I.V. Therapeutics Evidence Based Practice for Infusion Therapy 6th Edition by Lynn Dianne Phillips, Lisa Gorski – Test Bank

I.V. Therapeutics Evidence Based Practice for Infusion Therapy 6th Edition by Lynn Dianne Phillips, Lisa Gorski – Test Bank

Chapter 6: Techniques for Initiation and Maintenance of Peripheral Infusion Therapy

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A client is being discharged to home with continuous I.V. infusion therapy. Which assessment made by the nurse before proceeding with the discharge plan is most important?

a.

If the client lives alone

b.

If the client is medically stable

c.

If the client has a working telephone

d.

If the client has a working refrigerator

____ 2. A nurse is time-taping an I.V. bag of 1,000 mL that is to infuse over 8 hours. The nurse places the 1100 hour marking at the 500-mL level. At which level should the nurse place the mark for 1200 hours?

a.

350 mL

b.

375 mL

c.

400 mL

d.

425 mL

____ 3. A nurse is inspecting a container of infusate prior to client administration. Prior to use, the infusate solution container should be inspected for:

a.

clarity, the expiration date, and air vents.

b.

clarity, the expiration date, and punctures or cracks.

c.

clarity, punctures or cracks, and the number of access ports.

d.

the number of access ports, the expiration date, and floating particles.

____ 4. A nurse is initiating infusion therapy for a client using a Teflon over-the-needle catheter (ONC). The major hazard associated with the use of Teflon ONCs for peripheral infusion is:

a.

risk for phlebitis.

b.

risk for infiltration.

c.

that they can be used for only 24 hours.

d.

that they can remain in place for only 48 hours.

____ 5. A medical-surgical nurse is caring for multiple clients who have peripheral I.V. access devices. According to the Centers for Disease Control and Prevention (CDC), how often should the nurse change the clients’ I.V. catheters?

a.

As needed (PRN)

b.

At 24- to 48-hour intervals

c.

At 48- to 72-hour intervals

d.

At 72- to 96-hour intervals

____ 6. A nurse is calculating the drip rate before initiating an I.V. infusion. Upon which factor(s) should the calculation of the drip rate depend?

a.

Drop factor of tubing

b.

Tubing length and filter size

c.

Drop factor of the tubing and physician order of mL/hr

d.

Filter size and number of injection ports on administration set

____ 7. A nurse is preparing to initiate an I.V. infusion on a 3-year-old child. Which action should be taken by the nurse initially?

a.

Explain the procedure completely.

b.

Explain the procedure in simple terms.

c.

Restrain the child to perform the venipuncture.

d.

Provide reading materials before performing venipuncture.

____ 8. A nurse is attempting to obtain venous access on a 2-month-old infant. Which cannula size should the nurse select for use with this client?

a.

16-gauge scalp vein (metal) needle

b.

18-gauge over-the-needle catheter (ONC)

c.

22- to 24-gauge ONC

d.

23- to 25-gauge scalp vein (metal) needle

____ 9. A nurse is preparing to initiate an I.V. infusion on a toddler. To prevent fluid overload, the nurse understands that the toddler’s I.V. container should contain no more than:

a.

500 mL of fluid.

b.

1,000 mL of fluid.

c.

24-hour volume requirements of fluid.

d.

hourly volume requirements of fluid.

____ 10. A nurse is preparing to administer an I.V. potassium infusion I.V. piggyback to an older adult client diagnosed with hypokalemia. Which age-related body change may cause increased cardiac sensitivity to potassium infusion?

a.

Decreased muscle strength and a loss of bone density

b.

Decreased cough efficiency and decreased vital capacity

c.

Decreased salivation and decreased gastrointestinal motility

d.

Decreased lean body mass and decreased glomerular filtration rate

____ 11. A physician orders an I.V. infusion for a dehydrated older adult client diagnosed with congestive heart failure. A nurse prepares to implement the physician’s order. Which would be an appropriate choice of infusion equipment for the older adult client with cardiovascular compromise?

a.

Inline filter

b.

T adapter

c.

Three-way stopcock

d.

Microdrop administration set

____ 12. A prudent medical-surgical nurse frequently monitors the I.V. sites of his older adult clients because:

a.

older adult clients always pull at their I.V. lines.

b.

the veins of older adults always rupture, causing infiltration.

c.

older adult clients need to be mobile, therefore placing I.V. patency at risk.

d.

age-related neurologic changes can reduce tactile sensation, allowing infiltration or phlebitis to become severe before the client notices any discomfort.

____ 13. A nurse is applying a transparent, semipermeable membrane dressing to an I.V. site. The nurse should take care to place the dressing so that it:

a.

covers only the area surrounding the I.V. entry site.

b.

can be removed for observation of the site every 4 hours.

c.

covers the area surrounding the I.V. entry site up to the top margin of the cannula hub to help stabilize the cannula.

d.

covers the I.V. entry site, the catheter hub, and the connection between the I.V. device and the administration set tubing.

____ 14. A client is scheduled for surgical insertion of a midline catheter. A nurse explains to the client that a midline catheter is any peripheral catheter that is placed:

a.

with the tip in any location between the antecubital fossa and the subclavian vein.

b.

between the antecubital fossa and 3 to 5 cm distal to the axillary vein.

c.

between the antecubital fossa and 6 to 8 cm proximal to one of the innominate veins.

d.

between the antecubital fossa and the head of the clavicle, with optimal tip location level with the axilla.

____ 15. According to Infusion Nurses Society Standards of Practice (2011), which of the following should be used to secure the infusion device after insertion?

a.

Paper tape

b.

Stabilization device

c.

Sutures

d.

Combination of transparent, semipermeable membrane dressing and tape

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. A nurse is selecting a peripheral vein for I.V. access. Which factors should affect the nurse’s choice of an I.V. site? SELECT ALL THAT APPLY.

a.

Type of solution

b.

Condition of vein

c.

Whether client is right or left handed

d.

Presence of disease, shunts, or grafts in the extremity

____ 2. A critical care nurse is using a 0.22-mm filter for the delivery of infusion therapy. According to the Infusion Nurses Society’s Standards of Practice (2011), for nonlipid-containing solutions that require filtration, a 0.2-mm filter should be:

a.

air eliminating.

b.

particulate retentive.

c.

fat emboli reducing.

d.

bacterial retentive.

____ 3. Documentation of initiation of a short-peripheral infusion (PIV) device should include which of the following?

a.

Device type, length, and gauge

b.

Manufacturer and lot number

c.

Date and time of insertion

d.

Number and location of attempts

____ 4. A nurse is preparing to start a 30-year-old adult, normotensive client’s I.V. line. Which techniques best assist the nurse in distension of veins before cannulation? SELECT ALL THAT APPLY.

a.

Application of a blood pressure cuff with setting of 30 mm Hg

b.

Placing a cool compress over the site for 10 minutes

c.

Placing a warm compress over the site for 10 minutes

d.

Use of multiple tourniquet techniques

____ 5. A pediatric intensive care unit nurse is preparing to obtain an I.V. access using an infant’s scalp vein. The nurse is thinking critically about which type of catheter to use. What are the advantages of over-the-needle catheter (ONCs) needles over metal scalp vein needles? SELECT ALL THAT APPLY.

a.

ONCs are radiopaque.

b.

ONCs are patent longer than scalp vein needles.

c.

ONCs have decreased infiltration risks.

d.

ONCs have a low incidence of mechanical phlebitis.

____ 6. A nurse is selecting a peripheral vein for venipuncture. Which factors should affect the nurse’s choice of an I.V. site? SELECT ALL THAT APPLY.

a.

Condition of the vein

b.

Client’s preference

c.

Duration of therapy

d.

Type of solution to be administered

e.

Presence of disease, shunts, or grafts in the extremity

____ 7. A nurse has finished placing a 20-gauge over-the-needle catheter in a client’s forearm for a continuous infusion of 1000 mL of 5% dextrose and 0.45% sodium chloride. After the infusion has been initiated, which items should be labeled? SELECT ALL THAT APPLY.

a.

Tubing

b.

Catheter site

c.

Solution container

d.

Client’s armband

____ 8. A nurse is initiating I.V. therapy on a client who is receiving anticoagulant therapy. Which techniques should the nurse use when starting an I.V. line on this client?

a.

Avoid use of a tourniquet if possible or apply loosely.

b.

Avoid excess pressure when cleansing the skin.

c.

Use alcohol to loosen dressing.

d.

Use multiple tourniquet technique to dilate vein.

Completion

Complete each statement.

1. A physician orders 1,000 mL of 5% dextrose and lactated Ringer’s solution infused intravenously at 80 mL/hr. The nurse time-tapes the bag with a start time of 0700 hours. Based on this information, the infusion should be complete at _______ hours. Fill in the blank.

2. A physician orders 1,000 mL of 5% dextrose in water at 50 mL/hr. A nurse uses tubing with a drop factor of 15. The nurse calculates that the I.V. solution should be infused at _____ drops per minute (gtt/min). Fill in the blank.

3. A physician orders 1,000 mL of 5% dextrose and 0.45% sodium chloride to be infused intravenously at 125 mL/hr. A nurse uses tubing with a drop factor of 20. The nurse calculates that the I.V. solution should be infused at _____ drops per minute (gtt/min). Fill in the blank.

4. A child who weighs 10 kg sustains an estimated total body surface area (TBSA) burn of 50% from a house fire. The Parkland formula of fluid resuscitation is used to determine the amount of fluid that this child requires. According to this formula, a nurse should intravenously administer _____ mL of fluid to the child in the first 8 hours from the time of the injury. Fill in the blank.

5. A physician orders 0.45% sodium chloride to be infused intravenously at 45 mL/hr for an 8-month-old infant. A nurse calculates that, using a microdrip controller, the solution should infuse at a rate of _____ drops per minute (gtt/min). Fill in the blank.

Short Answer

1. A nurse has just successfully inserted an I.V. cannula into a client’s vein. Which action should be taken by the nurse next? Place each nursing action in the order of priority.

a.___ Adjust the flow rate.

b.___ Attach the primed I.V. tubing.

c.___ Observe for signs of infiltration.

d.___ Begin the flow of I.V. fluid.

2. A nurse is preparing to flush a client’s I.V. catheter before injecting medication. Which steps should be taken by the nurse when flushing the client’s intermittent locking device? Prioritize the nurse’s actions by placing each step in the correct order.
3. ___ Flush with sodium chloride using push-pause method.
4. ___ Check for patency of the catheter.
5. ___ Administer the medication.
6. ___ Flush with sodium chloride applying positive pressure.

3. A nurse is preparing to flush a client’s I.V. catheter before injecting medication. Which steps should be taken by the nurse when flushing the client’s intermittent locking device? Prioritize the nurse’s actions by placing each step in the correct order.
4. ___ Flush with sodium chloride using push-pause method.
5. ___ Check for patency of the catheter.
6. ___ Administer the medication.
7. ___ Flush with sodium chloride applying positive pressure.

Chapter 6: Techniques for Initiation and Maintenance of Peripheral Infusion Therapy

Answer Section

MULTIPLE CHOICE

1. ANS: A

One common criterion for continuous I.V. infusion therapy in the home setting is having a part-time or full-time caregiver to assist the client with the therapy. Therefore, the nurse should determine whether the client lives alone. The client should also be medically stable, have a refrigerator (for storage of infusion supplies), and have access to a telephone.

PTS: 1 KEY: Cognitive Level: Analysis

2. ANS: B

If the I.V. is scheduled to run over 8 hours, then the hourly rate would be 125 mL/hr. Using 500 mL as the reference point, the next hourly marking should be at 375 mL, which is 125 mL less than 500 mL.

PTS: 1 KEY: Cognitive Level: Analysis

3. ANS: B

To ensure the integrity of solutions that are administered to clients, the nurse must check the solution’s clarity and expiration date before connection to the administration set. To check a glass system for damage, hold the glass bottle up to the light and check for flashes of light and floating particles or discoloration. The glass system should be crystal clear. Squeeze plastic containers to check for pinholes or punctures to the system.

PTS: 1 KEY: Cognitive Level: Application

4. ANS: A

Teflon ONCs tend to increase the risk for infusion-related phlebitis with small peripheral catheters.

Reference: Maki, D.G., & Mermel, L. A. (2008). Infections due to infusion therapy. In W. R. Javis (Ed.), Bennett & Brachman’s hospital infections (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

PTS: 1 KEY: Cognitive Level: Application

5. ANS: D

The CDC (2009) recommends changing a client’s I.V. catheter no more frequently than 72 to 96 hours as long as the hospital phlebitis rate is less than 5%.

Reference: O’Grady, N., & Alexander, M. (2011). Guidelines for prevention of intravascular catheter-related infections. Atlanta, GA: Centers for Disease Control and Prevention.

PTS: 1 KEY: Cognitive Level: Application

6. ANS: C

To accurately calculate drops per minute, the nurse should know the manufacturer’s drop factor of tubing and the amount to be infused over a given hour.

PTS: 1 KEY: Cognitive Level: Application

7. ANS: B

The stage of development for a 3-year-old child, according to Erikson, is initiative versus guilt—the major stressor of which is loss of control. There is a fear at this age of bodily injury, intrusive procedures, and mutilation. Explanations should be simple and direct. Allow the child to express protest but provide play and diversional activity.

PTS: 1 KEY: Cognitive Level: Analysis

8. ANS: C

The choice of needle depends on the site selected for insertion; however, a 22- to 24-gauge ONC is most commonly used with infants because of their small vessel size.

PTS: 1 KEY: Cognitive Level: Analysis

9. ANS: C

The nurse should consider use of small-volume containers in infants and toddlers because of complications of fluid volume overload. The volume of the solution container should be based on the age, height, and weight or body surface area of the toddler and should contain no more than the 24-hour volume requirement.

PTS: 1 KEY: Cognitive Level: Application

10. ANS: D

Frail, older adults are at risk for developing increased cardiac sensitivity to potassium infusion because of decreased lean body mass and decreased glomerular filtration rate associated with age. Serum potassium must be closely monitored. The kidneys excrete potassium.

PTS: 1 KEY: Cognitive Level: Application

11. ANS: D

To prevent fluid overload, a microdrop administration set should be used when appropriate. Inline filters, three-way stopcocks, and T adapters do not regulate infusions and have no effect on the client’s cardiovascular status.

PTS: 1 KEY: Cognitive Level: Analysis

12. ANS: D

The physiological changes that occur in aging produce changes that affect a client’s ability to feel for changes in I.V. catheter integrity.

PTS: 1 KEY: Cognitive Level: Analysis

13. ANS: C

This technique is used to allow the hub to be accessed for changes in administration set or adding a locking device and allows for stabilization of the catheter.

Reference: Phillips, L. D., & Gorski, L. (2014). Techniques for initiation and maintenance of peripheral infusion therapy. In Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

PTS: 1 KEY: Cognitive Level: Application

14. ANS: D

A midline catheter, usually 6 inches in length, is placed percutaneously between the antecubital fossa and the head of the clavicle. The catheter is then advanced into larger vessels below the axilla, where there is good hemodilution. The midline catheter is intended for intermediate-term therapy of 1 to 4 weeks.

Reference: Phillips, L. D., & Gorski, L. (2014). Techniques for initiation and maintenance of peripheral infusion therapy. In Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

PTS: 1 KEY: Cognitive Level: Application

15. ANS: B