Chapter 06: Dosage Calculation of Intravenous Solutions and Drugs Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 06: Dosage Calculation of Intravenous Solutions and Drugs

Test Bank

MULTIPLE CHOICE

1. What is the most important advantage for intravenous (IV) infusion of drugs?
a. Anyone can administer IV drugs.
b. The drug reaches the bloodstream immediately.
c. Drugs given intravenously cost less than drugs given orally.
d. The patient is not required to be alert to swallow the drug.
ANS: B
Drugs administered by IV infusion are immediately in the bloodstream and reach their target tissues fastest. This means that both the drug benefits (intended actions) and any adverse actions can happen more quickly. IV drugs tend to cost more than oral drugs. Although the patient does not have to be alert to receive IV drugs, it is not their main advantage. Administering IV drugs can only be performed by a skilled health care provider.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 83 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. How does the drop factor affect IV infusions?
a. Fluid with a larger drop factor infuses more slowly than fluid with a smaller drop factor.
b. Smaller drop factors occur with smaller needles (or cannulas) and larger drop factors occur with larger needles.
c. The smaller the drop factor, the fewer the number of drops needed to administer 1 mL of infusion fluid.
d. The larger the drop factor, the fewer the number of drops needed to administer 1 mL of infusion fluid.
ANS: D
The drop factor is the number of drops (gtt) needed to make 1 mL of IV fluid. The larger the drop, the fewer drops needed to make 1 mL.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 84 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. A patient is to receive 1000 mL intravenously of dextrose 5% in lactated Ringers solution in 8 hours. When the nurse checks the intravenous (IV) bag after 2 hours, 700 mL remain in the bag. How many milliliters have already infused?
a. 100
b. 300
c. 700
d. 1000
ANS: B
The amount infused is equal to the starting amount (1000 mL) minus the amount remaining in the IV bag or other container (700 mL). 1000 700 = 300 mL have infused.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 85-86 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

4. A patient is to receive 125 mL of intravenous fluid per hour and the drop factor is 10 gtt per mL. The nurse counts the 15-second drip rate to be 8 gtt per minute. What is the nurses best action?
a. Nothing, the IV flow rate is correct.
b. Turn the rate down to 5 gtt/15 seconds.
c. Turn the rate up to 11 gtt/15 seconds.
d. Turn the rate up to 15 gtt/15 seconds.
ANS: B
At 125 mL per hour, the patient should receive 2 mL per minute (125 mL 60 min). With a drop factor of 10 gtt/mL, the total number of drops per minute should be 20. The 15-second drop rate should be 5 (20 gtt/min 4).

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

5. How is extravasation different from infiltration?
a. Infiltration occurs in the hand, whereas extravasation occurs in the arm.
b. Both conditions lead to swelling, but extravasation causes tissue damage.
c. Infiltration is swelling accompanied by pain, whereas extravasation is not painful.
d. Extravasation causes phlebitis along with tissue swelling, whereas infiltration causes fluid overload along with swelling.
ANS: B
Both conditions result from leakage of fluid out of the vein and into surrounding tissues. Infiltration, although uncomfortable, does not result in tissue damage. Extravasation results directly or indirectly in tissue damage. If the damage is severe enough, tissue can become necrotic and slough.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 86 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

6. An IV infusion order for a patient reads 1000 mL dextrose 5% in normal saline intravenously, immediately. What additional information does the nurse ask the prescriber to provide?
a. Drip rate
b. Drop factor
c. Duration
d. Start time
ANS: C
A valid intravenous (IV) therapy order must include the duration of infusion. The word immediately in this prescription refers to when the IV infusion is to start, not its duration.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 86 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

7. Which precaution is most important for the nurse to teach a patient who is receiving intravenous (IV) drug therapy?
a. Turn on your call light if the IV machine starts to beep for any reason.
b. Do not use the arm that has the IV running in it for any reason whatsoever.
c. Call me immediately if you start to feel any pain or burning in the arm with the IV.
d. If you think the IV is running too slowly, just push the up-arrow button on the machine once or twice.
ANS: C
Pain and burning at the site are indicators of infiltration and extravasation. These indicators must be investigated as soon as they start to prevent tissue damage. Although it is helpful for the patient to alert the nurse that the machine is beeping, it is not the most important precaution. The patient should never be told to adjust the flow rate. Depending on the specific location of the needle, the arm with the IV can be used gently.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

8. While examining a patients peripheral intravenous (IV) site, the nurse observes a red streak along the length of the vein. On palpation, the vein feels hard and cordlike. What is the nurses best action?
a. Check for a blood return and notify the prescriber.
b. Discontinue the infusion and remove the IV needle.
c. Apply ice packs to the vein and continue the infusion.
d. Change the IV fluid to normal saline and redress the site.
ANS: B
Phlebitis is an inflammation of the vein. Its presence in a vein being used for IV therapy may be caused by mechanical forces associated with the IV device or by chemical factors related to the composition and osmolarity of the drug solution. The key manifestation is that the symptoms are directly associated with the vein. The vein with phlebitis should not receive any additional fluids and the IV therapy is discontinued. If IV therapy needs to continue, it is restarted in a different vein.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

9. Which problem is a major disadvantage of an intravenous (IV) pump?
a. The alarms are so sensitive that nurses tend to ignore them when they sound frequently.
b. Patients and families can override the automatic features and reset the infusion rate.
c. It can run away and cause a patient to experience fluid overload.
d. It can continue to push fluid into the tissue when infiltration occurs.
ANS: D
IV pumps push fluid into the patient at a rate greater than gravity and can continue to push even when resistance is increased. Infiltration or extravasation may not be detected by the machine until the situation is serious.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 88 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

10. The intravenous (IV) site of a patient who has been receiving IV therapy for 2 days is red and has a small amount of pus oozing from around the needle. What is the nurses best action?
a. Document the finding as an expected response to long-term IV therapy as the only action.
b. Immediately notify the prescriber to get an order to discontinue the IV therapy.
c. Use an iodine solution to clean the site and replace the dressing.
d. Discontinue the IV therapy and notify the prescriber.
ANS: D
An infected infusion site is an indication to immediately discontinue the IV therapy. An order is not needed under these circumstances, but the prescriber should be notified.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

11. A patient is receiving an intravenous (IV) infusion of solution containing 60 mEq/L of potassium chloride. Which nursing action allows early detection of complications common to this therapy?
a. Lowering the IV bag below the level of the IV site to obtain a blood return
b. Palpating the vein above the IV site in which the cannula is placed
c. Placing a light source on the tissue around the IV site
d. Checking the pulse distal (lower than) to the IV
ANS: B
Potassium chloride is an irritant that can traumatize the vein and stimulate the response of phlebitis. When phlebitis is present, the vein feels hard and cordlike above the IV insertion site.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

12. A patient is prescribed 25 mg by intravenous (IV) push of a drug that is a known chemical irritant. The drug vial contains 100 mg/mL of the drug. To reduce the risk for chemical trauma when administering this drug, what is the nurses best action?
a. Immediately after injecting the drug by IV push, apply firm pressure over the site for 1 minute.
b. Dilute the drug with 9.75 mL of an appropriate solution before administration.
c. Apply a cold compress to the IV site for 10 minutes before administering the drug.
d. Apply a cold compress to the IV site for 10 minutes after administering the drug.
ANS: B
Diluting a drug that is chemically irritating can reduce the chemical trauma it produces in veins. It is necessary to check first with the pharmacist to determine which specific fluid can be used to dilute the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

13. An 82-year-old patient returns to the floor after being gone for 1 hour for an x-ray examination. On return, the nurse notes that 700 mL of fluid have infused during the last hour and the patient is short of breath. What is the nurses best action?
a. Check the intravenous (IV) site and document the findings.
b. Slow the IV rate and notify the prescriber immediately.
c. Discontinue the IV therapy and notify the prescriber immediately.
d. Notify the prescriber and ask whether the IV therapy should be discontinued.
ANS: B
A volume of 700 mL in an hour is a large amount, even for a much younger patient. The fact that this 82-year-old is now short of breath is an indicator of fluid overload. The nurse slows the IV rate but does not discontinue it. It may be needed to administer IV drugs to treat the fluid overload. The prescriber must be notified immediately of the patients change in status and this IV volume error.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

ESSAY

1. What is the hourly flow rate for 250 mL of normal saline to be administered over 2 hours?
_____ mL/hour

ANS:
125 mL/hour
The patient should receive 125 mL per hour (250 mL 2 hours = 125 mL).

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 87 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. A patient is to receive 1000 mL of D5W intravenously over 6 hours. The nurse selects a tubing set with a drop factor of 15 gtt/mL. How many drops per minute are needed to infuse this fluid in the prescribed time?
_____ gtt per minute

ANS:
42 gtt per minute
1000 mL in 6 hours = 167 mL per hr (1000 6 = 166.6 mL, round up to 167). 2.8 mL per min (167 mL 60 min = 2.78 mL, round up to 2.8 mL per min); 42 gtt per min (2.8 mL drop factor of 15 = 42 gtt per min)

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Safe and Effective Care Environment

3. A patient is to receive 100 mL of normal saline over the next 5 hours with microdrip tubing. How many drops per minute does the nurse administer to infuse this fluid in the prescribed time?
_____ gtt per minute

ANS:
20 gtt per minute
The flow rate for 100 mL over 5 hours is 20 mL per hour (100 mL 5 hr). With microdrip tubing, the drop factor of 60 drops per mL is the same as the number of minutes in 1 hour (60). The two sets of 60 cancel each other out, and the flow rate for microdrip tubing always equals the drop rate. So, 20 mL per hr by microdrip tubing = 20 gtt per minute.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Safe and Effective Care Environment

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