ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 13 : Intravenous Therapy Questions
Question 1 of 5
The nurse is caring for an older adult client with an IV infusing at $100 \mathrm{mL/hr}$. What should the nurse monitor this client for?
Correct Answer: B
Rationale: Circulatory overload can develop if the volume of infusing solution exceeds the heart's ability to circulate it effectively. The scenario does not indicate that the client is at risk for urinary retention or incontinence. IV fluids infusing at $100 \mathrm{mL/hr}$ do not put the client at risk for a pulmonary embolism.
Question 2 of 5
The nurse is caring for a client who has just had total parenteral nutrition (TPN) ordered. The LPN is correct when informing the client that TPN is used for what?
Correct Answer: D
Rationale: TPN uses a solution of nutrients to meet the client's caloric and nutritional needs. TPN does provide calories and glucose to the client, but it does not prevent weight loss. TPN does include protein, but it usually does not meet the total protein requirement of the adult client.
Question 3 of 5
The client has just had a transfusion ordered for severe anemia. The nurse is gathering the supplies that are needed in order to transfuse the client. What kind of tubing does the nurse know is needed to infuse blood or blood products?
Correct Answer: A
Rationale: Blood is administered through Y-administration tubing. Blood is never infused through any tubing except $\mathrm{Y}$-administration tubing, which makes the other options incorrect.
Question 4 of 5
The nursing instructor is teaching student nurses about venipuncture techniques and possible complications from the procedure. What can happen if the venipuncture device is left in the clients' vein too long?
Correct Answer: A
Rationale: Because the venous access device traumatizes the vein wall and disturbs the flow of blood cells in the vein, there is a potential for phlebitis, inflammation of the vein, and thrombus formation (development of a clot). Gangrene is not an issue; necrosis of the skin depends on the fluid being infused and if it has infiltrated; and warm compresses are used, not cold packs.
Question 5 of 5
Which provides the best practice for the graduate nurse in the administration and regulation of intravenous fluids to clients?
Correct Answer: D
Rationale: The state nurse practice act specifies the qualifications and regulations for scope of practice of nurses. In addition, the nurse must follow the policies/procedures of the institution in which the nurse is presently employed. The nursing supervisor should be able to provide guidance to a new employee but is not the ultimate authority. The nursing instructor prepares the educational track for learning but does not provide guidance in employment situations. The physician initiates the orders for IV therapy but does not provide nursing guidance.