Basic Pharmacology For Nurses 17th Edition By Clayton – Test Bank

Chapter 11: Parenteral Administration: Intravenous Route
Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

MULTIPLE CHOICE

1. A patient is diagnosed with cancer and requires 6 months of chemotherapy infusions. Which type of intravenous (IV) access device will likely be used?
a. Peripheral venous access device
b. Midline catheter
c. Winged needle venous access device
d. Implantable venous infusion port

ANS: D
Implantable venous infusion ports are placed into central veins for long term therapy. Chemotherapy treatment is often irritating and best tolerated in the larger central veins. Peripheral lines are not used for administration of chemotherapy because of the risk of extravasation. A midline catheter is intended only for a 2 to 4 week interval, less than the projected length of time for chemotherapy infusion. Winged needles are for use in peripheral veins that are too small for ongoing infusion of chemotherapy.

DIF: Cognitive Level: Application REF: Page 147 | Page 149
OBJ: 5 TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment

2. The nurse notes that a patient with cardiac disease has IV heparin infusing and that it is behind by 2 hours. What is the best nursing action?
a. Increase the IV rate and recheck in 1 hour.
b. Change the infusion rate to TKO.
c. Discontinue the solution using aseptic technique.
d. Contact the health care provider for consultation.

ANS: D
The patient has a history of cardiac problems and is receiving a critical care medication, IV heparin. In this case, contacting the patient’s health care provider would be appropriate to avoid harm. Increasing the infusion rate might place the patient into fluid overload and might infuse too much heparin in a short time. Reducing the infusion rate to TKO or discontinuing the solution would put the schedule even further behind.

DIF: Cognitive Level: Application REF: Page 154 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Safety; Collaboration; Communication

3. What is the composition of hypotonic intravenous solutions such as 0.45% NaCl?
a. Fewer dissolved particles than blood
b. Approximately the same number of dissolved particles as blood
c. Higher concentrations of dissolved particles than blood
d. Electrolytes and dextrose

ANS: A
Hypotonic solutions have fewer dissolved particles than blood. Half normal saline does not contain dextrose.

DIF: Cognitive Level: Knowledge REF: Page 150 OBJ: 3
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Fluid and Electrolyte Balance; Cellular Regulation

4. Which condition would the nurse expect to be treated with an isotonic solution?
a. Fluid overload
b. Hemorrhagic shock
c. Cellular dehydration
d. Cerebral edema

ANS: B
Isotonic solutions have approximately the same osmolality as blood. Isotonic fluids are ideal replacement fluids for patients experiencing an intravascular fluid deficit that occurs in conditions such as acute blood loss from hemorrhage and gastrointestinal bleeding. Isotonic fluids increase vascular volume, thus counteracting hypovolemia and hypotension. Administering isotonic solutions for fluid overload would exacerbate the problem. Hypotonic solutions are administered for cellular dehydration. Hypertonic solutions are administered for cerebral edema.

DIF: Cognitive Level: Application REF: Page 150 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Fluid and Electrolyte Balance; Cellular Regulation

5. The nurse determines that an elderly patient’s IV of D50.2 NS with 20 mEq KCl at 75 mL/hr is running 3 hours behind. After determining the IV site is patent, what action will the nurse take?
a. Call the health care provider to obtain an order to decrease the IV rate.
b. Administer a bolus to make up the deficit.
c. Recalculate the flow rate and slowly make up the fluids.
d. Maintain the ordered rate.

ANS: D
The safest action is to maintain the ordered rate. The health care provider should be consulted if the patient has not received critical IV replacement therapy. Increasing an IV rate without a health care provider’s order can be detrimental for patients who have cardiac, renal, or circulatory impairment. Normal aging process results in decreased cardiac, renal, and circulatory function. The rate ordered is the one the provider intended for the administration of fluids; changing it to fit the prevailing situation is not appropriate. The bolus technique should only be used for the administration of medications or fluid challenges in patients who need a volume of IV fluid quickly. The flow rate must be consistent with the provider’s order.

6. Which technique by the nurse accurately maintains asepsis of a peripheral IV access device?
a. Wear gloves when hanging all IV solutions.
b. Apply a topical antibiotic ointment to the insertion site.
c. Change fluid administration sets according to institutional policy.
d. Flush with heparin before use.

ANS: C
Generally all IV solution bag and bottles should be changed every 24 hours to minimize the development of new infections. IV administration sets used to deliver blood and blood products are changed after each unit is administered. Administration sets to deliver lipids and TPN are often changed every 4 hours, whereas administration sets for maintenance fluids may be changed every 72 hours. It is important to follow institutional policies. All IV bags, bottles, and administration sets should be labeled with the date, time, and nurse’s initials of the set change. Wearing gloves is not required for maintenance of routine infusion. Topical antibiotics may promote fungal infections and antimicrobial resistance. A peripheral line that is infusing should not need an anticoagulant to maintain patency.

DIF: Cognitive Level: Application REF: Page 153 OBJ: 8
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Safety; Infection; Health Promotion

7. Which needle is used to access implanted infusion devices?
a. Jamshidi
b. Huber
c. Gigli
d. Crutchfield

ANS: B
The Huber needle is a special noncoring 90-degree needle used to penetrate the skin and septum of the implanted device. The Jamshidi needle is used for biopsy purposes such as bone marrow. The Gigli saw is a wire with serrations used to cut through cranial bone. Crutchfield tongs are used to stabilize the cervical spine by traction in cases of fracture.

DIF: Cognitive Level: Comprehension REF: Page 149 OBJ: 5
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment

8. The nurse assesses erythema, warmth, and burning pain along the patient’s IV site. Which complication is this patient most likely experiencing?
a. Air embolism
b. Extravasation
c. Phlebitis
d. Pulmonary edema

ANS: C
Erythema, warmth, and tenderness along the course of the vein and swelling are signs of phlebitis. Air embolism occurs as a result of an air bubble entering the vascular system, and shortness of breath, chest pain, and hypotension are indicative of this complication. Extravasation is the leakage of an irritant and is accompanied by redness, warmth or coolness, swelling, and a dull ache to severe pain at the venipuncture site. Pulmonary edema is caused by fluid infusing too rapidly; dyspnea, cough, anxiety, rales, and possible cardiac dysrhythmias are indicative of pulmonary edema.

DIF: Cognitive Level: Comprehension REF: Page 171 OBJ: 9
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Infection; Tissue Integrity; Perfusion

9. An elderly patient receiving an infusion of an isotonic fluid at 100 mL/hr complains of dyspnea. The nurse notes shallow rapid respirations and a cough that produces frothy sputum. Which is the priority nursing action?
a. Assess the urine output.
b. Elevate the head of the bed.
c. Encourage the patient to cough.
d. Maintain the IV rate.

ANS: B
Elevating the head of the bed is an appropriate action for signs and symptoms of pulmonary edema. Urine output is important to assess, but it is not the priority nursing action. Encouraging the patient to cough and take deep breaths is not the priority nursing action. The IV rate should be slowed immediately based on the signs and symptoms the patient is displaying.

DIF: Cognitive Level: Application REF: Page 172 OBJ: 9
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Fluid Electrolyte Balance; Perfusion

10. A diabetic patient requires the administration of insulin continuously at home. Which system would most likely be used in this instance?
a. Central line catheter
b. Microdrip set
c. Piggyback system
d. Syringe pump

ANS: D
Syringe pumps are used in patients with diabetes. A central line is not appropriate for the diabetic patient requiring insulin. A microdrip set is a type of IV tubing that is used when small volumes of fluid are given to patients with fluid volume concerns. A piggyback system is a type of administration set that connects to a primary setup and administers a small volume over 20 to 60 minutes.

DIF: Cognitive Level: Application REF: Page 147 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety