Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Test Bank for Clayton's Basic Pharmacology for Nurses 19th Edition, Study Guides, Projects, Research of Pharmacy

A test bank for clayton's basic pharmacology for nurses, 19th edition. It contains multiple choice questions and answers related to various aspects of parenteral administration, including safe preparation of parenteral medications, injection techniques, and iv therapy. The questions cover topics such as needle gauge selection, injection site preparation, and complications associated with iv therapy. This resource can be valuable for nursing students preparing for exams or clinical practice.

Typology: Study Guides, Projects, Research

2023/2024

Uploaded on 09/07/2024

tinacoore
tinacoore 🇺🇸

1 document

1 / 21

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
58
Test Bank For Clayton’s Basic Pharmacology for Nurses 19th Edition
To facilitate flow into the large intestine, patients should be positioned on the left side. The
solution should be held for 30 minutes before defecating. Enemas are medications, so the
seven rights of medication administration should be followed. Lubrication of the rectal tube
will facilitate insertion into the rectum. Gravity will not facilitate the administration of a small
volume of enema solution administered from a bottle.
DIF: CognitiveLevel: Knowledge REF: p. 115 OBJ: 5
NAT: NCLEXClient Needs Category: Physiological Integrity
TOP: NursingProcess Step: Implementation
CON: Clinical Judgment | Safety | Patient Education
7. Which type of medication is appropriate to give through a gastrointestinal tube? (Select all
that apply.)
a. Liquid medication
b. Tablets crushed and diluted in 30 mL of water
c. Enteric coated tablets crushed and diluted in 30 mL of water
d. Capsules emptied into 30 mL of water
e. Timed release capsules emptied into 30 mL of water
f. Suppositories
ANS: A, B, D
Liquid forms of medications are preferable. Tablets may be crushed and diluted in water.
Capsules may be opened and the contents added to approximately 1 oz of water. Enteric
coated medications and timed release capsules should never be broken for administration.
Suppositories are not given via NG route.
DIF: CognitiveLevel: Application REF: p. 110 | p. 111
OBJ: 4 NAT: NCLEXClient Needs Category: Physiological Integrity
TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
8. Which method(s) of administration can be used for an adult patient receiving 10 mL of cough
syrup at 0800? (Select all that apply.)
a. Soufflé cup
b. Medicine cup
c. Oral syringe
d. Teaspoon
e. Nipple
ANS: B, C
The medicine cup is a plastic container with three scales to measure liquid medications. An
oral syringe comparable to the volume to be measured can be used for smaller volumes such
as 10 mL. A soufflé cup is a small paper or plastic cup used to transport solid medication
forms such as a capsule or tablet to the patient to prevent contamination by handling. A
teaspoon is equal to 5 mL. An infant feeding nipple with additional holes may be used for
administering oral medications to infants.
DIF: CognitiveLevel: Comprehension REF: p. 106 OBJ: 3
NAT: NCLEXClient Needs Category: Physiological Integrity
TOP: NursingProcess Step: Implementation CON: Clinical Judgment
Chapter 09: Parenteral Administration: Safe Preparation of Parenteral Medications
Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15

Partial preview of the text

Download Test Bank for Clayton's Basic Pharmacology for Nurses 19th Edition and more Study Guides, Projects, Research Pharmacy in PDF only on Docsity!

To facilitate flow into the large intestine, patients should be positioned on the left side. The solution should be held for 30 minutes before defecating. Enemas are medications, so the seven rights of medication administration should be followed. Lubrication of the rectal tube will facilitate insertion into the rectum. Gravity will not facilitate the administration of a small volume of enema solution administered from a bottle. DIF: CognitiveLevel: Knowledge REF: p. 115 OBJ: 5 NAT: NCLEXClient Needs Category: Physiological Integrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Patient Education

  1. Which type of medication is appropriate to give through a gastrointestinal tube? ( Select all that apply. ) a. (^) Liquid medication b. (^) Tablets crushed and diluted in 30 mL of water c. (^) Enteric coated tablets crushed and diluted in 30 mL of water d. (^) Capsules emptied into 30 mL of water e. (^) Timed release capsules emptied into 30 mL of water f. (^) Suppositories ANS: A, B, D Liquid forms of medications are preferable. Tablets may be crushed and diluted in water. Capsules may be opened and the contents added to approximately 1 oz of water. Enteric coated medications and timed release capsules should never be broken for administration. Suppositories are not given via NG route. DIF: CognitiveLevel: Application REF: p. 110 | p. 111 OBJ: 4 NAT: NCLEXClient Needs Category: Physiological Integrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  2. Which method(s) of administration can be used for an adult patient receiving 10 mL of cough syrup at 0800? ( Select all that apply. ) a. (^) Soufflé cup b. Medicine cup c. (^) Oral syringe d. (^) Teaspoon e. (^) Nipple ANS: B, C The medicine cup is a plastic container with three scales to measure liquid medications. An oral syringe comparable to the volume to be measured can be used for smaller volumes such as 10 mL. A soufflé cup is a small paper or plastic cup used to transport solid medication forms such as a capsule or tablet to the patient to prevent contamination by handling. A teaspoon is equal to 5 mL. An infant feeding nipple with additional holes may be used for administering oral medications to infants. DIF: CognitiveLevel: Comprehension REF: p. 106 OBJ: 3 NAT: NCLEXClient Needs Category: Physiological Integrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment

Chapter 09: Parenteral Administration: Safe Preparation of Parenteral Medications

Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition

MULTIPLE CHOICE

  1. Which part of the syringe contains the calibrations for drug volume measurement? a. (^) Plunger b. (^) Tip c. (^) Luer Lok d. (^) Barrel ANS: D The barrel contains the calibrations necessary for measurement. The plunger, the tip, and the Luer Lok do not have the calibrations indicated on them. DIF: CognitiveLevel: Knowledge REF: p. 120 OBJ: 1 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  2. Which needle will the nurse use to administer an intramuscular (IM) immunization on an 18 - month-old child? a. (^18) - gauge, 1 - inch needle b. (^20) - gauge, - inch needle c. 27 - gauge, - inch needle d. (^25) - gauge, - inch needle ANS: C The most appropriate needle gauge for pediatric IM injections is a 25 - or 27 - gauge, - inch needle. An 18-gauge, 1-inch needle is too short and too large in diameter for pediatric injections. A 20 - gauge, - inch needle is too short and too large in diameter for pediatric injections. A 25 - gauge, - inch needle is too short for pediatric IM injections. DIF: CognitiveLevel: Application REF: p. 124 OBJ: 3 NAT: NCLEXClient Needs Category: Physiological Integrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Development
  3. Which syringe will the nurse use to administer insulin subcutaneously to a patient? a. (^) A syringe calibrated in minims. b. (^) A syringe calibrated in units. c. (^) A syringe calibrated in tenths of mL. d. (^) A syringe calibrated in mL. ANS: B A syringe calibrated in units is used for insulin. A tuberculin syringe is not properly calibrated for use with insulin. A syringe calibrated in mL or in tenths of mL would not be an accurate way to measure insulin doses. DIF: CognitiveLevel: Comprehension REF: p. 121 OBJ: 1 NAT: NCLEXClient Needs Category: Physiological Integrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety

a. (^100) mL/unit b. (^10) units/mL c. (^100) units/mL d. (^10) units/100 mL ANS: C U 100 means 100 units/mL. DIF: CognitiveLevel: Comprehension REF: p. 121 OBJ: 3 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Assessment CON: Clinical Judgment | Safety

  1. Which statement by the patient learning about proper disposal of used syringes and needles indicates a need for further teaching? a. (^) ―Even needles with sleeves should be disposed of appropriately.‖ b. (^) ―It is unusual that anyone could get a needle injury or disease from used needles.‖ c. (^) ―It is important for me to use the designated container to dispose of my syringes and needles.‖ d. (^) ―I am going to purchase the ‗Sharps by Mail Disposal System‘ once I am home.‖ ANS: B The patient needs more education because injury from needlesticks and transfer of pathogens is a health concern. It is accurate that even needles with sleeves should be disposed of appropriately and that a designated container to dispose of syringes and needles should be used. The patient should be encouraged to purchase the ―Sharps by Mail Disposal System.‖ DIF: CognitiveLevel: Application REF: p. 126 OBJ: 1 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Evaluation CON: Clinical Judgment | Safety | Patient Education
  2. Which nursing action is accurate when administering parenteral medication? a. (^) Adjust the route of the medication, if needed. b. (^) Document the response to PRN medications at the end of the shift. c. (^) Request the pharmacist to provide education about the medication to the patient. d. (^) Use clinical judgment when rescheduling missed doses of a medication. ANS: D The nurse must exercise clinical judgment about the scheduling of new drug orders, missed dosages, modified drug orders or substitution of therapeutically equivalent medicines by the pharmacy, or changes in the patient‘s condition that require consultation with the physician, healthcare provider, or pharmacist. Adjusting the route is not within the role of the nurse. Documenting the response to PRN medications at the end of the shift is not an acceptable time frame. Educating the patient about the medication is within the nurse‘s role. DIF: CognitiveLevel: Comprehension REF: p. 119 OBJ: 1 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  3. Which advantage applies to administering a drug parenterally? a. (^) The duration of action is longer. b. (^) Medications given by this route are inexpensive. c. (^) The onset of action is more rapid.

d. (^) The dose is usually larger than an oral dose. ANS: C The onset of drug action is generally more rapid but of shorter duration. Duration of action is not affected by administering a drug parenterally. Parenteral administration can be expensive. The dose of parenteral medications is typically smaller than an oral dose. DIF: CognitiveLevel: Comprehension REF: p. 119 OBJ: 1 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety

  1. Which information provided by the nurse is most important to include when teaching a patient about the use of an EpiPen? a. (^) ―Hold the syringe at a 45 - degree angle against the skin.‖ b. (^) ―Monitor the expiration date of this medication.‖ c. ―After using the EpiPen, lie down for 1 hour.‖ d. (^) ―Place the syringe in a cartridge prior to using.‖ ANS: B It is important to monitor the expiration date of this medication on a regular basis. The syringe is held perpendicular to the skin. The patient should go to the emergency department after use of an EpiPen. Placing the syringe into a cartridge is not accurate for use of an EpiPen. DIF: CognitiveLevel: Application REF: p. 122 OBJ: 4 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Patient Education
  2. Which type of parenteral medication container is made of glass, is scored, and needs to be broken open before withdrawing the medication? a. Ampule b. (^) Carpuject c. (^) Mix-O-Vial d. (^) Vial ANS: A Ampules are glass containers that need to be broken open before withdrawing medication. Carpujects are prefilled syringes. Mix-O-Vial containers have two compartments for mixing medications and are not scored. Vials are glass or plastic containers that are not broken open. DIF: CognitiveLevel: Knowledge REF: p. 126 OBJ: 5 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  3. The operating room (OR) nurse is preparing medications for use in a sterile field during a surgical procedure. While preparing these medications, the nurse will a. (^) save unused portions of medication for use in another procedure. b. (^) differentiate between sterile and nonsterile medications to be used in the OR. c. (^) ensure the scrub (sterile) nurse retrieves the medication from storage. d. (^) read the label aloud for verification against the order from the surgeon. ANS: D
  1. Which risk factor(s) should be considered when administering medications by injection? ( Select all that apply. ) a. (^) Trauma at the site of the needle puncture b. (^) Possibility of infection c. (^) Irretrievability of the medication once administered d. (^) Delayed absorption e. (^) Delayed onset of action f. (^) Chance of allergic reaction ANS: A, B, C, F Injecting medications involves risk for trauma, infection, and allergic reaction and increases the difficulty of treating adverse reactions or errors because of the inability to retrieve the medication. Delayed absorption and onset of action are not risks of injecting medications. DIF: CognitiveLevel: Comprehension REF: p. 119 OBJ: 1 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Health Promotion
  2. Which intervention(s) should be performed when preparing parenteral medications? ( Select all that apply. ) a. (^) Check the expiration date. b. (^) Use sterile technique throughout the entire procedure. c. (^) Check the drug dose form ordered against the source available. d. (^) Prepare the drug in a clean well-lighted area. e. (^) Check calculations. ANS: A, C, D, E The standard procedure for preparing all parenteral medications includes checking the expiration date on the medication container, checking the drug dose form ordered against the source available, preparing the drug in a clean well-lighted area, and checking calculations for accuracy. Aseptic technique is used at times during preparation. The primary rule is ―sterile to sterile‖ and ―unsterile to unsterile.‖ DIF: CognitiveLevel: Application REF: p. 129 OBJ: 1 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Health Promotion

Chapter 10: Parenteral Administration: Intradermal, Subcutaneous, and

Intramuscular Routes

Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition

MULTIPLE CHOICE

  1. The nurse is educating a patient about diabetes. Which statement, based on recommendations from the American Diabetes Association, is best regarding site rotation? a. (^) ―Insulin injection sites should always be in the abdomen to ensure absorption into the stomach.‖ b. (^) ―It is important to rotate injection sites systematically within one area before progressing to a new site for injection.‖

c. (^) ―Following exercise, site rotation is not indicated because the circulation in the muscles will absorb the medication efficiently.‖ d. (^) ―If you aspirate, site rotation can be done every other day to avoid developing problems with absorption.‖ ANS: B The American Diabetes Association Clinical Practice recommendations include rotating injections systematically at one site before progressing to another. Insulin is not absorbed into the stomach. Failure to rotate sites can result in lipohypertrophy or lipoatrophy. When subcutaneous (subcut) insulin is administered, aspiration should never be performed. DIF: CognitiveLevel: Comprehension REF: p. 140 OBJ: 2 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Patient Education

  1. Which technique by the nurse is accurate when administering heparin to a thin, older adult patient? a. (^) Aspirate before injecting the medication. b. Inject at a 45 - degree angle. c. (^) Inject at a 90 - degree angle. d. (^) Massage site following injection. ANS: B For thin individuals, the skin may need to be pinched and a 45 - degree angle used to avoid administration into the muscle. Heparin should never be aspirated. Subcut injections are properly administered at a 45-degree angle. The injection site of heparin should never be massaged. DIF: CognitiveLevel: Application REF: p. 141 OBJ: 2 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Development
  2. Which anatomic site would be best for the injection containing 0.5 mL when administering immunizations to kindergarten students? a. (^) Rectus femoris b. (^) Dorsogluteal c. (^) Deltoid d. (^) Ventrogluteal ANS: C The deltoid muscle is often used because of its easy access and the fact that it can tolerate 0. mL of medication volume. Having the child disrobe is not efficient in this setting. DIF: CognitiveLevel: Comprehension REF: p. 142 | p. 143 OBJ: 5 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Development
  3. A 65 - year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic by intramuscular (IM) injection. Which needle and syringe will be used?

TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety

  1. Which parenteral route has the longest absorption time? a. (^) Intradermal b. (^) Subcut c. IM d. (^) Intravenous (IV) ANS: A Absorption rate is determined by the proximity of the medication to the vascular system. Medication injected into an intradermal site is farther away from the vascular system than the other sites. Therefore, absorption in this site is the slowest. Subcut tissue is more vascular than intradermal tissue. IM tissue is more vascular than intradermal tissue. IV administration places medication directly into the vascular system. DIF: CognitiveLevel: Knowledge REF: p. 137 OBJ: 1 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Assessment CON: Clinical Judgment | Safety | Care Coordination
  2. Which site is identified by the posterior superior iliac spine and greater trochanter? a. (^) Ventrogluteal b. (^) Dorsogluteal c. (^) Vastus lateralis d. Rectus femoris ANS: B The dorsogluteal site is identified by drawing an imaginary line from the posterior superior iliac spine to the greater trochanter of the femur. The injection is then administered at any point between the imaginary straight line and below the curve of the iliac crest (hipbone). DIF: CognitiveLevel: Comprehension REF: p. 142 | p. 143 OBJ: 4 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment
  3. Which nursing action is accurate when administering an IM injection using the Z-track method? a. (^) Use a 1 - inch needle. b. (^) Add 0.5 mL of air to the syringe. c. (^) Vigorously massage the injection site. d. (^) Pinch up the skin. ANS: B Adding 0.5 mL of air ensures that the drug will clear the needle. A 1-inch needle may not ensure deep muscle penetration. Massaging the injection site could cause the medication to leak into the muscle tissue. The skin should be stretched, not pinched up. DIF: CognitiveLevel: Comprehension REF: p. 145 OBJ: 3 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment
  4. Which gauge needles are used for subcut injections? a. (^14) - to 16 - gauge

b. (^18) - to 21 - gauge c. (^22) - to 24 - gauge d. (^25) - to 29 - gauge ANS: D Commonly used gauges for subcut injection are 25- to 29-gauge needles. Needles that are 14 to 16 gauge are used for administration of blood or large volumes of fluid in a short period of time. Needles that are 18 to 21 gauge are used for routine parenteral fluid administration. Needles that are 22 to 24 gauge are used for administering fluids or medication via small veins. DIF: CognitiveLevel: Knowledge REF: p. 140 OBJ: 2 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety

  1. Which situation is acceptable to use the deltoid muscle as an injection site for infants? a. (^) Medication is irritating. b. (^) Dose is a long-acting medication. c. (^) Child is combative. d. (^) Volume is quite small. ANS: D The deltoid site should be used in infants only when the volume is quite small, the medication is nonirritating, and the dose will be quickly absorbed. Irritating and long-acting medications should be injected in deep muscle tissue such as the vastus lateralis. A combative child should be adequately restrained and injected in a fairly large muscle mass. DIF: CognitiveLevel: Comprehension REF: p. 143 OBJ: 5 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  2. Which action by the nurse is most accurate when administering an intradermal injection? a. (^) Insert the needle at a 45 - degree angle. b. (^) Inject 0.1 mL. c. (^) Use a 22 - gauge needle. d. (^) Wipe the site with alcohol after injection. ANS: B Small volumes, usually 0.1 mL, are injected. The needle is inserted at a 15 - degree angle. A 26 - gauge needle is used. After injection, the site should not be wiped with alcohol. DIF: CognitiveLevel: Comprehension REF: p. 138 OBJ: 1 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  3. Which assessment by the nurse is most important to obtain prior to performing allergy sensitivity testing? a. (^) Identify areas of loose connective tissue. b. (^) Question the patient about frequency of exercise. c. (^) Determine if the patient is using aspirin. d. (^) Palpate and measure the size of induration.

ANS: A, C, E Allergy sensitivity testing requires the intradermal route. Before administering allergy testing, gathering of equipment and physician‘s orders are necessary. This route is injected into the dermal layer of skin, using a 15 - degree angle. Connective tissue, having poor blood supply, is not appropriate for injection of medication. Previous injection sites would not factor into the decision about where to conduct allergy testing. DIF: CognitiveLevel: Comprehension REF: p. 138 | p. 139 OBJ: 1 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety

  1. Which statement(s) about administering medications parenterally is/are true? ( Select all that apply. ) a. (^) Subcut absorption is slower than intradermal absorption. b. (^) Two mL or less should be administered in a subcut site. c. (^) The gluteal area is recommended for children. d. (^) Needles 1 to inches in length are common for IM injections. e. (^) The scapular areas of the back may be used for intradermal injections. ANS: B, D, E No more than 2 mL of medication should be injected into a subcut site. Needle length of 1 to inches is common for IM injections. The upper chest, scapular areas of the back, and the inner aspect of the forearms are commonly used as sites for intradermal injections. Subcutaneous absorption is faster than intradermal absorption. Because of the undeveloped muscle mass in children, the gluteal area is not recommended for IM injection. DIF: CognitiveLevel: Knowledge REF: p. 137 | p. 139 | p. 140 OBJ: 1 | 2 | 3 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety
  2. Which category of patient(s) are appropriate to administer injections into the vastus lateralis muscle? ( Select all that apply. ) a. (^) Children younger than 3 years of age b. (^) Elderly c. (^) Debilitated d. (^) Nonambulatory e. (^) Ambulatory f. (^) Healthy ANS: A, E, F Children younger than 3 years of age, ambulatory patients, and otherwise healthy patients may receive injections in the vastus lateralis. Elderly, debilitated, and nonambulatory patients may have reduced muscle mass in the vastus lateralis and therefore poor absorption of injected medications. DIF: CognitiveLevel: Comprehension REF: p. 142 OBJ: 4 | 5 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Assessment CON: Clinical Judgment | Safety | Development
  3. Which^ action(s)^ should^ be^ implemented^ after^ administering^ B 12 IM^ to a^ patient^ in^ a^ long-term care facility? ( Select all that apply. )

a. (^) Carefully recap the needle. b. (^) Identify the patient. c. (^) Massage site of injection. d. (^) Dispose of the used needle according to policy. e. (^) Apply a small bandage to the site. ANS: D, E After administering an IM injection, the nurse should dispose of used needles according to policy and apply a small bandage to the site. Needles should never be recapped following use. The patient requires identification before the injection is given. After the needle is removed, gentle pressure should be applied to the site. Massage can increase the pain if the muscle mass is stressed by the amount of medication given. DIF: CognitiveLevel: Application REF: p. 141 | p. 142 OBJ: 3 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment | NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety

Chapter 11: Parenteral Administration: Intravenous Route

Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition

MULTIPLE CHOICE

  1. Which type of intravenous (IV) access device will likely be used for a patient diagnosed with cancer that requires 6 months of chemotherapy infusions? a. (^) Peripheral venous access device b. (^) Midline catheter c. (^) Winged needle venous access device d. (^) Implantable venous infusion port ANS: D Implantable venous infusion ports are placed into central veins for long-term therapy. Chemotherapy treatment is often irritating and best tolerated in the larger central veins. Peripheral lines are not used for administration of chemotherapy because of the risk of extravasation. A midline catheter is intended only for a 2 to 4 week interval, less than the projected length of time for chemotherapy infusion. Winged needles are for use in peripheral veins that are too small for ongoing infusion of chemotherapy. DIF: CognitiveLevel: Comprehension REF: p. 155 OBJ: 4 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment
  2. What is the best nursing action when the nurse assesses that a patient with cardiac disease has IV heparin infusing and that it is behind by 2 hours? a. (^) Increase the IV rate and recheck in 1 hour. b. (^) Change the infusion rate to TKO. c. (^) Discontinue the solution using aseptic technique. d. (^) Contact the healthcare provider for consultation. ANS: D

d. (^) Maintain the ordered rate. ANS: D The safest action is to maintain the ordered rate. The healthcare provider should be consulted if the patient has not received critical IV replacement therapy. Increasing an IV rate without a healthcare provider‘s order can be detrimental for patients who have cardiac, renal, or circulatory impairment. Normal aging process results in decreased cardiac, renal, and circulatory function. The rate ordered is the one the provider intended for the administration of fluids; changing it to fit the prevailing situation is not appropriate. The bolus technique should only be used for the administration of medications or fluid challenges in patients who need a volume of IV fluid quickly. The flow rate must be consistent with the provider‘s order. DIF: CognitiveLevel: Application REF: p. 160 OBJ: 6 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Cellular Regulation

  1. Which technique by the nurse accurately maintains asepsis of a peripheral IV access device? a. (^) Wear gloves when hanging all IV solutions. b. Apply a topical antibiotic ointment to the insertion site. c. (^) Change fluid administration sets according to institutional policy. d. (^) Flush with heparin before use. ANS: C Generally all IV solution bag and bottles should be changed every 24 hours to minimize the development of new infections. IV administration sets used to deliver blood and blood products are changed after each unit is administered. Administration sets to deliver lipids and TPN are often changed every 4 hours, whereas administration sets for maintenance fluids may be changed every 72 hours. It is important to follow institutional policies. All IV bags, bottles, and administration sets should be labeled with the date, time, and nurse‘s initials of the set change. Wearing gloves is not required for maintenance of routine infusion. Topical antibiotics may promote fungal infections and antimicrobial resistance. A peripheral line that is infusing should not need an anticoagulant to maintain patency. DIF: CognitiveLevel: Comprehension REF: p. 159 OBJ: 6 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Infection | Health Promotion
  2. Which needle is used to access implanted infusion devices? a. (^) Jamshidi b. Huber c. (^) Gigli d. (^) Crutchfield ANS: B The Huber needle is a special non-coring 90-degree needle used to penetrate the skin and septum of the implanted device. The Jamshidi needle is used for biopsy purposes such as bone marrow. The Gigli saw is a wire with serrations used to cut through cranial bone. Crutchfield tongs are used to stabilize the cervical spine by traction in cases of fracture. DIF: CognitiveLevel: Knowledge REF: p. 155 OBJ: 5

NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment

  1. Which complication is this patient most likely experiencing when the nurse assesses erythema, warmth, and burning pain along the patient‘s IV site? a. (^) Air embolism b. Extravasation c. (^) Phlebitis d. (^) Pulmonary edema ANS: C Erythema, warmth, and tenderness along the course of the vein and swelling are signs of phlebitis. Air embolism occurs as a result of an air bubble entering the vascular system, and shortness of breath, chest pain, and hypotension are indicative of this complication. Extravasation is the leakage of an irritant and is accompanied by redness, warmth or coolness, swelling, and a dull ache to severe pain at the venipuncture site. Pulmonary edema is caused by fluid infusing too rapidly; dyspnea, cough, anxiety, rales, and possible cardiac dysrhythmias are indicative of pulmonary edema. DIF: CognitiveLevel: Comprehension REF: p. 174 OBJ: 7 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Evaluation CON: Clinical Judgment | Safety | Infection | Tissue Integrity | Perfusion
  2. An elderly patient receiving an infusion of an isotonic fluid at 100 mL/hr complains of dyspnea. The nurse notes shallow rapid respirations and a cough that produces frothy sputum. Which is the priority nursing action? a. (^) Assess the urine output. b. (^) Elevate the head of the bed. c. (^) Encourage the patient to cough. d. (^) Maintain the IV rate. ANS: B Elevating the head of the bed is an appropriate action for signs and symptoms of pulmonary edema. Urine output is important to assess, but it is not the priority nursing action. Encouraging the patient to cough and take deep breaths is not the priority nursing action. The IV rate should be slowed immediately based on the signs and symptoms the patient is displaying. DIF: CognitiveLevel: Application REF: p. 176 OBJ: 7 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Fluid and Electrolytes | Perfusion
  3. Which system would most likely be used when a patient diagnosed with diabetes requires the administration of insulin continuously at home? a. (^) Central line catheter b. (^) Microdrip set c. (^) Piggyback system d. (^) Syringe pump ANS: D

ANS: D PICC lines routinely remain in place for 1 to 3 months but can last for a year or more if cared for properly. DIF: CognitiveLevel: Knowledge REF: p. 154 OBJ: 1 | 6 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Infection | Tissue Integrity

  1. Which sign or symptom indicates that the patient with a central venous access device is experiencing an air embolism? a. (^) Chest pain b. (^) Erythema c. (^) Frothy sputum d. (^) Sweating ANS: A Chest pain is a symptom associated with air embolism. Erythema occurs with infiltration or extravasation. Frothy sputum occurs with circulatory overload or pulmonary edema. Sweating is indicative of a pulmonary embolism. DIF: CognitiveLevel: Comprehension REF: p. 176 OBJ: 7 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Assessment CON: Clinical Judgment | Safety | Perfusion | Gas Exchange
  2. Following the insertion of a central venous access device, the nurse notes a weak, thready pulse and decreased blood pressure. The patient complains of shortness of breath and palpitations. Which action will the nurse take first? a. (^) Place the patient on the left side. b. (^) Reassess vital signs. c. (^) Stop the infusion. d. (^) Verify placement of the device. ANS: A Signs and symptoms indicate an air embolism. The nurse‘s immediate action will be to place the patient onto his or her left side. The nurse has determined change in pulse and blood pressure already, and although it is appropriate to reassess, it is not the first action the nurse will take. There is no indication that anything is infusing into this venous access device. Verifying the placement of the device is not the first action the nurse would take. DIF: CognitiveLevel: Application REF: p. 176 OBJ: 7 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Gas Exchange
  3. Which action will the nurse take first when administering a prescribed medication IV push into a patient‘s Hickman catheter? a. (^) Administer the prescribed drug. b. (^) Flush with saline. c. (^) Flush with heparin. d. (^) Prepare a pump.

ANS: B Drugs given by IV push or bolus through a Hickman catheter generally follow the SASH guideline: s aline flush first; a dminister the prescribed drug; s aline flush following the drug; and h eparin flush line. A pump is not used when a drug is administered by push technique. DIF: CognitiveLevel: Application REF: p. 160 OBJ: 6 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment | NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Health Promotion

  1. A 90-year-old woman is admitted to an acute care facility with the diagnosis of pneumonia. She has a past medical history of diabetes mellitus, hypertension, and right-sided mastectomy. Which action will the nurse take when starting an IV for infusion of antibiotic therapy? a. (^) Insert the IV catheter into the left hand. b. (^) Use a lower extremity vein for insertion. c. (^) Choose the left radial artery for insertion. d. (^) Attempt insertion into the left antecubital space vein. ANS: D IV insertion should not be initiated in an arm with compromised lymphatic or venous flow such as a mastectomy. The left antecubital space vein would be a good choice for this patient given her age and medical history. In the older adult, using the veins in the hand area may be a poor choice because of the fragility of the skin and veins in this area. When possible, the veins of the lower extremities should be avoided for IV insertion because of the danger of developing thrombi and emboli. IV therapy should never be started in an artery. DIF: CognitiveLevel: Application REF: p. 160 OBJ: 3 NAT: NCLEXClient Needs Category: Safe, Effective Care Environment TOP: NursingProcess Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Tissue Integrity MULTIPLE RESPONSE
  2. Which information will the nurse explain when teaching a patient about a PICC line? ( Select all that apply. ) a. (^) The catheter may have a single or double lumen. b. (^) There is greater risk of clotting and infiltration with this type of catheter. c. (^) The patient will be receiving infusions continuously to ensure patency. d. (^) The tip of the catheter may be open or valved. e. (^) The catheter may be used for drawing blood. ANS: A, D PICC lines may have more than one lumen. The catheter may have an open tip or a valved (Groshong) tip. The risk of infiltration and clotting is less than with other types of central lines. The line should be flushed with a saline heparin solution after every use, or daily, in order to maintain patency if it is not in continuous use. PICC lines are not appropriate for blood drawing because of their small size. DIF: CognitiveLevel: Comprehension REF: p. 154 OBJ: 1 NAT: NCLEXClient Needs Category: PhysiologicalIntegrity TOP: NursingProcess Step: Implementation