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12 Cards in this Set

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Which of the following nursing interventions is correct for clients receiving I.V. therapy?
1. Change the tubing every 8 hours.
2. Monitor the flow rate at least every hour.
3. Change the I.V. catheter and entry site daily.
4. Increase the rate to catch up if the correct amount hasn't been infused at the end of the shift.
2. Closely observing the rate of infusion prevents underhydration and overhydration. The I.V. catheter and entry site should be changed every 48-72 hours in most situations. Tubing is changed according to agency policy but not at the frequency of every 8 hrs. Increasing rate may lead to fluid overload.
A nursing home client is transferred to the hospital with dehyrdration and pnuemonia. After receiving the client from the emergency department, the nurse notices that his I.V. infusion has infiltrated. Which of the following is the best initial response by the nurse?
1. Stop the infusion, remove the I.V.
2. Remove the I.V. catheter and apply a cool compress to the site.
3. Apply moist heat to the site.
4. Gently massage the site.
1. Immediately after discovering an I.V. infiltration, the nurse should stop the infusion, remove the I.V. catheter, restart the infusion in another site. A cool compress doesn't promote fluid absorption. Moist heat shouldn't be applied until the infusion is stopped, the catheter is removed, and another catheter is inserted at a different site. Massaging the site is likely to cause pain and isn't effective in treating an infiltration.
The physician has ordered an I.V. of 5% dextrose in lactated Ringer's solution at 125ml/hr. The I.V. tubing tubing delivers 10 drops per ml. How many drops per minute should fall into the drip chamber?
1. 10 to 11
2. 12 to 13
3. 20 to 21
4. 22 to 24
3. Multiply the number of ml to be infused (125) by the drop factor (10); 125 x 10 = 1,250. Then divide the answer by the number of minutes to run the infusion (60); 1,250 divided by 60 = 20.83 or 20 to 21 gtt/minute
Calculate the hours that I.V. will run:

Order: 250 mL D5 1/2 NS IV at 30 ml/hr
8.3 hours approximately
Calculate the hours that I.V. will run:

Order: Ringer's lactate 500 ml IV; run 60 ml/hr
8.3 hours approximately
Calculate the hours that I.V. will run:

Order: 1000 ml D5W IV 4pm-2am
10 hours (no math)
Calculate the hours that I.V. will run:

Order: 1000 ml D5W IV KVO 24 hours
24 hours (no math)
Calculate the hours that I.V. will run:

Order: 500 ml D51/2NS at 70 ml/hr
7.1 hours approximately
Calculate the hours that I.V. will run:

Order: 500 ml D5W IV at 50 ml/hr
10 hours (no math)
Calculate the hours that I.V. will run:

Order: LR 1000 ml IV 10 hours
10 hours (no math)
Calculate the hours that I.V. will run:

Order: 250 ml NS IV at 100 ml/hr
2.5 hours
Calculate the hours that I.V. will run:

Order: 1000ml NS IV 12 noon-6pm
6 hours (no math)