Deck 7: Nursing Care of Patients Receiving Intravenous Therapy

Question 1

The nurse is caring for a patient receiving a continuous IV infusion who develops sudden dyspnea, chest pain, and change in mental status. Which interventions should the nurse implement? (Select all that apply.)

A)Notify the health care provider (HCP).
B)Place the patient in high-Fowler position.
C)Administer oxygen as ordered.
D)Monitor vital signs.
E)Culture the IV site.

Answer 1

Notify the health care provider (HCP).
Administer oxygen as ordered.
Monitor vital signs.

Question 2

For which patient would a port be most beneficial?

A)A patient receiving a dose of piperacillin-tazobactam (Zosyn)
B)A patient being rehydrated with normal saline
C)A patient receiving a blood transfusion for anemia
D)A patient receiving chemotherapy

Answer 2

A patient receiving chemotherapy

Question 3

The nurse is caring for a patient receiving a continuous IV infusion who develops sudden dyspnea, chest pain, and change in mental status. Which interventions should the nurse implement? (Select all that apply.)

A)Notify the health care provider (HCP).
B)Place the patient in high-Fowler position.
C)Administer oxygen as ordered.
D)Monitor vital signs.
E)Culture the IV site.

Answer 3

Notify the health care provider (HCP).
Administer oxygen as ordered.
Monitor vital signs.

Question 4

A patient is prescribed 100 mL of 25% albumin IV to run over 1 hour. The albumin will transfuse using a 60 gtt/mL set. Calculate the drip rate. Round to the nearest whole number. Enter the numeral only.

Question 5

The nurse mistakenly assesses the blood pressure of the patient on the arm an IV is transfusing. What can this cause?

A)Fluid overload
B)Increase in venous pressure
C)Septicemia
D)Electrolyte imbalance

Question 6

The IV infusion pump for a patient receiving an IV therapy begins to alarm and displays occlusion. When the silence button is pushed, the alarm quickly resumes. Which action should the nurse take first?

A)Notify the physician.
B)Check for kinking of the tubing or a closed clamp.
C)Decrease the rate to 10 mL/hr and flush the line with 1 mL of heparin solution.
D)Turn off the IV solution and gently flush the line with 3 mL of saline flush solution.

Question 7

Upon entering a patient's room, the licensed practical nurse (LPN) notes a white precipitate forming in the IV tubing at the site of a piggybacked antibiotic. What should the nurse do first?

A)Stop the infusion.
B)Notify the physician.
C)Call the pharmacy to see whether this is an expected reaction.
D)When the infusion is complete, remove the tubing and send it to the laboratory for analysis.

Question 8

Which patient would benefit most from hypodermoclysis?

A)A 5-year-old patient with poor venous access receiving normal saline
B)A 16-year-old patient receiving multiple blood transfusions
C)A 24-year-old patient receiving chemotherapy
D)A 35-year-old patient with poor venous access receiving multiple antibiotic transfusions

Question 9

A patient is prescribed levofloxacin (Levaquin) 500 mg in 100 mL of normal saline to be infused over 1 hour. At what rate will the nurse set the infusion pump? Enter the numeral only.

Question 10

The nurse suspects the patient has developed septicemia as a complication of peripheral IV therapy. Which clinical manifestation supports the nurse's suspicion?

A)Sharp pain at the site
B)Fever and chills
C)Coolness of skin at the site
D)Resistance during flushing

Question 11

The nurse is preparing to administer a medication IV push. What should the nurse do prior to administering the medication? (Select all that apply.)

A)Assess the catheter for patency.
B)Look up the rate of the medication.
C)Dilute the medication with normal saline.
D)Change the dressing of the IV site.
E)Assess allergies. 6.Flush the IV with heparin.

Question 12

The nurse is preparing to start an IV on a newly admitted patient. Which action by the nurse places the patient at risk for infection?

A)The nurse dons gloves before starting the IV.
B)The nurse applies a tourniquet to assess a vein.
C)The nurse cleans the area with an alcohol pad.
D)The nurse blows on the area cleansed with alcohol.

Question 13

The nurse is preparing to administer a hypertonic solution to a patient with hypovolemia. Which fluids are considered to be hypertonic? (Select all that apply.)

A)5% dextrose in 0.9% sodium chloride (D5NS)
B)Albumin 25% 3.0.45% sodium chloride (1/2NS)
C)5% dextrose in water (D5W)
D)0.9% sodium chloride (NS)

Question 14

At a monthly staff meeting, the nurse manager announces that all central line insertion and dressing kits will now come bundled with 2% chlorhexidine gluconate (CHG) for site preparation and cleansing. Which evidence best supports this decision?

A)The use of 2% chlorhexidine gluconate reduces hospital costs by 7%.
B)CHG is the preferred prep solution of choice based on scientific evidence.
C)The company that supplies IV and central line catheter equipment has recently changed the product bundling to include 2% CHG.
D)The chief of surgery is interested in performing a direct comparison study examining infection rates associated with long-term access devices as they are related to length of time the catheters are in place.

Question 15

A patient is prescribed IV fluid of 500 mL of lactated Ringer to infuse over 2 hours. At what rate will the nurse set the infusion pump? Enter the numeral only.

Question 16

The nurse is preparing to administer IV fluid to a patient using a microdrop set. Which tubing will the nurse select? 1.10 tt/mL

A)15 gtt/mL
B)20 gtt/mL
C)60 gtt/mL

Question 17

A patient is prescribed D5W to run over 12 hours using a set delivering 15 gtt/mL. Calculate the drip rate. Round to the nearest whole number. Enter the numeral only.

Question 18

A patient is prescribed to receive two units of packed red blood cells. When preparing for this patient's infusion of blood, which type of IV solution should the LPN/LVN select?

A)0.9% normal saline
B)0.45% normal saline
C)Dextrose 5% and water
D)Dextrose 5% and 0.9% normal saline

Question 19

The nurse is caring for a patient who is receiving parenteral nutrition (PN). The patient develops increased thirst, blurred vision, and a headache. Which action should the nurse take?

A)Check the patient's glucose level.
B)Assess blood pressure.
C)Discontinue the PN.
D)Apply oxygen.

Question 20

The licensed practical nurse/licensed vocational nurse (LPN/LVN) is assessing a patient receiving IV therapy and notes crackles upon auscultation of lung sounds and puffy eyelids. Which action should the nurse take?

A)Notify the registered nurse (RN) immediately.
B)Stop the IV and switch the patient to a different IV solution.
C)Place the patient in semi-Fowler position.
D)Obtain cultures of the IV site.