Test Bank for Understanding Medical-Surgical Nursing, 3rd Edition: Linda Williams

Test Bank for Understanding Medical-Surgical

Nursing, 3rd Edition: Linda Williams

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 Chapter 6: Nursing Care of Patients Receiving Intravenous Therapy

1. A patient has been on total parenteral nutrition (TPN) for 3 weeks after an episode of severe
gastrointestinal bleeding. The TPN is now being discontinued. How should the nurse begin to
feed this patient?
A) Start with tube feedings and then progress to oral feeding.
B) Place the patient on clear liquids for 1 week to continue to rest the gastrointestinal tract.
C) Introduce oral feedings slowly as TPN is being decreased.
D) Provide mostly proteins to begin to rebuild tissue integrity.

2. When an intravenous catheter is being inserted on a newly admitted patient, a vein in which
area should be used first?
A) Upper arm
B) Antecubital space
C) Forearm
D) Hand

3. A patient is receiving an intravenous (IV) solution delivered by an electronic control device.

The alarm begins sounding, and the display panel indicates occlusion. The nurse pushes the
alarm silence button, but the alarm quickly resumes. Which of the following actions should
be taken first?
A) Notify the physician.
B) Check for kinking of the tubing or a closed clamp.
C) Turn off the IV solution, and gently flush the line with 3 mL of saline flush solution.
D) Decrease the rate to 10 mL/hr, and flush the line with 1 mL of heparin solution.

4. The nurse walks into a patient's room and finds the central intravenous line disconnected and
the patient cyanotic and gasping for breath. Which action should the nurse take first?
A) Call the physician STAT.
B) Pinch off the tubing of the central line.
C) Place the patient in a left side lying position.
D) Listen to the patient's lung sounds.

5. Blood glucose levels are prescribed every 6 hours for a patient who is receiving total
parenteral nutrition (TPN). The patient asks why this is necessary. Which of the following
responses by the nurse is most appropriate?
A) “When people receive TPN, they develop mild diabetes, which needs to be well regulated.”
B) “TPN contains a lot of sugar. We monitor blood glucose to be sure it doesn't get too high.”
C) “There is a lot of sugar in the solution, which can increase the risk for rebound
hypoglycemia.”
D) “We have to monitor your glucose because the physician prescribed it.”

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 Chapter 6: Nursing Care of Patients Receiving Intravenous Therapy

6. When changing the dressing on a central line, which of the following actions by the nurse is
least appropriate?
A) Wear a mask and gloves when changing the dressing.
B) Have the patient perform the Valsalva maneuver when the line is disconnected for a tubing
change.
C) Date, time, and initial the dressing change.
D) Position the patient on the left side with head down during the procedure.

7. An angiocatheter site in a patient's left forearm has become reddened and tender. What
should the nurse do first?
A) Check for a blood return.
B) Apply a warm compress over the insertion site.
C) Remove the angiocatheter.
D) Run the intravenous solution at a slightly faster rate to encourage sluggish circulation.

8. As soon as the nurse begins to insert an intravenous catheter in the patient's antecubital
space, blood begins to spurt from the site. What should the nurse do first?
A) Finish threading the catheter quickly, and apply a pressure dressing and tape.
B) Remove the catheter, and insert a new one in the same site.
C) Remove the catheter, and apply pressure to the site.
D) Remove the catheter, and call for help.

9. When is it appropriate to use the SASH (saline-administer medication-saline-heparin)

technique for administering intravenous (IV) medications?
A) When the medication is not compatible with heparin
B) When the patient is allergic to heparin
C) When agency policy recommends saline instead of heparin
D) When the IV site is red or puffy

10. A patient in an outpatient oncology clinic says is going to have a PICC line placed, and wants
to know what that means. What is the best response by the nurse?
A) “A PICC line is a catheter that is inserted into your jugular vein and ends in the central
circulation.”
B) “A PICC line is just a regular IV, but an extra-small catheter is used to prevent vein
irritation.”
C) “A PICC line is a percutaneous intravenous core catheter.”
D) “A PICC line is an intravenous device that is inserted into your arm and ends in the
circulation near your heart.”

11. An intravenous infusion is not running. The insertion site looks normal. Which of the
following actions by the nurse is appropriate to try to get it running again?
A) Flush the catheter with 1 to 2 mL of heparin flush solution.
B) Flush the catheter with 1 to 2 mL of normal saline solution.
C) Reposition the extremity.
D) Place gentle pressure on the bag of solution.

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 Chapter 6: Nursing Care of Patients Receiving Intravenous Therapy

12. A patient is in the intensive care unit with acute renal failure secondary to septic shock, and
is receiving intravenous fluids of 0.9% NaCl at 125 mL/hr. The patient develops crackles in
the lungs, distended neck veins, 1+ pitting edema in the feet, and a 4-lb weight gain from
yesterday. What nursing diagnosis is most appropriate to this situation?
A) Imbalanced nutrition: greater than body requirements
B) Excess fluid volume
C) Decreased cardiac output
D) Ineffective tissue perfusion: peripheral

13. An intravenous (IV) insertion site begins to leak. The tape over the site is wet. What should
the nurse do first?
A) Call the physician to report the problem.
B) Remove the dressing from the IV site, and observe the insertion site.
C) Slowly increase the speed of the IV drip, and watch the site carefully for increased leaking of
IV solution.
D) Discontinue the angiocatheter, and start an IV in another site.

14. Which technique best dilates a vein for venipuncture?

A) Elevate the extremity for 5 minutes.
B) Apply a cool compress for 15 minutes.
C) Apply a tourniquet for 3 minutes.
D) Apply an alcohol swab for 60 seconds.

15. A patient with breast cancer is receiving an intravenous (IV) infusion of chemotherapy. The
agent being used is a known vesicant. The LPN enters the room and finds the IV insertion
site red and puffy. Which of the following actions is appropriate first?
A) Stop the infusion.
B) Call the physician STAT.
C) Remove the IV dressing and examine the site.
D) Call the RN to assess the situation.

16. The LPN enters a patient's room and notes a white precipitate forming in the IV tubing at the
site where an antibiotic is piggybacked in. Which of the following actions is appropriate
first?
A) Call the pharmacy to see whether this is an expected reaction.
B) When the infusion is complete, remove the tubing, and send it to the laboratory for analysis.
C) Stop the infusion.
D) Notify the physician.

17. Which of the following factors can slow the flow rate of a gravity solution?
A) Raising the level of the solution container
B) Opening the roller clamp
C) Flexing the extremity above the insertion site
D) Flushing the cannula with saline solution

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 Chapter 6: Nursing Care of Patients Receiving Intravenous Therapy

18. Which fluid shift occurs when a hypertonic intravenous solution is administered?
A) Fluid moves from the venous circulation into the interstitial space.
B) Fluid moves from the interstitial space into the venous circulation.
C) Fluid moves from the arterial circulation into the venous circulation.
D) Fluid moves from the plasma into the cells.

19. The nurse assesses a patient receiving intravenous therapy and suspects fluid overload.
Which assessment is most important for the nurse to perform?
A) Assess lung sounds for crackles.
B) Inspect the insertion site for infiltration.
C) Check the patient's weight.
D) Observe the patient's feet for edema.

20. What type of solution is used to replace electrolytes and expand plasma volume?
A) Isotonic solution
B) Hypotonic solution
C) Hypertonic solution
D) Dextrose solution

21. When assessing a patient with an intravenous line in the right arm, the LPN notices that the
skin near the infusion site is taut and cool, and that when the arm is lowered it appears to
swell. What is most likely occurring?
A) Infection
B) Venous spasm
C) Infiltration
D) Embolism

22. Why should an intermittent catheter be flushed regularly? Select all that apply.
A) To prevent the mixing of incompatible medications and solutions.
B) To ensure the patency of the catheter.
C) To prevent the formation of emboli.
D) To open an occluded catheter.
E) To replace lost fluids.

23. Which patients are most likely to need intravenous therapy? Select all that apply.
A) A 3-year-old who has had frequent diarrhea and vomiting for 3 days
B) A patient with pitting edema and lung crackles
C) An 85-year-old man with Alzheimer's disease who refuses to eat or drink
D) A 36-year-old fireman with second-degree burns and exhibiting signs of smoke inhalation
E) A 16-year-old girl with anorexia who has been repeatedly purging
F) A 45-year-old woman with a broken humerus

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 Chapter 6: Nursing Care of Patients Receiving Intravenous Therapy

24. Which of the following are systemic complications of peripheral intravenous therapy? Select
all that apply.
A) Fluid overload
B) Air embolism
C) Phlebitis
D) Septicemia
E) Extravasation

25. Place the following steps in starting a peripheral line in the order in which they should be
completed. All options must be included.
____ Check the physician's order.
____ Select the site, and dilate the vein.
____ Wash your hands for 15 to 20 seconds
____ Enter the vein using the direct or indirect method.
____ Stabilize the catheter with tape, and apply a dressing.
____ Dispose of used equipment properly.
____ Assess the patient.

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Test Bank for Understanding Medical-Surgical Nursing, 3rd Edition: Linda Williams

Chapter 6: Nursing Care of Patients Receiving Intravenous Therapy

Answer Key
1. C
2. D
3. B
4. B
5. B
6. D
7. C
8. C
9. A
10. D
11. C
12. B
13. B
14. C
15. A
16. C
17. C
18. B
19. A
20. C
21. C
22. A, B
23. A, C, D, E
24. A, B, D
25A. 1
25B. 4
25C. 2
25D. 5
25E. 6
25F. 7
25G. 3

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