IV Therapy

In preparing for insertion of a peripheral I.V. catheter, the nurse must select an appropriate site. Which area should the nurse try first if an appropriate vein is found?

Back of the hand.

Which actions by the nurse will most likely ensure that the correct client receives a medication? Select all that apply.

Check the name on the armband with the name on the medication. Compare the date of birth on the client's medical record to the date of birth on the client's armband.

If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first?

Clamp the catheter.

When making rounds on the pediatric neurology unit, the nurse manager notes that, when giving IV medications, many of the staff nurses are disconnecting the flush syringe first and then clamping the intermittent infusion device. The nurse manager is concerned that the nurses do not understand the benefits of positive pressure technique and turbulence flow flush in preventing clots. After the nurse manager discusses the problem with the staff educator, which intervention would be the most effective way to improve the nursing practice?

Create a poster presentation on the topic with a required posttest.

The health care team has noticed an increase in IV infiltrations on the pediatric floor. As part of a "Plan, Do, Study, Act" quality improvement plan, the team should perform the actions in which order? All options must be used.

Decide to monitor IV gauges. Perform chart audits. Analyze the data. Write a new IV insertion policy.

A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) with the preceptor. Which planned action by the graduate nurse should the preceptor correct?

Discarding the catheter in a trash container

A physician orders an I.V. bolus injection of diltiazem hydrochloride for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus?

Gently aspirate the I.V. catheter to check for a blood return.

Total parenteral nutrition (TPN) is prescribed for a client who has recently had a small and large bowel resection and who is currently not taking anything by mouth. What should the nurse do to safely administer the TPN?

Handle TPN using strict aseptic technique.

While making rounds, a nurse observes that a client's primary bag of intravenous (IV) solution is light yellow. The label on the IV bag says the solution is D5W. What should the nurse do first?

Hang a new bag of D5W, and complete an incident report.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000 mm3. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, reports having severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order?

Intramuscular (IM)

A nurse is administering IV fluids to a dehydrated client. When administering an IV solution of 3% sodium chloride, what should the nurse do? Select all that apply.

Measure the intake and output. Inspect the jugular veins for distention. Evaluate the client for neurologic changes.

A client is receiving TPN administered through a central line. What should the nurse do to prevent complications associated with this infusion?

Secure all connections of the system.

The nurse finds an unopened bag of IV 50% dextrose in a sink on the nursing unit. What should the nurse do with the IV bag?

Send it to the pharmacy.

When caring for a client with a central venous line, which nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply.

Verify patency of the line by the presence of a blood return at regular intervals. Inspect the insertion site for swelling, erythema, or drainage. If unable to aspirate blood, reposition the client and encourage the client to cough. Contact the health care provider about verifying placement if the status is questionable.

Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration?

altered drug dose

The health care provider's (HCP's) prescription for an intravenous infusion is 3% normal saline to infuse at 125 mL/h. The client's most recent sodium level is 132 mEq/L (132 mmol/L). The nurse should:

consult the prescriber about the prescription.

In a client with a urine specific gravity of 1.040, a subnormal serum osmolality, and a serum sodium level of 128 mEq/L, the nurse should question an order for which I.V. fluid?

dextrose 5% in water (D5W)

A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively?

elevating the hand and wrapping it in a warm towel

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream?

hypertonic

A nurse may delegate adding medications to I.V. fluid containers to a

pharmacist.

A nurse fails to give the evening dose of an IV antibiotic that is to be administered every 12 hours. The evening dose was scheduled for 1800; it is now 2200. The nurse should next:

report the incident to the health care provider.

While performing rounds, a nurse finds that a client is receiving the wrong I.V. solution. The nurse's initial response should be to

slow the I.V. flow rate and hang the appropriate solution.

When positioned properly, the tip of a central venous catheter should lie in the

superior vena cava.

To determine the I.V. drip rate, a nurse must know the drip factor, which is

the number of drops in one milliliter.

A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, the phyician connects a 10-ml syringe to the catheter and withdraws a sample of blood. The phyisician then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. The nurse should

turn the client on the left side and place the bed in Trendelenburg's position.

Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate?

urine output greater than 30 ml/hour

When teaching about prevention of infection to a client with a long-term venous catheter, the nurse determines that the client has understood discharge instructions when the client makes which statement?

"My husband will change the dressing three times per week, using sterile technique.

A client who weighs 187 lb (85 kg) has an order to receive enoxaparin 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? Record your answer using two decimal places.

0.85

The neonate has a prescribed IV rate of 8 mL/h. Fluid totals are recorded every 2 hours on the even hours. There is a new prescription written at 1030 to decrease the IV rate to 6 mL/h. What is the fluid total to be infused and recorded at 1200? Record your answer using a whole number.

13

A physician prescribes penicillin potassium oral suspension 56 mg/kg/day in four divided doses for a client with anorexia nervosa who weighs 25 kg. The medication dispensed by the pharmacy contains a dosage strength of 125 mg/5 mL. How many milliliters of solution should the nurse administer with each dose? Record your answer using a whole number.

14

A client is receiving magnesium sulfate at 3 g/h intravenously. The bag of 1,000 mL normal saline contains 20 g of magnesium sulfate. At what rate (in mL/hour) should the nurse set the IV pump to deliver 3 g/h? Record your answer using a whole number.

150

An infusion of lidocaine hydrochloride is running at 30 mL/hour. The dilution is 1,000 mg/250 mL. What dosage is the client receiving per minute? Record your answer using a whole number.

2

The physician prescribes acetaminophen 650 mg by mouth every 4 hours for a client with a temperature of 102° F (38.8° C) who has a feeding tube in place. The nurse has acetaminophen solution on hand containing 160 mg/5 ml. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.

20.3

A client is to receive 1 unit of packed red blood cells over 2 hours. There are 250 mL in the infusion bag. The IV administration infusion set delivers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse run the infusion? Record your answer using a whole number.

21

A client who is experiencing an exacerbation of ulcerative colitis is receiving IV fluids that are to be infused at 125 mL/h. The IV tubing delivers 15 gtt/mL. How quickly should the nurse infuse the fluids in drops per minute to infuse the fluids at the prescribed rate? Record your answer using a whole number.

31

The nurse is to administer chloramphenicol 50 mg IV in 100 mL of dextrose 5% in water over 30 minutes. The infusion set administers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse set the infusion? Round to the nearest whole number.

33

A client with a deep vein thrombosis has heparin sodium infusing at 1,500 units/hour. The concentration of heparin is 25,000 units/500 mL. If the infusion remains at the same rate for a full 12 hour shift, how many milliliters of fluid will infuse? Record your answer using a whole number.

360

A client admitted to the hospital with diabetic ketoacidosis is receiving a continuous infusion of regular insulin. The physician orders an I.V. containing 1 liter of dextrose 5% in water at 150 ml/hour to be started when the client's blood glucose level reaches [250 mg/dl (13.9 mmol/L)]. The drip factor of the I.V. tubing is 15 gtt/ml. What is the drip rate for this I.V. infusion in drops per minute? Record your answer using one decimal place.

37.5

A physician prescribes intravenous heparin 25,000 units in 250 ml of normal saline solution to infuse at 600 units/hour for a client who suffered an acute myocardial infarction (MI). After 6 hours of heparin therapy, the client's partial thromboplastin time is subtherapeutic. The healthcare provider orders the infusion to be increased to 800 units/hour. The nurse would set the infusion pump to deliver how many milliliters per hour? Record your answer using a whole number.

8

A nurse is caring for a 22-year-old female client with type 1 diabetes mellitus and toxic shock syndrome (TSS). Which action should the nurse perform first?

Administer 5% dextrose in half-normal saline solution at 150 mL/h IV.