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I.V. 138 Final

QuestionAnswer
True or False. X-ray verification is necessary for PICC line placement confirmation but NOT for all Central Venous Access Devices. FALSE
True or False. PICC line dressing is routinely changed every seven days using sterile technique. TRUE
The nurse notices VISIBLE crystalization on the administration set. This drug incompatibility is called? PHYSICAL - because you can see it
The proper location for the tip of the PICC line is: SUPERIOR VENA CAVA
The choice of syringe barrel capacity for irrigating a central line would be: 10 ml
What is the correct drop factor when you are using a microdrip set? 60 gtts/ml
When preparing to piggyback an antibiotic to a primary infusion, the nurse should plan to administer the antibiotic by: Hanging the antibiotic higher than the primary solution (allows the atb to combine with the primary solution)
Containers for the disposal of needles and syringes should have which of the following features? Be puncture resistant
The frequent monitoring of the IV site is extremely important in the elderly becuase of: Age related neurologic changes can reduce tactile sensation
You are mixing two medications in one syringe and the solution of combined medications becomes cloudy and white. What type of incompatability might this be? PHYSICAL - because you can SEE it
What is an incorrect technique for changing a hospital gown for a patient with an IV? Disconnecting the IV administration set at the hub of the cannula (creates opportunity for infection)
You are caring for patient with external epidural infusion and alarm goes off. What do you do? Assess the system to be sure there are no kninks in the tubing
Which of the following tubes would you draw first? blood culture, red, lavender, blue Blood Culture! (only draw red first with butterfly needle b/c it will underfill by .5ml)
IV labels should be on which areas? Catheter site, tubing, solution container
Intrathecal drug administration provides medication directly to the: Cerebral Spinal Fluid
Physiologic changes in geriatric patients that affect IV placement include all of the following: thinning of the shin, loss of subcutaneous fat, sensory perception changes
How long do you wash your hands? 15-20 seconds
What are the 5 steps to pre-cannulation? 1. check the dr's orders 2. wash your hands 3. gather supplies and inspect equipment 4. patients assessment, psychological prep and patient identification 5. site selection and vein dilation
What are the 5 steps of the cannulation phase? 6. select appropriate catheter 7. apply gloves 8. site prep - 30 seconds and let dry 9. vein entry, direct vs indirect 10. cath stabilization and dressing
What are the 5 steps of the post-cannulation phase? 11. labeling 12. equipment disposal 13. patient education 14. rate calculation 15 documentation
What phase does labelling fall into? post-cannulation
True or false. "Since I did a blood draw on this patient yesterday, I don't need consent today." FALSE. We need to obtain consent for EVERY invasive procedure
What site prep solutions should be used when taking a blood sample for alcohol screening? Betadine or Chlorhaxadine. NOT ALCOHOL, probably doesn't affect results but causes reasonable doubt in court of law.
What would be a reason to use intraperitoneal medication administration? For delivery of chemotherapy med to abdominal tumor. Med goes directly to affected area (not systemically) produces fewer side effects.
If a patient has an IV in one arm, which arm would you use the draw blood? The other one!
define extravasation. Irritating/vesicant fluids leaking from vascular space into surrounding tissue
If your patient's potassium was 3 yesterday and 6 today what would you do? Recheck the results. The tournequet may have been left on too long and K+ may have leaked from tissue into vascular space.
Can an LPN give experimental/investigation medications? NO
What is the best way to identify your patient? Armband is best
What is the number one reason for allergic reaction during blood transfusion? ABO incompatibility
Where is the vascular area of our skin? In the Dermis
What are the signs and symptoms of an allergic reaction to blood transfusion? Itching, SOB, rash (not altered vision)
True or false. The Physicians order needs to state the IV rate in ml/hr. FALSE we calculate rate based on the order
What is a non-immune related complication of blood transfusion? circulatory overload
Can an LPN give pain med via IV push? NO!
What are the advantages to IV medication administration? route for irritating medications and rapid onset
What feature should a sharps box posess? it should be puncture proof
If Bob has type O negative blood, and is scheduled for a surgical procedure, what teaching should the nurse do? Advise Bob to give his own blood prior ro surgery for his own use. (Autologous blood)
Should vital signs be included in the IV documentation? NO
What phase of Philips 15 steps is vein dilation? pre-cannulation (it's Philips, what can I say...)
During the discontinuation of an IV, how do you care for the site after the catheter is removed? Apply pressure to site for 60 sec and use strerile 2X2 gauze dressing
Will the physician specify an IV location/site in the order? NO, we choose the site
What patient teaching should you do for a patient receiving a blood transfusion? Tell patient to report chills, itchyness and shortness of breath immediately
You are taking a temperature on a patient about to receive a blood transfusion and your thermometer reads 103 degrees. What is your first action? Notify the RN
What tube do you fill first with butterfly needle? the red one (no additives in red tube, 1st tube will underfill and screw up additive to blood ratio)
Is it OK not to use a tournequet with elderly patients? yes because elderly patients have fragile veins.
Haw many times can a needle/cannula be used to stick the patient? ONE time
What phase of Phillips 15 steps is patient assessment preformed? pre-cannulation (this one makes more sense)
Do all lab specimins need to be treated as hazardous? yes
What do you label after you start an IV? tubing, insertion site and container
What are side effects of an epidural? urinary retention, putitis, respirtory supression
Should the nurse use a 45-90 degree angle when preforming venipuncture? NO 30-45 degrees in adult, 15-30 for older adult
What do you do if you are gathering your supplies, inspecting your equipment and the tubing falls to the floor? Get new tubing
Can we use bed number or room number to identify our patient? NO
Can incorrectly labelled lab specimins have a useful result? NO
Where would you hang IVP of ATB? Higher than the primary solution
Does the RN accept total responsibility for your patient receiving a blood transfusion. NO - They are still your patient
What does drop factor mean? The number of drops in 1 ml of solution
How much of a neonate's body is water? 70% (greatest risk for dehydration, pee a lot and get diarrhea a lot, higer risk for pH imbalance)
What is the intraosseous route for IV administration Bone - stab a long bone as hard as you can. Used by paramedics with Dr. order
What are disadvantages of intraosseous route? potential for compartment syndrome, osteomyelitis, cellulitis, damage to epiphyseal plate, potential fat embolusfrom marrow cavity
What gauge needle do you use for elderly? 22-24 (smaller r/t fragile veins and less sub q tissue.) Place tournequet over gown if needed to protect skin
How many furrows should the tongue have? one (two indicates dehydration)
IV tips for fragile veins: avoid multiple tapping of vein, use smallest gauge necessary, lower angle of approach r/t less sub q tissue,
How do you asses for veins in patients with edema? push down on limb, then pull back to look for vein
Advantages of IV administration: direct access to circ sys, route for drugs that might irritate gastric mucosa, instant action, can deliver high concentrations, admin will terminate as soon as you close clamp, better control of rate, provides route for NPO PT's
Disadvantages of IV med administration: can't use if med has incompatabilities with solution, can't use in meds that neet to metabolize in digestive tract, drug loss by absorption in container, speed shock, extravasation, phlebitis
How do you verify drug compatibilities? call pharmacist and ask
What are the 6 rights? right patient, right drug, right route, right dose, right time, right documentation
How long can medications and solutions be kept? 24 hours: they are no good after 24 hours
What is a physical drug incompatibility? something you can see, crystals in the bag, STOP INFUSION IMMEDIATELY
What is a chemical drug incompatability? Like oil and water, somethings don't mix with D5W or NS
What is a continuous infusion? large volume of solution 250-1000 ml administered over 2-24 hours
What is an intermittent infusion? small volumes 25-250 ml infused over 15-90 minute intervals (IV piggyback) Can be given simultaneously to a continuous infusion
Can LPN administer IV push meds? NO outside scope of practice
When are subcutaneous infusions used? in home care for frequent intermittant injections, insulin pump or pain pump
Can LPN manage/program PCA Pump? NO - outside scope of practice (no one but patient can push the button)
Lecture NCLEX ?: By inserting the catheter at a 20-30 degree and in a single motion penetrating the skin and the vein simultaneously the nurse is using a: Direct method (NOT indirect method, incorrect method or two-step method)
Lecture NCLEX ?: Which of the following are side effects of epidural pain medication? Urinary retention, pruritis, and respiratory depression
Lecture NCLEX ?: Complications of intraosseous infusions include all of the following EXCEPT: Osteomyelitis - YES Cellulitis - YES Damage to epiphyseal plate - YES Fractured Humerous - NO (rare complication)
What position should the bevel be in during venipuncture? UP, towards the ceiling
Can an LPN start a peripheral IV on an infant? NO, must be adults, 18 or over
What layer is the adipose tissue located? Hypodermis layer
Is it OK to refrain from using tournequet in elderly patients? YES
How long can we use a bag/container? 24 hours
How long can tubing be used? change in 72-96 hours or as needed
How long can an insertion site be used? 72-96 hours
Can the LPN check the bag of blood with the RN at the bedside? YES
What are the advantages of an intermittant infusion device? (hep/saline lock, prn device) Have venous access in emergency
What are the uses for flushing? maintains patency of catheter, prevents mixing of meds that are incompatible
What does SASH mean? Saline, Additive, Saline, Heparin
What are the sizes of macrodrip tubing? 10, 15, 20
How do you prepare refridgerated antibiotics? All IV solutions must be given at room temperature
How do you assess for emotional status for procedure? "Are you OK with needles?"
How long should you monitor venipuncture site for hematoma formation? 5 minutes
If client is immunosupressed how often should you check the venapuncture site for S & S of infection? every 8 hours
If the arm needs to be in a dependant position during venapuncture, what is a dependent position? Below the level of the heart
Does every blood draw require consent and patient education? YES
Can an LPN stop a blood transfusion if a complication arises? YES (LPN cannot innitiate or maintain)
Can an LPN sign as COSIGNER for an RN on transfusion verification paperwork? YES
What are S & S of transfusion reaction? Itching, rash, SOB, increased temp, increased HR (if noted, immediately stop infusion and notify RN
Blood donor collection methods include Autologu, Homologus and Designated. What do these terms mean? Autologus - recipitient's own blood Homologus - donated by someone other than intended recipient Designated - blood donated by friends and relatives of recipient
What are the non-immune complications of blood transfusions? circulatory overload, potassium toxicity, hypothermia, hypocalcemia, bacterial contamination, infectious disease
Can LPN change bag on central line? Yes, but not tubing (RN hangs first bag)
How long is the dwell time on a picc? 6 weeks to one year
Do picc's have a higher or lower infection rate than peripheral IV's? LOWER
Who inserts an arterial line? surgeon
Who inserts picc? Trained RN
How are dressings manages with central lines? Gauze dressing for first 24 hours then changed to tegaderm which can be changed every 7 days
What do you do if you find a picc leaking? Clamp it and call the doctor
What os the dwell time for implanted ports 3 years
Can an LPN innitiate IVP of ATB on central line? YES
Can an LPN discontinue PICC? NO
How do you check for infiltration during chemotherapy administration? Flush with normal saline before, during, and after administration
What are the three steps if patient experiences extravasation? 1. stop the infusion, 2. Notify doctor 3. instill the appropriate antedote
Can an LPN with IV certification flush a hep lok? YES
Created by: Merrill15888