Manual of IV Therapeutics 6th Edition By Gorski – Test Bank

 

 

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Sample Questions

 

Chapter 4: Parenteral Solutions

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A nurse administers a parenteral solution to a client that contains portions of electrolytes, similar to plasma, as well as bicarbonate. The nurse is administering a(n):

a.	hypotonic solution.
b.	isotonic solution.
c.	balanced solution.
d.	hypertonic solution.

 

 

____    2.   A client presents in an emergency department and is diagnosed with fluid volume deficit. A nurse begins I.V. therapy per a physician’s order to replace the client’s lost fluids. Which hypotonic I.V. solution should the nurse anticipate being ordered for this client?

a.	0.45% sodium chloride
b.	5% dextrose in water
c.	10% dextrose in water
d.	5% dextrose in 0.9% sodium chloride

 

 

____    3.   An emergency department nurse is administering a colloidal I.V. solution to a client diagnosed with hypovolemia. Which solution, administered by the nurse, is considered a colloid solution?

a.	Lactated Ringer’s
b.	Albumin
c.	5% dextrose in water
d.	5% dextrose in 0.45% sodium chloride

 

 

____    4.   A nurse is preparing to begin fluid replacement therapy on an older adult, dehydrated client. Before a client is started on replacement therapy, which physiological function should be assessed?

a.	Respiratory function
b.	Renal function
c.	Endocrine function
d.	Adrenal function

 

 

____    5.   A nurse prepares to administer a blood transfusion to a client. Which I.V. solution is the only acceptable solution for the nurse to use to prime the administration set before administering blood?

a.	Lactated Ringer’s solution
b.	5% dextrose in water
c.	0.9% sodium chloride
d.	5% dextrose and 0.45% sodium chloride

 

 

____    6.   A pediatric nurse is preparing to administer a hypotonic I.V. solution to a child experiencing profound dehydration. Which solution would be considered a hydrating solution?

a.	5% dextrose in water
b.	Lactated Ringer’s solution
c.	10% dextrose in water
d.	5% dextrose and 0.45% sodium chloride

Chapter 3: Fundamentals of Fluid and Electrolyte Balance

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A nurse is assessing an older adult client who is disoriented to time and place. The nurse notes that the client’s eyes are sunken, the mouth is coated, the tongue has an extra longitudinal furrow, and the client’s lips are cracked. The client’s hand vein filling takes more than 5 seconds; tenting is apparent over the sternum; and the vital signs are BP 110/60 mm Hg, pulse 62, and respiratory rate of 12. Based on these assessment findings, which fluid or electrolyte imbalance should the nurse suspect?

a.	Sodium excess
b.	Magnesium deficit
c.	Fluid volume deficit
d.	Fluid volume excess

 

 

____    2.   A nurse prepares to assess a client who has been vomiting for several days. For which signs of fluid volume deficit (FVD) should the nurse assess?

a.	Bounding pulse, decreased blood pressure, and moist crackles
b.	Dyspnea, jugular vein distention, and sternum fingerprinting
c.	Increased pulse rate, decreased blood pressure, and poor skin turgor
d.	Increased respiratory rate; warm, moist skin; and decreased body temperature

 

 

____    3.   A nurse assesses a client who has moist crackles (rales) in the lung bases, an increased respiratory rate, dyspnea, and 3+ edema of the ankles. Which is the most accurate nursing diagnosis for this client?

a.	Fluid volume deficit
b.	Fluid volume excess
c.	Impaired tissue integrity
d.	Altered tissue perfusion, renal

 

 

____    4.   A nurse analyzes a client’s laboratory report that shows a serum potassium level of 5.7 mEq/L. Which client’s laboratory report is the nurse most likely reviewing?

a.	The client with ulcerative colitis
b.	The client with Cushing’s syndrome
c.	The client who has overused laxatives
d.	The client who has sustained a traumatic burn

 

 

____    5.   A nurse notes that a client admitted with renal failure has a serum phosphorus level of 7.0 mg/dL. Which medication should a nurse expect to be prescribed for this client?

a.	Calcium gluconate
b.	Calcium chloride
c.	Calcitonin (Calcimar)
d.	Aluminum hydroxide gel (Amphojel)

 

 

____    6.   A nurse is caring for a client with an ileostomy. Which acid-base imbalance will this client most likely experience?

a.	Metabolic alkalosis
b.	Metabolic acidosis
c.	Respiratory acidosis
d.	Respiratory alkalosis

 

 

____    7.   A nurse assesses a newly admitted client and notes fatigued muscles, reports of nausea and anorexia, irritability, and diminished deep tendon reflexes. The nurse reviews the client’s laboratory reports that reveal a serum chloride level of 92 mEq/L, a serum potassium level of 3.1 mEq/L, and a serum sodium level of 135 mEq/L. Which treatment should the nurse anticipate for this electrolyte imbalance?

a.	Treatment with sodium bicarbonate
b.	Change of infusion to 5% dextrose in water
c.	Replacement therapy with potassium chloride
d.	Replacement therapy with sodium and chloride

 

 

____    8.   A pediatric nurse is thinking critically to determine the best methods for assessing an infant’s 24-hour fluid needs. Which three methods for assessment of 24-hour fluid needs in an infant should the nurse consider?

a.	Meter square, diaper weight, and urinary output
b.	Meter square, body weight, and caloric methods
c.	Meter square, specific gravity of urine, and urinary output
d.	Diaper weight, urinary output, and caloric needs

 

 

____    9.   A nurse is administering I.V. potassium at a rate of 15 mEq/hr via a peripheral vein. When infusing potassium at this rate via this route, for which imbalance should the nurse monitor?

a.	Hypernatremia
b.	Hypercalcemia
c.	Hyperkalemia
d.	Hyperglycemia

 

 

____  10.   A client in a critical-care unit is experiencing drastic fluctuations in serum potassium. Which sentinel event can occur if the client’s serum potassium level is less than 2.5 mEq/L or greater than 7.0 mEq/L?

a.	Embolic stroke
b.	Cardiac arrest
c.	Atrial fibrillation
d.	Intracranial hemorrhage

 

 

____  11.   A nursing instructor is teaching a group of nursing students about the intracellular and extracellular fluid compartments of the cell. Which is the major electrolyte in the intracellular compartment?

a.	Calcium
b.	Sodium
c.	Potassium
d.	Bicarbonate

 

 

____  12.   A nursing instructor is teaching a group of nursing students about the intracellular and extracellular fluid compartments of the cell. Which electrolyte is the second most plentiful cation in the intracellular fluid compartment?

a.	Calcium
b.	Sodium
c.	Chloride
d.	Magnesium

 

 

____  13.   A nurse educator is conducting an in-service presentation on electrolytes. Which group of electrolytes should the educator refer to as being “positively charged”?

a.	Potassium, sodium, calcium
b.	Potassium, sodium, bicarbonate
c.	Bicarbonate, phosphate, chloride
d.	Chloride, magnesium, bicarbonate

 

 

____  14.   A nurse is caring for a client who has been experiencing prolonged vomiting prior to being admitted to a hospital. The client has experienced development of metabolic alkalosis. Which of the following are manifestations of alkalosis (bicarbonate excess)?

a.	Tetany, soft tissue calcification
b.	Dizziness, tingling of fingers and toes, carpopedal spasm
c.	Kussmaul respirations, confusion, increased respiratory rate
d.	Impaired mentation, tingling of fingers and toes, depressed respirations

 

 

____  15.   A nurse assesses a newly admitted client and notes fatigued muscles, reports of nausea and anorexia, irritability, and diminished deep tendon reflexes. The nurse reviews the client’s laboratory reports, which reveal a serum chloride level of 92 mEq/L, a serum potassium level of 3.1 mEq/L, and a serum sodium level of 135 mEq/L. Which electrolyte imbalance should the nurse suspect?

a.	Hyponatremia
b.	Hypokalemia
c.	Hyperchloremia
d.	Hypernatremia

 

 

____  16.   A client presents to an emergency department with confusion, a respiratory rate of 30 breaths per minute, blood pressure 100/70 mm Hg, and a previous admission for renal failure. The client’s arterial blood gases reveal a pH of 7.32, an HCO₃ of 20 mEq/L, and a PaCO₂ of 34 mm Hg. Which acid-base imbalance should a nurse suspect?

a.	Metabolic acidosis
b.	Metabolic alkalosis
c.	Respiratory acidosis
d.	Respiratory alkalosis

 

 

____  17.   An intensive care nurse is implementing orders for an elderly client diagnosed with hypermagnesemia. What is the most likely cause of hypermagnesemia in this client?

a.	Renal failure
b.	Nasogastric tubes to suction
c.	Use of mechanical ventilators
d.	Overzealous administration of I.V. potassium chloride

 

 

____  18.   A nurse is caring for an elderly, hospitalized client diagnosed with emphysema. The client’s arterial blood gases reveal that the blood chemistry is slightly alkaline but is considered physiologically neutral. To be considered physiologically neutral, or normal, what is the client’s serum pH?

a.

7.2

b.

7.3 Chapter 6: Techniques for Initiation and Maintenance of Peripheral Infusion Therapy   Multiple Choice Identify the choice that best completes the statement or answers the question.   ____    1.   A client is being discharged to home with continuous I.V. infusion therapy. Which assessment made by the nurse before proceeding with the discharge plan is most important? a. If the client lives alone b. If the client is medically stable c. If the client has a working telephone d. If the client has a working refrigerator     ____    2.   A nurse is time-taping an I.V. bag of 1,000 mL that is to infuse over 8 hours. The nurse places the 1100 hour marking at the 500-mL level. At which level should the nurse place the mark for 1200 hours? a. 350 mL b. 375 mL c. 400 mL d. 425 mL     ____    3.   A nurse is inspecting a container of infusate prior to client administration. Prior to use, the infusate solution container should be inspected for: a. clarity, the expiration date, and air vents. b. clarity, the expiration date, and punctures or cracks. c. clarity, punctures or cracks, and the number of access ports. d. the number of access ports, the expiration date, and floating particles.     ____    4.   A nurse is initiating infusion therapy for a client using a Teflon over-the-needle catheter (ONC). The major hazard associated with the use of Teflon ONCs for peripheral infusion is: a. risk for phlebitis. b. risk for infiltration. c. that they can be used for only 24 hours. d. that they can remain in place for only 48 hours.     ____    5.   A medical-surgical nurse is caring for multiple clients who have peripheral I.V. access devices. According to the Centers for Disease Control and Prevention (CDC), how often should the nurse change the clients’ I.V. catheters? a. As needed (PRN) b. At 24- to 48-hour intervals c. At 48- to 72-hour intervals d. At 72- to 96-hour intervals     ____    6.   A nurse is calculating the drip rate before initiating an I.V. infusion. Upon which factor(s) should the calculation of the drip rate depend? a. Drop factor of tubing b. Tubing length and filter size c. Drop factor of the tubing and physician order of mL/hr d. Filter size and number of injection ports on administration set     ____    7.   A nurse is preparing to initiate an I.V. infusion on a 3-year-old child. Which action should be taken by the nurse initially? a. Explain the procedure completely. b. Explain the procedure in simple terms. c. Restrain the child to perform the venipuncture. d. Provide reading materials before performing venipuncture.     ____    8.   A nurse is attempting to obtain venous access on a 2-month-old infant. Which cannula size should the nurse select for use with this client? a. 16-gauge scalp vein (metal) needle b. 18-gauge over-the-needle catheter (ONC) c. 22- to 24-gauge ONC d. 23- to 25-gauge scalp vein (metal) needle     ____    9.   A nurse is preparing to initiate an I.V. infusion on a toddler. To prevent fluid overload, the nurse understands that the toddler’s I.V. container should contain no more than: a. 500 mL of fluid. b. 1,000 mL of fluid. c. 24-hour volume requirements of fluid. d. hourly volume requirements of fluid.     ____  10.   A nurse is preparing to administer an I.V. potassium infusion I.V. piggyback to an older adult client diagnosed with hypokalemia. Which age-related body change may cause increased cardiac sensitivity to potassium infusion? a. Decreased muscle strength and a loss of bone density b. Decreased cough efficiency and decreased vital capacity c. Decreased salivation and decreased gastrointestinal motility d. Decreased lean body mass and decreased glomerular filtration rate     ____  11.   A physician orders an I.V. infusion for a dehydrated older adult client diagnosed with congestive heart failure. A nurse prepares to implement the physician’s order. Which would be an appropriate choice of infusion equipment for the older adult client with cardiovascular compromise? a. Inline filter b. T adapter c. Three-way stopcock d. Microdrop administration set     ____  12.   A prudent medical-surgical nurse frequently monitors the I.V. sites of his older adult clients because: a. older adult clients always pull at their I.V. lines. b. the veins of older adults always rupture, causing infiltration. c. older adult clients need to be mobile, therefore placing I.V. patency at risk. d. age-related neurologic changes can reduce tactile sensation, allowing infiltration or phlebitis to become severe before the client notices any discomfort.     ____  13.   A nurse is applying a transparent, semipermeable membrane dressing to an I.V. site. The nurse should take care to place the dressing so that it: a. covers only the area surrounding the I.V. entry site. b. can be removed for observation of the site every 4 hours. c. covers the area surrounding the I.V. entry site up to the top margin of the cannula hub to help stabilize the cannula. d. covers the I.V. entry site, the catheter hub, and the connection between the I.V. device and the administration set tubing.     ____  14.   A client is scheduled for surgical insertion of a midline catheter. A nurse explains to the client that a midline catheter is any peripheral catheter that is placed: a. with the tip in any location between the antecubital fossa and the subclavian vein. b. between the antecubital fossa and 3 to 5 cm distal to the axillary vein. c. between the antecubital fossa and 6 to 8 cm proximal to one of the innominate veins. d. between the antecubital fossa and the head of the clavicle, with optimal tip location level with the axilla.     ____  15.   According to Infusion Nurses Society Standards of Practice (2011), which of the following should be used to secure the infusion device after insertion? a. Paper tape b. Stabilization device c. Sutures d. Combination of transparent, semipermeable membrane dressing and tape     Multiple Response Identify one or more choices that best complete the statement or answer the question.   ____    1.   A nurse is selecting a peripheral vein for I.V. access. Which factors should affect the nurse’s choice of an I.V. site? SELECT ALL THAT APPLY. a. Type of solution b. Condition of vein c. Whether client is right or left handed d. Presence of disease, shunts, or grafts in the extremity     ____    2.   A critical care nurse is using a 0.22-mm filter for the delivery of infusion therapy. According to the Infusion Nurses Society’s Standards of Practice (2011), for nonlipid-containing solutions that require filtration, a 0.2-mm filter should be: a. air eliminating. b. particulate retentive. c. fat emboli reducing. d. bacterial retentive.     ____    3.   Documentation of initiation of a short-peripheral infusion (PIV) device should include which of the following? a. Device type, length, and gauge b. Manufacturer and lot number c. Date and time of insertion d. Number and location of attempts     ____    4.   A nurse is preparing to start a 30-year-old adult, normotensive client’s I.V. line. Which techniques best assist the nurse in distension of veins before cannulation? SELECT ALL THAT APPLY. a. Application of a blood pressure cuff with setting of 30 mm Hg b. Placing a cool compress over the site for 10 minutes c. Placing a warm compress over the site for 10 minutes d. Use of multiple tourniquet techniques     ____    5.   A pediatric intensive care unit nurse is preparing to obtain an I.V. access using an infant’s scalp vein. The nurse is thinking critically about which type of catheter to use. What are the advantages of over-the-needle catheter (ONCs) needles over metal scalp vein needles? SELECT ALL THAT APPLY. a. ONCs are radiopaque. b. ONCs are patent longer than scalp vein needles. c. ONCs have decreased infiltration risks. d. ONCs have a low incidence of mechanical phlebitis.     ____    6.   A nurse is selecting a peripheral vein for venipuncture. Which factors should affect the nurse’s choice of an I.V. site? SELECT ALL THAT APPLY. a. Condition of the vein b. Client’s preference c. Duration of therapy d. Type of solution to be administered e. Presence of disease, shunts, or grafts in the extremity     ____    7.   A nurse has finished placing a 20-gauge over-the-needle catheter in a client’s forearm for a continuous infusion of 1000 mL of 5% dextrose and 0.45% sodium chloride. After the infusion has been initiated, which items should be labeled? SELECT ALL THAT APPLY. a. Tubing b. Catheter site c. Solution container d. Client’s armband     ____    8.   A nurse is initiating I.V. therapy on a client who is receiving anticoagulant therapy. Which techniques should the nurse use when starting an I.V. line on this client? a. Avoid use of a tourniquet if possible or apply loosely. b. Avoid excess pressure when cleansing the skin. c. Use alcohol to loosen dressing. d. Use multiple tourniquet technique to dilate vein.     Completion Complete each statement.   1.    A physician orders 1,000 mL of 5% dextrose and lactated Ringer’s solution infused intravenously at 80 mL/hr. The nurse time-tapes the bag with a start time of 0700 hours. Based on this information, the infusion should be complete at _______ hours. Fill in the blank.   2.    A physician orders 1,000 mL of 5% dextrose in water at 50 mL/hr. A nurse uses tubing with a drop factor of 15. The nurse calculates that the I.V. solution should be infused at _____ drops per minute (gtt/min). Fill in the blank.   3.    A physician orders 1,000 mL of 5% dextrose and 0.45% sodium chloride to be infused intravenously at 125 mL/hr. A nurse uses tubing with a drop factor of 20. The nurse calculates that the I.V. solution should be infused at _____ drops per minute (gtt/min). Fill in the blank.   4.    A child who weighs 10 kg sustains an estimated total body surface area (TBSA) burn of 50% from a house fire. The Parkland formula of fluid resuscitation is used to determine the amount of fluid that this child requires. According to this formula, a nurse should intravenously administer _____ mL of fluid to the child in the first 8 hours from the time of the injury. Fill in the blank.   5.    A physician orders 0.45% sodium chloride to be infused intravenously at 45 mL/hr for an 8-month-old infant. A nurse calculates that, using a microdrip controller, the solution should infuse at a rate of _____ drops per minute (gtt/min). Fill in the blank.   Short Answer   1.    A nurse has just successfully inserted an I.V. cannula into a client’s vein. Which action should be taken by the nurse next? Place each nursing action in the order of priority. a.___ Adjust the flow rate. b.___ Attach the primed I.V. tubing. c.___ Observe for signs of infiltration. d.___ Begin the flow of I.V. fluid.   2.    A nurse is preparing to flush a client’s I.V. catheter before injecting medication. Which steps should be taken by the nurse when flushing the client’s intermittent locking device? Prioritize the nurse’s actions by placing each step in the correct order. 3.    ___ Flush with sodium chloride using push-pause method. 4.    ___ Check for patency of the catheter. 5.    ___ Administer the medication. 6.    ___ Flush with sodium chloride applying positive pressure.   3.    A nurse is preparing to flush a client’s I.V. catheter before injecting medication. Which steps should be taken by the nurse when flushing the client’s intermittent locking device? Prioritize the nurse’s actions by placing each step in the correct order. 4.    ___ Flush with sodium chloride using push-pause method. 5.    ___ Check for patency of the catheter. 6.    ___ Administer the medication. d. ___ Flush with sodium chloride applying positive pressure