Chapter 20- Intravenous Therapy Nursing School Test Banks

 

1.

The nursing instructor is discussing IV fluid overload with the nursing students. Which of the following will the nurse include in her discussion? Select all that apply.

A)

The use of packed cells instead of whole blood will decrease the fluid volume delivered to the patient.

B)

A symptom of fluid overload is distended neck veins.

C)

The patient will likely develop a fever in the presence of fluid overload

D)

Fluid overload is more likely in very young children

E)

The infusion rate must be carefully monitored during the administration of blood.

Ans:

A, B, D, E

Feedback:

Fluid overload can occur if blood components are infused too quickly or too voluminously. Transfusion-associated circulatory overload is more likely in the very young patient or the older adult with poor cardiac or renal function. Symptoms include increased venous pressure, distended neck veins, dyspnea, coughing, and abnormal breath sounds. Circulatory overload can be minimized by infusing packed RBCs (rather than whole blood) and volume-reduced platelets for high-risk patients and carefully monitoring the infusion rate of blood components.

2.

The nurse is administering blood to the patient. During the infusion, the patient reports a headache and feeling very tired. Which of the following will the nurse do first?

A)

Notify the physician

B)

Notify the blood bank

C)

Check the patients vital signs

D)

Check the patients temperature

E)

Stop the infusion

Ans:

E

Feedback:

If symptoms occur after the infusion of blood has started, stop the transfusion immediately and keep the IV open with normal saline.

3.

The chemotherapy patient has been admitted for thrombocytopenia. Which of the following blood products will the nurse anticipate administering?

A)

Platelets

B)

Fresh frozen plasma

C)

Whole blood

D)

Packed cells

E)

White blood cells

Ans:

A

Feedback:

One common indication for platelet transfusion is thrombocytopenia following chemotherapy.

4.

A patient with chronic anemia is admitted for the administration of blood. Which of the following would the nurse expect the physician to order?

A)

Whole blood

B)

Packed cells

C)

White blood cells

D)

Platelets

E)

D5W 1000 mL

Ans:

B

Feedback:

Packed cells are especially useful in the treatment of chronic anemia.

5.

A 2-year-old child has been injured in a motor vehicle accident and is in immediate need of a blood transfusion for profuse bleeding. Which of the following access sites might the nurse expect to use for the infusion?

A)

Antecubital

B)

Dorsalis pedis

C)

Great saphenous vein

D)

Scalp vein

E)

Intraosseous access

Ans:

E

Feedback:

Intraosseous access with a large-bore rigid needle inserted into the medullary cavity of a long bone may be required for the critically injured child who needs emergency fluid, medication, or blood administration, if adequate venous access is not accessible.

6.

The nurse is discussing epidural analgesia with the nursing student. Which of the following statements by the nursing student indicate a need for additional education?

A)

Epidural analgesia is always administered in a continuous infusion to prevent or treat the patients pain.

B)

The patient may be able to control the epidural analgesia infusion.

C)

The epidural analgesia may be used in the laboring patient.

D)

The epidural is always discontinued after delivery of the newborn.

Ans:

A

Feedback:

The infusion can be set on a continuous rate (basal mode) or an intermittent mode controlled by the patient (patient-controlled epidural analgesia [PCEA]).

7.

The charge nurse on the medical/surgical unit is reviewing physician orders for a patient with a diagnosis of congestive heart failure. Which of the following infusion orders would the nurse question?

A)

50 mL D5W to run in 60 minutes

B)

250 mL 0.9 NaCl to run in 60 minutes

C)

1000 D5W to run in 30 minutes

D)

20 mL 0.9 NaCl to run in 20 minutes

Ans:

C

Feedback:

Medications administered by intermittent infusion are supplied either in bags that contain 50 to 250 mL of IV fluid (0.9 normal saline or 5% dextrose in water) or in 20- to 60-mL syringes to be used with an infusion pump.

8.

Which of the following are required to manually regulate an IV drip? Select all that apply.

A)

A clock

B)

A minimum of 1000 cc of fluid

C)

Tubing with a roller clamp

D)

An antecubital access site

Ans:

A, C

Feedback:

A roller clamp adjusts the flow rate according to drops per minute counted in the drip chamber. Count the drops as they fall into the drip chamber for 15 seconds, then multiply this number by 4 to determine the rate of flow for 1 full minute. Use the roller clamp to adjust the flow rate until it corresponds with the prescribed rate of flow.

9.

The nurse is preparing to insert an intravenous needle in a 1-year-old child for a one-time administration of fluids due to dehydration. Which of the following needles would the nurse likely select?

A)

A 22-gauge intravenous catheter

B)

A 19-gauge winged infusion set

C)

A 23-gauge winged infusion set

D)

An 18-gauge intravenous catheter

Ans:

C

Feedback:

Winged infusion or small vein needles may be used for short-term or one-time infusion therapies or may be used with infants and small children. These are short, beveled needles with plastic flaps or wings.

10.

A patient suffers from a genetic bleeding deficiency. What blood product will be administered?

A)

Whole blood

B)

Albumin

C)

Platelets

D)

Cryoprecipitate

Ans:

D

Feedback:

Cryoprecipitate may be pooled from several units of blood and administered to patients with fibrinogen deficiencies who are predisposed to bleeding problems because genetically they lack Factor VII.

11.

A patient suffers from infectious diarrhea. Based on her loss of fluid, her protein level is below normal. What blood product will the physician order to restore intravascular volume?

A)

Whole blood

B)

Packed red cells

C)

Platelets

D)

Albumin

Ans:

D

Feedback:

Albumin is a plasma protein contained within the plasma. It is used to restore intravascular volume and to maintain cardiac output in patients with hypoproteinemia.

12.

A central line is inserted by the medical resident on an elderly patient. During the insertion, you assess the patients sudden shortness of breath. What does this symptom indicate?

A)

Pneumothorax

B)

Myocardial infarction

C)

Hemothorax

D)

Pulmonary embolism

Ans:

A

Feedback:

Pneumothorax may occur during insertion of a central venous catheter if the catheter inadvertently punctures the pleural membrane. Symptoms of a pneumothorax include chest or shoulder pain, sudden shortness of breath, tachycardia, and absence of breath sounds on the affected side.

13.

Which of the following nursing actions is appropriate in the care of a patient with an implanted vascular access device?

A)

Cleanse around the site of insertion with an antibacterial solution

B)

Clean the external portion of the catheter after infusion is complete

C)

Maintain patency by routine flushing with a heparinized solution

D)

Observe the site only; only the physician will assess the site

Ans:

C

Feedback:

Most central line catheters and implanted vascular devices are flushed with a heparinized solution.

14.

A young woman has an IV infusing for magnesium sulfate to treat preterm labor. The woman develops a fever. What is the first assessment the nurse should make?

A)

Monitor the IV infusion rate

B)

Assess the vaginal mucosa

C)

Assess the IV site for redness

D)

Assess the patients blood pressure

Ans:

C

Feedback:

If tenderness, fever without obvious source, or symptoms of local or bloodstream infection are present, remove the dressing and inspect the site directly.

15.

When preparing to start an intravenous infusion on an adult, the nurse should

A)

Prepare the skin with 70% alcohol and povidone-iodine

B)

Apply sterile gloves before inserting the intravenous device

C)

Place a cold cloth over the intended site for greater access

D)

Place a tourniquet 2 below the selected site

Ans:

A

Feedback:

Prepare the site using a vigorous circular motion, with 70% alcohol as a defatting agent; work from the center outward to a diameter of 2 to 3; follow with an application of povidone-iodine.

16.

The nurse is educating a patient with a peripheral intravenous infusion of dextrose 5%. What is the most important information to share with the patient who has an IV infusing in the right hand?

A)

Keep the IV fluids 18 inches above the extremity

B)

Caution the patient not to bend the right wrist

C)

Instruct on ambulating with an IV pole

D)

Instruct the patient on fluid volume excess

Ans:

B

Feedback:

Bending the extremity at a point of flexion, such as the wrist or elbow, or leaning on the arm can slow the rate of infusion.

17.

The nurse has an order to infuse 1000 mL of dextrose 5% with 0.45 normal saline. The infusion is ordered over 8 hours. The solution set delivers 10 gtt/cc. How many drops per minute will the nurse need to infuse the intravenous fluids?

A)

5 gtts/minute

B)

15 gtts/minute

C)

21 gtts/minute

D)

30 gtts/minute

Ans:

C

Feedback:

The drip rate of an IV that is to infuse 1000 mL in 8 hours using a 10-gtt infusion set is 21 gtts/minute.

18.

A patient requiring frequent chemotherapeutic products will require a(an)

A)

Multilumen central catheter

B)

Central venous access

C)

Over-the-needle catheter

D)

Hickman catheter

Ans:

D

Feedback:

When IV therapy is needed for a long time, a more permanent catheter is used. Hickman, Groshong, and Broviac are common brand names of these catheters.

19.

Total parenteral nutrition is hypertonic. What is the percentage of dextrose in these solutions?

A)

2.5% dextrose

B)

5% dextrose

C)

10% dextrose

D)

50% dextrose

Ans:

D

Feedback:

Total parenteral nutrition is a hypertonic solution containing 20% to 50% dextrose, proteins, vitamins, and minerals that is administered into the venous system.

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