Deck 18: Administering Intravenous Therapy

Question 1

Which aspect of intravenous therapy could the nurse safely assign to the assistive personnel (AP)?

A) Watching the IV insertion site of the client who complained of pain at the site
B) Changing the IV site dressing on the client's left hand
C) Reporting client's complaints of pain or leakage from the IV site when bathing the client
D) Replacing client's IV solution when bag runs dry if it is only D₅W without medications added

Answer 1

C
Explanation:1. The AP can safely be taught to report complaints of pain or leakage from an IV site if it is noted during routine care, but the AP is not responsible for assessing the site, because the nurse is responsible for all assessments. The IV dressing should be changed using sterile technique and should not be delegated to the AP. Whether medications are added to the IV fluid or not, only the nurse can change the bag, because sterile technique is required, and even a plain solution is considered a medication.
2. The AP can safely be taught to report complaints of pain or leakage from an IV site if it is noted during routine care, but the AP is not responsible for assessing the site, because the nurse is responsible for all assessments. The IV dressing should be changed using sterile technique and should not be delegated to the AP. Whether medications are added to the IV fluid or not, only the nurse can change the bag, because sterile technique is required, and even a plain solution is considered a medication.
3. The AP can safely be taught to report complaints of pain or leakage from an IV site if it is noted during routine care, but the AP is not responsible for assessing the site, because the nurse is responsible for all assessments. The IV dressing should be changed using sterile technique and should not be delegated to the AP. Whether medications are added to the IV fluid or not, only the nurse can change the bag, because sterile technique is required, and even a plain solution is considered a medication.
4. The AP can safely be taught to report complaints of pain or leakage from an IV site if it is noted during routine care, but the AP is not responsible for assessing the site, because the nurse is responsible for all assessments. The IV dressing should be changed using sterile technique and should not be delegated to the AP. Whether medications are added to the IV fluid or not, only the nurse can change the bag, because sterile technique is required, and even a plain solution is considered a medication.

Question 2

A client receiving parenteral nutrition via a central venous catheter has an elevated temperature, elevated white blood cell count, and lethargy. Which action should the nurse take when sepsis is suspected? Select all that apply.

A) Replacing the parenteral nutrition with a normal saline solution
B) Changing the IV tubing
C) Saving the remaining TPN
D) Recording the lot number of the TPN
E) Notifying the health care provider.

Answer 2

Changing the IV tubing
Saving the remaining TPN
Recording the lot number of the TPN
Notifying the health care provider.

Question 3

A client needs an intravenous access device inserted. For which reason should the nurse use the client's dominant arm?

A) A fistula for dialysis is in the nondominant arm.
B) A mastectomy was performed on the dominant arm.
C) The antecubital vein is the best on the dominant arm.
D) The infusion equipment can be more easily accessed on the dominant arm.

Answer 3

A
Explanation:1. The dominant arm should be used if a fistula for dialysis is in the nondominant arm.
2. The arm on the side of a mastectomy should be avoided.
3. The antecubital vein should be avoided when inserting an intravenous access device.
4. The ease of equipment access is not a reason for using the dominant arm.

Question 4

Assistive personnel (AP) report that a client's intravenous infusion is leaking at the site. Which response should the nurse make?

A) "Change the dressing."
B) "Turn off the infusion."
C) "I will go and check it."
D) "Insert a new access device."

Question 5

A client is prescribed to receive 1 liter of intravenous fluid in 16 hours. The infusion set administers 20 drops/mL. How many drops per minute should be provided to the client?
Record the answer rounding to the nearest whole number.

Question 6

A client received two units of packed red blood cells over the last 8 hours. What information should the nurse include when documenting these transfusions? Select all that apply.

A) Client vital signs
B) Blood unit number
C) Time of the transfusions
D) Amount of blood provided
E) Name of ordering physician