NUR172/ NUR 172 EXAM WITH VERIFIED ANSWERS FROM EXPERT

NUR172/ NUR 172 EXAM WITH VERIFIED ANSWERS FROM EXPERT Infiltration - Cool, taunt skin and edema at site Suspect blood stream infection - • Report S/S to doctor • Anticipate culture (SAVE IV CATH) • Antibiotics, fluids, oxygen Red, swollen, and warm skin - • Stop infusion • Remove IV • Save IV Phlebitis - Red, raised rope-feeling veins MRSA precautions - Gloves and gown What to chart when infiltration occurs - Assessment of site • Date and time • Notified physician • Treatment ordered • What you did • How patient tolerated it Hematoma - Ice, Elevate, Pressure Best practice for IVs - Use alcohol caps Sending patient home with a PICC. What should the nurse teach? - Report s/s of infection (redness, swelling, drainage, fever, etc) Patient has bloody tinged sputum - Pulmonary edema IV fluids an LPN can administer - D5W, D5/LR, D5/NS, NS, LR, 0.45% NaCl, 0.2% NaCl, Antibiotics Change tubing - • Primary- 96 hours • Secondary-24 hours • Change tubing with every blood transfusion Factors affecting size of IV catheter used - • Type of solution ordered • Condition of vein • Length of time S/S of Septicemia - • Tachycardia • Change in mental status • Hypotension • Increased lactate levels Patient is receiving antibiotics and becomes SOB. FLUID OVERLOAD - • Slow IV rate Solution used for treatment of burns - • Lactated ringers Solution used for hypervolemia - • Dextrose 5% with 0.9% NaCl Solution used for trauma and blood loss - • 0.9% NaCl Hypertonic solutions - • Raises BP Hypotonic solutions - • Lowers BP What should be monitored while a patient is receiving potassium - • IV site • Cardiovascular status • Tissue integrity 76 y.o. patient receiving 0.9% NS for dehydration. Which assessments? - • Elimination • Vitals • Oxygenation • IV site Potassium level - 3.5-5.0 Sodium - 135-145 Calcium - 4.5-5.5 Magnesium - 1.5-2.5 Phosphorous -2.5-4.5 BUN - 10-20 Creatinine - 0.5-1 Platelets - 150k-400k Bigger number gauge - = smaller needle size Macro - 10-20 qt/ml Micro - 60 qt/ml Scope of practice - • Infuse/maintain solutions with NO meds except for antibiotics • 18 years old and older • Only insert in the antecubital space, hands, and forearm IV Stopcocks - • 4 way intersection used when IV fluids are compatible • One or both lines can run into the patient, either alone or combined • Controls the direction of flow of an infusate • High contamination chances