Clinical Nursing Skills Chapter 28: Intravenous and Vascular Access Therapy

A patient is receiving 1 L of D5 lactated Ringer's (LR) every 12 hours using an administration set with a drop factor of 15 gtt/mL. At what rate should the nurse set this infusion?

1. 10 gtt/min

2. 21 gtt/min

3. 33 gtt/min

4. 83 gtt/min

2

A patient had an intravenous (IV) catheter inserted 48 hours ago to receive antibiotic therapy. During assessment of the IV site the nurse observes redness and tenderness on palpation. The nurse documents that the IV was discontinued and restarted because of which complication of IV therapy?

1. Clotting of the IV catheter

2. Infiltration

3. Phlebitis

4. Puncturing of the opposite side of the vein

3

Rationale: Phlebitis is evidenced by what the patient is experiencing. Coolness and swelling would be seen with infiltration. There are no data to support the other two options.

Considerations for selecting an intravenous (IV) catheter for a patient include which of the following?

1. Selecting the longest catheter with the largest gauge

2. Selecting the longest catheter with the smallest gauge

3. Selecting the shortest catheter with the smallest gauge

4. Selecting the shortest catheter with the largest gauge

3

Rationale: The smallest device possible with the smallest gauge is recommended to prevent complications to inner layers of the veins.

Place in correct order the following steps for changing a dressing

over a short peripheral IV device:

1. Clean insertion site with antiseptic swab.

2. After removing tape, remove transparent dressing (transparent semipermeable membrane [TSM]).

3. Apply new transparent dressing (TSM).

4. Observe site for signs and symptoms of intravenous (IV)-related complications.

2, 4, 1, 3

Rationale: After the tape is removed,

the old or current dressing (TSM) is removed; once the dressing is removed, the site is observed for signs and symptoms of IV- related complications; site is cleaned with antiseptic swab to remove any surface microorganisms before new dressing is applied; new dressing (TSM) is applied to protect site and prevent any microorganisms from entering the insertion site.

A midline catheter is considered a central vascular access device.

1 True

2 False

False

Rationale: A midline catheter is considered a peripheral device because of the location of the final tip placement, which is not in the superior vena cava (SVC); it terminates below the axilla.

An obese patient who had a right mastectomy several years ago

has better veins in her right hand but is left handed. Where should the nurse place the intravenous (IV) catheter?

1. In her right hand

2. In her left lower arm

3. Wherever the patient wants

4. In her right antecubital site

2

Rationale: Although it is desirable to place an IV infusion in the patient's nondominant hand, this patient has a medical condition that dictates that the IV catheter be placed in her dominant hand or arm.

The health care provider discontinued a patient's anticoagulant therapy. Which nursing intervention is most appropriate after the nurse removes the intravenous (IV) catheter from his hand?

1. Apply pressure to the IV site until the bleeding stops.

2. Convert the catheter to an intermittent heparin lock for 24 hours.

3. Encourage the patient to keep his hand elevated for 10 minutes.

4. Use a warm compress at the site for several minutes.

1

Rationale: The patient is susceptible to bleeding; thus pressure should be applied whenever a device such as a catheter is removed from his body while he still has prolonged bleeding times. You or the patient (if capable) can apply the pressure for the required period of time.

A patient just had a peripherally inserted central catheter (PICC) placed in the right antecubital site. When reading the x-ray film report verifying correct placement of the catheter, the nurse knows that the tip of the PICC is located correctly if it is in which vessel?

1. The inferior vena cava

2. The basilic vein

3. The cephalic vein

4. The superior vena cava

4

Rationale: The tip of the catheter should be in the superior vena cava above the right atrium of the heart.

Which of the following is a key component of the Central Line Bundle?

1. Chlorhexidine skin antisepsis

2. Soap and water skin preparation

3. Alcohol skin antisepsis

4. Hydrogen peroxide skin preparation

1

Rationale: Current evidence states that chlorhexidine skin anti- sepsis has been shown to reduce the risk of catheter-associated infections when used as a skin prep.

An order is received to provide a solution with an osmolarity greater than 600 mOsm/L to a patient. Which of the following intravenous (IV) devices is appropriate?

1. Short peripheral in cephalic vein

2. Midline in basilic vein

3. Peripherally inserted central catheter (PICC) in subclavian vein

4. Implanted venous port in superior vena cava (SVC)

4

Rationale: Solution with an osmolarity of greater than 600 mOsm/L needs to be administered by a catheter placed in the SVC. The only correct option is the implanted venous port. Although the PICC is a central device, the tip placement is not in the SVC.