Chapter 13: Infusion Therapy

Chapter 13: Infusion Therapy

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse is caring for a client who has just had a central venous access line inserted. Which action should the nurse take next?
   1. Begin the prescribed infusion via the new access.
   2. Ensure an x-ray is completed to confirm placement.
   3. Check medication calculations with a second RN.
   4. Make sure the solution is appropriate for a central line.

ANS:   B

A central venous access device, once placed, needs an x-ray confirmation of proper placement before it is used. The bedside nurse would be responsible for beginning the infusion once placement has been verified. Any IV solution can be given through a central line.

DIF:     Applying/Application                         REF: 193

KEY:   Vascular access device

MSC:   Integrated Process: Nursing Process: Implementation           NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

2. A nurse assesses a client who has a radial artery catheter. Which assessment should the nurse complete first?
   1. Amount of pressure in fluid container
   2. Date of catheter tubing change
   3. Percent of heparin in infusion container
   4. Presence of an ulnar pulse

ANS:   D

An intra-arterial catheter may cause arterial occlusion, which can lead to absent or decreased perfusion to the extremity. Assessment of an ulnar pulse is one way to assess circulation to the arm in which the catheter is located. The nurse would note that there is enough pressure in the fluid container to keep the system flushed, and would check to see whether the catheter tubing needs to be changed. However, these are not assessments of greatest concern. Because of heparin-induced thrombocytopenia, heparin is not used in most institutions for an arterial catheter.

DIF:     Applying/Application                         REF: 212

KEY:   Vascular access device

MSC:   Integrated Process: Nursing Process: Assessment                 NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

3. A nurse teaches a client who is being discharged home with a peripherally inserted central catheter (PICC). Which statement should the nurse include in this client’s teaching?
   1. “Avoid carrying your grandchild with the arm that has the central catheter.”
   2. “Be sure to place the arm with the central catheter in a sling during the day.”
   3. “Flush the peripherally inserted central catheter line with normal saline daily.”
   4. “You can use the arm with the central catheter for most activities of daily living.”

ANS:           A

A properly placed PICC (in the antecubital fossa or the basilic vein) allows the client considerable freedom of movement. Clients can participate in most activities of daily living; however, heavy lifting can dislodge the catheter or occlude the lumen. Although it is important to keep the insertion site and tubing dry, the client can shower. The device is flushed with heparin.

DIF:            Applying/Application                         REF:    194                   KEY: Vascular access device                     MSC:                                                  Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

4. A nurse is caring for a client who is having a subclavian central venous catheter inserted. The client begins to report chest pain and difficulty breathing. After administering oxygen, which action should the nurse take next?
   1. Administer a sublingual nitroglycerin tablet.
   2. Prepare to assist with chest tube insertion.
   3. Place a sterile dressing over the IV site.
   4. Re-position the client into the Trendelenburg position.

ANS:           B

An insertion-related complication of central venous catheters is a pneumothorax. Signs and symptoms of a pneumothorax include chest pain and dyspnea. Treatment includes removing the catheter, administering oxygen, and placing a chest tube. Pain is caused by the pneumothorax, which must be taken care of with a chest tube insertion. Use of a sterile dressing and placement of the client in a Trendelenburg position are not indicated for the primary problem of a pneumothorax.

DIF:     Applying/Application             REF:    194       KEY: Vascular access device| medical emergencies              MSC: Integrated Process: Nursing Process: Implementation            NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential