0.9% sodium chloride because it replaces extracellular volume and maintains intravascular volume d. 3% sodium chloride because it draws fluid into blood vessels and reduces interstitial compartments

b, 0.45% sodium chloride because it dilutes extracellular fluid and rehydrates the cells, 0.45% NaCl

A nurse is caring for a client who has a peripherally inserted central catheter (PICC) line. The nurse should identify that which of the following information is true about this type of IV route? a. A PICC line is a midline catheter used to administer blood. b. A PICC line is a catheter that allows for infusion of IV fluids without an infusion pump. c. A PICC line is a long catheter inserted through the veins of the antecubital fossa. d. A PICC line is a catheter that is used for emergent or trauma situations.

c, a PICC line is a long catheter inserted through the veins of the antecubital fossa

a nurse notices infiltration at the IV site; in what order should the following actions be performed a. apply warm or cold compress b. apply a sterile dressing c. stop the infusion d. remove the IV catheter e. elevate the extremity

c, d, b, e, a

A nurse assesses a client's IV insertion site and finds that it is red, warm, and slightly edematous. Which of the following actions should the nurse take? a. Check for a blood return. b. Elevate the extremity. c. Discontinue the IV line. d. Apply warm, moist heat.

c, discontinue the IV line, discontinue

a nurse is assessing an IV site on a toddler's left hand. which of the following findings should the nurse identify as an indication of an infiltration a. blood in IV tubing b. absence of blanching of the insertion site c. edema in the palm of the hand d. warmth around injection site

c, edema in palm of hand, edema

A nurse is caring for a client who is receiving dextrose in 5% water with 20 mEq of potassium chloride at 75 mL/hr. The provider has prescribed 1 g ceftriaxone IV. When preparing to administer this medication by intermittent IV bolus, which of the following actions should the nurse take first? a. Obtain the client's vital signs. b. Determine the client's level of consciousness. c. Verify the medication's compatibility with the primary IV solution. d. Check the amount of IV solution in the primary bag

c, verify the medication's compatibility with the primary IV solution, check compatibility

Which of the following actions should the nurse take when converting an IV infusion to a saline lock? a. Open the roller clamp of the primary infusion to prime the saline lock b. Apply pressure with a syringe to clear resistance in the IV catheter c. Attach secondary tubing to allow mobility d. Flush the IV catheter to confirm patency

d, flush the IV catheter to confirm patency, flush

A nurse is inserting an IV catheter for an older client in preparation for an outpatient procedure. Which of the following veins should the nurse select? a. dorsal metacarpal vein b. radial vein in wrist c. antecubital vein d. median vein in the forearm

d, median vein in the forearm

peripheral venous access

over-the-needle catheters; saline lock/NS lock; distal to proximal, caution in hands