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A patient is receiving an intravenous (IV) infusion of 5% dextrose in 0.45% saline. This solution is
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A patient will be receiving a blood transfusion. The nurse will need to use a
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| Question | Answer |
|---|---|
| A patient is receiving an intravenous (IV) infusion of 5% dextrose in 0.45% saline. This solution is | hypertonic. |
| A patient will be receiving a blood transfusion. The nurse will need to use a | Y administration set. |
| The nurse is gathering equipment needed for a pediatric patient who will begin IV therapy. The tubing size appropriate for this patient is | 60 gtt/mL. |
| A patient is receiving a medication via IV piggyback. What indicates the setup is incorrect? | Primary line clamp is closed. |
| The nurse is assisting in the care of a patient who will receive a unit of blood. The appropriate solution to infuse through a parallel infusion set before and after the infusion is | normal saline. |
| A patient who is able to eat a normal diet has an order to receive an IV infusion of an antibiotic every 6 hours. This patient is likely to have a(n) | intermittent infusion device. |
| A patient is receiving IV fluids through an infusion pump. How often should the nurse check the functioning of the pump? | Every 1 to 2 hours |
| A patient has an IV line dressing that is dated 7/17. Today is July 18. The catheter should be changed | tomorrow or the next day. |
| A patient is admitted with a peripherally inserted central catheter (PICC). As part of standard care for this patient, the nurse should | avoid taking blood pressures on the arm with the PICC line. |
| A patient has just undergone placement of a central venous catheter through the subclavian vein. Fluid infusions through the catheter cannot begin until placement is verified by | results of chest x-ray. |
| The nurse observes that the insertion site of an IV catheter looks pale and puffy. When palpated, the area feels cool to the touch. The best action for the nurse to take is to | discontinue the infusion and start a new IV site. |
| A patient rings the call bell and states that the IV insertion site is painful. The site is reddened, warm, and swollen. The patient is most likely experiencing | phlebitis. |
| A patient who has been receiving IV fluid therapy experiences an air embolus in the line. The nurse should immediately turn the patient onto the | left side and lower the head of the bed. |
| Regardless of the state or setting in which an LPN/LVN practices, he can expect to have which responsibility with regard to IV therapy? | Monitor IV therapy. |
| A nurse is monitoring the status of an elderly patient who is receiving IV therapy. Which clinical sign is more indicative that this patient is experiencing fluid overload? | Crackles in the lung fields |
| A nurse is caring for a patient with an IV piggyback whose infusion is behind schedule. The best nursing action is to | track accurate intake and output every shift. |
| A patient is to have an IV insertion site changed. The current line is in the lower right forearm. Which location is contraindicated for the new site? | Right hand |
| A patient who needs to have an IV line started has poor-quality veins. Her nurse would plan to get another nurse to try to obtain a line if he was not successful in | two attempts. |
| A nurse is assigned to care for a patient with a continuous IV infusion running. The IV bag should be changed when how many milliliters of solution remain in the old one? | 50 |
| A patient who requires an immediate transfusion of blood has previously signed a consent form to receive it. The consent must be signed within the last | 48 to 72 hours. |
| A patient complains of chills, back pain, and shortness of breath a few minutes after the blood infusion is started. The first thing the nurse should do is | stop the blood infusion and start the saline. |
| The LVN/LPN is told by the RN to discontinue an IV line to the patient. The best nursing action is to | check the physician’s order. |
| A patient has an intermittent IV device, or a saline lock. An important nursing consideration is to | infuse saline or heparin solution to maintain patency. |
| Which is the least valid reason to administer a drug by the parenteral route? | The patient does not like the taste of the medication. |
| The nurse is administering an intradermal injection to a patient who needs a tuberculin test. Which should the nurse do to ensure proper administration? | Inject slowly to form a bleb. |
| The physician orders the nurse to administer a subcutaneous injection to a patient. The best angle to insert the needle before administration is at | 45 to 90 degrees. |
| A postoperative patient experiencing pain has an order for analgesic medication to be given by the intramuscular route. The maximum number of milliliters that can be injected into the dorsogluteal site is | 3 mL. |
| A nurse is preparing to draw up medication to administer by injection. The nurse understands that the only part of the syringe that can be touched and not contaminated is the | outside of the barrel. |
| A nurse has just administered a medication to a patient using a syringe that is not a safety syringe. To dispose of the needle and syringe safely, the nurse should | leave the needle uncapped and dispose of it in the sharps container. |
| When the nurse is preparing to draw medication from an ampule, the proper procedure is to | wrap the neck with a gauze or alcohol sponge. |
| When withdrawing medication from an ampule, the best needle to use is a | filter needle. |
| The nurse has an order to administer an injection of a medication that comes in a vial. The proper technique when withdrawing medication from the vial is to | inject into the vial an amount of air that is equal to the dose. |
| A patient has an order to receive two intramuscular injections at the same time. The nurse should first | determine if the two medications are compatible in the same syringe. |
| A patient has an order to receive a mixture of short- and long-acting insulin. The first step to properly draw them up in the same syringe is to | inject air into the long-acting cloudy insulin. |
| A nurse has opened and used part of a new multidose vial of medication. Which action should be taken before replacing the vial in its storage area on the medication cart? | Write the current date on the vial. |
| When reinforcing instructions to a patient who will self-administer insulin injections at home, it is important to remind the patient to | rotate injection sites systematically. |
| The nurse has an order to administer an injection of purified protein derivative (PPD) by the intradermal route. The maximum amount of medication that can be given using this route is | 0.1 mL. |
| A nurse has administered a Mantoux skin test to a patient in the outpatient clinic at 9:00 AM on Monday. The patient should be scheduled to return to the clinic to have the result read | any time on Wednesday. |
| A hospitalized patient has an order for subcutaneous heparin. The best location to administer this medication is the | abdomen. |
| When administering an intramuscular injection to an adult patient using the dorsogluteal site, which landmark should be used to locate the area for injection? | The head of the trochanter and the posterior iliac spine |
| When administering an intramuscular injection for a 4-year-old child, the best site to use is the | vastus lateralis. |
| A nurse is administering a parenteral injection. The best nursing action to decrease discomfort to the patient is | using the smallest gauge needle that is appropriate for the site. |
| A patient has a medication order for iron dextran (Imferon) to be given using the Z-track technique. The rationale for using this method is | to avoid medication irritation. |
| A patient received a first dose of a parenteral medication in the outpatient clinic and will be monitored for 30 minutes. The nurse explains to the patient that it is important to monitor for | any allergic reaction. |
| When preparing to reconstitute a drug from a powder form, the nurse should first | check the medication with the MAR. |
| Which medication order should be documented in the MAR and in the nurses’ notes after it is given? | Demerol 75 mg IM PRN pain |
| A nurse is trying to remember what correct size syringe and needle to use for a subcutaneous injection. The best choice is a | 3-mL syringe and 25-gauge, -inch needle. |
| The nurse is teaching a patient who weighs 325 pounds how to administer a subcutaneous injection. The nurse knows that, when administering this type of injection, the patient will | require a longer needle because of his weight |
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