Pharm & IV Therapies
d d d
Question 1 d
pts
d d d
Adnursednotesdthatdthedsitedofdadclient’sdperipheraldintravenousd(IV)dcatheterdisdreddened,d
warm,dpainful,danddslightlydedematousdneardthedinsertiondpointdofdthedcatheter.dOndthedba
sisdofdthisdassessment,dthednursedshoulddtakedwhichdactiondfirst?
Checkdfordloosedcatheterdconnections
Notifydthedhealthdcaredprovider
RemovedthedIVdcatheter
Slowdthedratedofdinfusion
Rationale:dPhlebitisdisdandinflammatorydprocessdindthedvein.dPhlebitisdatdandIVdsitedmaydbed
indicateddbydclientddiscomfortdatdthedsitedordbydredness,dwarmth,danddswellingdindthedaread
ofdthedcatheter.dThedIVdcatheterdshoulddbedremoveddanddadnewdIVdlinedinserteddatdaddiffere
ntdsite.dSlowingdthedratedofdinfusiondanddcheckingdfordloosedcatheterdconnectionsdarednotdc
orrectdresponses.dThedhealthdcaredproviderdwoulddbednotifieddifdphlebitisdweredtodoccur,dbu
tdthisdisdnotdthedinitialdaction.
Test-
TakingdStrategy:dNotedthedstrategicdword,dfirst.dFocusdondtheddatadindthedquestion.dElimin
atedslowingdthedratedofdinfusiondanddcheckingdthedconnection,dbecausedtheydaredcompara
bledordalikedindthatdtheydindicatedcontinuationdofdIVdtherapy.dAlthoughdthedhealthdcaredprovi
derdwoulddbednotifieddofdthisdoccurrence,dthedwordd“first”dshouldddirectdyoudtodselectdthedop
tiondofdremovingdthedIVdcatheter.dReviewdthedsignsdofdphlebitisdanddthedactionsdtodbedtake
ndwhenditdoccurs
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dIntravenousdTherapy
GiddensdConcepts:dClinicaldJudgment,dInflammation
HESIdConcepts:dClinicaldDecision-
Making/ClinicaldJudgment,dInflammationdReference:dPerry,dA.,dPotter,dP.,d&dOste
ndorf,dW.d(2014).dClinicaldnursingdskillsd&dtechniquesd(8thd ed.,dp.d707).dSt.dLouis:d
Mosby.
,Question 2 d
pts
d d d
Adnursedhangsdad500-
mLdbagdofdintravenousd(IV)dfluiddfordandassigneddclient.dOnedhourdlaterdthedclientdcomplain
sdofdchestdtightness,disddyspneicdanddapprehensive,danddhasdandirregulardpulse.dThedIVdba
gdhasd100dmLdremaining.dWhichdactiondshoulddthednurse
takedfirst?
RemovedthedIV
Sitdthedclientdupdindbed
ShutdoffdthedIVdinfusion
Slowdthedratedofdinfusion
Rationale:dThedclient’sdsymptomsdaredindicativedofdspeeddshock,dwhichdresultsdfromdthedr
apiddinfusiondofddrugsdordadbolusdinfusion.dIndthisdcase,dthednursedwoulddnotedthatd400dmLd
hasdinfuseddoverd60dminutes.dThedfirstdactiondondthedpartdofdthednursedisdshuttingdoffdthedIV
dinfusion.dOtherdactionsdmaydfollowdindrapiddsequence:dThednursedmaydelevatedthedheaddo
fdthedbeddtodaiddthedclient’sdbreathingdanddthendimmediatelydnotifydthedhealthdcaredprovider
.dSlowingdthedinfusiondratedisdinappropriatedbecausedthedclientdwilldcontinuedtodreceivedflui
d.dThedIVddoesdnotdneeddtodbedremoved.dItdmaydbedneededdtodmanagedthedcomplication.
Test-
TakingdStrategy:dNotedthedquestiondcontainsdthedstrategicdwordd“first.”dRecognizingdthedsig
nsdofdspeeddshockdanddrecallingdthedappropriatedinterventionsdshoulddalsoddirectdyoudtodth
edoptiondofdshuttingdoffdthedIVdinfusion.dReviewdthedinitialdnursingdactionsdfordspeeddshock
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dCriticaldCare
GiddensdConcepts:dFluiddanddElectrolytes,dPerfusion
HESIdConcepts:dFluiddanddElectrolytes,dPerfusion
Reference:dIgnatavicius,dD.,d&dWorkman,dM.d(2013).dMedical-surgicaldnursing:dPatient-
dcentereddcollaborativedcare.d(7 ed.,dp.d230).dSt.dLouis:dSaunders.
thd
Question 3 d
, pts
d d d
dAdnurseddiscontinuesdandinfusiondofdadunitdofdpackeddreddblooddcellsd(RBCs)dbecausedthed
clientdisdexperiencingdadtransfusiondreaction.dAfterddiscontinuingdthedtransfusion,dwhichdac
tiondshoulddthednursedtakednext?
Contactdthedhealthdcaredprovider
Obtaindadculturedofdthedtipdofdthedcatheterddevicedremoveddfromdthedclient
RemovedthedIVdcatheter
Changedthedsolutiondtod5%ddextrosedindwater
Rationale:dIfdthednursedsuspectsdadtransfusiondreaction,dthedtransfusiondisdstoppeddanddno
rmaldsalinedsolutiondinfuseddatdadkeep-vein-
opendratedpendingdfurtherdhealthdcaredproviderdprescriptions.dThednursedthendcontactsdth
edhealthdcaredprovider..dDextrosedindwaterdisdnotdused,dbecauseditdmaydcausedclottingdordh
emolysisdofdblooddcells.dNormaldsalinedsolutiondisdthedonlydtypedofdIVdfluiddthatdisdcompatib
ledwithdblood.dThednursedwoulddnotdremovedthedIVdcatheter,dbecausedthendtheredwoulddbed
nodIVdaccessdroutedthroughdwhichdtodtreatdthedreaction.dTheredisdnodreasondtodobtaindadcult
uredofdthedcatheterdtip;dthisdisddonedwhendandinfectiondisdsuspected.
Test-
TakingdStrategy:dNotedthedstrategicdwordd“next.”dKnowingdthatdthedIVdshoulddnotdbedremov
eddwilldassistdyoudindthedeliminationdprocess.dRecallingdthatdnormaldsalinedsolutiondisdthedo
nlydtypedofdIVdfluiddthatdisdcompatibledwithdblooddwilldalsodhelpdyoudanswerdcorrectly.dTodse
lectdfromdthedremainingdoptions,dnotedthatdinfectiondisdnotdthedconcern;dthisdwilldhelpdyoudel
iminatedthedoptiondofdobtainingdadculturedofdthedcatheterdtip.dReviewdcaredofdthedclientdexp
eriencingdadtransfusiondreaction
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dBlooddadministration
GiddensdConcepts:dClinicaldJudgment,dPerfusion
HESIdConcepts:dClinicaldDecision-
Making/ClinicaldJudgment,dPerfusiondReference:dPerry,dA.,dPotter,dP.,d&dOstendo
rf,dW.d(2014).dClinicaldnursingdskillsd&dtechniquesd(8thd ed.,dpp.d740-
741).dSt.dLouis:dMosby.
Question 4 d
, pts
d d d
Adclientdwithdheartdfailuredisdbeingdgivendfurosemidedandddigoxin.dThedclientdcallsdthednurs
d
edanddcomplainsdofdanorexiadanddnausea.dWhichdactiondshoulddthednursedtakedfirst?
Administerdtheddailyddosedofddigoxin
Discontinuedthedmorningddosedofdfurosemide
Checkthedresultdofdlaboratorydtestingdfordpotassiumdondthedsampleddrawnd3dhoursdago
Administerdandantiemetic
Rationale:dAnorexiadanddnauseadaredsymptomsdcommonlydassociateddwithddigoxindtoxici
ty,dwhichdisdcompoundeddbydhypokalemia.dEarlydclinicaldmanifestationsdofddigoxindtoxicity
dincludedanorexiadanddmilddnausea,dbutdtheydaredfrequentlydoverlookeddordnotdassociatedd
withddigoxindtoxicity.dHallucinationsdanddanydchangedindpulsedrhythm,dcolordvision,dordbeh
aviordshoulddbedinvestigateddanddreporteddtodthedhealthdcaredprovider.dThednursedshoulddfi
rstdcheckdthedresultsdofdthedpotassiumdlevel,dwhichdwilldprovidedadditionaldwhendthednursed
callsdthedhealthdcaredprovider,andimportantdfollow-
updaction.dThednursedshoulddalsodcheckdtheddigoxindreadingdifdonedisdavailable.dThednurse
dwoulddnotdadministerdandantiemeticdwithoutdfurtherdinvestigatingdthedclient’sdproblem.dBe
causeddigoxindtoxicitydisdsuspected,dthednursedwoulddwithholddtheddigoxinduntildthedhealthd
caredproviderdhasdbeendconsulted.dThednursedwoulddnotddiscontinuedadmedicationdwithou
tdadprescriptiondtoddodso.
Test-
TakingdStrategy:dNotedthedstrategicdwordd“first”danddusedthedstepsdofdthednursingdprocessdt
odanswerdthedquestion.dThedcorrectdoptiondisdthedonlydonedthatdaddressesdassessment.dRe
viewdnursingdinterventionsdfordsuspectedddigoxindtoxicity
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dPharmacology
GiddensdConcepts:dCellulardRegulation,dClinicaldJudgment
HESIdConcepts:dCellulardRegulation,dClinicaldDecision-
Making/ClinicaldJudgmentdReferences:dHodgson,dB.,d&dKizior,dR.d(2015).dSaunde
rsdnursingddrugdhandbookd2015.d(p.d363)dSt.dLouis:dSaunders.
Ignatavicius,dD.,d&dWorkman,dM.d(2013).dMedical-surgicaldnursing:dPatient-
centereddcollaborativedcare.d(7thd ed.,dp.d753).dSt.dLouis:dSaunders.
d d d
Question 1 d
pts
d d d
Adnursednotesdthatdthedsitedofdadclient’sdperipheraldintravenousd(IV)dcatheterdisdreddened,d
warm,dpainful,danddslightlydedematousdneardthedinsertiondpointdofdthedcatheter.dOndthedba
sisdofdthisdassessment,dthednursedshoulddtakedwhichdactiondfirst?
Checkdfordloosedcatheterdconnections
Notifydthedhealthdcaredprovider
RemovedthedIVdcatheter
Slowdthedratedofdinfusion
Rationale:dPhlebitisdisdandinflammatorydprocessdindthedvein.dPhlebitisdatdandIVdsitedmaydbed
indicateddbydclientddiscomfortdatdthedsitedordbydredness,dwarmth,danddswellingdindthedaread
ofdthedcatheter.dThedIVdcatheterdshoulddbedremoveddanddadnewdIVdlinedinserteddatdaddiffere
ntdsite.dSlowingdthedratedofdinfusiondanddcheckingdfordloosedcatheterdconnectionsdarednotdc
orrectdresponses.dThedhealthdcaredproviderdwoulddbednotifieddifdphlebitisdweredtodoccur,dbu
tdthisdisdnotdthedinitialdaction.
Test-
TakingdStrategy:dNotedthedstrategicdword,dfirst.dFocusdondtheddatadindthedquestion.dElimin
atedslowingdthedratedofdinfusiondanddcheckingdthedconnection,dbecausedtheydaredcompara
bledordalikedindthatdtheydindicatedcontinuationdofdIVdtherapy.dAlthoughdthedhealthdcaredprovi
derdwoulddbednotifieddofdthisdoccurrence,dthedwordd“first”dshouldddirectdyoudtodselectdthedop
tiondofdremovingdthedIVdcatheter.dReviewdthedsignsdofdphlebitisdanddthedactionsdtodbedtake
ndwhenditdoccurs
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dIntravenousdTherapy
GiddensdConcepts:dClinicaldJudgment,dInflammation
HESIdConcepts:dClinicaldDecision-
Making/ClinicaldJudgment,dInflammationdReference:dPerry,dA.,dPotter,dP.,d&dOste
ndorf,dW.d(2014).dClinicaldnursingdskillsd&dtechniquesd(8thd ed.,dp.d707).dSt.dLouis:d
Mosby.
,Question 2 d
pts
d d d
Adnursedhangsdad500-
mLdbagdofdintravenousd(IV)dfluiddfordandassigneddclient.dOnedhourdlaterdthedclientdcomplain
sdofdchestdtightness,disddyspneicdanddapprehensive,danddhasdandirregulardpulse.dThedIVdba
gdhasd100dmLdremaining.dWhichdactiondshoulddthednurse
takedfirst?
RemovedthedIV
Sitdthedclientdupdindbed
ShutdoffdthedIVdinfusion
Slowdthedratedofdinfusion
Rationale:dThedclient’sdsymptomsdaredindicativedofdspeeddshock,dwhichdresultsdfromdthedr
apiddinfusiondofddrugsdordadbolusdinfusion.dIndthisdcase,dthednursedwoulddnotedthatd400dmLd
hasdinfuseddoverd60dminutes.dThedfirstdactiondondthedpartdofdthednursedisdshuttingdoffdthedIV
dinfusion.dOtherdactionsdmaydfollowdindrapiddsequence:dThednursedmaydelevatedthedheaddo
fdthedbeddtodaiddthedclient’sdbreathingdanddthendimmediatelydnotifydthedhealthdcaredprovider
.dSlowingdthedinfusiondratedisdinappropriatedbecausedthedclientdwilldcontinuedtodreceivedflui
d.dThedIVddoesdnotdneeddtodbedremoved.dItdmaydbedneededdtodmanagedthedcomplication.
Test-
TakingdStrategy:dNotedthedquestiondcontainsdthedstrategicdwordd“first.”dRecognizingdthedsig
nsdofdspeeddshockdanddrecallingdthedappropriatedinterventionsdshoulddalsoddirectdyoudtodth
edoptiondofdshuttingdoffdthedIVdinfusion.dReviewdthedinitialdnursingdactionsdfordspeeddshock
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dCriticaldCare
GiddensdConcepts:dFluiddanddElectrolytes,dPerfusion
HESIdConcepts:dFluiddanddElectrolytes,dPerfusion
Reference:dIgnatavicius,dD.,d&dWorkman,dM.d(2013).dMedical-surgicaldnursing:dPatient-
dcentereddcollaborativedcare.d(7 ed.,dp.d230).dSt.dLouis:dSaunders.
thd
Question 3 d
, pts
d d d
dAdnurseddiscontinuesdandinfusiondofdadunitdofdpackeddreddblooddcellsd(RBCs)dbecausedthed
clientdisdexperiencingdadtransfusiondreaction.dAfterddiscontinuingdthedtransfusion,dwhichdac
tiondshoulddthednursedtakednext?
Contactdthedhealthdcaredprovider
Obtaindadculturedofdthedtipdofdthedcatheterddevicedremoveddfromdthedclient
RemovedthedIVdcatheter
Changedthedsolutiondtod5%ddextrosedindwater
Rationale:dIfdthednursedsuspectsdadtransfusiondreaction,dthedtransfusiondisdstoppeddanddno
rmaldsalinedsolutiondinfuseddatdadkeep-vein-
opendratedpendingdfurtherdhealthdcaredproviderdprescriptions.dThednursedthendcontactsdth
edhealthdcaredprovider..dDextrosedindwaterdisdnotdused,dbecauseditdmaydcausedclottingdordh
emolysisdofdblooddcells.dNormaldsalinedsolutiondisdthedonlydtypedofdIVdfluiddthatdisdcompatib
ledwithdblood.dThednursedwoulddnotdremovedthedIVdcatheter,dbecausedthendtheredwoulddbed
nodIVdaccessdroutedthroughdwhichdtodtreatdthedreaction.dTheredisdnodreasondtodobtaindadcult
uredofdthedcatheterdtip;dthisdisddonedwhendandinfectiondisdsuspected.
Test-
TakingdStrategy:dNotedthedstrategicdwordd“next.”dKnowingdthatdthedIVdshoulddnotdbedremov
eddwilldassistdyoudindthedeliminationdprocess.dRecallingdthatdnormaldsalinedsolutiondisdthedo
nlydtypedofdIVdfluiddthatdisdcompatibledwithdblooddwilldalsodhelpdyoudanswerdcorrectly.dTodse
lectdfromdthedremainingdoptions,dnotedthatdinfectiondisdnotdthedconcern;dthisdwilldhelpdyoudel
iminatedthedoptiondofdobtainingdadculturedofdthedcatheterdtip.dReviewdcaredofdthedclientdexp
eriencingdadtransfusiondreaction
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dBlooddadministration
GiddensdConcepts:dClinicaldJudgment,dPerfusion
HESIdConcepts:dClinicaldDecision-
Making/ClinicaldJudgment,dPerfusiondReference:dPerry,dA.,dPotter,dP.,d&dOstendo
rf,dW.d(2014).dClinicaldnursingdskillsd&dtechniquesd(8thd ed.,dpp.d740-
741).dSt.dLouis:dMosby.
Question 4 d
, pts
d d d
Adclientdwithdheartdfailuredisdbeingdgivendfurosemidedandddigoxin.dThedclientdcallsdthednurs
d
edanddcomplainsdofdanorexiadanddnausea.dWhichdactiondshoulddthednursedtakedfirst?
Administerdtheddailyddosedofddigoxin
Discontinuedthedmorningddosedofdfurosemide
Checkthedresultdofdlaboratorydtestingdfordpotassiumdondthedsampleddrawnd3dhoursdago
Administerdandantiemetic
Rationale:dAnorexiadanddnauseadaredsymptomsdcommonlydassociateddwithddigoxindtoxici
ty,dwhichdisdcompoundeddbydhypokalemia.dEarlydclinicaldmanifestationsdofddigoxindtoxicity
dincludedanorexiadanddmilddnausea,dbutdtheydaredfrequentlydoverlookeddordnotdassociatedd
withddigoxindtoxicity.dHallucinationsdanddanydchangedindpulsedrhythm,dcolordvision,dordbeh
aviordshoulddbedinvestigateddanddreporteddtodthedhealthdcaredprovider.dThednursedshoulddfi
rstdcheckdthedresultsdofdthedpotassiumdlevel,dwhichdwilldprovidedadditionaldwhendthednursed
callsdthedhealthdcaredprovider,andimportantdfollow-
updaction.dThednursedshoulddalsodcheckdtheddigoxindreadingdifdonedisdavailable.dThednurse
dwoulddnotdadministerdandantiemeticdwithoutdfurtherdinvestigatingdthedclient’sdproblem.dBe
causeddigoxindtoxicitydisdsuspected,dthednursedwoulddwithholddtheddigoxinduntildthedhealthd
caredproviderdhasdbeendconsulted.dThednursedwoulddnotddiscontinuedadmedicationdwithou
tdadprescriptiondtoddodso.
Test-
TakingdStrategy:dNotedthedstrategicdwordd“first”danddusedthedstepsdofdthednursingdprocessdt
odanswerdthedquestion.dThedcorrectdoptiondisdthedonlydonedthatdaddressesdassessment.dRe
viewdnursingdinterventionsdfordsuspectedddigoxindtoxicity
LeveldofdCognitivedAbility:dApplying
ClientdNeeds:dPhysiologicaldIntegrity
IntegrateddProcess:dNursingdProcess/Implementation
ContentdArea:dPharmacology
GiddensdConcepts:dCellulardRegulation,dClinicaldJudgment
HESIdConcepts:dCellulardRegulation,dClinicaldDecision-
Making/ClinicaldJudgmentdReferences:dHodgson,dB.,d&dKizior,dR.d(2015).dSaunde
rsdnursingddrugdhandbookd2015.d(p.d363)dSt.dLouis:dSaunders.
Ignatavicius,dD.,d&dWorkman,dM.d(2013).dMedical-surgicaldnursing:dPatient-
centereddcollaborativedcare.d(7thd ed.,dp.d753).dSt.dLouis:dSaunders.
