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A nurse in an outpatient infusion clinic discusses with a friend the admission of a woman community leader who is receiving treatment for cancer. The nurse’s friend then talks to others, who talk to still others, until there is widespread knowledge of the patient’s cancer in the community. The woman’s daughter hears about her mother’s cancer diagnosis at school and is very upset. (3 points)
What recent act was violated in the initial conversation?
Discuss at least 2 ethical principles that are involved in this situation.
What are the ramifications for this case?
Who is at fault?
Mrs. Cole is admitted with uncontrolled diabetes mellitus. She has a saline lock in place in her left wrist area. A symptomatic drop in blood sugar to 38 requires she receive 50 ml of 50% dextrose infused at 3 mL/min via the peripheral infusion site. She responds well, but the next day needs another dose of dextrose via the same infusion site for a second drop in blood sugar. At discharge, she complains of burning and pain at the site. The nurse documents that the catheter is intact on discontinuation of the peripheral catheter, but no assessment data or subjective patient complaints are recorded. The patient is admitted three days later with purulent drainage form the left wrist infusion site, temperature of 101 degrees F, and pulse rate of 100. (2 points)
What is the probable reason for the second admission?
What are the legal ramifications of this case?
Describe 3 areas of concern in IV therapy that can put a nurse at risk for litigation. (1 point)
Missy, an LPN, has been asked to administer a drug by IV push. She is uncertain whether or not this task falls within her scope of practice. Which are the proper resources to refer to for information related to her scope of practice? Select all that apply. (1 point)
Hospital and unit policies and procedures
The ordering physician
The CNA working with her
The hospital pharmacist
Nurse Practice Act
State Board of Nursing
A pediatric client is admitted to the unit with pneumonia. A peripheral IV is ordered. (2 points)
What equipment would you choose for this infusion and why?
What education would you provide the parents?
The nurse is inserting a peripheral IV catheter into Mr. Twinkle’s right arm. The client suddenly says, “That feels like there is an electrical shock going down my arm and into my fingers!” What should the nurse do first? (2 points)
Explain to the client that is a common response to having an IV inserted
Instruct the client to relax and take deep breaths
Pull the needle out slightly and then advance it again
Remove the needle from the client’s arm
Give rationale for your answer:
Explain at least 2 things that the RN could delegate to a CNA in the preparation of the venipuncture procedure for an elderly client. (1 point)
The nurse is caring for Mrs. Fellow on a medical unit. She was admitted with deep vein thrombosis (DVT). Admission orders include IV heparin 2,000 units per hour continually. (1 point)
If the heparin is available as 25,000 units in 500 ml of 5% dextrose in water, at what rate will the nurse set the infusion pump?
What med should available as an antidote?
How will the nurse know if the treatment for DVT is successful?
Give 2 therapeutic communication statements that the RN could use to ease the worry of the pediatric client whom must undergo venipuncture. (1 point)
Describe the consequences to a client if a nurse unintentionally punctures an artery for infusion therapy instead of venipuncture. (1 point)
Describe the rationale for using the smallest cannula possible for venipuncture. (1 point)
The use of laminar flow hoods in the pharmacy when preparing IV solutions: (Select all that apply-1 point)
May decrease airborne contaminants entering the IV solution
Will protect the pharmacist from exposure to all chemicals
Provides a constant, one-directional flow of filtered area on the work space
Should especially be used when preparing cytotoxic medications
Mr. Cummings, a client with delirium, is admitted to the hospital. His lab results were: Na 155, Cl 101, K 3.9, HCO3 21, BUN 88, glucose 99. Based on these results, which of the following nursing diagnoses are the most appropriate for this client? (1 point)
Imbalanced nutrition, less than body requirements
Impaired urinary elimination
Fluid volume deficit
Fluid volume excess
Self-care deficit: feeding
What are the two main different types of IV replacement fluid and describe the difference between the two different types of fluid? Give an example of both kinds of solutions. (2 points)
List three ways to prevent complications from occurring with IV therapy. (1 point)
An increased amount of circulating antidiuretic hormone will cause (increased/decreased) water retention. (1 point)
What is the normal serum level for potassium? ____________ and list 3 symptoms of hypokalemia. (1 point)
List 5 nursing interventions which would be effective with treatment of fluid volume deficit. (1 point)
Joseph, a young adult client, has been admitted to a medical unit with complaints of fever, vomiting and diarrhea. The nurse documents the nursing diagnosis of Fluid Volume Deficit on his care plan. Which of the following lab results would demonstrate an improvement in Joseph’s condition? (1 point)
Urine specific gravity 1.025, Hematocrit 44%, Sodium 140
Urine specific gravity 1.000, Hematocrit 37%, Sodium 133
Urine specific gravity 1.040, Hematocrit 55%, Sodium 156
When giving potassium infusions, the medication must be _____________, the concentration should not exceed ____________and should not be given at a rate that exceeds __________. _________monitoring should be done during potassium infusions. The most common client complaint during potassium infusion is _______________. If this occurs, the nurse should __________________________
What is biofilm and what are the implications of it in IV therapy?
List signs and symptoms that could be present in the following body systems during fluid volume excess and fluid volume deficit.
Fluid Volume Excess
Fluid Volume Deficit
Cardiovascular
Urinary
Gastrointestinal
Musculoskeletal
Neurosensory
Integumentary
Respiratory
What are the dangers of using D5W for hydration?
Describe 4 specialized nursing considerations related to safety for each of the following categories of clients regarding IV therapy:
Pediatric clients
Geriatric clients
If children require 20ml/kg/hr of IV fluid replacement for the first hour of initial management of fluid loss, how many ml/hr will the nurse set the pump at for a child weighing 14 pounds? Calculate ml/hr for the first hour, rounding to the nearest whole number.
Using scholarly resources and/or a state board of nursing website, please discuss the scope of practice for IV therapy for the LPN and the RN.
True or False Scalp veins do not contain valves, which allows for two-way flow of the blood.
True or False When inserting an IV into a scalp vein, aim the needle upward toward the top of the head.
True or False In the geriatric client, the veins in the hands are not the best choice at times for infusion therapy due to thinning of the skin and loss of subcutaneous tissue.
True or False Stabilization of the vein is a very important technique in successful IV insertion in the geriatric client.

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