Test Bank For Basic Pharmacology For Nurses 17th Edition by Michelle Willihnganz Bruce D Clayton Download

Test Bank for Basic Pharmacology for Nurses, 17th Edition, by Michelle Willihnganz Bruce D.
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Edition, by Michelle Willihnganz Bruce D. Clayton
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Chapter 11: Parenteral Administration: Intravenous Route
Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition
MULTIPLE CHOICE
1. A patient is diagnosed with cancer and requires 6 months of chemotherapy infusions. Which
type of intravenous (IV) access device will likely be used?
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: Cognitive Level: Application REF: Page 147 | Page 149

OBJ: 5 TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment
2. The nurse notes that a patient with cardiac disease has IV heparin infusing and that it is behind
by 2 hours. What is the best nursing action?
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 health care provider for consultation.
ANS: D
The patient has a history of cardiac problems and is receiving a critical care medication, IV
heparin. In this case, contacting the patient’s health care provider would be appropriate to
avoid harm. Increasing the infusion rate might place the patient into fluid overload and might
infuse too much heparin in a short time. Reducing the infusion rate to TKO or discontinuing
the solution would put the schedule even further behind.
DIF: Cognitive Level: Application REF: Page 154 OBJ: 8

TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Safety; Collaboration; Communication
3. What is the composition of hypotonic intravenous solutions such as 0.45% NaCl?

a. Fewer dissolved particles than blood
b. Approximately the same number of dissolved particles as blood
c. Higher concentrations of dissolved particles than blood
d. Electrolytes and dextrose
ANS: A
Hypotonic solutions have fewer dissolved particles than blood. Half normal saline does not
contain dextrose.
DIF: Cognitive Level: Knowledge REF: Page 150 OBJ: 3

TOP: Nursing Process Step: Assessment
NOT: CONCEPT(S): Clinical Judgment; Fluid and Electrolyte Balance; Cellular Regulation
4. Which condition would the nurse expect to be treated with an isotonic solution?
a. Fluid overload
b. Hemorrhagic shock
c. Cellular dehydration
d. Cerebral edema
ANS: B
Isotonic solutions have approximately the same osmolality as blood. Isotonic fluids are ideal
replacement fluids for patients experiencing an intravascular fluid deficit that occurs in
conditions such as acute blood loss from hemorrhage and gastrointestinal bleeding. Isotonic
fluids increase vascular volume, thus counteracting hypovolemia and hypotension.
Administering isotonic solutions for fluid overload would exacerbate the problem. Hypotonic
solutions are administered for cellular dehydration. Hypertonic solutions are administered for
cerebral edema.

5. The nurse determines that an elderly patient’s IV of D50.2 NS with 20 mEq KCl at 75 mL/hr
is running 3 hours behind. After determining the IV site is patent, what action will the nurse
take?
a. Call the health care provider to obtain an order to decrease the IV rate.
b. Administer a bolus to make up the deficit.
c. Recalculate the flow rate and slowly make up the fluids.
d. Maintain the ordered rate.
ANS: D
The safest action is to maintain the ordered rate. The health care provider should be consulted
if the patient has not received critical IV replacement therapy. Increasing an IV rate without a
health care 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.

6. 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.

NOT: CONCEPT(S): Clinical Judgment; Safety; Infection; Health Promotion
7. 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 noncoring 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: Cognitive Level: Comprehension REF: Page 149 OBJ: 5

NOT: CONCEPT(S): Clinical Judgment
8. The nurse assesses erythema, warmth, and burning pain along the patient’s IV site. Which
complication is this patient most likely experiencing?
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.

TOP: Nursing Process Step: Evaluation
NOT: CONCEPT(S): Clinical Judgment; Safety; Infection; Tissue Integrity; Perfusion
9. 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.

NOT: CONCEPT(S): Clinical Judgment; Safety; Fluid Electrolyte Balance; Perfusion
10. A diabetic patient requires the administration of insulin continuously at home. Which system
would most likely be used in this instance?
a. Central line catheter
b. Microdrip set
c. Piggyback system
d. Syringe pump
ANS: D
Syringe pumps are used in patients with diabetes. A central line is not appropriate for the
diabetic patient requiring insulin. A microdrip set is a type of IV tubing that is used when
small volumes of fluid are given to patients with fluid volume concerns. A piggyback system
is a type of administration set that connects to a primary setup and administers a small volume
over 20 to 60 minutes.

NOT: CONCEPT(S): Clinical Judgment; Safety
11. A patient is admitted with hypovolemia resulting from lack of fluid intake and requires an
infusion of isotonic fluids. Which IV solution will the nurse administer?
a. D50.2 NS
b. D5W
c. 0.45 NS
d. 0.9 NS
ANS: D
0.9 NS is an isotonic solution appropriate for hypovolemia. D50.2 NS, D5W, and 0.45 NS are
hypotonic solutions.

12. Which potential complication will the nurse expect in patients with a venous access device?
a. Circulatory overload
b. Extravasation
c. Infection
d. Pain
ANS: C
Because venipuncture alters skin integrity, the patient is vulnerable to infection at all times.
Circulatory overload is a concern but does not occur with any type of venous access device
because the device may just be used for administration of small volumes of drugs (e.g.,
chemotherapy in cancer patients). Extravasation is a potential complication when there is
infusion of an irritating chemical. IV drug administration is usually more comfortable for
patients than other routes, and pain would not be considered a complication.

NOT: CONCEPT(S): Clinical Judgment; Safety; Infection; Tissue Integrity
13. A patient has a peripherally inserted central catheter (PICC) line inserted to continue IV
antibiotic therapy at home. With proper care, how long can this type of venous access device
remain in place?
a. 2 months
b. 4 months
c. 6 months
d. 12 months
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: Cognitive Level: Knowledge REF: Page 148 OBJ: 2 | 5

NOT: CONCEPT(S): Clinical Judgment; Safety; Infection; Tissue Integrity
14. In assessing a patient with a central venous access device, which sign or symptom indicates
that the patient 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.

NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Gas Exchange
15. 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.

NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Gas Exchange
16. The nurse is about to administer a prescribed medication IV push into a patient's Hickman
catheter. When providing this medication, the nurse will first
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: saline flush first; administer the prescribed drug; saline flush following the drug;
heparin flush line. A pump is not used when a drug is administered by push technique.
DIF: Cognitive Level: Application REF: Page 154 OBJ: 2 | 4

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client Needs
Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety; Health Promotion
17. 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.
When starting an IV for infusion of antibiotic therapy, the nurse will
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: Cognitive Level: Application REF: Page 154 OBJ: 4 | 5

NOT: CONCEPT(S): Clinical Judgment; Safety; Perfusion; Tissue Integrity
MULTIPLE RESPONSE
1. What 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.

NOT: CONCEPT(S): Clinical Judgment; Patient Education
2. Which patient assessment finding(s) suggest(s) extravasation of an IV solution? (Select all

that apply.)
a. Coolness
b. Edema
c. Fever
d. Pain at venipuncture site
Test Bank for Basic Pharmacology for Nurses, 17th Edition, by Michelle Willihnganz Bruce D.
e. Redness at the site

f. Shortness of breath
ANS: A, B, D, E
Coolness, edema, pain, and redness are indicative of extravasation. Fever does not indicate
extravasation. Shortness of breath does not indicate extravasation.

NOT: CONCEPT(S): Clinical Judgment; Safety; Tissue Integrity
3. The nurse assesses a patient’s right hand IV site to be infiltrated. Appropriate nursing actions
include (Select all that apply.)
a. stopping the infusion.
b. attempting to aspirate the medication.
c. elevating the affected limb.
d. checking capillary refill.
e. removing the catheter as directed by policy.
ANS: A, C, D, E
For an infiltration, stop the infusion. Elevate the affected limb. Assess for circulatory
compromise; check capillary refill and pulses proximal and distal to the area of infiltration. If
the infiltration is caused by an IV solution, remove the catheter as directed by policy. For
extravasation, attempts may be made to aspirate the medication.
DIF: Cognitive Level: Analysis REF: Page 171 | Page 172

OBJ: 9 TOP: Nursing Process Step: Implementation
NOT: CONCEPT(S): Clinical Judgment; Safety; Tissue Integrity
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Test Bank for Basic Pharmacology for Nurses, 17th Edition, by Michelle Willihnganz Bruce D.

Test Bank for Basic Pharmacology for Nurses, 17th

To download the complete and accurate content document, go to:

Visit TestBankBell.com to get complete for all chapters

DIF: Cognitive Level: Application REF: Page 147 | Page 149

DIF: Cognitive Level: Application REF: Page 154 OBJ: 8

3. What is the composition of hypotonic intravenous solutions such as 0.45% NaCl?

DIF: Cognitive Level: Knowledge REF: Page 150 OBJ: 3

DIF: Cognitive Level: Application REF: Page 150 OBJ: 3

DIF: Cognitive Level: Application REF: Page 154 OBJ: 8

DIF: Cognitive Level: Application REF: Page 153 OBJ: 8

7. Which needle is used to access implanted infusion devices?

DIF: Cognitive Level: Comprehension REF: Page 149 OBJ: 5

DIF: Cognitive Level: Comprehension REF: Page 171 OBJ: 9

9. An elderly patient receiving an infusion of an isotonic fluid at 100 mL/hr complains of

DIF: Cognitive Level: Application REF: Page 172 OBJ: 9

DIF: Cognitive Level: Application REF: Page 147 OBJ: 2

DIF: Cognitive Level: Comprehension REF: Page 150 OBJ: 3

DIF: Cognitive Level: Application REF: Page 171 OBJ: 9

DIF: Cognitive Level: Knowledge REF: Page 148 OBJ: 2 | 5

DIF: Cognitive Level: Application REF: Page 172 OBJ: 9

DIF: Cognitive Level: Application REF: Page 172 OBJ: 9

DIF: Cognitive Level: Application REF: Page 154 OBJ: 2 | 4

DIF: Cognitive Level: Application REF: Page 154 OBJ: 4 | 5

DIF: Cognitive Level: Comprehension REF: Page 148 OBJ: 2

2. Which patient assessment finding(s) suggest(s) extravasation of an IV solution? (Select all

e. Redness at the site

DIF: Cognitive Level: Comprehension REF: Page 171 OBJ: 9

DIF: Cognitive Level: Analysis REF: Page 171 | Page 172

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