IV Therapy Final Exam
A bag of intravenous solution should not hang longer than how many
hours? - -24 hours
- A physician's order for IV therapy must contain what components? - -
date of order, type of fluid solution, volume, and length of infusion time
- A tourniquet should be left no longer than how many minutes? - -2
minutes
- According to the CDC, when should hands be washed, or an alcohol-
based hand rub be used during the venipuncture procedure? - -before and
after palpating IV sites, before and after inserting IV catheter, and before
and after accessing IV system for any purpose
- After medication is added to a solution, it must be infused or discarded
within how many hours? - -24 hours
- After performing venipuncture, when can you let go of the catheter? - -
after the IV catheter is secured
- After the fluids are connected and started, what do you look for? - -
redness, edema, skin, pain, any other complaints that the patient has
- Are gloves required during venipuncture? - -yes
- At what point in the procedure is the tourniquet removed? - -Either
when blood is present in the catheter hub or after the nurse has advanced
the cannula but before the stylet is taken out.
- Besides the tourniquet, identify four ways to further dilate veins. - -
Position arm in a dependent position, rub or stroke arm, cover entire arm
with warm, moist towels for 5 - 10 minutes, and after applying tourniquet,
have patient open and close fist
- Define the following local complications and list the signs and
symptoms for: extravasation - -infiltration of a vesicant
- Define the following local complications and list the signs and
symptoms for: infection - -redness, edema, exudate at siteredness,
edema, exudate at site
- Define the following local complications and list the signs and
symptoms for: infiltration - -nonvesicant solution leaks out of vein into
surrounding tissue, IV site edematous and cool
, - Define the following local complications and list the signs and
symptoms for: pain - -discomfort at or above IV site
- Define the following local complications and list the signs and
symptoms for: phlebitis - -inflammation of vein; can result in
thrombophlebitis
leading to an emboli, pain, erythema at site
- Define the following systemic complications and list the signs and
symptoms: air embolism - -*Gas bubble in the vascular space
*Venous - small - usually stopped at heart, large - stops blood flow (death)
*Arterial - stops blood flow (brain, heart) - shock, decreased LOC, (death)
- Define the following systemic complications and list the signs and
symptoms: Circulatory overload (fluid volume excess; FVE ) - -*Vascular
space, heart and kidneys are unable to handle the excess fluid volume,
Especially children and elderly resulting in heart failure and pulmonary
edema
*S&S - coughing, wheezing, dyspnea, cyanosis, tachycardia, hypertension,
pulmonary edema, anxiety, restlessness
- Define the following systemic complications and list the signs and
symptoms: incompatability - -*IV drugs may not be compatible with other
IV drugs or solutions. Drug incompatibility is a true risk to the patient
because it can cause
crystallization of the solution. This precipitation at the least will clog the IV
line and at the worst present as emboli.
*S&S: Same as pulmonary and air embolism.
- Define the following systemic complications and list the signs and
symptoms: infection - -*When micro-organisms occur in the bloodstream,
this is called sepsis. Sepsis is a very serious condition, the body's
response to this is called
systemic inflammatory response syndrome (SIRS).
*S&S - chills, fever, confusion, delirium, hypotention (shock), tachycardia
- Define the following systemic complications and list the signs and
symptoms: pulmonary embolism - -*a blockage of the main artery of the
lung or one of its branches by a substance, usually a blood clot, that has
travelled from elsewhere (extremity) in the body through the bloodstream.
*S&S - chest pain, dyspnea, tachypnea, cyanosis, shock state
- Define the following systemic complications and list the signs and
symptoms: speed shock - -*a sudden adverse reaction to IV medications
or drugs that are administered too quickly
*S&S - causing, irregular heart rhythm, tight feeling in chest, changes in
the LOC, headache, cardiac arrest
, - Describe a vein that is suitable for venipuncture. - -Round, firm,
elastic, engorged with blood; not hard, bumpy or flat
- Describe how to dress a catheter site using a transparent dressing. - -
Insertion site clean and dry, DON'T cover tubing and cannula hub, Place
transparent dressing over insertion site and up to cannula hub, don't
stretch dressing, and "tuck" transparency dressing around hub to keep out
microorganisms
- Describe how to immobilize the vein. How long should you maintain
immobilization during venipuncture? - -Use thumb of nondominant hand
to stretch skin downward to anchor vein. Do not apply too much pressure
or you will flatten vein.
- Describe how to regulate an IV infusing by gravity. How high should the
solution be positioned above the infusion site? - -The nurse has to first
figure out how many gtt/min to deliver the specific amount of fluid or the
dose of medication. Using a watch with a second hand and using a manual
controller to either speed up the gtt/min or the slow the gtt/ml. IV bag
should be 36 inches above insertion site
- Describe one method for systematic assessment of IV therapy and list
its components (i.e, what are you doing and what are you looking for?) - -
start at IV insertion site and work toward IV solution
Assess for signs and symptoms of fluid overload
daily weight
I&O
skin turgor
moist mucus membranes
VS
LOC
lung sounds - new or increased crackles
Assess IV site
redness
edema
dressing intact
date of insertion
rubing connections tight, unkinked
fluid, type, rate amount
- Describe OSHA guidelines regarding the use of tourniquets among
clients. - -Occupational Safety and Health Administration (OSHA)
establishes enforced guidelines to assist employers in implementing
safety standards for employers. Tourniquets are single patient use only. IV
sylets are to have safety shields to reduce the possibility of needle sticks.
Dispose of IV stylets in sharps container. Dispose of sharps container when
½ to ¾ full. Know your "needle stick" protocol in your hospital.
A bag of intravenous solution should not hang longer than how many
hours? - -24 hours
- A physician's order for IV therapy must contain what components? - -
date of order, type of fluid solution, volume, and length of infusion time
- A tourniquet should be left no longer than how many minutes? - -2
minutes
- According to the CDC, when should hands be washed, or an alcohol-
based hand rub be used during the venipuncture procedure? - -before and
after palpating IV sites, before and after inserting IV catheter, and before
and after accessing IV system for any purpose
- After medication is added to a solution, it must be infused or discarded
within how many hours? - -24 hours
- After performing venipuncture, when can you let go of the catheter? - -
after the IV catheter is secured
- After the fluids are connected and started, what do you look for? - -
redness, edema, skin, pain, any other complaints that the patient has
- Are gloves required during venipuncture? - -yes
- At what point in the procedure is the tourniquet removed? - -Either
when blood is present in the catheter hub or after the nurse has advanced
the cannula but before the stylet is taken out.
- Besides the tourniquet, identify four ways to further dilate veins. - -
Position arm in a dependent position, rub or stroke arm, cover entire arm
with warm, moist towels for 5 - 10 minutes, and after applying tourniquet,
have patient open and close fist
- Define the following local complications and list the signs and
symptoms for: extravasation - -infiltration of a vesicant
- Define the following local complications and list the signs and
symptoms for: infection - -redness, edema, exudate at siteredness,
edema, exudate at site
- Define the following local complications and list the signs and
symptoms for: infiltration - -nonvesicant solution leaks out of vein into
surrounding tissue, IV site edematous and cool
, - Define the following local complications and list the signs and
symptoms for: pain - -discomfort at or above IV site
- Define the following local complications and list the signs and
symptoms for: phlebitis - -inflammation of vein; can result in
thrombophlebitis
leading to an emboli, pain, erythema at site
- Define the following systemic complications and list the signs and
symptoms: air embolism - -*Gas bubble in the vascular space
*Venous - small - usually stopped at heart, large - stops blood flow (death)
*Arterial - stops blood flow (brain, heart) - shock, decreased LOC, (death)
- Define the following systemic complications and list the signs and
symptoms: Circulatory overload (fluid volume excess; FVE ) - -*Vascular
space, heart and kidneys are unable to handle the excess fluid volume,
Especially children and elderly resulting in heart failure and pulmonary
edema
*S&S - coughing, wheezing, dyspnea, cyanosis, tachycardia, hypertension,
pulmonary edema, anxiety, restlessness
- Define the following systemic complications and list the signs and
symptoms: incompatability - -*IV drugs may not be compatible with other
IV drugs or solutions. Drug incompatibility is a true risk to the patient
because it can cause
crystallization of the solution. This precipitation at the least will clog the IV
line and at the worst present as emboli.
*S&S: Same as pulmonary and air embolism.
- Define the following systemic complications and list the signs and
symptoms: infection - -*When micro-organisms occur in the bloodstream,
this is called sepsis. Sepsis is a very serious condition, the body's
response to this is called
systemic inflammatory response syndrome (SIRS).
*S&S - chills, fever, confusion, delirium, hypotention (shock), tachycardia
- Define the following systemic complications and list the signs and
symptoms: pulmonary embolism - -*a blockage of the main artery of the
lung or one of its branches by a substance, usually a blood clot, that has
travelled from elsewhere (extremity) in the body through the bloodstream.
*S&S - chest pain, dyspnea, tachypnea, cyanosis, shock state
- Define the following systemic complications and list the signs and
symptoms: speed shock - -*a sudden adverse reaction to IV medications
or drugs that are administered too quickly
*S&S - causing, irregular heart rhythm, tight feeling in chest, changes in
the LOC, headache, cardiac arrest
, - Describe a vein that is suitable for venipuncture. - -Round, firm,
elastic, engorged with blood; not hard, bumpy or flat
- Describe how to dress a catheter site using a transparent dressing. - -
Insertion site clean and dry, DON'T cover tubing and cannula hub, Place
transparent dressing over insertion site and up to cannula hub, don't
stretch dressing, and "tuck" transparency dressing around hub to keep out
microorganisms
- Describe how to immobilize the vein. How long should you maintain
immobilization during venipuncture? - -Use thumb of nondominant hand
to stretch skin downward to anchor vein. Do not apply too much pressure
or you will flatten vein.
- Describe how to regulate an IV infusing by gravity. How high should the
solution be positioned above the infusion site? - -The nurse has to first
figure out how many gtt/min to deliver the specific amount of fluid or the
dose of medication. Using a watch with a second hand and using a manual
controller to either speed up the gtt/min or the slow the gtt/ml. IV bag
should be 36 inches above insertion site
- Describe one method for systematic assessment of IV therapy and list
its components (i.e, what are you doing and what are you looking for?) - -
start at IV insertion site and work toward IV solution
Assess for signs and symptoms of fluid overload
daily weight
I&O
skin turgor
moist mucus membranes
VS
LOC
lung sounds - new or increased crackles
Assess IV site
redness
edema
dressing intact
date of insertion
rubing connections tight, unkinked
fluid, type, rate amount
- Describe OSHA guidelines regarding the use of tourniquets among
clients. - -Occupational Safety and Health Administration (OSHA)
establishes enforced guidelines to assist employers in implementing
safety standards for employers. Tourniquets are single patient use only. IV
sylets are to have safety shields to reduce the possibility of needle sticks.
Dispose of IV stylets in sharps container. Dispose of sharps container when
½ to ¾ full. Know your "needle stick" protocol in your hospital.
