ABCs of IVs Index

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Carefully review the answers and explanations below.  Some items have more than one correct answer depending on the situation.

1. The nurse has drawn up two syringes of medications for the patients that occupy Bed 1 and Bed 2. She gets a telephone call and returns back to the medication administration for her patients and realizes that she can't remember which syringe is for which patient. Which of the following would be her best course of action?

A. Make an educated guess as to which syringe is which

B. Dispose of both and call the Pharmacy for new doses

C. Chart that a medication error was made and skip the dose

D. Apply a label to the medications and administer them

Medication errors are one of the main ways the patients are injured or killed in the hospital setting.  It is important to minimize distractions when preparing medications and reduce as many opportunities for mistakes as possible. Labeling medications or preparing medications for one patient at a time may help reduce mistakes. The eight rights are a big part of keeping patient's safe as is common sense. If there is any doubt a medication, throw it out!

2. You have a new order to administer Lasix 20mg IV.  The vial you have contains 50mg/10cc of Lasix. How many cc's should you draw up?

You can use either of the methods shown below to answer calculate the dose:

 Ratio-Proportion Method   50mg         X       20mg 10cc                       Zcc   20(10) = 50(Z) 50              50   Z= 4cc Desired/Have X Quantity Method  20mg (Desired)  X   10cc (Quantity) 50mg (Have)   200(10) 50   Dose= 4cc
 3. The nurse is preparing to administer medication via IV Piggyback.  You enter the room to see the following set up.  What is wrong with this picture? A. The pump is set to the wrong rate B. The primary and IVPB bags are at the wrong heights C. There is air in the line D. The IVPB line is connected below the pump   It is important that the IVPB line be connected above the pump otherwise it will free-flow into the patient. For more information on how to set up an IVPB click here.

4. The nurse has finished administering IV Ketorolac through a patient's saline lock.  It is important for the nurse to then:

A. Turn the pump back on

B. Re-establish the lock

C. Massage the IV site

D. Assess the patient's pain level

A saline lock would not have a pump attached.  Massaging the IV site could potentially dislodge the catheter and cause the IV to infiltrate. The nurse would not reasses the pain level until the medication would have had time to take effect (15-30 minutes).  It is important that the "lock" be re-established via injection of 2-3cc of normal saline or heparin depending on institution protocol.

5. As you are completing your focused assessment, you note that there is a blood in the tubing of the IV near the insertion site.  You should (SELECT ALL THAT APPLY):

A. Assess for infiltration

B. Discontinue the IV

C. Flush at the closet port with 2-3cc normal saline to determine patency

D. Call the physician

A small amount of blood in the IV line especially close the site can mean everything from a small occlusion for a moment to complete occlusion or infiltration of the site itself. Further assessment for infiltration is important.  Flushing at the closest port with a small amount of normal saline can help determine if the line is still patent. Calling the physician is not necessary and the site should not be discontinued until the options A and C are done.

6. The nurse needs to infuse a medication that can sometimes cause stinging when it is injected.  What is the best action for the nurse?

A. Dilute the medication (if it is safe for this medication)

B. Call the Pharmacist for a different medication with similar properties to be given

C. Infuse the medication at the port closest to the insertion site

D. Pre-medicate the patient for pain

Medications such as Toradol for example are best given diluted because they can cause pain and stinging along the vein when they are infused.  Be aware that not all medications can be diluted. Only in select cases (such as chemotherapy) would pre-medications for pain be appropriate. Infusing close the patient's insertion site would hurt worse.

7. You need to administer a medication by IV push over a period of 5 minutes. What is the best way to do this?

A. Push the medication and then stay with the patient for 5 minutes

B. Give the dose in small increments over a period of 5 minutes (i.e. give 0.2 cc doses every minute for a 1cc total dose)

C. Instruct the patient to push the plunger a small amount every 10 seconds

D. Call to have the medication injected into an IVPB solution for easier administration

The method described in option B is the best way to give the medication correctly.  In some cases option D may be an appropriate answer.  The main consideration is that the medication be given as instructed over the specified period of time in small increments.

8. A patient with nausea has an order for 25mg of IV Dramamine to be injected into the current IV fluids.  After injecting the medication, it is important for the nurse to: (SELECT ALL THAT APPLY)

A. Chart that medication was given

B. Label the bag with the med, RN initials, dose, date, time and expiration

C. Increase the rate of the primary IV fluids to get all of the medication in

D. Re-evaluate medication effectiveness in 10 minutes

Increasing the rate of the IV fluids would not be appropriate.  The idea is that the medication will slowly infuse over time. It is essential to label the IV bag if any additives are injected with the information listed in the question.  This helps to prevent medication errors that occur from the mixing of two incompatible medications.

9. The nurse is verifying that the IVPB that they have started is actually running. What is wrong with the item pictured?

A. There are air bubbles in the line

B. The spike for the line is not fully into the bag

C. The drip chamber is full of fluid

D. The incorrect type of tubing has been attached

If the drip chamber is full of fluid, the nurse will not be able to verify that the IVPB is actually infusing. There are no air bubbles in the line, the correct tubing is attached and the spike has been fully inserted into the bag.

10. You are caring for a child that recently returned from surgery and is crying and groggy. The parent asks why the arm with the IV is wrapped in bandages and has a restraint on it. Your response should be:

A. This will help prevent the child from pulling of their dressing

B. A skin tear occurred on their arm during the surgery

C. Their IV is infiltrated so this acts as a pressure dressing

D. This helps prevent them from pulling out their IV

Many times children will try and pull out their IV depending on their age, how awake they are and other circumstances. Special dressings and in some cases special restraints may be used to prevent children from pulling out their IV's.  It becomes even more important when the site is covered that that the nurse remove or pull back part of it to  visualize the IV site per policy protocol so that the IV to verify that it has not become infiltrated.

1.You are preparing to administer the patient's morning medications.  Which of the following describes the correct way to verify the patient's identification?

A. Compare the name on the medication bottles with what name the patient states.

B. While looking at their ID band, have the patient state their name and compare this to the medical record as well.

C. Ask a family member to state the patient's name and have the patient repeat it.

D. Look at the record in the patient's room and compare it to the name on the prescription bottles.

It is important to use two patient identifiers before giving any medication.  By looking at the ID band and doing a variety of verifications (verbal, medication administration record, etc.) you can accomplish this.  The other options create potential for error if more than one patient is in the room, if the patient were confused, or if the wrong paperwork or medications were in the patient's room.

2. A patient is in need of a 10mEq of Potassium due to low levels from the morning lab draw. The bag comes up mixed in 150cc of normal saline and the directions on it say to infuse it over two hours.  How fast would you set the pump rate at?

A. 90cc/hr

B. 75cc/hr

C. 50cc/hr

D. 150cc/hr

Divide the number of 150cc of volume by two to get 75cc/hr.

3.You enter the patient's room to check on their IVPB infusion and see the following.  What's wrong with this picture?

A. The wrong medication is infusing

B. The syringe pump is not loaded or running

C. The IVPB solution bag should be hanging higher than the primary bag

D. Nothing wrong

When an IVPB solution is running, it should be hanging higher than the primary bag. For more info on the IVPB set up, click here.

4. Your patient is currently receiving the Heparin in their primary line.  The physician called to order a stat dose of Vancomycin.  The nurse should (be sure you look up this medication as you would in clinical before answering this question): (Select all answers that apply)

A. Administer the Vancomycin as a piggyback onto the primary line

B. Educate the patient to call the nurse if they have ringing in their ears.

C. Stop the infusion and flush the line before giving the medication

D. Contact the physician regarding the incompatibility and for an order to stop the Heparin

All of the answers are correct. Vancomycin may cause worsening otoxicity (ear damage, a symptom of which is ringing in the ears) and nephrotoxicity (renal damage). You would not be able to run these medications into the same line and if the physician OK's holding the Heparin, the line would need to be flushed before administering Vancomycin.

 5.The nurse is preparing to administer an IV push medication. What's wrong with this picture?   A. This port and needle are not compatible together B. The cap has not been removed from the needle C. There is air in the medication syringe D. Sterility has been broken   Blunt tip needles should not be inserted into a clave port. For more info about clave ports, click here. You can see from the photo that connecting these two would cause fluid to leak out of the port.

6. Your patient is receiving IV PCA Morphine.  What is it important to assess on a regular basis (every 2 hours at SCH)? (SELECT ALL THAT APPLY):

A. Sedation level

B. Pain level

C. Lower extremity strength

D. Respiratory rate

Because Morphine is a narcotic it has the potential to lower the patients respiratory rate and over-sedate them. It is important to know the patients pain level in order to gauge the effectiveness of the treatment. Lower extremity strength should not be affected by IV PCA Morphine.

 7. The nurse is about to administer a medication via IV Syringe Pump.  What's wrong with the setup? A. The IVSP must be attached directly to the IV insertion site B. The IVSP must be attached below the level of the pump C. The IVSP needs to be run with wider tubing D. The IVSP should not have a clip-lock cannula attached   The syringe pump administers the fluid independent of the pump so it should be attached below it as seen in the photo. For more info on the IVPB set up, click here.

8. When opening a glass ampule to administer and draw up medications from it, it is important to always use:

A. Gloves

B. Filter needle

C. Blunt-tip needle

D. Clip-lock cannula

Using a filter needle prevents glass from being drawn up into the syringe and potentially entering the patient's blood stream.  You can find a photo of a filter needle here.

9. You are assessing a patient receiving IV fluids and are waiting for the pump to arrive.  You adjust the roller clamp to a KVO (keep vein open) rate.  The IV seems sluggish and only runs periodically.  What would you suspect is the problem?

A. The patient probably has an air embolus

B. The site is infiltrated

C. The IV is most likely positional

D. Incorrect tubing has been selected for the fluids infusing

Many times, IV's are considered positional, which means that the patients arm has to be positioned in a particular way for it to run. Depending on how bad it is, a new site may have to be started. Other things that may impact the flow of the solution and the IV include: height of the bag, viscosity (thickness) of fluid infusing, the gauge of the IV inserted, clogged air vents and patency.

10. Why is it important to use a buretrol and to carefully monitor IV fluid intake for small children and infants?

A. Children can more easily become fluid overloaded

B. Children experience a greater number of medication side effects

C. IV fluids are highly irritating to childrens' veins

D. The buretrol has multiple access sites on it

Children cannot tolerate high amounts of IV fluid so it is important to use a buretrol and a pump to help prevent fluid overload. Children generally do not experience greater vessel irritation or side effects than adults. Buretrols may have one port for injecting medications, but it generally does not have more than one. For more information on buretrols click here.