172 final Complete 2023
An experienced nurse is reviewing with a new nurse about discontinuing an IV. The new nurse needs
more education when he states which of the following? Ans- " apply pressure over the IV site, then pull
the catheter out"
An LPN is working on a medical/surgical floor of a small town hospital. The shift has just started, it is
now 7:30 AM. Several patients need an IV inserted. Which patient will the LPN insert an IV first? Ans- A
46-year-old postop patient. Who has hyperlipidemia. Hypertension and is complaining of severe chest
pain
A 40-year-old patient was in a car accident three days ago. The patient is NPO. The patient is to receive a
unit of blood today for A hemoglobin of 6.8. Which task would be appropriate for the RN to delegate to
an LPN? Ans- Start the IV with and 18 gauge needle in the right forearm
A patient is receiving an IV of LR at 50 mL/hours. The patient has also received 2 IVPBs today: 100 mL
and 75 mL. The patient is NPO. The patient had a urine output per urinal of 200 mL. Then an indwelling
catheter was inserted and the catheter was emptied at the end of the shift, 700 mL were obtained. The
patient had to JP drains. JP drain A was emptied twice: 50 mL and 75 mL. JP drain B was emptied three
times: 50 mL, 45 mL, 50 mL. The patient had two diarrhea stools that measured 65 mL and 100 mL. The
patient was also diaphoretic today (unable to measure). The LPN has an order to call the physician at the
end of the shift and give an update. This facility is on 12 hour shifts. What will the LPN
report/recommend to the physician? Ans- This patient needs more IV fluids
Which complication will the LPN immediately remove the IV catheter? Ans- The IV site is red and warm
A patient has an IV with albumin 25% infusing. Which symptom, related to this infusion would most
concerned the nurse? Ans- Lungs now have crackles in the bases
A nurse is presenting an in-service to her unit about blood transfusion reactions. The nurse states which
of the following signs and symptoms represent a probable acute hemolytic transfusion reaction? Ans-
Fever, tachycardia, chest pain, back pain, low blood pressure
A nurse is teaching a student nurse about hypotonic solutions. The nurse will include which statement in
the teaching? Ans- " The blood pressure will usually decreased when given this type of fluid"
, Which statement made by the student nurse indicates a need for further teaching about solutions with
IV dextrose? Ans- " administering an IV with dextrose gives the patient carbohydrates and lipids"
A patient has a sodium level of 120. The nurse will do which of the following actions? Ans- Place seizure
pads on the patient side rails
The nurse is caring for a patient with a 1000 mL bag of 5% dextrose in 0.9% sodium chloride (D5/NS)
ordered to run at 100 mL/hour. The IV bag was hung at 4 PM. At 6 PM the IV bag has only 200 mL
remaining. The patient reports a pounding headache, dyspnea, and has increased pulse rate. The nurse
is orientating a new LPN and teaching her what to do in this situation. The new LPN needs more
instruction when she makes which statement? Ans- " go find the RN and ask her/him what to do"
Which statement is true regarding insertion of a peripheral IV? Ans- The insertion site should be
scrubbed with chlorhexidine and alcohol combo (Chloaprep) For 30 seconds prior to IV insertion an
allowed to air dry.
When observing a new nurse performing phlebotomy for a lab test on a patient, which action indicates a
need for further education? Ans- The nurse labels the tubes at the nurses station
An RN is teaching an LPN about albumin transfusions. Which statement by the LPN indicates further
teaching is needed? Ans- " when transfusing albumin there is a high risk of transmitting hepatitis"
A 25-year-old patient with diabetes mellitus is in the ER with blood sugar of 550 and key tones in the
urine. No cause of nausea at this time. The ABG result is: pH: 7.30, PCO2: 29, HCO3: 19, PO2: 95. The
potassium level is 5.8. The nurse would question the physician about which order? Ans- Apply a
nonrebreather mask at 15 L/minute oxygen
A patient has Vancomycin in fusing. When assessing the site you notice that the IV site is cool, pale and
swollen. What action will the LPN take first? Ans- Stop the IV solution
Which statement made by the patient about they are peripheral nerve catheter care would indicate a
need for further teaching? Ans- " if my pain level increases I should just squeeze the 'ball' of pain
medicine"
An experienced nurse is reviewing with a new nurse about discontinuing an IV. The new nurse needs
more education when he states which of the following? Ans- " apply pressure over the IV site, then pull
the catheter out"
An LPN is working on a medical/surgical floor of a small town hospital. The shift has just started, it is
now 7:30 AM. Several patients need an IV inserted. Which patient will the LPN insert an IV first? Ans- A
46-year-old postop patient. Who has hyperlipidemia. Hypertension and is complaining of severe chest
pain
A 40-year-old patient was in a car accident three days ago. The patient is NPO. The patient is to receive a
unit of blood today for A hemoglobin of 6.8. Which task would be appropriate for the RN to delegate to
an LPN? Ans- Start the IV with and 18 gauge needle in the right forearm
A patient is receiving an IV of LR at 50 mL/hours. The patient has also received 2 IVPBs today: 100 mL
and 75 mL. The patient is NPO. The patient had a urine output per urinal of 200 mL. Then an indwelling
catheter was inserted and the catheter was emptied at the end of the shift, 700 mL were obtained. The
patient had to JP drains. JP drain A was emptied twice: 50 mL and 75 mL. JP drain B was emptied three
times: 50 mL, 45 mL, 50 mL. The patient had two diarrhea stools that measured 65 mL and 100 mL. The
patient was also diaphoretic today (unable to measure). The LPN has an order to call the physician at the
end of the shift and give an update. This facility is on 12 hour shifts. What will the LPN
report/recommend to the physician? Ans- This patient needs more IV fluids
Which complication will the LPN immediately remove the IV catheter? Ans- The IV site is red and warm
A patient has an IV with albumin 25% infusing. Which symptom, related to this infusion would most
concerned the nurse? Ans- Lungs now have crackles in the bases
A nurse is presenting an in-service to her unit about blood transfusion reactions. The nurse states which
of the following signs and symptoms represent a probable acute hemolytic transfusion reaction? Ans-
Fever, tachycardia, chest pain, back pain, low blood pressure
A nurse is teaching a student nurse about hypotonic solutions. The nurse will include which statement in
the teaching? Ans- " The blood pressure will usually decreased when given this type of fluid"
, Which statement made by the student nurse indicates a need for further teaching about solutions with
IV dextrose? Ans- " administering an IV with dextrose gives the patient carbohydrates and lipids"
A patient has a sodium level of 120. The nurse will do which of the following actions? Ans- Place seizure
pads on the patient side rails
The nurse is caring for a patient with a 1000 mL bag of 5% dextrose in 0.9% sodium chloride (D5/NS)
ordered to run at 100 mL/hour. The IV bag was hung at 4 PM. At 6 PM the IV bag has only 200 mL
remaining. The patient reports a pounding headache, dyspnea, and has increased pulse rate. The nurse
is orientating a new LPN and teaching her what to do in this situation. The new LPN needs more
instruction when she makes which statement? Ans- " go find the RN and ask her/him what to do"
Which statement is true regarding insertion of a peripheral IV? Ans- The insertion site should be
scrubbed with chlorhexidine and alcohol combo (Chloaprep) For 30 seconds prior to IV insertion an
allowed to air dry.
When observing a new nurse performing phlebotomy for a lab test on a patient, which action indicates a
need for further education? Ans- The nurse labels the tubes at the nurses station
An RN is teaching an LPN about albumin transfusions. Which statement by the LPN indicates further
teaching is needed? Ans- " when transfusing albumin there is a high risk of transmitting hepatitis"
A 25-year-old patient with diabetes mellitus is in the ER with blood sugar of 550 and key tones in the
urine. No cause of nausea at this time. The ABG result is: pH: 7.30, PCO2: 29, HCO3: 19, PO2: 95. The
potassium level is 5.8. The nurse would question the physician about which order? Ans- Apply a
nonrebreather mask at 15 L/minute oxygen
A patient has Vancomycin in fusing. When assessing the site you notice that the IV site is cool, pale and
swollen. What action will the LPN take first? Ans- Stop the IV solution
Which statement made by the patient about they are peripheral nerve catheter care would indicate a
need for further teaching? Ans- " if my pain level increases I should just squeeze the 'ball' of pain
medicine"
