Question 1

The nurse needs to draw multiple laboratory samples from a client. Which sample should be drawn first?

Accepted Answer

Blood cultures are drawn first. Then the order goes by the color of the specimen tube's top which indicates whether or not the tube contains additives and if so, what kind.

Question 2

The new nurse is inserting a peripheral IV line on a client. Which action demonstrates that the nurse needs to review the correct technique?

Accepted Answer

Prior to inserting a PIV catheter, clean the skin at the insertion site with an approved antiseptic solution, not antibacterial ointment. Antibacterial ointment is not used as it has been shown to encourage fungal growth and bacterial resistance. The other actions are appropriate and show good technique.

Question 3

A client reports that the fluid in the IV is making the hand "turn cold." What action by the nurse is best?

Accepted Answer

A cool hand, or distal area to the IV, may be an indicator of infiltration. The nurse would assess the site thoroughly. Warm compresses and warmed IV fluids are not indicated unless problems are ruled out. The nurse would not discontinue the IV without assessing the site first.

Question 4

The nurse understands that the normal saline solution (0.9% NS) is often used to rehydrate clients due to which property?

Accepted Answer

0.9% NS (NSS) is an isotonic solution. Infusing this solution does not result in movement of fluids or solutes between the intravascular and extravascular spaces. They expand volume only, which is their main benefit. NSS is inexpensive and readily available but does not contain glucose. NSS is no more or no less prone to infiltrating as fluid choice does not affect it.

Question 5

Which statement by the student about IV tubing sets shows good understanding?

Accepted Answer

The primary tubing is longer and should have needleless access ports to prevent needle stick injuries. Secondary tubing is shorter and designed to connect a secondary line to the primary line. Any kind of medication can run through a secondary line.

Question 6

A nurse is working with IVs in several clients. Which action by the nurse demonstrates a need to review this material?

Accepted Answer

The CDC recommends changing IV dressings at least every 7 days but not more frequently than every 96 hours in most instances. The other actions are appropriate.

Question 7

A nurse has hung a secondary medication as an IV piggyback into a primary line being run on an infusion pump. The piggyback attaches to the primary tubing above the pump. The piggyback is not infusing properly. What action does the nurse take?

Accepted Answer

When the piggyback, or secondary line, attaches to the primary line above the pump, the primary line must be lowered so that the piggyback bag is higher. Otherwise the fluids will not run correctly.

Question 8

A new nurse is preparing to administer an IV push medication. After drawing the medication up, determining how fast to push the medication, identifying the client, performing hand hygiene, and assessing the IV site, the nurse gives the medication. What step would an experienced nurse include that the new nurse forgot?

Accepted Answer

When giving IV push medications, always check for compatibility between the solution running and the medication. Documentation comes after administration. A bag is not used for a push medication. The IV may or may not need to be stopped.

Question 9

What does the nurse understand about an autologous transfusion?

Accepted Answer

An autologous transfusion uses a client's own blood. Other sources of blood include single random donors, pooled random donors, and direct donors.

Question 10

A client in the Emergency Department is hemorrhaging severely and needs immediate blood transfusion. What type of blood can this client safely receive without being crossmatched to it?

Accepted Answer

Type O blood is called universal donor blood because it can be given to anyone without risk of reaction. This would be the choice of blood types for this client.

Question 11

When collecting blood samples with a butterfly needle and vacutainer, what disadvantage is the nurse aware of?

Accepted Answer

The vacuum with a butterfly needle and vacutainer may be too much for small, fragile veins. No visible flashback is a problem with just a vacutainer. A syringe and needle can only draw a small amount of blood. Sampling blood with a syringe and butterfly needle is very slow and may allow blood to clot.

Question 12

The nurse needs to hang an isotonic IV solution. Which solution will the nurse choose?

Accepted Answer

Normal saline is isotonic. D10W is hypertonic. 1/2 NS and D5 1/2 NS are both hypotonic.

Question 13

The nurse caring for a client who has hemophilia understands the client will receive transfusions of which blood product?

Accepted Answer

Cryoprecipitate is generally used in clients who have hemophilia or von-Willebrand disease.

Question 14

A client is receiving a transfusion of packed red blood cells and reports chills, fever, and back pain. What action by the nurse is best?

Accepted Answer

This client has signs of a hemolytic transfusion reaction which is usually caused by an infusion of incompatible blood. The nurse would stop the transfusion immediately and notify the provider or call an RRT. Obtaining an oxygen saturation is not a bad idea, but that is more closely related to transfusion-related lung injury or transfusion-related circulatory overload. Interventions specifically for fever and back pain are not the priority.

Question 15

A client with heart failure is to receive a transfusion of 2 units of packed red blood cells. What action by the nurse is best?

Accepted Answer

This client is at risk for Transfusion-Related Circulatory Overload (TACO). TACO generally occurs when too much blood volume is given or it is given too quickly. The nurse would run the transfusion over the maximum time allowed to prevent this from occurring. Diphenhydramine is given to clients who have a history of mild reactions. Hematuria is a concern with acute hemolytic transfusion reactions. Unless it is an emergency requiring universal donor blood, all clients have blood drawn for type and crossmatch prior to the transfusion.

Question 16

The provider left an order for a client to receive 1000 mL of normal saline solution over 6 hours. The student nurse sets the pump to run at 145 mL/hour. What action by the faculty is best?

Accepted Answer

To run 1000 mL in over 6 hours, the student would set the pump at 167 (166.67) mL/hour. The faculty would tell the student to recalculate the rate. That fast of a rate does require a pump. The IV would be run through a primary IV set.

Question 17

What information does the nurse give the client about delayed transfusion reactions?

Accepted Answer

Delayed transfusion reactions have manifestations similar to acute hemolytic reactions with back pain and fever. They usually occur within 24 hours. Shortness of breath is often seen with transfusion related circulatory overload, which is most frequently seen in clients who have heart or renal disease.

Question 18

During handoff report, the nurse is informed that a client has had an extravasation. What does the nurse understand about this condition?

Accepted Answer

Extravasation is inadvertent infiltration of a vesicant solution/medication into surrounding tissue. A vesicant is an agent capable of causing blistering, tissue sloughing, or necrosis when it escapes from the intended vascular pathway into surrounding tissue. When nonvesicant fluid leaks from a vein it is called infiltration. Hemolysis is rupture of blood cells. Hardened veins are sclerosed.

Question 19

The nurse is hanging an IV piggyback with 100 mL with a microdrop tubing set. The infusion is to go over 60 minutes. How many drops per minute would deliver the rate correctly?

Accepted Answer

A microdrop set has a drop factor of 60 (this means that 60 drops = 1 mL).To infuse 100 mL over 60 minutes = 100 mL/60 min or 1.67 mL/minute(100 mL/hour)/60 minutes = 1.67 mL/minute F1F1F1S1?F1F1F10 60 drops/mL = 100 drops/minute

Question 20

The nurse is hanging an IV piggyback with 100 mL with a macrodrop tubing set (drop factor 20). The infusion is to go over 60 minutes. How many drops per minute would deliver the rate correctly?

Accepted Answer

A macrodrop set has a drop factor of 20 (this means that 20 drops = 1 mL).To infuse 100 mL over 60 minutes = 60 mL/hour or 1.67 mL/minute(100 mL/hour)/60 minutes = 1.67 mL/minute F1F1F1S1?F1F1F10 20 drops/mL = 33.33 drops/minute

Quiz 12: Venous Access