ATI IV Skills Module Post Test – Flashcards
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A nurse finds a patients IV site red, warm and slightly endematous. What should the nurse do first?
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Discontinue the IV line R: The pt has classic symptoms of phlebitis, an inflammation of the vein. The IV line must be discontinued immediately to reduce the risk of thrombophlebitis and embolism.
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The nurse has just initiated a primary IV infusion of 5% dextrose in water. How often should the nurse plan to replace the primary infusion tubing?
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72 hours R: The CDC and Prevention recommends changing IV tubing no more often than 72-hour intervals unless the tubing has become contaminated, punctured or obstructed.
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a nurse has just inserted a peripheral IV catheter for continuous infusion. to secure the catheter the nurse should:
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Leave the connection between the hub and the tubing uncovered. R: This makes it possible to replace the tubing without removing the dressing.
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What is an important nursing action when converting an IV infusion into a saline lock?
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Flush the IV catheter to confirm patency R: it is essential to attach the primed saline lock adapter to the extension tubing and to flush the tubing with normal saline to confirm patency.
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A nurse who has just initiated an IV infusion explains to the patient that complications are possible and she will monitor the infusion regularly. The nurse should teach the patient that _______is an indication of early infiltration.
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Coolness R: Coolness is a classic sign of infiltration, along with sweating, pallor and possibly tenderness. Infiltration is a leakage of IV solution out of the intravascular compartment into the surrounding tissue.
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A nurse initiating a peripheral IV infusion punctures the skin and the selected vein and observes blood return in the flashback chamber of the IV catheter. What should the nurse perform next?
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Lower the catheter until it is almost flush with the skin. R: Lowering the angle and then advancing the catheter slightly facilitates full penetration of the wall of the vein, thus placing the catheter within the vein's lumen and making it easy to advance the catheter off of the stylet.
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A nurse is removing an IV catheter from a patient whose IV infusion has been discontinued. What action is appropriate?
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Pull the catheter straight back from the patient. R: With the catheter stabilized and using slow steady movement, the nurse should withdraw the catheter straight back and away from the insertion site, making sure to keep the hub parallel to the skin
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A patient in early stage renel failure is prescribed an infusion of 0.45% sodium chloride. This type of solution is appropriate because it
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delutes extracellular fluid and rehydrates the cells R: Using hypotonic solution such as 0.45% NaCl moves fluid into the cells, thus enlarging and rehydrating them.
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A nurse is discontinueing an IV infusion. What is the reason why it is important to verify and document the integrity and condition of the catheter?
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A broken off catheter tip indicates the risk for an embolus. R: If the tip is broken off the nurse should place a tourniquet high on the extremity where the IV line was and notify the provider immediately.
