PrepU

Question 1

Which fluid should be administered slowly to prevent circulatory overload?

Answer 1

5% NaCl

Question 2

When providing care for a patient who has a peripheral intravenous catheter in situ, the nurse should:

Answer 2

change the site every 3-4 days

Question 3

The nurse is preparing to perform venipuncture. Which items will the nurse plan to gather? (Select all that apply.)

Answer 3

• clean gloves
• tourniquet
• antiseptic swabs
• transparent dressing
• adhesive tape

Question 4

The nurse is caring for a client who was in a motor vehicle accident and has severe cerebral edema. Which fluid does the nurse anticipate infusing?

Answer 4

hypertonic

Question 5

The nurse is caring for a client who was found after spending 2 days without food or water in the desert and was admitted through the emergency department. The client is severely dehydrated. What are reasons why the human body requires fluid? Select all that apply.

Answer 5

• facilitates cellular metabolism
• helps maintain normal body temperature
• acts as a solvent for electrolytes

Question 6

A 70-year-old client is scheduled for a colonoscopy and is prescribed a bowel preparation solution. The nurse would be alert for which potential imbalance? Select all that apply.

Answer 6

Hypokalemia
• Hypocalcemia
• Hyperphosphatemia

Question 7

The nurse is caring for a client with severe edema. Which intervention will the nurse choose to restore fluid balance? (Select all that apply.)

Answer 7

• Ask provider to order a low-salt diet.
• Administer furosemide as ordered.
• Reduce infusing fluid volume as ordered.
• Treat the underlying condition that contributes to increased fluid volume.

Question 8

A client is receiving a secondary infusion of a new antibiotic through a peripherally inserted central line (PICC). After 5 minutes of administration, the client reports itching and appears flushed. What is the most appropriate nursing intervention?

Answer 8

clamp the picc line

Question 9

A nurse is in the process of converting a continuous IV infusion to an intermittent infusion device. The nurse has clamped off the primary IV tubing, donned clean gloves, clamped the extension tubing and disconnected the primary IV tubing. The nurse is now cleansing the port on the extension tubing with an antiseptic swab. The nurse cleanses the port for which duration of time?

Answer 9

15 seconds

Question 10

(see full question) Which nursing assessment should be conducted by the nurse for a client with chronic lung disease who is noncompliant with the inhaler?

Answer 10

observing the client’s pattern of respirations, such as the usage of accessory muscles

Question 11

What does the nurse expect to be included in the directions for reconstitution on a drug label? (Select all that apply.)

Answer 11

• directions for storing the drug
• amount of diluent to be added
• dosage per volume after reconstitution

Question 12

Which of the following clients should the nurse determine is at greatest risk for vancomycin-resistant enterococci (VRE) infection?

Answer 12

client recieving chemo

Question 13

An operating room nurse is putting on sterile gloves to assist with client surgery. Which actions are performed correctly in this procedure? Select all that apply.

Answer 13

The nurse opens the outside wrapper by carefully peeling the top layer back.
• The nurse carefully opens the inner package by folding open the top flap, then the bottom and sides.
• The nurse lifts and holds the glove up and off the inner package with fingers down and carefully inserts hand palm up into glove

Question 14

The nurse is preparing to administer nasal medications to a client. In which order is the nurse is expected carry out the procedure?

Answer 14

The nurse will help the client to a sitting position with the client’s head tilted backward.
The nurse will aim the tip of the container towards the nasal passage and squeeze the number of drops prescribed.
The nurse will instruct the client to breathe through the mouth as the drops are instilled.
The nurse will advise the client to remain in the position for approximately 5 minutes

Question 15

The nurse is administering medication to a client through a drug-infusion lock using the saline flush. During the process, the client complains of pain at the site. Which interventions are appropriate in this situation? Select all that apply.

Answer 15

• Stop the medication and assess the site for signs of infiltration and phlebitis.
• Flush the medication lock with normal saline again to recheck patency.
• If site is within normal limits, resume medication administration at a slower rate.

Question 16

(see full question) The experienced nurse is teaching a new nurse about chemotherapy administration. What teaching will the experienced nurse include?

Answer 16

• Central venous catheters (CVC) are often used to administer antineoplastic drugs.
• Pharmacists must be specifically trained to prepare chemotherapy agents.
• Double-glove when administering these drugs.
Correct

Question 17

(see full question) What signs of complications and their probable causes may occur when administering an IV solution to a client? Select all that apply.

Answer 17

• Swelling, pain, coolness, or pallor at the insertion site may indicate infiltration of the IV.
• Redness, swelling, heat, and pain at the site may indicate phlebitis.
• Local or systemic manifestations may indicate an infection is present at the site.

Question 18

A nurse is administering insulin to a diabetic client. What are three recommended times to check the label before administration? (Select all that apply.)

Answer 18

“Three Checks” denotes that the label on the medication package or container should be checked three times during medication preparation and administration. The nurse should read the label: (1) When reaching for the container or unit dose package; (2) after retrieving from the drawer and comparing with the CMAR, or comparing with the CMAR immediately before pouring from a multidose container; and (3) when replacing the container to the drawer or shelf or before giving the unit dose medication to the client.

Question 19

A nurse assessing the skin of clients knows that the following are health states that may predispose clients to skin alterations. Select all that apply.

Answer 19

Obesity
• Excessive perspiration
• Low BMI