Chapter 11 Parenteral Administration: Intravenous Route

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Chapter 11  Parenteral Administration: Intravenous Route

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

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.

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; Fluid and Electrolyte Balance; Cellular Regulation

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