Iv therapy

A physician orders a soap suds enema in 500mL. What is this equivalent to in Liters?

0.5L

The physician prescribes furosemide, 2 mg/kg PO, as a one-time dose for an infant with fluid overload. The infant's documented weight is 14 lb (6.4 kg). The oral solution contains 10 mg/mL. How many milliliters of solution should the nurse administer? Round the answer to the nearest tenth of a millilter.

1.3

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream? a. hypotonic b. hypertonic c. isotonic d. sodium chloride

b A hypertonic solution causes the bloodstream to absorb fluids until pressure on both sides of the blood vessel is equal. A hypotonic solution causes fluids to move from the bloodstream into the tissues. An isotonic solution has no effect on the cell. Depending on the concentration of sodium, a sodium chloride solution can be isotonic, hypertonic, or hypotonic.

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? a. Place a tourniquet on the arm in which the injection will be administered. b. Warm the I.V. medication to room temperature. c. Insert a second I.V. line into the opposite arm. d. Gently aspirate the I.V. catheter to check for a blood return.

d Before administering an I.V. bolus, the nurse should gently aspirate the I.V. catheter for a small amount of blood to ensure correct placement of the I.V. catheter. Then the nurse may inject the medication over the recommended time interval. The nurse doesn't need to insert another I.V. line unless the ordered medication is incompatible with the medication in the I.V. solution. Warming the medication could alter the drug's action. Placing a tourniquet on the arm would close off the venous system and prevent drug injection.

A client has requested to have patient-controlled analgesia (PCA) after surgery? When is it appropriate for a client to receive PCA? a. The client has the ability to self-administer. b. There is a nurse to assist with self-administration. c. A family member is able to assist with self-dosing. d. There are advanced directives in place.

a The ability to self-administer the drug is a requirement for the client to use PCA. Having a family member or advance directives is not a requirement for initiating PCA. The nurse teaches the client about how to use PCA and monitors effectiveness of the pain medication; however, it is not necessary for the nurse to assist with the administration of the drug.

A physician orders cefoxitin, 1 g in 100 ml of 5% dextrose in water, to be administered I.V. A nurse determines that the recommended infusion time is 15 to 30 minutes. The available infusion set has a calibration of 10 drops/ml. To infuse cefoxitin over 30 minutes, which drip rate should the nurse use? a. 30 drops/minute b. 33 drops/minute c. 66 drops/minute d. 10 drops/minute

a

A child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which condition represents the greatest risk to this child? a. hypokalemia b. hyperphosphatemia c. hypercalcemia d. hypernatremia

a Hypokalemia occurs when insulin administration causes glucose and potassium to move into the cells. Insulin administration doesn't directly affect calcium levels. Hypophosphatemia — not hyperphosphatemia — may occur with insulin administration because phosphorus enters the cells with insulin and potassium. Insulin administration doesn't directly affect sodium levels.

A nurse gives a client 0.25 mg of digoxin instead of the prescribed dose of 0.125 mg. What should the nurse do next? a. Assess the client and notify the client's physician. b.Nothing; the dose will not make a significant difference. c. Give another 0.125 mg as soon as possible. d. Hold the next dose to make sure the total amount balances.

a This is a medication error. The priority is to assess the client and then call the physician to advise them of the error and seek further direction. The other options do not describe the steps the nurse should take to ensure client safety following a medication error. They also include decisions and judgments outside the nurse's scope of practice.

The nurse is caring for a client with an I.V. line. During care of the I.V. line, the nurse would be required to wear protective gloves in which situations? Select all that apply. a. when inserting the I.V. b. When changing the I.V. site c. When spiking a new I.V. bag d. When discontinuing the I.V. e. When priming the I.V. tubing

a, b, d The nurse should wear protective gloves when inserting the I.V., when discontinuing the I.V., and when changing the I.V. site due to the risk of exposure to blood and bodily fluids. The nurse would not be required to wear protective gloves while spiking or hanging a new bag of solution.

The health care provider has prescribed penicillin for a client admitted to the hospital for treatment of pneumonia. Prior to administering the first dose of penicillin, the nurse should ask the client: a. have you had any recent infections? b. do you have a history of seizures? c. have you had a previous allergy to penicillin? d. do you have any cardiac history?

c The nurse should determine if the client is allergic to penicillin prior to administering the drug. History of seizures, recent infections, and a cardiac history are not contraindications for this client to receive penicillin. While important to know, recent infections will not preclude this client receiving penicillin at this time.

A nurse is preparing to give an average-size 9-year-old child a preoperative I.M. injection. Which size needle should the nurse use? a. 22G, 1½″ b. 20G, 1″ c. 22G, 1″ d. 20G, 1½″

c The nurse should evaluate the muscle mass and amount of subcutaneous fat and then select the correct needle size. Without more information, the nurse would select the 22G, 1″ needle, appropriate for an average-size school-age child. The 20G, 1″ needle would be unnecessarily large. The 22G, 1½″ needle would be too long. The 20G, 1½″ needle would be too long and unnecessarily large.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? a. Notify the physician. b. Remove the catheter, check for catheter integrity, and send the tip for culture. c. Draw a circle around the moist spot and note the date and time. d. Remove the dressing, clean the site, and apply a new dressing.

d A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. The nurse should notify the physician if any catheter-related complications are observed. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.

The physician orders 20 mEq of potassium chloride to be added to the IV solution of a client in diabetic ketoacidosis. The nurse is aware that the reason for this is which of the following? a. Treatment of cardiac dysrhythmias b. Prevention of flaccid paralysis during rehydration c. Treatment of hypercapnia d. Replacement of electrolyte deficit

d After treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cells, causing hypokalemia. Therefore, potassium, along with the replacement fluids, is generally supplied. Potassium will not correct hypercapnea or flaccid paralysis. Cardiac dysrhythmias are a result of excess or deficit of potassium.

A physician orders an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, a client should receive how many milliliters of I.V. fluid per hour? a. 240 ml/hour b. 50 ml/hour c. 120 ml/hour d. 100 ml/hour

c

A client returns to the room from the postanesthesia care unit after undergoing a right hemicolectomy. The health care provider orders 1 L of dextrose 5% in half-normal saline solution to infuse at 125 ml/hour. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Round your answer to the nearest whole number. (For example: 62)

31

What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking beta-adrenergic blocker? a. increased respiratory rate b. irregular pulse c. decreased respiratory rate d. abnormally low blood pressure

b Abrupt withdrawal of a beta-adrenergic blocker results in rebound cardiac excitation, which causes ventricular arrhythmias and an irregular pulse. Abnormally low blood pressure would be unlikely because beta-adrenergic blockers are used to treat hypertension. Abrupt withdrawal of this medication wouldn't directly affect a client's respiratory rate.

Which is an expected outcome when a client is receiving an IV administration of furosemide? a. increased blood pressure b. increased urinary output c. decreased premature ventricular contractions d. decreased pain

b Furosemide is a loop diuretic that acts to increase urine output. Furosemide does not increase blood pressure, decrease pain, or decrease arrhythmias.

Following surgery, a client is receiving 1,000 mL normal saline (IV) with 40 mEq (40 mmol/L) KCl, which has been ordered to be infused at 125 mL/h. The client states, "My IV hurts." What should the nurse do first? a. Slow down the infusion to a keep-open rate (20-50 mL/h). b. Assess the IV site for signs of phlebitis, extravasation, or IV-related infection. c. Contact the client's health care provider (HCP) for a different IV prescription. d. Check the hanging parenteral fluid and administration set for documentation as to when they were last changed.

b Potassium in an IV solution may be irritating to a vein. The nurse should assess the IV site before taking any of the other actions listed. The infusion may have to be slowed and/or stopped, and the HCP contacted. An outdated parenteral fluid setup does not cause pain, but may be a source of infection.

The antidote for heparin is: a. thrombin. b. protamine sulfate. c. vitamin K. d. warfarin.

b The antidote for heparin is 1% protamine sulfate. Vitamin K is the antidote for warfarin, an oral anticoagulant. Thrombin is a topical anticoagulant.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: a. is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. b. is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II. c. blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. d. increases norepinephrine secretion and thus decreases blood pressure and heart rate

c Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction. Propranolol does not increase norepinephrine secretion, cause vasodilation, or block conversion of angiotensin I to angiotensin II.

A client is brought to the emergency department with abdominal trauma following an automobile accident. The vital signs are heart rate, 132 bpm; respirations, 28 breaths/min; blood pressure, 84/58 mm Hg; temperature, 97.0° F (36.1° C); oxygen saturation 89% on room air. Which prescription should the nurse implement first? a. Obtain an abdominal X-ray. b. Insert an indwelling urinary catheter. c. Administer 1 liter 0.9% saline IV. d. Draw a complete blood count with hematocrit and hemoglobin.

c The client is demonstrating vital signs consistent with fluid volume deficit, likely due to bleeding and/or hypovolemic shock as a result of the automobile accident. The client will need intravenous fluid volume replacement using an isotonic fluid (e.g., 0.9% normal saline) to expand or replace blood volume and normalize vital signs. The other prescriptions can be implemented once the intravenous fluids have been initiated.

A client rates the pain level of a migraine an 8 on a scale of 1-10. How would the nurse administer the medication to give the client the quickest relief? a. buccal b. intravenous (IV) c. intramuscular (IM) d. sublingual

b The nurse would want the client to receive the benefit of the medication as quickly a possible to help alleviate the migraine. A drug placed directly into intravenous system enters the client's bloodstream more quickly than oral, IM, or buccal, thereby avoiding the barriers of food and the destructive effects of stomach acid. With oral, IM, and buccal administration, the client's response to the drug is slower.

A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The health care provider (HCP) has prescribed 2 units of packed red blood cells (RBCs). What should the nurse determine prior to initiating the blood transfusion? Select all that apply. a. There is the second unit of blood in the medication room. b. Blood typing and cross-matching are documented in the medical record. c. There is an IV access with the appropriate tubing and normal saline as the priming solution. d. There is a signed informed consent for transfusion therapy. e. The vital signs have been taken and documented in accordance with facility policy and procedure. f. The client has an identification bracelet.

b, c, d, e, f Before prescribing and administering packed RBCs, the nurse should assess the IV site to make sure it has an 18G to 20G infusion set. The nurse should also ensure that normal saline solution is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent for the procedure by signing the consent form. The client's blood must be typed to determine ABO blood typing and Rh factor and ensure that the client receives compatible blood. Cross-matching is done to detect the presence of recipient antibodies to the donor's minor antigens. Vital signs provide a baseline reference for continuous monitoring throughout the transfusion. An identification bracelet and red blood band are essential for client identification per facility policy. Two nurses must double check the client's identification with the client listed on the unit of RBCs. The transfusion should be started within 30 minutes of the time that the RBC unit is checked out of the blood bank. Thus, no blood should be kept in the medication room before transfusion.