Critical Care - Medications & Intravenous Therapy.txt

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bamaguh1988
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Critical Care - Medications & Intravenous Therapy.txt
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2015-01-08 17:15:34
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  1. A client with parenteral nutrition (PN) infusing has disconnected the tubing from the central line catheter. The nurse assesses the client and suspects an air embolism. The nurse should immediately place the client in which position?
    1. On the left side, with the head lower than the feet
    2. On the left side, with the head higher than the feet
    3. On the right side, with the head lower than the feet
    4. On the right side, with the head higher than the feet
    1. On the left side, with the head lower than the feet
  2. The nurse has a prescription to hang a 1000-mL intravenous (IV) bag of 5% dextrose in water with 20 mEq of potassium chloride and needs to add the medication to the IV bag. The nurse should plan to take which action immediately after injecting the potassium chloride into the port of the IV bag?
    1. Rotate the bag gently.
    2. Attach the tubing to the client.
    3. Prime the tubing with the IV solution.
    4. Check the solution for yellowish discoloration.
    1. Rotate the bag gently.
  3. The nurse is making initial rounds on the nursing unit to assess the condition of assigned clients. The nurse notes that a client's intravenous (IV) site is cool, pale, and swollen, and the solution is not infusing. The nurse concludes that which complication has occurred?
    1. Infection
    2. Phlebitis
    3. Infiltration
    4. Thrombosis
    3. Infiltration
  4. The nurse is inserting an intravenous line into a client's vein. After the initial stick, the nurse would continue to advance the catheter in which situation?
    1. The catheter advances easily.
    2. The vein is distended under the needle.
    3. The client does not complain of discomfort.
    4. Blood return shows in the backflash chamber of the catheter.
    4. Blood return shows in the backflash chamber of the catheter.
  5. The nurse notes that the site of a client's peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. After taking appropriate steps to care for the client, the nurse should document in the medical record that the client experienced which condition?
    1. Phlebitis of the vein
    2. Infiltration of the IV line
    3. Hypersensitivity to the IV solution
    4. Allergic reaction to the IV catheter material
    1. Phlebitis of the vein
  6. The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to insert the spike end of the IV tubing into the IV bag, the tubing drops and the spike end hits the top of the medication cart. The nurse should take which action?
    1. Obtain a new IV bag.
    2. Obtain new IV tubing.
    3. Wipe the spike end of the tubing with Betadine.
    4. Scrub the spike end of the tubing with an alcohol swab.
    2. Obtain new IV tubing.
  7. A health care provider has written a prescription to discontinue an intravenous (IV) line. The nurse should obtain which item from the unit supply area for applying pressure to the site after removing the IV catheter?
    1. Elastic wrap
    2. Betadine swab
    3. Adhesive bandage
    4. Sterile 2 × 2 gauze
    4. Sterile 2 × 2 gauze
  8. A client rings the call bell and complains of pain at the site of an intravenous (IV) infusion. The nurse assesses the site and determines that phlebitis has developed. The nurse should take which actions in the care of this client?Select all that apply.
    1. Notify the health care provider (HCP).
    2. Remove the IV catheter at that site.
    3. Apply warm moist packs to the site.
    4. Start a new IV line in a proximal portion of the same vein.
    5. Document the occurrence, actions taken, and the client's response.
    • 1. Notify the health care provider (HCP).
    • 2. Remove the IV catheter at that site.
    • 3. Apply warm moist packs to the site.
    • 5. Document the occurrence, actions taken, and the client's response.
  9. A client involved in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive and unresponsive. The nurse anticipates that which intravenous (IV) solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume, and increase blood pressure?
    1. 5% dextrose in lactated Ringer's
    2. 0.33% sodium chloride (⅓ normal saline)
    3. 0.225% sodium chloride (¼ normal saline)
    4. 0.45% sodium chloride (½ normal saline)
    1. 5% dextrose in lactated Ringer's
  10. The nurse provides a list of instructions to a client being discharged to home with a peripherally inserted central catheter (PICC). The nurse determines that the client needs further instructions if the client made which statement?
    1. "I need to wear a Medic-Alert tag or bracelet."
    2. "I need to restrict my activity while this catheter is in place."
    3. "I need to have a repair kit available in the home for use if needed."
    4. "I need to keep the insertion site protected when in the shower or bath."
    2. "I need to restrict my activity while this catheter is in place."
  11. A client has just undergone insertion of a central venous catheter at the bedside. The nurse would be sure to check which results before initiating the flow rate of the client's intravenous (IV) solution at 100 mL/hour?
    1. Serum osmolality
    2. Serum electrolyte levels
    3. Portable chest x-ray film
    4. Intake and output record
    3. Portable chest x-ray film
  12. A client with the recent diagnosis of myocardial infarction and impaired renal function is recuperating on the step-down cardiac unit. The client's blood pressure has been borderline low and intravenous (IV) fluids have been infusing at 100 mL/hour via a central line catheter in the right internal jugular for approximately 24 hours to increase renal output and maintain the blood pressure. Upon entering the client's room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is most likely experiencing which complication of IV therapy?
    1. Hematoma
    2. Air embolism
    3. Systemic infection
    4. Circulatory overload
    4. Circulatory overload
  13. A nurse in the hospital emergency department is preparing to administer fomepizole (Antizol) to a client with ethylene glycol (antifreeze) intoxication. The nurse should plan to administer this medication by which route?
    1. Oral route
    2. Intramuscular route
    3. Intravenous (IV) route
    4. Through a nasogastric tube
    3. Intravenous (IV) route
  14. The emergency department nurse is preparing to administer fomepizole (Antizol) to a client suspected of having ethylene glycol (antifreeze) intoxication. The nurse should prepare to administer this medication by which method?
    1. Direct intravenous (IV) bolus
    2. Diluting the medication and administering it rapidly by the IV route
    3. Administering the medication through a nasogastric tube, followed by activated charcoal
    4. Diluting the medication in 100 mL of 0.9% normal saline and administering over 30 minutes
    4. Diluting the medication in 100 mL of 0.9% normal saline and administering over 30 minutes
  15. The emergency department nurse is preparing to administer fomepizole (Antizol) to a client suspected of having ethylene glycol (antifreeze) intoxication. The nurse obtains the vial of medication and notes that the medication has solidified. Which action should the nurse take?
    1. Discard the vial.
    2. Run the vial under warm water.
    3. Contact the health care provider.
    4. Call the pharmacy and request another vial of medication.
    2. Run the vial under warm water.
  16. A client in shock is receiving dopamine hydrochloride by intravenous (IV) infusion. The nurse should have which medication available for local injection if IV infiltration and medication extravasation occur?
    1. Vitamin K
    2. Phentolamine
    3. Atropine sulfate
    4. Protamine sulfate
    2. Phentolamine
  17. A client admitted with hypertensive crisis has an intravenous (IV) infusion of 1000 mL of normal saline with 20 mEq of potassium chloride added. A prescription is written to administer sodium nitroprusside by continuous IV infusion. The nurse should plan to do which to administer this medication?
    1. Monitor the blood pressure every 15 minutes during administration.
    2. Protect the sodium nitroprusside from light with an opaque material.
    3. Check the solution for a faint brown coloration and discard it if this is noticed.
    4. Piggyback the sodium nitroprusside into the IV line containing the potassium chloride.
    2. Protect the sodium nitroprusside from light with an opaque material.
  18. The nurse has a new prescription to administer verapamil (Calan) by the intravenous (IV) route. In administering this medication, the most important nursing action should be to use what item to monitor the client's response to the medication?
    1. A pulse oximeter
    2. A cardiac monitor
    3. Supplemental oxygen
    4. A noninvasive blood pressure monitor
    2. A cardiac monitor
  19. A client with rapid-rate atrial fibrillation has a new prescription for diltiazem hydrochloride by intravenous bolus followed by a continuous intravenous infusion of the same medication. What should the nurse know when administering this medication safely?
    1. A bolus needs to be pushed very rapidly over 2 to 3 seconds.
    2. A continuous infusion should not infuse for more than 24 hours.
    3. This medication is one of the most effective beta-blockers in treating dysrhythmias.
    4. This medication increases myocardial contractility and thus decreases oxygen demand.
    2. A continuous infusion should not infuse for more than 24 hours.
  20. A client being admitted to the coronary care unit from the emergency department has a stat prescription to receive a dose of procainamide. The nurse interprets that the client has which condition if this medication is needed?
    1. Dyspnea
    2. Bradycardia
    3. Hypertension
    4. Ventricular ectopy
    4. Ventricular ectopy
  21. The nurse has a prescription to give amiodarone (Cordarone) intravenously to a client. During administration of this medication, the nurse should monitor which option as the priority?
    1. Blood pressure
    2. Cardiac rhythm
    3. Skin color and dryness
    4. Oxygen saturation level
    2. Cardiac rhythm
  22. The nurse is caring for a client with a diagnosis of myocardial infarction (MI). The client is experiencing chest pain that is unrelieved by the administration of nitroglycerin. The nurse administers morphine sulfate to the client as prescribed by the health care provider. After administration of the morphine sulfate, the nurse plans to monitor which item(s) most closely?
    1. Mental status
    2. Urinary output
    3. Respirations and blood pressure
    4. Temperature and blood pressure
    3. Respirations and blood pressure
  23. A client hospitalized with a diagnosis of myocardial infarction calls for the unit nurse because the client is experiencing chest pain. The nurse administers a sublingual nitroglycerin tablet as prescribed. The client, who is receiving oxygen by nasal cannula, reports that her chest pain is unrelieved by the nitroglycerin. Which is the next nursing action for this client?
    1. Call the client's family.
    2. Increase the flow rate of oxygen.
    3. Contact the health care provider (HCP).
    4. Administer another nitroglycerin tablet.
    4. Administer another nitroglycerin tablet.
  24. A client in the telemetry unit is receiving an intravenous infusion of 1000 mL of 5% dextrose in water (D5W) plus 40 mEq of potassium chloride. Which finding indicates the presence of hyperkalemia?

    1. A
    2. B
    3. C
    4. D
    1. A
  25. A client is admitted to the hospital with a diagnosis of myocardial infarction (MI) and is going to have an intravenous nitroglycerin infusion started. Noting that the client does not have an intra-arterial monitoring line in place, what piece of equipment should the nurse obtain for use at the bedside?
    1. Defibrillator
    2. Pulse oximeter
    3. Noninvasive blood pressure monitor
    4. Central venous pressure (CVP) insertion tray
    3. Noninvasive blood pressure monitor
  26. A client returning to the nursing unit after a cardiac catheterization procedure has a stat prescription to receive a dose of procainamide. Which piece of equipment would be most appropriate for the nurse to use in determining the client's response to this medication?
    1. Glucometer
    2. Pulse oximeter
    3. Cardiac monitor
    4. Noninvasive blood pressure cuff
    3. Cardiac monitor
  27. A client with heart failure has been started on intravenous medication therapy with inamrinone. The nurse determines which finding, if noted in the client, is an adverse effect of the medication?
    1. Hypotension
    2. Decreased weight
    3. Absence of lung crackles
    4. Reduced peripheral edema
    1. Hypotension
  28. A client sustained a burn injury at 7:00 am. The client's spouse states that before the burn, his body weight was 198 lb (90 kg). The health care provider has estimated that the total body surface area burned is 83%. Using the Parkland (Baxter) formula, the nurse determines that the total amount of intravenous lactated Ringer's solution that the client will receive by 3 pm of the same day that the burn occurred is which value?
    1. 3735 mL
    2. 7470 mL
    3. 14,940 mL
    4. 29,880 mL
    3. 14,940 mL
  29. A client has a closed head injury with increased intracranial pressure (ICP). The increased ICP is being managed by mannitol (Osmitrol) 25 g by the intravenous (IV) route every 2 hours. The nurse is planning to administer this medication via IV pump and plans to administer this medication in what manner?
    1. Mixed in solution with the IV antibiotics
    2. By giving it slowly over 30 to 90 minutes
    3. Piggybacked into the packed red blood cells
    4. By giving it rapidly over 5 minutes by IV bolus
    2. By giving it slowly over 30 to 90 minutes
  30. The nurse is administering lidocaine hydrochloride by the intravenous route. Which finding would indicate to the nurse that the client is experiencing toxicity?
    1. Urine output of 275 mL over the past 8 hours
    2. Client complaints of blurred vision and nausea
    3. Heart rate of 70 beats/min, blood pressure of 130/72 mm Hg
    4. Client complaints of a headache and a temperature of 100° F orally
    2. Client complaints of blurred vision and nausea
  31. The nurse is caring for a client with acute pulmonary edema. The health care provider (HCP) tells the nurse that medication will be prescribed to help reduce preload and afterload. The nurse anticipates that the HCP will prescribe which medication?
    1. Morphine sulfate
    2. Digoxin (Lanoxin)
    3. Furosemide (Lasix)
    4. Nitroprusside sodium
    4. Nitroprusside sodium
  32. A client is scheduled for placement of a peripherally inserted central catheter (PICC). The nurse has explained the advantages of this catheter to the client. Which statement made by the client indicates a need for further explanation?
    1. "It is reasonable in cost."
    2. "There is less pain and discomfort."
    3. "This type of catheter is very reliable."
    4. "It is specifically designed for short-term use."
    4. "It is specifically designed for short-term use."
  33. The nurse in the hospital emergency department is caring for a client with suspected opioid overdose and is preparing to administer naloxone hydrochloride (Narcan) via the intravenous route. Which indicates that the nurse has accurate knowledge of the administration of this medication?
    1. Administers the entire dose of naloxone hydrochloride by slow intravenous push to avoid phlebitis
    2. Administers the naloxone hydrochloride rapidly intravenously to reverse respiratory depression
    3. Prepares only one dose of naloxone hydrochloride because that is all that is necessary to reverse respiratory depression
    4. After the initial dose, prepares to administer additional intravenous doses of naloxone hydrochloride in increments at 2- to 5-minute intervals
    4. After the initial dose, prepares to administer additional intravenous doses of naloxone hydrochloride in increments at 2- to 5-minute intervals
  34. A nurse is obtaining blood from a client's double-lumen central venous catheter for blood cultures. Which actions are correct for performing this procedure? Select all that apply.
    1. Use the distal port of the catheter for obtaining the blood specimen.
    2. Flush with 5 to 10 mL of normal saline before obtaining the specimen.
    3. Turn the infusion off for at least 1 minute before obtaining the specimen.
    4. Use the initial specimen of blood obtained from the catheter for the blood cultures.
    5. Discard the first syringe of blood and use the second syringe for the blood cultures.
    6. Avoid flushing the catheter with normal saline before drawing up the blood sample for cultures.
    • 3. Turn the infusion off for at least 1 minute before obtaining the specimen.
    • 4. Use the initial specimen of blood obtained from the catheter for the blood cultures.
    • 6. Avoid flushing the catheter with normal saline before drawing up the blood sample for cultures.
  35. A client has an epidural catheter in place after colon surgery and received pain medication through the catheter with a patient-controlled epidural analgesia device. During the night the client calls the nurse and says, "I have a terrible headache that just started now." The nurse checks the epidural catheter insertion site and notes a small amount of clear drainage leaking from the bandage. What is the first action the nurse should take?
    1. Stop the infusion.
    2. Change the dressing bandage.
    3. Remove the epidural catheter.
    4. Notify the health care provider.
    1. Stop the infusion.
  36. A client who is receiving intravenous (IV) fluid therapy complains of burning and a feeling of tightness at the IV insertion site. On assessment, the nurse detects coolness and swelling at the site and notes that the IV rate has slowed. The nurse determines that which complication has occurred?
    1. Infection
    2. Phlebitis
    3. Infiltration
    4. Thrombosis
    3. Infiltration

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