Advanced Skills IV Theory (Exam One) Flashcards
1
Q
What is the most commonly used infusion route?
A
Intravenous (IV) route
2
Q
List the advantages of IV therapy.
A
- Instant effects
- Better control of medications
- More specific (mL/hr)
- Boluses
- Direct access to blood stream
- Able to give medications if patient is NPO
- Good for medications that cannot be absorbed via another route
3
Q
List the disadvantages of IV therapy.
A
- Irritating substances
- Medication incompatibility
- Errors in mixing medication
- Extravasation
- Speed shock
- Chemical phlebitis
4
Q
IV substance irritation usually occurs due to what?
A
- Lack of assessment
- Incorrect placement
5
Q
What is the nurses role in relation to IV therapy?
A
- Assess
- Manage
- Initiate
6
Q
How is competency assessed in relation to IV therapy?
A
Evidence-based practice
7
Q
A patient complains of pain after having an IV placed. The site is without redness, swelling, and is not warm to the touch. This is considered what type of data?
A
Subjective
8
Q
Upon assessment of a patient’s IV site, the nurse visualizes redness and swelling along with warmth and tenderness upon palpation. This is considered what type of data?
A
Objective
9
Q
What population may be less likely to be aware of IV site complications? Why?
A
-Older population
- Decreased sensory perception
- Acute confusion
10
Q
The nurse should __________ care for each patient.
A
Individualize
11
Q
The nurse should provide _________ to each patient regarding IV therapy.
A
Education
12
Q
What must the nurse know when providing medications to patients via infusion therapy?
A
- Antidote(s)
- Reversal agent(s)
- Physicians order
13
Q
The physicians order for IV therapy will include what?
A
- Type of solution
- Rate of solution
- Duration of the solution
14
Q
The nurse may decide what two factors when inserting an IV?
A
- Size of catheter
- Location of catheter insertion
15
Q
The nurse will require an order from the physician to place an IV site on which body part?
A
Foot
16
Q
What is a sentinel event?
A
Any event that has caused major harm to the patient
17
Q
The nurse is responsible for including what information within their documentation when inserting an IV?
A
- Placement time
- Placement site
- Securement device
- Currently infusing
- How the patient is tolerating the IV
- IV site description
18
Q
T/F: The nurse is allowed to place an IV in a patient, even if the patient is coherent and denies the IV. Explain.
A
- False
- Coercion of a coherent adult patient can result in the nurse being charged with assault or battery
19
Q
What is the most common type of error made by nurses?
A
Medication error
20
Q
What must the nurse do before administering a high-risk medication?
A
Have the medications check by another nurse (double-check)
21
Q
What medications are considered high-risk or double-check medications?
A
- Insulin
- Blood thinners
22
Q
What must the nurse know about the medication being administered prior to running or pushing the medication?
A
How fast to run or how slow to push the medication/solution
23
Q
If infusing more than one solution, they must be what?
A
Compatible
24
Q
What is a nonspecific immune response?
A
- Acquired at birth
- May function without previous exposure to antigen
25
What is a specific immune response?
Acquired immunity through repeated exposure to antigens
26
What is the body's first line of defense against an antigen?
Intact skin
27
What vital sign changes will a patient exhibit if an infection is present or worsening?
- Decreased blood pressure
- Increased heart rate
- Increased temperature
28
A decrease in blood pressure and an increase in heart rate and temperature are considered what type of mechanism?
Second line defense mechanism
29
Older adults are most likely to NOT exhibit which symptom when presenting with an infection?
May not show an increase in temperature
30
What is the most common type of IV related sepsis?
Staph infection
31
List the type of patients who are immunosuppressed and most at risk for infection?
- Chemotherapy patients
- HIV patients
- Transplant patients
32
What are the four major concerns if a patient is considered to be immunosuppressed?
- More frequent infections
- More severe infections
- Unusual infections
- Decreased response to therapy
33
Define colonization.
- Growth of an organism without detection
| - Person has infectious agent and does not know
34
Define dissemination.
- Person is shedding the organism into their environment
| - Person has infectious agent and is infecting other people
35
What type of patient is most at risk for complications or health acquired infections?
Patient with co-morbidities
36
List the three sources of infusion related infections.
- Insertion site
- Cannula hub
- Contaminated fluids
37
Define phlebitis?
Inflammation of the vein
38
What size of veins are more prone to irritation?
Small veins
39
List the signs and symptoms of phlebitis.
- Inflammation
- Pain
- Tenderness
40
An elderly patient begins to display signs of phlebitis along her IV site, which was inserted this morning. The night nurse stated the patient was a hard stick at hand-off. The IV site cannot be moved to her other arm due to an intact fistula. How should the nurse treat the phlebitis?
Manage the symptoms using a warm compress
41
What is infiltration?
When IV fluid escapes from the vein into the surrounding tissue
42
Is a local or systemic infection accompanied by vital sign changes?
Systemic
43
Which bacteria is the most common source of infection?
Staph
44
Where does a local infection occur?
In one central or localized area on the body
45
What are the signs and symptoms of a local infection?
- Drainage from insertion site
- Erythema
- Swelling
- Pain or tenderness
46
Will a patient who has a local infection also display signs and symptoms of a systemic infection?
No
47
Describe extrinsic contamination.
Contamination that occurs during preparation or administration
48
Describe intrinsic contamination.
Contamination that occurs during manufacturing
49
List factors that contribute to contamination during infusion procedures.
- Faulty handling
- Admixtures
- Manipulation of in-use IV equipment
- Injection ports
- Additional ports
50
What procedure is necessary if an infusion related infection is suspected?
Obtaining a culture from the suspected source
51
Where should a peripheral IV end up after insertion?
In the vein
52
Valves of the veins are located how far apart? Can a peripheral IV catheter be inserted into a vein valve?
- Approximately every 3 in
| - No
53
T/F: A pulse can be felt in a vein.
False, you cannot feel a pulse in a vein
54
When attempting to start a peripheral IV, should the nurse begin high and work down the arm or begin low and work up the arm?
Begin low and work up the arm
55
A nurse has attempted to insert a peripheral IV in the AC vein of a patients left arm, but was unsuccessful. A different nurse attempts to insert another peripheral IV on the same arm immediately following the unsuccessful attempt . Can the current nurse attempt to insert below the AC vein previously accessed by the first nurse?
No, the new IV must be proximal to the previous attempted IV insertion
56
What is the first step of a peripheral IV insertion?
Confirm the provider order
57
What should the nurse check the IV fluid, or solution, for, prior to starting the IV?
- Expiration date
- Clarity
- Holes or punctures of the bag
58
After cleaning, why does the skin need to dry completely before inserting the IV?
To avoid skin irritation
59
If a patient becomes anxious before or during an IV insertion what will this cause?
Vasoconstriction
60
List the considerations of IV site selection.
- Type of solution
- Condition of vein
- Duration of therapy
- Cannula size
- Patient age
- Patient activity
61
An IV may NOT be placed over what type of skin conditions?
- Rash
| - Scar
62
An IV may NOT be placed in a patients arm if they have/had what?
- Graft
- Fistula
- Mastectomy
63
Why should the AC vein be avoided when choosing an IV site?
Constant manipulation and bending can cause IV to go bad
64
What size gauge needles are used to administer blood?
- 18 gauge
| - 20 gauge
65
List the different methods used to dilate a vein.
- Tourniquet
- BP cuff (>30 mmHg)
- Warm compress
- Flicking vein
- Hanging dependent
66
What is a 16 gauge catheter used for? What color is it?
- Trauma
| - Gray
67
What is an 18 gauge catheter used for? What color is it?
- Blood
- Pre-surgery
- Green
68
What is a 20 gauge catheter used for? What color is it?
- Routine and most common
| - Pink
69
What is a 22 gauge catheter used for? What color is it?
- Pediatric or older adults
| - Blue
70
What is a 24 gauge catheter used for? What color is it?
- Pediatric or older adults
| - Yellow
71
What length of needle is used for IV catheter insertion?
1 inch or smaller
72
The catheter must be _______ than the vein.
Smaller
73
Larger needles are required for what type of solutions?
Caustic (irritating)
74
The tourniquet should be applied how many inches above the IV site?
3 to 4 inches
75
What type of solutions are acceptable to use for cleaning the IV site?
- Chlorhexidine gluconate
- Iodine
- 70% isopropyl alcohol
76
What percentage of alcohol is acceptable to use for cleaning the IV site?
70%
77
What is considered the first choice of cleaning solution to prep the IV site?
Chlorhexidine gluconate
78
What cleaning solution can NOT be used on pediatrics/infants or neonates?
Iodine
79
When inserting an IV, the bevel should face what direction?
Up
80
When is it considered safe to thread the catheter off of the needle?
When flashback is visualized (blood return is confirmed)
81
Why are transparent dressings used for IV sites?
Ability to assess and identify problems with the IV
82
How often is the nurse required to assess a patient IV site?
AT LEAST once a shift, preferably more if possible
83
What should the nurse label on the cannula post-insertion?
- Initials
- Date
- Time
84
How often should an IV cannula be replaced? Why?
- Every 72 to 96 hours
| - Risk of phlebitis increases past 4-day indwelling time
85
Is it necessary to replace the IV cannula every 72 to 96 hours even if the IV is patent and without complications?
Yes
86
Upon removal of an IV, the nurse should assess what? Why?
The tip of the catheter to ensure it is intact
87
How often should mainline sets be replaced or changed?
Every 72 hours
88
How often must an IV be flushed?
Once every 12 hours
89
Describe the order of administration when giving a medication via IV push?
- Flush with 5 mL of NS
- Push medication over required length of time
- Flush with 5 mL of NS at the same rate of time as medication was administered
90
What is the minimum size syringe that can be used to flush an IV?
3 mL
91
The nurse knows they may have to do what when administering medications to special populations via IV push?
Push the medication in at a slower rate
92
What percentage of total adult body weight is water?
60%
93
Does a newborn have more or less total body water weight compared to an adult? What is the percentage?
- More
| - 70% to 80%
94
List instances in which fluid replacement via IV would be necessary.
- Dehydration
- Burns
- Bleeding
95
List the routes of fluid intake.
- Oral
| - IV
96
List the routes of fluid loss.
- Sweat
- Vomit
- Diarrhea
- Existence
97
What are the three classifications of tonicity of solutions?
- Isotonic
- Hypotonic
- Hypertonic
98
What does protein do in relation to fluid?
Protein keeps fluid inside of the cells
99
Describe isotonic solutions.
Balanced amount of solution on the inside and outside of the cell
100
Isotonic solutions are most commonly given to patients who present with what types of medical issues?
- Dehydration
| - Sodium imbalance
101
List examples of isotonic solutions.
- Lactated ringers
- 0.9% Sodium chloride (NS)
- 5% Dextrose in water
102
Describe hypotonic solutions.
Solution stays on the inside of the cell
103
Hypotonic solutions are most commonly given to patients who present with what types of medical issues?
- Intracellular dehydration
| - Diabetic ketoacidosis
104
List examples of hypotonic solutions.
- 0.45% Sodium chloride
- 0.33% Sodium chloride
- 0.225% Sodium chloride
105
Describe hypertonic solutions.
- Causes the cells to shrink
| - Enters and exits the cell
106
Hypertonic solutions are most commonly given to patients who present with what types of medical issues?
Intracranial pressure
107
List examples of hypertonic solutions.
- 3% Sodium chloride
- 5% Dextrose and 0.45% Sodium chloride
- 5% Dextrose and 0.9% Sodium chloride
108
What type of solution would the nurse administer to a patient with intracranial pressure?
Hypertonic solution
109
The nurse knows to be extra cautious when providing IV fluids to a patient with medical diagnoses involving what specific organs?
- Heart
- Liver
- Kidneys
110
What percentage of dextrose solution can be administered via peripheral IV? How must it be administered if it exceeds this percentage?
- 10% or less
| - Central line
111
Hypertonic solutions are usually ran for _______ periods of time in _______ amounts.
- Short
| - Small
112
List signs and symptoms of fluid volume deficit.
- Decreased skin turgor
- Hypotension
- Thirst
- Dry skin
- Dry mucous membranes
- Tachycardia
113
List signs and symptoms of fluid volume excess.
- Pitting edema
- Weight gain
- JVD
- Hypertension
- Dyspnea
114
List signs of dehydration of the pediatric patient.
- Lack of tears
| - Shrunken fontanels
115
What is the primary cause of hypervolemia?
Cardiac dysfunction
116
What is the safest intravenous solution to give a patient with severe hypernatremia?
0.45% Sodium chloride
117
For a patient diagnosed with hyponatremia, at what rate should electrolytes be replaced?
Slowly
118
If electrolytes are replaced too quickly in a patient with hyponatremia, what may happen?
Neurological issues
119
What electrolyte should never be given through IV push?
Potassium!
120
How should potassium be administered intravenously? A patient receiving potassium might complain of what type of sensation?
- Combined with other fluids
- Small milliequivalent bags
- Slowly in small increments
-Burning sensation
121
What is a common medication given to a patient with hyperkalemia?
Kayexalate
122
What does kayexalate cause?
Diarrhea
123
What is considered a temporary fix for hyperkalemia?
Combination glucose and insulin
124
What should the nurse monitor in a hypokalemic patient?
Dysrhythmias
125
How much potassium can be given over a 24 hour period?
No more than 120 MEQ
126
Potassium affects the ______/_______ balance of the body.
Acid/Base
127
What are the two signs of hypocalcemia?
- Trousseau's
| - Chvostek's
128
What electrolyte is complementary to potassium?
Magnesium
129
What is the most common cause of hypermagnesemia?
Renal failure
130
A patient with hypomagnesemia should be on what type of precautions?
Seizure precautions
131
Hypomagnesemia can cause what other comorbidities?
- Renal impairment
| - CNS depression
132
Chronic alcoholism can cause what?
Hypomagnesemia
133
How does hypermagnesemia affect the respiratory system?
Can cause decreased respirations
134
What are the two types of infusion delivery systems?
- Plastic
| - Glass
135
What must the nurse do before spiking the plastic infusion delivery system?
Clamp!
136
Is a primary IV set long or short?
Long
137
How is the nurse able to distinguish between primary and secondary tubing?
- Blue key on primary tubing
| - Primary tubing is 2x longer than secondary tubing
138
List the advantages of the plastic infusion delivery system.
- Closed system
- Flexible
- Lightweight
- Container composed of one substance
- Better storage
139
List the disadvantages of the plastic infusion delivery system.
- Puncture easily
- Difficult to determine fluid level
- Some systems composed of plasticizers
- Environmentally unsafe
140
Only one main bag of infusate is used with which tubing set?
Primary administration set
141
What specific medication and what specific population require a volutrol?
- Heparin drip
| - Pediatric population
142
What is a volutrol?
Metered-volume chamber/volume controlled set
143
The nurse knows they will have to do what if the patient has a volutrol? Why?
- More frequent assessment
| - Volutrol can only hold a specific amount of fluid
144
Why must the piggyback/secondary set be connected to the primary port above the pump?
The pump must control the rate at which the medication is being delivered
145
The secondary set can deliver how many milliliters of fluid?
50 mL to 150 mL
146
What should the nurse do before priming the tubing?
Clamp!
147
Piggyback set must always be _______ than the primary set.
Higher
148
Which fluid bag is hung with the blue hook? Why?
Primary bag to ensure it is lower than the piggyback/secondary set
149
The primary y administration set is used to infuse what substance?
Blood
150
Blood can be hung with what other substances?
- 0.9% Normal saline
| - Plasmalyte
151
How long can blood remain viable (expires) after being received from the blood bank?
4 hours
152
What size of filter is used when infusing blood products?
170 micron filter (in-line)
153
Lipids cannot be infused through what type of set?
PVC
154
What size of filter is used when infusing lipid products?
1.2 micron filter
155
How long can lipids be infused before they expire?
12 hours
156
What must be changed out every time a lipid set expires or a new bag is hung?
Tubing
157
Does a J-Loop slow down fluids or speed up fluids in an emergent situation?
Slows down fluids
158
What size of filter is the most common?
0.22 micron filter
159
List the benefits of using a 0.22 micron filter.
- Decreases the risk of air emboli
- Decreases the risk of phlebitis
- Prevent bacteria contamination
160
What size of filter is used when infusing parental or IV nutrition?
1.2 micron filter
161
What are the benefits of a needless system?
- Safest mechanism
- Maintains a more closed system
- Reduces infection risk
- Less manipulation
162
What are electronic infusion devices (EID's) used for?
Delivering fluids, medications, or nutrients into circulatory system accurately
163
What must the nurse know regarding an infusion regulation device?
- Indications for use
- Operation of pump
- Troubleshooting of pump
164
Where does a downstream occlusion occur?
Below the pump (pump to patient)
165
Where does an upstream occlusion occur?
Above the pump (pump to bag of solution)
166
PCA pumps are often used for what types of patients?
- Surgical
- Chronic pain
- Epidural
167
The nurse should always _______ guess the amount of fluid in the bag to be infused.
Under guess
168
What two solutions are titrated?
- Heparin
| - Insulin
169
List nursing management of infusion equipment.
- Suitable vascular access for length and type of therapy
- Adequate level of patient understanding and compliance for delivery of infusion
- Knowledge of therapies and equipment used to deliver specific infusions
- Monitor the infusion equipment
170
What should the nurse do if a reaction occurs during infusion?
Stop infusing the medication immediately
171
What is infiltration?
Cannula is no longer in the vein and regular/maintenance fluid goes into the surrounding tissue
172
What is extravasation?
Cannula is not longer in the vein and caustic medication goes into the surrounding tissue
173
What does vesicant refer to?
Irritating substance
174
What does non-vesicant refer to?
Non-irritating substance
175
Before administering a medication via IV, what must the nurse know?
- Potential side effects
- Why the medication is being given
- Interventions
- Allergies
- Last dose of medication received
- Laboratory levels
- Has the patient ever received this medication before
176
What type of needle is used when withdrawing medication from an ampule or glass packing? Why?
- Filter needle
| - To eliminate pieces of glass
177
What is physical drug incompatibility?
When mixed medication is unsafe to administer to the patient
178
What is chemical drug incompatibility?
A pH reaction that makes one drug unstable in a solution
179
What is therapeutic drug incompatibility?
When two drugs given at the same time (or too closely together) cause a reaction or problem for the patient
180
List the different modes of medication delivery via IV therapy?
- Intravenous infusion
- Intermittent infusion
- Intraosseous
- Epidural/intrathecal
181
Intraosseous catheterization occurs where?
Directly into the bone
182
In the pediatric population, the intraosseous route can cause damage to what?
Growth plate
183
What types of infection should the nurse monitor for a patient with an intraosseous catheter?
- Osteomyelitis
| - Cellulitis
184
What is the most common delivery method of intermittent infusions?
Secondary infusion through primary pathway
185
A secondary infusion through a primary pathway is often referred to as what?
Piggyback
186
Secondary infusions are generally administered over what length of time?
15 to 120 minutes
187
What is the purpose of administering medications via direct injection or IV push medication?
Achieve rapid serum concentrations of medications
188
Why are most medications diluted before being administered via IV push?
Makes the substance less irritating to the vein
189
List the advantages of IV push.
- Drug response is rapid
- Drug response usually predictable
- Patient must be closely monitored during entire medication administration
190
List the disadvantages of IV push.
- Adverse effects occur at the same time and rate as therapeutic effects
- Greatest risk of adverse effect and toxicity
- Speed shock
- Faster onset of complications and reaction
191
What should the nurse do prior to administering medication via direct IV push?
Flush the line with 0.9% sodium chloride
192
Medications should be diluted with what type and what amount of substance?
10mL of NS
193
After administering medication via direct IV push, what should the nurse do?
Flush the line with 0.9% sodium chloride
194
How long should the nurse flush the IV cannula after completing a direct IV push?
The same amount of time as the medication was pushed
195
How do PCA pumps prevent post surgical complications?
- Patients ambulate sooner
- Patients better able to cough and deep breath
- Therapeutic level remains consistent therefore patient is more relaxed
196
What must be closely monitored in a patient receiving opioid analgesics via PCA?
- Respiratory rate
- LOC
- Heart rate
- Oxygen saturation
- Blood pressure
- Constipation
- N/V
197
Who is allowed to push the control of a PCA pump?
Only the patient!
198
A spinal catheter is inserted into which part of the spine?
Subarachnoid space
199
An epidural is inserted into which part of the spine?
Epidural space
200
How many Gtts/mL is delivered in macrodrops?
10, 15, or 20
201
How many Gtts/mL is delivered in microdrips?
60
202
Microdrips are used in what population?
Pediatrics
