Quiz 79: Intravenous and Vascular Access Therapy
Perry et al.: Clinical Nursing Skills & Techniques, 9th Edition
Instructor Verified Answers Included
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1. The nurse is caring for a patient receiving antineoplastic medications intravenously. The nurse discovers that the intravenous site is red, edematous, and painful. The nurse knows that antineoplastic medications are vesicant medications and documents that the patient has experienced which of the following events?
2. Established standards for routine replacement of peripheral IV catheters and intravenous administration sets have recommended a maximum of _____ hours to reduce intravenous (IV) fluid contamination and prevent catheter site complications.
3. While assessing the patient, the nurse recognizes that special caution should be taken with the intravenous (IV) infusion because of fluid volume excess when the nurse notes the presence of which condition?
a. Poor skin turgor
b. Crackles in the lungs
c. Decreased blood pressure
d. Dry skin and mucous membranes
4. The nurse needs to specifically prevent air emboli that may result from intravenous (IV) therapy. What should the nurse make sure to do to prevent air emboli?
a. Use a needleless system.
b. Prime the tubing completely.
c. Check for medication compatibility.
d. Select a larger-gauge needle or catheter.
5. Which of the following steps is necessary when a patient is prepared for intravenous (IV) catheter insertion?
a. Shaving the hair from the site
b. Selecting a proximal site in an extremity
c. Applying a tourniquet 4 to 6 inches above the selected site
d. Vigorously taping and massaging the selected vein
6. What should be the next action by the nurse once an over-the-needle catheter (ONC) has been inserted through the skin and into the vein?
a. Loosen the stylet for removal.
b. Check for blood return in the flashback chamber.
c. Stabilize the catheter and release the tourniquet.
d. Advance the catheter until the hub rests at the insertion site.
7. What should the nurse do once she recognizes that the patient has phlebitis at his intravenous (IV) catheter site?
a. Reduce the IV flow rate.
b. Elevate the affected extremity.
c. Place a moist warm compress over the site.
d. Adjust the additive in the current IV.
8. What should the nurse do upon noting bleeding around a dressing at an intravenous (IV) catheter insertion site?
a. Discontinue the IV.
b. Assess the insertion site.
c. Leave the dressing intact, but reinforce it.
d. Elevate and apply warm compresses to the extremity.
9. Which patient would a nurse anticipate would be a candidate for a peripherally inserted central catheter (PICC)?
a. An older adult who is having cataracts removed
b. A perinatal patient who is having prolonged labor
c. A neonate requiring blood therapy
d. An adolescent who is having surgery for reduction of a fracture
10. The nurse is caring for a patient receiving intravenous therapy. The nurse should report which of the following to the primary care provider?
a. Completion of each liter of fluid
b. Initiation of intravenous (IV) fluids
c. Small infiltration
11. The patient has intravenous (IV) therapy ordered to infuse at 1000 mL over 10 hours. The infusion set has a calibration of 15 gtt/mL. At which rate does the nurse regulate the infusion?
a. 20 gtt/min
b. 25 gtt/min
c. 30 gtt/min
d. 32 gtt/min
12. The order is for the patient to receive 500 mL over 4 hours. The nurse has an electronic infusion device (EID) in place that provides for the regulation of hourly infusion. The intravenous (IV) tubing available is 10 gtt/mL. What is the setting for the infusion device?
a. 125 mL/hr
b. 500 mL/hr
c. 21 gtt/min
d. 32 gtt/min
13. A pediatric patient has an intravenous (IV) catheter with microdrip tubing. The order is for 40 mL/hr to infuse. At what rate does the nurse set the microdrip?
a. 10 gtt/min
b. 20 gtt/min
c. 40 gtt/min
d. 80 gtt/min
14. While assessing the patient’s intravenous (IV) infusion, the nurse notes that it is infusing more slowly than it should be. What should the nurse do first?
a. Discontinue the IV.
b. Increase the rate of infusion.
c. Observe for fluid overload.
d. Check the position of the IV fluid and extremity.
15. The nurse caring for a patient receiving intravenous (IV) fluids knows that the current recommendation for changing the tubing on a continuously running IV is:
a. at least every 48 hours.
b. every 24 hours.
c. no more often than every 96 hours.
d. with each IV solution bag change.
16. The nurse is caring for a patient diagnosed with pneumonia who receives intravenous (IV) antibiotics every 8 hours. How often should the nurse change the primary intermittent IV sets?
a. No more often than every 72 hours
b. At least every 72 hours
c. With each IV bag change
d. Every 24 hours
17. What is an appropriate technique for the nurse to implement when changing the dressing at a peripheral intravenous (IV) catheter site?
a. Wear sterile gloves to remove the old dressing.
b. Keep one finger over the IV catheter until the tape is replaced.
c. Cleanse with an antiseptic solution in a circular manner toward the site.
d. Tape the connection between the IV catheter port and the tubing.
18. What should the nurse do when discontinuing a peripheral intravenous (IV) catheter?
a. Withdraw the catheter quickly.
b. Keep the hub perpendicular to the skin.
c. Apply pressure to the site for 1 minute.
d. Inspect the catheter for intactness after removal.
19. The patient is expected to require intravenous therapy for several years as treatment for a chronic disease process. Which of the following would be the best choice for venous access in this patient?
a. Peripherally inserted central catheter (PICC)
b. Nontunneled percutaneous central venous catheter
c. Subcutaneous implanted port
d. Peripheral IV
20. The nurse is assisting the physician during the insertion of a central line into the subclavian vein. How should the nurse cleanse the area?
a. With chlorhexidine in a back and forth scrubbing motion
b. With chlorhexidine followed by alcohol in a back and forth scrubbing motion
c. With alcohol in a circular motion for 5 minutes
d. With antimicrobial solution that must be dabbed dry with a sterile towel
21. The nurse is preparing to draw blood from a central venous access device for blood cultures. Which of the following steps is part of that process?
a. Apply sterile gloves.
b. Flush the port with 5 to 10 mL of 0.9% sodium chloride.
c. Slowly aspirate 5 mL of blood and discard the syringe.
d. Use the distal lumen to draw blood.
22. What should the nurse do to decrease the potential for infection related to intravenous (IV) infusion therapy?
a. Use the clean technique for dressing changes.
b. Change the IV tubing every 12 hours.
c. Palpate the insertion site daily through the intact dressing.
d. After cleansing the skin, dab it dry with a sterile gauze pad.
23. The nurse is caring for a patient with a continuous intravenous infusion of 0.9% normal saline with 40 mEq of potassium chloride added to each liter. During a routine hourly check of the infusion, the nurse discovers that 4 hours of fluid has infused in the past 1 hour. The nurse’s first action should be to:
a. notify the primary care provider.
b. assess the patient.
c. reduce the infusion rate.
d. notify the charge nurse.
24. The nurse is caring for a patient who has experienced hypovolemia secondary to acute vomiting and diarrhea. The nurse anticipates what type of intravenous fluid to be ordered by the health care provider?
a. Hypotonic or isotonic solutions
b. Hypertonic or isotonic solutions
c. Hypertonic solutions only
d. Whole blood
25. Which of the following patients would the nurse anticipate requiring the placement of a central venous catheter?
a. A patient in same-day surgery who might require blood transfusions
b. A patient in the intensive care unit requiring multiple simultaneous intravenous medications
c. A patient in the cardiac care unit diagnosed with possible myocardial infarction
d. A patient on the surgical unit recovering from hernia repair
26. The nurse assigns nursing assistive personnel (NAP) to care for several patients with continuous IV infusions. Which of the following can NAP assist with?
a. Changing empty IV solution containers
b. Confirming the correct IV drip rate
c. Assessing the patient for response to IV therapy
d. Informing the nurse if they notice anything abnormal
1. The patient is on daily weights and is receiving intravenous therapy. The nurse notices that the patient has gained 2 kg since the previous morning. What else would the nurse expect to observe? (Select all that apply.)
a. Dry skin and mucous membranes
b. Distended neck veins
c. Tenting of the skin
d. Crackles or rhonchi in the lungs
2. What should the nurse do upon noting that the patient’s intravenous (IV) catheter site is pale, cool, and edematous? (Select all that apply.)
a. Stop the infusion.
b. Elevate the extremity.
c. Start a new IV.
d. Flush the IV site.
3. The nurse is preparing to start an intravenous (IV) infusion on a 92-year-old patient. The nurse realizes that she may need to take which of the following actions? (Select all that apply.)
a. Avoid using veins in the hand.
b. Avoid using veins in the dominant arm.
c. Use the largest-gauge catheter possible for maximum flow.
d. Avoid using a tourniquet.
4. For which patients are electronic infusion devices (EIDs) used? (Select all that apply.)
a. Those who require low hourly rates
b. Those who are at risk for volume overload
c. Those who have impaired renal clearance
d. Those who are receiving fluids that require a specific hourly volume
5. Central venous access devices (CVADs) can be used in the home, in the hospital, and in long-term care facilities for patients who require which of the following? (Select all that apply.)
a. Supplemental nutrition
b. Blood and blood products
c. Hemodynamic monitoring
d. Blood sampling
6. Which of the following are central venous access devices (CVADs)? (Select all that apply.)
a. Implanted subcutaneous ports
b. Peripherally inserted central catheter (PICC) lines
c. Saline locks
d. Heparin locks
1. Fluids that have the same osmolality as body fluids are used most often to replace extracellular volume and are known as _______________ fluids.
2. _________________________ pull fluid into the vascular space by osmosis, resulting in an increased vascular volume that possibly will result in pulmonary edema.
3. The nurse is caring for a patient who will be on long-term antibiotic therapy. The patient has had numerous intravenous (IV) catheters in the past, but because the upcoming therapy will be given on a long-term basis, the nurse suggests that a _________________ be inserted.
4. The nurse is caring for a patient who has a peripheral intravenous (IV) catheter. While performing her routine assessment, she notes that the insertion site is pale, cool, and edematous. The patient indicates that the site is also painful to the touch. The nurse recognizes these symptoms as revealing a possible _______________.
5. ___________________ is manifested by decreased urine output, dry mucous membranes, decreased capillary refill, a disparity in central and peripheral pulses, tachycardia, hypotension, and shock.
6. The nurse is caring for a patient who is receiving intravenous (IV) fluids at a rate of 150 mL per hour. During her assessment, the nurse notes that the patient is having more labored respirations, and that crackles have developed in the patient’s lungs. The nurse reduces the IV rate and notifies the physician. She does this while recognizing that the patient is experiencing signs of _______________.
7. While assessing the patient’s intravenous (IV) catheter site, the nurse notes that the site is reddened and warm. The patient states that it is “sore.” The nurse recognizes these as signs of ____________.
8. An electronic device that delivers a measured amount of intravenous fluid over a specified period (e.g., 100 mL/hr) using positive pressure is called an ___________________.
9. Intravenous pumps that have built-in software programmed from health care pharmacy databases with unit-specific profiles are known as ______________.
10. An intravenous catheter that is inserted through a large arm vein and is advanced until the tip enters the central venous system is known as a __________________.
11. Intravenous catheters that are inserted directly through the skin and into the internal or external jugular, subclavian, or femoral vein for up to several weeks are known as _______________.
12. _________________________ are surgically inserted through a tunnel into subcutaneous tissue, usually between the clavicle and the nipple, into the internal jugular or subclavian vein, with the catheter tip resting in the distal end of the superior vena cava. The subcutaneous tunnel allows the catheter to remain in place for months to years.