Question 1

A nurse is working in the hospital's blood bank. He is collecting an autologous blood donation from a patient who will have surgery in a few weeks. Because the patient's surgery could involve significant blood loss, she has been coming to the hospital's blood bank every week for the past four weeks. While collecting the blood, the patient complains of feeling faint. The nurse observes that the patient is pale, her skin is cool and clammy, and her breathing appears very rapid and shallow. He immediately clamps the blood collection tubing, covers the patient with a blanket, re-positions the blood donor chair into the Trendelenburg position, and calls for help. Why did the nurse do this?
A)The nurse believes her patient is about to faint.
B)The nurse is overreacting.
C)The nurse has observed the symptoms of hypovolemic shock.
D)The nurse believes her patient is experiencing an allergic reaction.

Accepted Answer

The nurse has correctly recognized the early signs of hypovolemic shock, and reacted appropriately. Hypovolemic shock happens when the body experiences blood loss or significant fluid loss. If the body senses a large blood or fluid loss, it attempts to maintain circulatory homeostasis by increasing pulse and breathing rate and dilating blood vessels, which drops blood pressure. Hypovolemic shock is a medical emergency. Classic signs of shock include pale and clammy skin, rapid and thready pulse, and low blood pressure. Nurses should be aware of these signs and react quickly if they observe them. Untreated shock can result in death. Treatment includes immediately terminating the blood collection, covering the patient, and elevating the patient's legs above the level of the heart (Trendelenburg position). Watch for signs of respiratory or cardiac arrest, be prepared to initiate CPR if necessary, and call for help.

Question 2

The patient on the operating table has started bleeding from several different orifices, including their mucous membranes and intravenous lines. What type of medication should the nurse administer in this situation?
A)Erythropoietin
B)Benazepril
C)Lactulose
D)Heparin

Accepted Answer

In this situation, the nurse should administer heparin. Bleeding from all orifices such as the mucous membranes and intravenous lines indicates disseminated intravascular coagulopathy (DIC). The condition results from extensive clotting in the small vessels, which in turn decreases the level of platelets in the body, leading to extensive bleeding. Heparin is an anticoagulant that will resolve the widespread clotting, allowing the body to correct the bleeding.

Question 3

A central venous pressure catheter directly measures the pressure of which portion of the heart?
A)Right atrium
B)Right ventricle
C)Left atrium
D)Left ventricle

Accepted Answer

The central venous pressure directly measures the pressure of the right atrium. This gives an indication of the patient's fluid status and cardiac output. Too much fluid for the patient results in high pressures, while low pressures indicate volume depletion and potential hypovolemia.

Question 4

The nurse is gathering equipment for an arterial puncture. She has gathered the following equipment: heparin solution of 1,000 IU per ml, sterile gauze, betadine wipes, sterile needle, and syringe. What has the nurse forgotten?
A)Container of ice water.
B)Alcohol wipes.
C)Tourniquet.
D)Requisition form.

Accepted Answer

The urse has forgotten to gather a container for ice water. An arterial blood sample is placed in a container of ice water to keep blood gasses from escaping. The sample should be transported to the lab in the container of ice water and analyzed within ten minutes of being collected. A tourniquet is not required for arterial punctures, because of arterial pressure. Tincture of iodine is used to cleanse the puncture site.

Question 5

The nurse is aware that their hospital has a policy that allows nursing aides to remove intravenous lines while on the surgical unit. The nurse delegates this task to the aide and the intravenous catheter is removed incorrectly. Who is responsible for this mistake?
A)The hospital, because the policy allowed the procedure.
B)The nurse, because they supervised the procedure.
C)The aide, because they performed the procedure.
D)Both B and C

Accepted Answer

In this situation, the nurse is responsible for the aide's actions, because they supervised the procedure. Tasks delegated to unlicensed personnel are ultimately the responsibility of the nurse. Although the hospital may have a policy allowing unlicensed personnel to perform certain tasks, this cannot override the state's nurse practice act.

Question 6

The nurse is preparing to insert an intravenous catheter to administer fluids for a patient who will have surgery. What is the most important factor that affects the nurse's choice of location for this site?
A)The type of cannula to be used
B)The duration of the infusion
C)The condition of the vein for use
D)Both B and C

Accepted Answer

When preparing to insert a catheter for intravenous fluids during surgery, factors that influence the site location choice include the infusion duration and the condition of the vein for use. An infusion that will run over a long period requires a vein that will tolerate the instillation of large amounts of fluid over time, rather than a short injection of fluid or medication. Additionally, veins that are in poor condition may be difficult to cannulate and may not tolerate a fluid infusion.

Question 7

What special precaution should be observed when collecting a specimen for blood cultures?
A)Maintaining aseptic technique.
B)Maintaining postural position.
C)Maintaining calmness.

Accepted Answer

A special precaution when collecting a specimen for blood cultures is establishing and maintaining aseptic technique during the collection process. Bacteria are found on the skin surface and are considered normal. Without using special precautions, the normal skin bacteria may contaminate the specimen. The puncture site and rubber stopper on collection bottles are prepared using tincture of iodine. After area has been prepared, the nurse should take care not to contaminate the site by inadvertently touching or allowing the tourniquet to touch the area.

Question 8

A patient is admitted with severe burns over 50 percent of their body. The nurse inserts an IV to begin fluid administration and for medications. What is the typical process of fluid shift for this type of patient within the first 48 hours?
A)Fluid is pulled out of the blood vessels and into the tissues.
B)Fluid is pulled out of the tissues and into the blood vessels.
C)Fluid maintains equilibrium between the blood vessels and the tissues.
D)Fluid movement depends on the type of burn and the patient's electrolyte status.

Accepted Answer

During the first 48 hours following a burn, fluid is pulled out of the blood vessels and into the tissues. The nurse must administer adequate fluids to prevent hypovolemia and subsequent hypotension. The tissues will swell with the excess fluid, but after approximately two to three days, the shift reverses and the fluid returns to circulation.

Question 9

Which statement is a requirement when managing exposure to blood borne pathogens?
A)Nurses should receive training in handling occupational exposure if there is a risk of coming in contact with blood borne pathogens.
B)Food and drink should be kept on a separate table in the operating suite, away from the patient.
C)A contaminated needle should be carefully recapped before placing it in a biohazard container.
D)Employers are required to provide measures for hand hygiene practices.

Accepted Answer

Employers are required to provide measures for hand hygiene practices. If employees are expected to wash their hands to protect themselves from blood borne pathogens, employers are mandated to provide materials for them, according to the Occupational Safety and Health Administration. Food and drink should be separate from operative procedures and not in the same room, and contaminated needles should never be recapped to reduce risk of injury. All healthcare personnel should receive training on exposure to blood borne pathogens.

Quiz 2: Vascular Access

The patient on the operating table has started bleeding from several different orifices, including their mucous membranes and intravenous lines. What type of medication should the nurse administer in this situation?

A central venous pressure catheter directly measures the pressure of which portion of the heart?

The nurse is gathering equipment for an arterial puncture. She has gathered the following equipment: heparin solution of 1,000 IU per ml, sterile gauze, betadine wipes, sterile needle, and syringe. What has the nurse forgotten?

The nurse is aware that their hospital has a policy that allows nursing aides to remove intravenous lines while on the surgical unit. The nurse delegates this task to the aide and the intravenous catheter is removed incorrectly. Who is responsible for this mistake?

The nurse is preparing to insert an intravenous catheter to administer fluids for a patient who will have surgery. What is the most important factor that affects the nurse's choice of location for this site?

What special precaution should be observed when collecting a specimen for blood cultures?

A patient is admitted with severe burns over 50 percent of their body. The nurse inserts an IV to begin fluid administration and for medications. What is the typical process of fluid shift for this type of patient within the first 48 hours?

Which statement is a requirement when managing exposure to blood borne pathogens?