Question 1

When removing a central catheter,the nurse should instruct the patient to:

Accepted Answer

A)  Lean forward and cough. 
B)  Take a deep breath and bear down. 
C)  Breathe deeply through the mouth. 
D)  Lie on the right side. 
A)  Lean forward and cough. 
B)  Take a deep breath and bear down. 
C)  Breathe deeply through the mouth. 
D)  Lie on the right side. B

Question 2

The patient with a subclavian line complains of shortness of breath after an infusion.The patient is diaphoretic and the blood pressure is 168/100 mm Hg,higher than a previous reading of 140/86 mm Hg.The nurse assesses these symptoms as an indication of:

Accepted Answer

A)  Fluid overload from too rapid an infusion 
B)  Incorrect dilution of the infused drug 
C)  Infection from faulty aseptic technique 
D)  Embolus from introduced air or blood clot 
A)  Fluid overload from too rapid an infusion 
B)  Incorrect dilution of the infused drug 
C)  Infection from faulty aseptic technique 
D)  Embolus from introduced air or blood clot D

Question 3

When the nurse assesses an infiltration at a peripheral IV site,the nurse should: (Place these options in the correct sequence.)

Accepted Answer

A)  Elevate the arm. 
B)  Apply warm compresses to the area. 
C)  Restart the infusion. 
D)  Stop the infusion. 
E)  Notify the charge nurse. 
A)  Elevate the arm. 
B)  Apply warm compresses to the area. 
C)  Restart the infusion. 
D)  Stop the infusion. 
E)  Notify the charge nurse. D,C,A,B,E

Question 4

When the nurse is to give a piggyback IV push medication to a patient who is receiving a continuous infusion,the nurse injects the medication:

Accepted Answer

A)  Into the hanging IV bag 
B)  Directly into the insertion cannula after temporarily disconnecting the IV bag 
C)  Into the port nearest to the insertion site to ensure quick delivery 
D)  Into the port nearest to the IV bag for less painful administration 
A)  Into the hanging IV bag 
B)  Directly into the insertion cannula after temporarily disconnecting the IV bag 
C)  Into the port nearest to the insertion site to ensure quick delivery 
D)  Into the port nearest to the IV bag for less painful administration

Question 5

The nurse assesses an area where an IV had been recently changed.The area has redness,swelling,and warmth,which are characteristics of:

Accepted Answer

A)  Infiltration and air embolus 
B)  Inflammation and possible phlebitis 
C)  Blood loss and hemorrhage 
D)  Embolus from the former catheter 
A)  Infiltration and air embolus 
B)  Inflammation and possible phlebitis 
C)  Blood loss and hemorrhage 
D)  Embolus from the former catheter

Question 6

The nurse explains that caloric sources in IVs come from:

Accepted Answer

A)  Electrolytes 
B)  Dextrose 
C)  Vitamins 
D)  Water 
A)  Electrolytes 
B)  Dextrose 
C)  Vitamins 
D)  Water

Question 7

The nurse transcribing orders should clarify the order of:

Accepted Answer

A)  Potassium chloride, 80 mEq in 1000 ml D5W in 24 hours 
B)  Potassium chloride, 40 mEq IV in 10 ml D5W IV push 
C)  Potassium chloride, 50 mEq in 500 ml D5W in 4 hours 
D)  Potassium chloride, 80 mEq in 1000 ml D5W in 12 hours 
A)  Potassium chloride, 80 mEq in 1000 ml D5W in 24 hours 
B)  Potassium chloride, 40 mEq IV in 10 ml D5W IV push 
C)  Potassium chloride, 50 mEq in 500 ml D5W in 4 hours 
D)  Potassium chloride, 80 mEq in 1000 ml D5W in 12 hours

Question 8

The nurse explains to the patient that,in the event of an accidental needle stick,the nurse should adhere to hospital policy,the usual directives of which are: (Select all that apply.)

Accepted Answer

A)  Antibiotics are taken if infection is present. 
B)  Blood is drawn from both the nurse and the patient. 
C)  Repeat blood draws are performed 4 weeks after the stick. 
D)  Obtain the physician's permission to return to work. 
E)  An incident report is initiated. 
A)  Antibiotics are taken if infection is present. 
B)  Blood is drawn from both the nurse and the patient. 
C)  Repeat blood draws are performed 4 weeks after the stick. 
D)  Obtain the physician's permission to return to work. 
E)  An incident report is initiated.

Question 9

The patient has suffered an air embolus.The quick-thinking nurse immediately:

Accepted Answer

A)  Turns the patient to the left side and lowers the head of the bed. 
B)  Calls the "Code Team." 
C)  Gives oxygen at 100% in a nonrebreathing mask. 
D)  Notifies the charge nurse. 
A)  Turns the patient to the left side and lowers the head of the bed. 
B)  Calls the "Code Team." 
C)  Gives oxygen at 100% in a nonrebreathing mask. 
D)  Notifies the charge nurse.

Question 10

The nurse explains to the patient that the peripheral IV tubing administration set and dressing should be changed every __________ hours.

Accepted Answer

72
To prevent infection,the IV

Question 11

The nurse charts signs of infected phlebitis as:

Accepted Answer

A)  Rupture of the cannula with a lump under the skin 
B)  Pale, cool skin with swelling at the puncture site 
C)  Firm, cool, raised, painful area at the puncture site; oozing and purulent drainage 
D)  Puncture site red, warm, with an oozing drainage 
A)  Rupture of the cannula with a lump under the skin 
B)  Pale, cool skin with swelling at the puncture site 
C)  Firm, cool, raised, painful area at the puncture site; oozing and purulent drainage 
D)  Puncture site red, warm, with an oozing drainage

Question 12

An older adult patient is assessed by the nurse as showing signs of fluid volume excess,which are:

Accepted Answer

A)  Redness, warmth, and drainage of fluid at the IV site 
B)  Redness, warmth, and tenderness at the IV site 
C)  Complaints of shortness of breath and pounding pulse 
D)  Puffiness of face, dyspnea, and pain at the IV site 
A)  Redness, warmth, and drainage of fluid at the IV site 
B)  Redness, warmth, and tenderness at the IV site 
C)  Complaints of shortness of breath and pounding pulse 
D)  Puffiness of face, dyspnea, and pain at the IV site

Question 13

Using an IV infusion system that delivers 60 drops/ml,the nurse hangs a 500-ml bag of normal saline (NS)at 8 AM.The physician has ordered a rate of 20 ml/hr.The nurse will set the roller clamp to deliver:

Accepted Answer

A)  10 gtts/min 
B)  20 gtts/min 
C)  25 gtts/min 
D)  30 gtts/min 
A)  10 gtts/min 
B)  20 gtts/min 
C)  25 gtts/min 
D)  30 gtts/min

Question 14

The patient is to receive ampicillin (Unasyn)IV piggyback in 100 ml of fluid every 8 hours.The main IV of D5W is running at 80 ml/hr and is on time.The nurse's responsibility is to calculate the total 24-hour intake.At the end of the 24-hour shift,how much IV intake will the nurse document that the patient has received?

Accepted Answer

A)  300 ml 
B)  800 ml 
C)  1920 ml 
D)  2220 ml 
A)  300 ml 
B)  800 ml 
C)  1920 ml 
D)  2220 ml

Question 15

In an assessment of a patient who has been receiving intravenous (IV)fluids for the last 6 hours,the nurse finds that the pulse is now bounding,the blood pressure is more than 15 mm Hg higher than the last reading,and pedal edema has developed.The nurse evaluates these signs as associated with:

Accepted Answer

A)  Infiltration of the IV site 
B)  Vascular fluid volume excess 
C)  Pulmonary air embolism 
D)  Phlebitis of the leg veins 
A)  Infiltration of the IV site 
B)  Vascular fluid volume excess 
C)  Pulmonary air embolism 
D)  Phlebitis of the leg veins

Question 16

An IV administration of doxycyclin (Vibramycin)has extravagated.After stopping the IV,the nurse should:

Accepted Answer

A)  Notify the physician, and restart the IV in another site. 
B)  Restart the IV at another site, and document the extravasation. 
C)  Flush NS through cannula at the insertion site. 
D)  Discard the IV tubing and the IV bag. 
A)  Notify the physician, and restart the IV in another site. 
B)  Restart the IV at another site, and document the extravasation. 
C)  Flush NS through cannula at the insertion site. 
D)  Discard the IV tubing and the IV bag.

Question 17

The physician orders an infusion of 1000 ml of 5% dextrose in 0.45 NS to be completed in 8 hours.The IV delivery system's drop factor is 20 gtts.The nurse should set the electronic infusion pump to deliver ______________ ml/hr?

Accepted Answer

A)  125 
B)  100 
C)  85 
D)  42 
A)  125 
B)  100 
C)  85 
D)  42

Question 18

The physician orders a hypertonic IV for an extremely edematous patient.The nurse anticipates that the IV preparation will be:

Accepted Answer

A)  D5W in NS 
B)  Lactated Ringer' solution 
C)  D5W in 0.25 NS 
D)  10% glucose in water 
A)  D5W in NS 
B)  Lactated Ringer' solution 
C)  D5W in 0.25 NS 
D)  10% glucose in water

Question 19

The nurse explains that a major advantage of IV therapy is that drugs administered via the IV route:

Accepted Answer

A)  Can better be maintained at a therapeutic blood level 
B)  Is less expensive than oral route 
C)  Is safer than administering by oral or intramuscular (IM) route 
D)  Has a lower incidence of allergy than other routes 
A)  Can better be maintained at a therapeutic blood level 
B)  Is less expensive than oral route 
C)  Is safer than administering by oral or intramuscular (IM) route 
D)  Has a lower incidence of allergy than other routes

Question 20

When discontinuing an IV,the nurse will:

Accepted Answer

A)  Remove the dressing, remove the catheter, dispose of the used equipment in the sharps container, and chart observations and actions. 
B)  Observe the site for redness, swelling, and pain, and put on sterile gloves. Remove the dressing catheter and chart the findings and action. 
C)  Observe the site for redness, swelling, and pain, and put on clean gloves. Remove the dressing and catheter, place a 2 ´ 2 dressing over the site, and chart the findings and action. 
D)  Observe the site for redness, swelling, and pain, and put on clean gloves. Remove the dressing and catheter; chart the findings and action. 
A)  Remove the dressing, remove the catheter, dispose of the used equipment in the sharps container, and chart observations and actions. 
B)  Observe the site for redness, swelling, and pain, and put on sterile gloves. Remove the dressing catheter and chart the findings and action. 
C)  Observe the site for redness, swelling, and pain, and put on clean gloves. Remove the dressing and catheter, place a 2 ´ 2 dressing over the site, and chart the findings and action. 
D)  Observe the site for redness, swelling, and pain, and put on clean gloves. Remove the dressing and catheter; chart the findings and action.

Exam 18: Intravenous Therapy

When removing a central catheter,the nurse should instruct the patient to:

The patient with a subclavian line complains of shortness of breath after an infusion.The patient is diaphoretic and the blood pressure is 168/100 mm Hg,higher than a previous reading of 140/86 mm Hg.The nurse assesses these symptoms as an indication of:

When the nurse assesses an infiltration at a peripheral IV site,the nurse should: (Place these options in the correct sequence.)

When the nurse is to give a piggyback IV push medication to a patient who is receiving a continuous infusion,the nurse injects the medication:

The nurse assesses an area where an IV had been recently changed.The area has redness,swelling,and warmth,which are characteristics of:

The nurse explains that caloric sources in IVs come from:

The nurse transcribing orders should clarify the order of:

The nurse explains to the patient that,in the event of an accidental needle stick,the nurse should adhere to hospital policy,the usual directives of which are: (Select all that apply.)

The patient has suffered an air embolus.The quick-thinking nurse immediately:

The nurse explains to the patient that the peripheral IV tubing administration set and dressing should be changed every __________ hours.

The nurse charts signs of infected phlebitis as:

An older adult patient is assessed by the nurse as showing signs of fluid volume excess,which are:

Using an IV infusion system that delivers 60 drops/ml,the nurse hangs a 500-ml bag of normal saline (NS)at 8 AM.The physician has ordered a rate of 20 ml/hr.The nurse will set the roller clamp to deliver:

In an assessment of a patient who has been receiving intravenous (IV)fluids for the last 6 hours,the nurse finds that the pulse is now bounding,the blood pressure is more than 15 mm Hg higher than the last reading,and pedal edema has developed.The nurse evaluates these signs as associated with:

An IV administration of doxycyclin (Vibramycin)has extravagated.After stopping the IV,the nurse should:

The physician orders an infusion of 1000 ml of 5% dextrose in 0.45 NS to be completed in 8 hours.The IV delivery system's drop factor is 20 gtts.The nurse should set the electronic infusion pump to deliver ______________ ml/hr?

The physician orders a hypertonic IV for an extremely edematous patient.The nurse anticipates that the IV preparation will be:

The nurse explains that a major advantage of IV therapy is that drugs administered via the IV route:

When discontinuing an IV,the nurse will:

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