Dayton Hondros Quiz 2 Week 9

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Answer

A patient is hypovolemic and plasma volume expanders are not availaible. What kind of solutions do you administer?

Hypertonic solutions pull O2 from intracellular and interstitial into vascular thus they expand the plasma space.

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What are the Hypertonic solutions?

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A patient is hypovolemic and plasma volume expanders are not availaible. What kind of solutions do you administer?

Hypertonic solutions pull O2 from intracellular and interstitial into vascular thus they expand the plasma space.

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What are the Hypertonic solutions?

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A disadvantage of Telfon over-the-needle catheter for peripheral is

increases the risk of mechanical phlebitis.

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A parental solution that contains portions of electrolytes similar to plasma, as well as bicarbonate or acetate ion is called

balance solution

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Hypotonic, isotonic and hypertonic solutions refer only to those solutions whose osmolarity is, respectively, less than, equal to, or greater than that of plasma-not to their

electrolyte or ionic contents.

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Which of the following technologies assist in the reduction needle-stick injuries?

Needleless systems.

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Which of the following connections should be used to secure a piggyback administration set to the primary administration set?

The male Luer lock has threads that secure and lock the connectors.

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Which of the following is a necessity for use with volumetric pumps?

A special cassette (cartridge) tubing.

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Midclavicular placement of a central line catheters are inserted into a

superficial vein of the peripheral vascular systems and advanced to the proximal axillary or subclavian veins. Radiographic confirmation is optional.

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To ensure integrity of a flexible plastic infusate solution container, the nurse should check for:

punctures, expiration date and integrity of solution.

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According to the Infusion Nurse Society’s Standards of Practice, a

0.22um filter may be used for the delivery of infusion therapy to decrease the risk of air emboli.

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A 0.2 um filter is considered a

bacterial/particulate retentive air-eliminating filter and is recommended for decreasing the potential of air emboli.

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Before a patient is started on replacement therapy, the first things that should be checked is the patient’s

kidney function.

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Y-type infusate administration sets are used:

for administration of blood to facilitate the priming infusate (0.9% sodium chloride) and the blood bag.

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According to Infusion Nurses Society Standards of Practice peripheral locking devices much be monitored every 4 hours and kept patent with:

0.9% sodium chloride solution.

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All of the following are examples of filter material except:

bubble point.

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All filters have a certain pressure valve at which they will allow the passage of air from one side of a wetted hydrophilic membrane to the other. This pressure is called the

bubble point of that particular membrane.

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Hypotonic solutions are used to:

hydrate cells.

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Hypotonic fluids move from the

vascular space to the interstitial and intracellular spaces hydrating cells. This follows the principles of osmosis and the movement of water.

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Microaggregate filters are used for the:

administration of whole blood and packed cells that are stored more than 5 days.

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Microaggregate filters are designed to remove 20 to 40 particles, which filters out the microaggregates that develop in

stored blood.

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Microaggregates constist primarily of

degenerated platelets, leukocytes and strands of fibrin.

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The standard blood administration set has a clot filter of :

170 um.

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Blood filters have a pore size of 170 um and are designed to remove

debris that accumulates in stored blood.

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It is necessary to completely fill the filter chamber to use all the surface area of the filter. One filter is used per

unit of blood.

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Which of the following most essential actions must take place if the nurse temporarily removes the IV line form an electronic infusion pump while it is still attached to the patient’s IV catheter?

Roller Clamp on the IV tubing must be closed.

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Which of the following solutions are considered colloid solutions?

Albumin is a natural plasma protein prepared from donor plasma.

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Colloid solutions contain

protein or starch molecules that remain distributed in the extracellular space and do not form a “true” solution.

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The limit to operating pressure at which an alarm is triggered on an electronic infusion device is known as the

occlusion pressure alarm.

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With an occlusion alarm, pumps and controllers are able to indicate

upstream or downstream occlusion by the absence of flow.

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A patient is admitted with 40% second-degree burns, which of the following IV solutions would be anticipated?

Lactated Ringer’s closely resembles the body’s extracellular fluid; it may be used to replace fluid loss from burns and is useful in mild acidosis.

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The expected outcome of administering a hypertonic solution is to:

Shifts ECF from intracellular space to plasma.

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Hypertonic fluids have osmolarities over

375 mOsm, which shifts fluids from the interstitial and intracellular spaces into the vascular space. This follows the principles of osmosis and the movement of water and solutes.

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The organism responsible for most cases of catheter-related bloodstream infections is:

Coagulasenegative staphylococci. Causes most septicemias that are related to infusions.

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Which of the following patients are at the highest risk for the development of IV-related phlebitis?

Immunosuppression.

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There are many factors that place a patient at high risk for development of IV related phlebitis. The following factors may put patients at risk:

catheter materials, insertion in an ER, type of infusate (hypertonic solutions), daily dressing changes, gender predilection (more common in women than men), and individual biologic vulnerability, such an immunosuppresion.

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What complication is suspected if the patient has a fluctuating fever, chills, malaise, tachycardia, tachypnea, hypotension, and altered mental status?

These symptoms are a systemic complication. Septicemia is a serious systemic complication of infusion therapy.

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All the other responses are local complications which are

inflammatory response syndrome, thrombophlebitis and local infection.

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During initial venipuncture, the nurse has difficulty advancing the cannula into the vein and observes ecchymosis over and around the insertion area. The area is also raised and hard. The nurse concludes that:

a hemotoma has formed.

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S/S of hematoma include

immediate or slow discoloration of the skin surrounding the venipuncture, swelling of the site, and discomfort.

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A nurse priming an IV administration set uncaps the distal end to attach a needleless device. Before attachment, the administration set falls and hits the counter top. Which of the following actions should the nurse take?

Change the administration set. The needleless device has not been contaminated and does not need replacement. Cleansing would be indicated because the device is still sterile.

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On assessment of a patient with an IV that is infusing intermittent vancomycin hydrochloride, the nurse finds warmth, edema, area of induration and red streaking on the skin, peau d’ orange skin, and vesicles. The nurse suspects:

extravasation.

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The term extravasation refers to the

infiltration of vesicant medications into the tissue.

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A vesicant solution is a fluid or medication that causes the formation of

blisters.

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S/S of extravasation include

complaints of pain or burning by the patient, skin tightness at the site, blanching and coolness of the skin, slowed or stopped infusion, dependent edema of the affected extremity, and peau d’ orange skin. Immediate interventions are necessary.

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The first symptom of venous spasm is:

A sharp pain extending from the site of infusion.

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A venous spasm can occur

suddenly and for various reasons.

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The spasm usually results from the

administration of a cold infusate, an irritating solution, or a too rapid administration of IV solution.

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A patient who has been discharged from the hospital for 48 hours now complains to the home care nurse of pain at previous infusion site. On inspection of the site, the nurse finds redness and tenderness along the vein. The nurse suspects:

Post-infusion phlebitis

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Post infusion phlebitis is associated w/ inflammation of a vein that usually becomes evident within

46 to 96 hrs after the cannula has been removed. Factors that contribute to the development of phlebitis are the

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The recommended treatment of phlebitis stage 2+ is to:

All phlebitis, whether stage 1+ or 4+, must have the cannula removed to prevent further intima damage.

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Which is the following are considered local complications of IV therapy?

Phlebitis, venous spasm, and hematoma are common local complications.

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Speed shock, septicemia, pulmonary edema, and air embolus are systemic complications.

?????

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S/S of an air embolus includes:

Cardiac dysrhythmia, hypotension, anxiety, and substernal pressure. Localized decreased breath sounds, chest pains w/ inhalation and exhalation, pleural rub, and a cogwheel murmur. Dyspnea, tachypnea, cough and diaphoresis.

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The nurse assesses the insertion of a peripheral IV catherter and notes that the site is reddish, warm, and slightly edematous proximal to the IV cannula, and that the pt displays discomfort when the site is touched.

phlebitis.

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Phlebitis at the IV site can be distinguished by

patient discomfort at the side, as well as redness, warmth, and swelling proximal to the catheter. The line should be discontinued and a new line should be inserted at a different site.

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A nurse assesses that the patient has developed 2+ phlebitis at the site of a current peripheral IV infusion. Which of the following is the highest priority nursing action?

The nurse should discontinue the IV at the phlebitis site and then apply warm moist compresses to the area to speed resolution of the inflammation. The nurse should restart the infusion, if possible, in the other extremity.

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The physician is usually notified when there is a

3+ phlebitis.

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On inspection on an IV site, the nurse discovers a 2+ phlebitis. The appropriate nursing intervention would be to:

Treatment for suspected phlebitis is first to remove the cannula and then to restart a cannula in a new IV site if appropriate. Apply hot or cold compress to the affected side.

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All the following are local complications of IV therapy expect: Speed shock is a

systemic complication associated w/ rapid introduction of medication or fluid into the circulatory system.

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Hematoma, phlebitis, and extravasation are

local complication of IV therapy.

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The risk of phlebitis is increases in all of the following patients except:

Patients receiving TPN are receiving the therapy via central line, and phlebitis is of lower risk for the patients.

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Pt who are immunosuppressed or have massive loss of skin integrity are at risk for complication related to

infusion therapy.

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The patient complains to the nurse that his or her IV site is sore. The nurse notes that the site is red, there is some swelling, and there is no palpable cord or streak. Using the criteria for infucion phlebitis, what is the severity of this phlebitis.

???

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Phlebitis is an

inflammation of the vein in which the endothelial cells of the venous wall become irritate and cells roughen, allowing platelets to adhere and predispose the vein to inflammation-unduced phlebitis.

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phlebitis scale is as follows: 1+ is

pain at the site, erthema or edema, and no streak or palpable cord; ???

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The Nursing Society’s Standards of Practice phlebitis scale is as follows: O

????

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phlebitis scale is as follows: 2+ is

pain at the site, erythema or edema, streak formation, and no palpable cord;

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phlebitis scale is as follows:3+ includes

all of the previous symptoms, as well as a palpable cord along the vein.

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A patient who has a central venous tunneled catheter for administration of chemotherapy presents to the hospital w/ a fluctuating fever, profuse sweating, nausea, a lower than normal blood pressure, and explosive diarrhea. The nurse suspects:

Septicemia.

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Septicemia is related to

poor aseptic technique and contaiminated equipment. Central venous access devices are at high risk for

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S/S of septicema influde a

fluctuating fever, tremors, a profuse cold sweat, neausea and vomiting, explosive diarrhea, abdominal pain, and tachycardia.

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Local infection and phlebitis are

local complications that do not usually cause systemic s/s.

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Superior vena cava syndrome is related to

central venous access.

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S/S of Superior Vena Cava Syndrome includes

progressive shortness of breath, Dyspnea, cough, unilateral edema, and engorgement of the jugular, temporal and arm veins.

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IV that has been in place for 1 hr. The infusion has slowed and the patient complains of severe pain the insertion site. The patient states, “It feels like an electric shock moving up my arm” There is blanching over the site, and redness around it.

Venous spasm.

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S/S of venous spasm include

sharp pain at the IV site that travels up the arm, which is caused by a piercing stream fluid that irritates or shocks the vein wall and slows the infusion.

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Speed shock that is related to infusion is:

when a foreign substance, usually a medication, is rapidly introduced into the circulation.

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Rapid injections permits the medicinal concentration in the plasma to reach

toxic proportions, flooding the organs rich in blood (heart and brain eg) Syncope, shock and cardiac arrest may result.

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After removing an over-the-needle catheter the nurse notices that the tip has broken off, and it can be palpated at the site. What should the nurse do first?

Applying a tourniquet prevents catheter migration, and then the nurse would notify the physician and prepare the patient to have the catheter removed by the physician under fluoroscopy.

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treatment for venous spams

Applying warm compresses and slowing the infusion until the spasm subsides are initial nursing interventions.

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