1
Q
Will lipid emulsion go through a 0.2 micron filter?
A
No
2
Q
How large can lipid emulsion particles be?
A
1.7 microns
3
Q
A bacterial retentive filter has a pore size of?
A
0.2 microns
4
Q
Dextrose 5% tonicity?
A
isotonic
5
Q
Dextrose 2.5% tonicity?
A
hypotonic
6
Q
Dextrose 10% tonicity?
A
hypertonic
7
Q
S/S hypermagnesemia?
A
hypotension, muscle weakness
8
Q
most inappropriate fluid for bowel obstruction?
A
D5W
9
Q
low urinary output leads to what electrolyte imbalance?
A
hyperkalemia
10
Q
Abx drug of choice for gram (+) infections
A
PCN G
11
Q
Maximum dextrose for PPN?
A
10%
12
Q
What type of administration set is not compatible with lipids?
A
PVC, DEHP
13
Q
What kind of administration set should be used for nitroglycerin?
A
Non-PVC lined
14
Q
Can I transfuse through a 0.2 micron filter?
A
No
15
Q
Filter for TPN?
A
1.2 microns
16
Q
Benzyl alcohol should not be used for..?
A
neonates
17
Q
Propofol change set Q?
A
12 hrs
18
Q
alkylating agent extravasation hot or cold?
A
cold
19
Q
anthracyclines extravasation hot or cold?
A
cold
20
Q
antitumor antibodies extravasation hot or cold
A
cold
21
Q
taxanes extravasation hot or cold
A
cold
22
Q
plant alkaloid extravasation hot or cold
A
hot
23
Q
vasoconstrictors extravasation hot or cold
A
hot
24
Q
alkylating agent extravasation antidote?
A
sodium thiosulfate
25
anthracyclines extravasation antidote?
dexrazoxane
26
plant alkaloids extravasation antidote?
hyaluronidase
27
vasopressor extravasation antidote?
phentolamine
28
maximum osmolarity for PPN?
900 mOsm/L
29
1 unit of RBC will raise Hgb by?
1 g/dL
30
What is nitrogen balance?
measurement of daily nitrogen intake VS excretion
31
Least likely CVAD to infect?
subclavian
32
Calories in dextrose?
3.4Cal/1g
33
Most common bacteria for catheter related infections?
Gram (+) Staph and E-coli
34
Most common fungi for catheter related infections?
candida albicans
35
1kg= ? pounds?
2.2
36
S/S hypocalcemia?
numbness and tingling of the fingers and toes, tetany, convulsions, inc deep tendon reflexes, positive Trouesseau's and Chvostek's sign,
37
S/S hypercalcemia?
anorexia, fatigue, lethargy, muscle weakness, N/V, consitipation
38
S/S hypomagnesemia?
positive Trouesseau's and Chvostek's sign, inc. reflexes, tremors, convulsions, tetany, paresthesias, cold sensation in hands and feet, dysrhythmias
39
S/S hypermagnesemia?
muscle weakness, paralysis, dec. DTR, respiratory depression, N/V, vasodilation
40
S/S hypophosphatemia?
fatigue, confusion, paresthesias, seizures, nystagmus, numbness, coma, dysrhythmias, alerted red and white blood cell function
41
S/S hyperphospfatemia?
relatively nonexistant
42
Dilantin S/E?
nystagmus, ataxia, lethargy, hypotension, thrombophlrbitis, vesicant
43
atropine S/E?
blurred vision, dilated pupils, postural hypotension, urinary retension
44
verapamil class?
calcium channel blocker
45
ditiazem class?
calcium channel blocker
46
nicardapine class?
calcium channel blocker
47
labetalol class?
Beta-blocker
48
atropine class?
anticholinergic
49
Dextran 40 considerations?
test dose, monitor electrolytes, may crystallize
50
Most common infusate contaminates
Enterobacter , Serratia, Kleibsiella
51
Common exogenous contaminates
Staph, Pseudomonas, pseudomonas, candida,
52
common intravascular comtaminates
Kleibsiella, E-coli. Enterobacter, pseudomonas
53
Which of the following CANNOT be filtered through a 0.2-micron filter?
a. lipid emulsion
b. 10% dextrose in water
c. amino acids
d. 0.9% sodium chloride
The correct answer is A. A lipid emulsion is composed of particles as large as 1.2
microns; thus, this emulsion will not flow through a 0.2-micron filter. Answers B, C,
and D are composed of particles smaller than 0.2 microns.
54
Consider the following policies:
* Resuscitation equipment should be in the immediate vicinity.
* Safe cumulative dose is 220 units/m2 or a total dose of 400 units, whichever
isless.
* A test dose should be given.
These policies are appropriate for which of the following antineoplastic
agents?
a. bleomycin sulfate (Blenoxane)
b. dactinomycin (Cosmegen)
c. carmustine (BiCNU)
d. daunorubicin HCl (Cerubidine)
The correct answeris A. Resuscitation equipmentshould be available because
1% of patients show a hypersensitivity to bleomycin; thus, a test dose should
be given. To prevent pulmonary complications, bleomycin is stopped when the
cumulative dose of 220 units/m2 is reached. Answer B is incorrect because it does
notrequire a test dose, nor doesit have a cumulative lifetime dose limit. Answer
C is incorrect because the recommended total cumulative dose is 1400 mg/m2.
Answer D is incorrect because it does not require a test dose, and its lifetime
cumulative dose is 550 mg/m2
55
Nausea, hyperreflexia, dysphagia, confusion, and paresthesias are
symptoms of which of the following electrolyte disturbances?
a. hypokalemia
b. hyperkalemia
c. hypomagnesemia
d. hypermagnesemia
The correct answer is C. The symptoms listed indicate hypomagnesemia.
56
The correctskin preparation priorto removal and culture ofthe tip of a CVAD
site would be
a. clean skin with both alcohol and iodine-containing solution
b. clean the skin around the catheter with alcohol
c. clean the skin with iodine-containing solution
d. no skin preparation is necessary
The correct answer is B. Answers A, C, and D are not consistent with
semiquantitative culture procedure. Use of iodine-containing solutions may
leave residual antimicrobial action that may kill organisms on the catheter as it is
withdrawn.
57
5. Which of the following is the recommended method of culture for purulent
drainage?
a. agar
b. semiquantitative
c. semiqualitative
d. broth culture
5. The correct answer is B. Quantitative or semiquantitative culture is the
recommended method for culturing purulent drainage. Answers A and D are
culture mediums, not culture methods. Answer C is incorrect because it is
qualitative not quantitative.
58
6. A patient has just begun cyclic TNA and completed a 12-hour infusion
within the last hour. The patient complains of weakness, headache,
chills, tingling in the hands and feet, and “nervousness.” These symptoms
most likely indicate
a. sepsis.
b. neuropathy.
c. early thrombosis.
d. rebound hypoglycemia.
6. The correct answer is D. Patients receiving cyclic regimens need careful
monitoring for the
59
7. Which of the following nursing assessments is indicative of isotonic dehydration in an infant?
a. anorexia, edema, convulsions, and decreased body temperature
b. poor skin turgor, and dry, dusky skin
c. thirst, sticky mucous membranes, increased irritability, and diarrhea
d. scaling rash, poor skin turgor, increased urinary output, and weight gain
7. The correct answer is B. The clinical signs of isotonic dehydration include poor
skin turgor, lethargy, oliguria, dry skin, and weight loss. Isotonic fluid volume deficit is the most common form of dehydration. Hypotonic dehydration results in more severe signs and symptoms of dehydration because more sodium than water is lost. Hypertonic dehydration results in a greater loss of water than sodium, irritability, doughy skin, a high-pitched cry, and seizures. Answer A is incorrect because anorexia and edema are not associated with isotonic dehydration. Answer C is more consistent with hypertonic dehydration. Answer D is incorrect
because rash and weight gain are not normally associated with dehydration.
60
8. A patient receiving an infusion through a CVAD complains of dyspnea and is
cyanotic. On auscultation, there is a churning sound over the pericardium.
Which of the following should the nurse suspect?
a. pulmonary edema
b. pneumothorax
c. air embolism
d. speed shock
8. The correct answer is C. An air embolism is caused by the entry of air into the
vascular system. In addition to cyanosis,symptoms include dyspnea, chest pain,
shortness of breath, hypotension, and a weak, rapid pulse. A distinctive mill-
wheel murmur is heard; a churning sound auscultated over the precordium may
be found. The air embolism is propelled into the heart, creating an intracardiac
lock at the pulmonic valve that prevents injection of blood from the right side
of the heart. Air embolism is the only condition from those listed that produces
the churning sound on auscultation. Differentiating signs and symptomsinclude
pulmonary edema (hypertension and frothy sputum); pneumothorax (sudden
chest pain, shortness of breath upon catheter insertion, and possibly a crunching
sound with the heartbeat upon auscultation); and speed shock (facial flushing,
headache, medication-related symptomology, and possible anaphylaxis).
61
9. A patient with a fractured hip who received 5% dextrose in water at 150 mL/
hour for 48 hours may exhibit which of the following sets of symptoms?
a. hypotension, bradycardia, flushing, drowsiness
b. nausea, vomiting, lethargy
c. thirst, muscle weakness, oliguria, confusion
d. anorexia, polyuria, abdominal pain, constipation
9. The correct answer is B. 5% dextrose in water in this circumstance and at this
rate provides an excess of free water, resulting in dilutional hyponatremia. The
symptoms listed in answer B are indicative of this imbalance. Answers A, C, and D
are not consistent with dilutional hyponatremia.
62
10. The patient benefit of narcotics given by PCA infusion with a basal rate is that
it
a. allows patient time intervals with no drug effect.
b. produces deeper sedation than IM narcotics.
c. uses less narcotic to achieve pain control.
d. provides greater peaks of pain control.
10. The correct answeris C. Because the patient is exposed to low doses of narcotic
administered frequently, rather than waiting for a prescribed time interval to
elapse, more consistent blood levels are maintained and, therefore, less narcotic
is required. Answers A, B, and D are incorrect because the PCA delivery method
provides a steady state of analgesia, avoiding the peaks and valleys of analgesia,
sedation, and pain.
63
11. A home care patient receiving doxycycline hyclate (Vibramycin Hyclate
Intravenous) should be instructed to avoid which of the following?
a. cheese
b. hot showers
c. sun exposure
d. Tylenol
11. The correct answer is C. Answer A is incorrect because certain cheeses are
contraindicated in combination with monoamine oxidase inhibitors, not doxycycline. Answers B and D are incorrect as there are no restrictions or
contraindications regarding hot showers or taking acetaminophen while on doxycycline.
64
12. A patient is admitted to the hospital with a weight loss of 10 lb over the past 2 weeks, hypotension, and poor skin turgor. The patient’s urine output is 18mL/hour, BUN is 29 mg/dL, and serum creatinine is 1.7 mg/dL. Which of the
following is the most appropriate IV solution?
a. 3% sodium chloride
b. 5% dextrose in water
c. lactated Ringer’s
d. 10% dextrose in water and 0.45% sodium chloride
12. The correct answer is C. Lactated Ringer’s is used in patients to treat dehydration.
65
13. In a performance improvement program looking at CR-BSI, structure, process, and outcome should be followed by
a. education and evaluation.
b. corrective action and education.
c. incident reports and evaluation.
d. corrective action and reevaluation.
13. The correct answer is D. Structure, process, and outcome are components of the quality process as well as types of standards by which quality is measured. They must be evaluated to determine compliance. An action plan can be developed to achieve improvement based on monitoring results. Then corrective action and reevaluation can be done. Answers A and B are incorrect because education can be a part of an action plan but not the plan itself. Answer C is incorrect because incident reports are data collection tools that are a basis for evaluation.
66
15. A patient with extensive small-bowel resection has been receiving home TNA for 6 months. He is experiencing diarrhea, alopecia, and night blindness. This patient is experiencing a deficiency of which of the following trace elements?
a. zinc
b. copper
c. selenium
d. chromium
15. The correct answer is A. Zinc supports RNA and DNA replication.
67
16. When preparing amphotericin B, a vial should be diluted with 10 mL of preservative-free sterile water. This solution should then be admixed with which of the following?
a. 0.9% sodium chloride
b. 3% sodium chloride
c. 5% dextrose in water
d. lactated Ringer’s
16. The correct answer is C. Answers A, B, and D are incorrect because they are all incompatible with amphotericin B. This medication is only compatible with 5% dextrose in water with a pH > 4.2.
68
17. When accessing a CVAD, disinfect the catheter hub with 70% alcohol for
a. 2-5 seconds.
b. 5-15 seconds.
c. 15-30 seconds.
d. 35-60 seconds.
17. The correct answer is B. Recent studies show varied effectiveness of scrub time between 5 and 15 seconds with 70% isopropyl alcohol and alcohol-based chlorhexidine gluconate.
69
18. In the event of suspected air embolism, the patient should be placed in what position?
a. left lateral, Trendelenburg
b. right lateral, Trendelenburg
c. semi-Fowler’s
d. reverse Trendelenburg
18. The correct answer is A. Placing the patient on the left side, with the head lower than the heart, moves the air bubble away from the pulmonic valve.
70
19. All of the following affect drug compatibility except
a. ionic strength.
b. solution opacity.
c. the drug’s container.
d. exposure to light.
19. The correct answer is D. Exposure to light affects drugs’ stability, not compatibility. Answers A, B, and C all affect compatibility by either a physical, chemical, or therapeutic effect.
71
20. A patient with frequent urticarial transfusion reactions may be pretreated with
a. antihistamines.
b. narcotic antagonists.
c. beta-adrenergic blockers.
d. nonsteroidal anti-inflammatory agents.
20. The correct answer is A. The cause of a urticarial reaction is thought to be a foreign plasma protein to which the recipient responds with an allergic display. Seldom does the clinical picture of a urticarial reaction warrants termination of the transfusion. Upon the physician’s order, the transfusion is interrupted long enough to administer an antihistamine by intravenous injection; wait for the
symptoms to subside and then proceed slowly with the transfusion.
72
21. Of the following medications, which should not be administered through a 0.2-micron filter?
a. cephalothin sodium (Keflin)
b. amphotericin B (Fungizone)
c. ampicillin sodium (Omnipen-N)
d. tobramycin sulfate (Nebcin)
21. The correct answer is B. An amphotericin B molecule is too large to pass through a 0.2-micron filter. Because of its size, an amphotericin B molecule would need a filter size of at least 1.0 microns to allow passage (infusion). The drugs in answers
A, C, and D will pass through a 0.2-micron filter without difficulty.
73
22. A patient receives a 1-week supply of TNA. Upon inventory of the previous week’s supplies, the home care nurse finds three extra administration sets. The patient states that it is too expensive to use a new set every day. The most appropriate response would be
a. 24-hour set changes are important for infection prevention measures.
b. a negotiated rate with the insurance carrier covers the cost of the sets.
c. it is permissible to change the administration set every 72 hours.
d. The Joint Commission
22. The correct answer is A. To ensure product sterility and minimize the risk of infectious-related complications, guidelines exist for proper care of administration sets and tubing products used for PN; 3-in-1 (TNA) administration sets are changed every 24 hours or immediately if contamination is suspected.
74
23. Which of the following indicates a patient with the GREATEST risk for developing a catheter-related infection?
a. WBC of 2,100 mm3
b. neutrophil count of 800 mm3
c. eosinophil rate of 200 mm
d. absolute lymphocyte count of 1,200 mm3
23. The correct answer is B. Neutrophils are the body’s first line of defense against infection. Neutropenia (absolute neutrophil count < 1000/mm3
) describes a patient at high risk for developing infection. Answer A is incorrect because neutrophils are a subset of white blood cells; answer C is incorrect because eosinophils are involved with allergic responses; answer D is incorrect because lymphocytes are primarily responsible for specific antigen recognition.
75
24. The substance used to protect the frozen red cells from destruction during
storage is called
a. glycerol.
b. adenine.
c. saline.
d. dextrose.
24. The correct answer is A. Glycerol is added to the cells before freezing because it is a cryoprotective agent that prevents cell dehydration and mechanical damage from ice formation.
76
25. For nonlipid-containing PN solutions that require a filter, the pore size is
a. 0.2 microns.
b. 1.0 microns.
c. 1.2 microns.
d. 5.0 microns.
25. The correct answer is C. Use a 1.2 micron filter for administration of all parenteral nutrition (PN) solutions with or without lipid injectable emulsions (ILEs) and for ILE infused separately from PN. PN and ILE infused without a filter can cause death by pulmonary embolism (refer to Standard 61, Parenteral
Nutrition).
77
A 50-year-old female is admitted with diabetic acidosis, and a solution of 5% dextrose in 0.33% sodium chloride with insulin is initiated. After two hours of therapy, the patient is alert and says that she feels better. One hour later, the patient is found picking at her bedclothes, not looking well; her grip is weak and pulse is irregular. The IV is infusing at the rate prescribed.
26. The MOST likely cause of the patient’s symptoms is
a. compensated metabolic acidosis.
b. uncompensated metabolic acidosis.
c. hypokalemia.
d. hyperkalemia.
26. The correct answer is C. With diabetic acidosis, fluid replacement therapy and reestablishment of urinary output causes the potassium level to decrease as the acidosis resolves. The potassium usually reaches its lowest level within 1-4 hours. The symptoms listed are descriptive of hypokalemia.
78
A 50-year-old female is admitted with diabetic acidosis, and a solution of 5% dextrose in 0.33% sodium chloride with insulin is initiated. After two hours of therapy, the patient is alert and says that she feels better. One hour later, the patient is found picking at her bedclothes, not looking well; her grip is weak and pulse is irregular. The IV is infusing at the rate prescribed.
27. On the basis of this information, the nurse should have which of the following available in anticipation of the physician’s next order?
a. regular insulin
b. sodium bicarbonate
c. furosemide (Lasix)
d. potassium chloride
27. The correct answer is D. Potassium chloride is the drug of choice for the treatment of hypokalemia. Answers A, B, and C are not appropriate for the initial treatment of the patient’s symptoms.
79
28. The blood component that must be type-specific is
a. packed red blood cells.
b. whole blood.
c. fresh frozen plasma.
d. platelets.
28. The correct answer is B. Whole blood contains antigens on the red cells and plasma, which carries antibodies. For packed red blood cells, only a type-O recipient needs to have a type-O donor. All others (A, B, or AB) may receive compatible blood types. For fresh frozen plasma, only an AB recipient needs to have a donor. All other blood types may receive compatible plasma. For platelets,
ABO compatibility is preferred but not required.
80
29. Which of the following microorganisms is NOT associated with IV infusate contamination?
a. Klebsiella pneumoniae
b. Serratia marcescens
c. Enterobacter cloacae
d. Coccidioides immitis
29. The correct answer is D. The other answers are all microorganisms identified in intrinsic and extrinsic contamination associated with IV therapy.
81
30. To change an infusion administration set and filter on a central vascular access device, the patient should be placed in which of the following positions?
a. left lateral
b. semi-Fowler’s
c. supine
d. right lateral
30. The correct answer is C. When changing an IV set on a central vascular access device, a major concern is the occurrence of air embolism. To prevent an air embolism when IV sets are changed, the patient should lie flat or supine and
perform the Valsalva maneuver.
82
31. An infant is more susceptible to volume depletion than an adult because infants have a
a. lower metabolic rate.
b. proportionally smaller surface area.
c. greater percentage of water in the extracellular compartment.
d. more efficient kidney function.
31. The correct answer is C. Infants are more susceptible to volume depletion than adults because infants have a greater percentage of free water in the extracellular compartment. Answer A is incorrect because the infant’s basal metabolic rate is also twice as great in relation to body weight as it is in the adult. Answer B is incorrect because infants have a larger body surface ratio per body weight. Answer D is incorrect because infants’ kidneys do not have the ability to concentrate urine.
83
32. Which of the following data would be pertinent to a patient receiving cisplatin (Platinol)?
a. CBC, platelets, BUN, creatinine
b. CBC, urinalysis, alkaline phosphatase
c. CBC, electrocardiogram, urinalysis
d. CBC, urinalysis, uric acid
32. The correct answer is A. CBC, platelets, BUN, and creatinine need to be monitored, as cisplatin can cause electrolyte disturbances and nephrotoxicity. Answers B, C, and D contain lab tests that are not indicated for cisplatin administration.
84
33. Sodium nitroprusside (Nitropress) should be admixed in which of the following solutions?
a. lactated Ringer’s
b. 5% dextrose in water
c. 0.9% sodium chloride
d. 0.45% sodium chloride
33. The correct answer is B. The admixture solution designation is a manufacturer’s recommendation.
85
34. When initiating a transfusion, the nurse should use which of the following sodium chloride solutions?
a. 0.2%
b. 0.45%
c. 0.9%
d. 3.0%
34. The correct answer is C. Normal saline solution is recommended for use with blood administration.
86
36. A patient’s culture results are positive for Candida albicans. Extrinsic contamination would be caused by which solution?
a. lactated Ringer’s
b. 0.9% sodium chloride
c. 0.45% sodium chloride
d. total nutrient admixture
36. The correct answer is D. TNA is the only solution provided with a dextrose concentration that will support Candida albicans.
87
37. Which statement is true regarding platelets?
a. platelets are stored at 18°C for up to 9 days
b. the normal level of platelets is 150,000 to 400,000 mm3 per liter of blood
c. activated platelets begin clot formation by binding to plasminogen
d. normal platelets survive for up to 10 days
37. The correct answer is B. Plasminogen is involved in the breakdown of the clot, not clot formation.
88
38. When administering the Total Nutrient Admixture (TNA), a nurse should use a
a. 0.22-micron in-line filter and change administration sets every 24 hours.
b. 1.2-micron in-line filter and change administration sets every 24 hours.
c. 0.22-micron in-line filter and change administration sets every 72 hours.
d. 1.2-micron in-line filter and change administration sets every 72 hours.
38. The correct answer is B. A smaller filter will not allow the fat particles in the intravenous fat emulsion to pass. Current US Food and Drug Administration recommendations call for the use of a 1.2-micron filter.
89
39. Which of the following trace minerals is an important cofactor in wound healing and is usually deficient in burn patients?
a. zinc
b. copper
c. chromium
d. manganese
39. The correct answer is A. Zinc has been found to facilitate wound healing. It is the most abundant of the trace elements and is an integral part of many enzymes and enzyme cofactors. Its functions include protein, carbohydrate and lipid metabolism, membrane stabilization, and RNA conformation.
90
40. Which of the following is a catheter-specific risk factor for phlebitis?
a. a small-gauge catheter
b. catheter insertion in the upper extremities
c. catheter insertion in the lower extremities
d. a polyurethane catheter
40. The correct answer is C. Phlebitis is inflammation of the intima of the vein, a commonly reported complication of infusion therapy that can be avoided when catheter insertion in the lower extremities of an adult is avoided.
91
41. Which of the following reactions is specific to the administration of etoposide (VePesid)?
a. red man syndrome
b. sudden hypotension
c. renal failure
d. pulmonary edema
41. The correct answer is B. Etoposide can cause severe hypotension if administered too rapidly.
92
42. Patients with marasmus often present with
a. visible loss of muscle.
b. widespread edema.
c. hypoalbuminemia.
d. severe hypoglycemia.
42. The correct answer is A. Marasmus is malnutrition evidenced by wasting of fat and muscle tissue. B is incorrect because edema is evident in kwashiorkor malnutrition.
93
43. The bacteria that is most commonly involved with catheter-related septicemia is
a. Citrobacter.
b. Staphylococcus.
c. Flavobacterium.
d. Streptococcus viridians.
43. The correct answer is B. Staphylococcus is a commonly found organism on the epidermis, as well as the most common source of catheter-related septicemia.
94
44. A 10-day-old infant is admitted with a history of liquid stools for the past 48 hours. Lab values include the following:
pH 7.3 sodium 135 mEq/L
PaCO2 40 mmHg bicarbonate 18 mEq/L
Based on the above information, the nurse should observe the infant for
which of the following?
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis
44. The correct answer is A. The laboratory value of 7.3 indicates an acidotic state. Metabolic acidosis will result when the bicarbonate concentration in the extracellular fluid falls below 22 mEq/L (i.e., 18 mEq/L). These parameters result from an increase in metabolic acids.
95
45. Twenty minutes after the initiation of a transfusion of 1 unit of packed red blood cells, the patient exhibits shaking, chills, and complains of low back pain. The patient has a BP of 84/40 mmHg, a pulse of 125/min, and a temperature of 102°F. The major cause of this patient’s reaction was
a. leukoagglutinins.
b. faulty equipment.
c. an ABO incompatibility.
d. contamination in component processing.
45. The correct answer is C. The symptoms described are a classic example of ABO
incompatibility.
96
46. Heparin sodium produces an anticoagulant effect by
a. blocking the ionized calcium receptor sites on proconvertin (factor VII) and thromboplastin.
b. inactivating thromboplastin activity through the intrinsic pathway.
c. inhibiting the conversion of prothrombin to thrombin and fibrinogen to fibrin.
d. enzymatically converting Hageman factor (factor XII) to its active form (factor XIIA).
46. The correct answer is C. Anticoagulants interfere with the coagulation pathways to prevent clot formation. They are effective in decreasing the risk of clot formation and preventing the enlargement or fragmentation of blood clots but cannot dissolve existing clots. Low doses of heparin sodium inhibit the conversion
of prothrombin to thrombin. Larger doses inactivate thrombin and prevent the conversion of fibrinogen to fibrin.
97
47. Which of the following is a risk factor for infiltration and extravasation?
a. low body weight
b. drugs with vasodilatory potential
c. small catheter size
d. obesity
47. The correct answer is B. Infiltration is the inadvertent administration of a nonvesicant solution into surrounding tissue. Extravasation is the inadvertent administration of a vesicant into the surrounding tissue. Both can be the result of drugs that cause an inflammatory response because of the irritation of the drug itself.
98
48. PPN solutions can be infused in a peripheral IV catheter as long as the osmolarity of the solution is less than
a. 900 mOsm/L.
b. 1200 mOsm/L.
c. 1500 mOsm/L.
d. 1800 mOsm/L.
48. The correct answer is A. To avoid vein phlebitis and injury, the final osmolarity should be less than 900 mOsm/L.
99
49. If two units of red blood cells are administered to a nonbleeding adult, each unit should raise the hemoglobin by how many g/dL?
a. 0.5
b. 1
c. 2
d. 3
49. The correct answer is B. One unit of RBCs can be expected to raise the Hgb by 1 g/dL.
100
50. A medication is considered hypotonic if the osmolarity is
a. 249 mOsm/L.
b. 250-350 mOsm/L.
c. 355-455 mOsm/L.
d. 500 mOsm/L.
50. The correct answer is A. Hypotonic solutions have an osmolarity lower than 250 mOsm/L. Isotonic solutions have an osmolarity approximate to 250-375 mOsm/L, and hypertonic solutions have osmolarity greater than 375 mOsm/L.
101
51. According to the InfusionTherapyStandardsofPractice, therapies
inappropriate for short peripheral catheters include
a. infusates with an osmolarity of 400 mOsm/L.
b. infusates with a pH > 5 and < 9.
c. continuous vesicant therapy.
d. infusates with an osmolarity of 500 mOsm/L.
51. The answer is C. Risk of extravasation. Would not administer vesicant on a pump.
102
52. Which of the following most accurately represents normal electrolytelaboratory data?
Sodium Potassium Calcium Magnesium
(mEq/L) (mEq/L) (mg/dL) (mEq/L)
a. 135 3.5 9.2 2
b. 140 5.5 10.4 4
c. 150 5.0 11.3 5
d. 155 4.0 9.6 2
52. The correct answer is A. All of the values listed in answer A are within normal range for the specified electrolytes.
103
53. When treating HIV-positive patients, foscarnet sodium (Foscavir) is used for which of the following opportunistic infections?
a. toxoplasmosis
b. cytomegalovirus
c. Mycobacterium avium
d. Pneumocystis carinii
53. The correct answer is B. Foscarnet sodium (Foscavir) is an antiviral agent capable of inhibiting replication of all known herpes viruses, including CMV. It does not
destroy existing viruses, but stops them from reproducing and invading healthy
cells. CMV strains resistant to ganciclovir sodium (Cytovene) may be sensitive to
forcarnet sodium (Foscavir).
104
54. The blood flow in each subclavian vein comes from the
a. innominate and external jugular veins.
b. cephalic and axillary veins.
c. inferior and superior venae cavae.
d. internal and external jugular veins.
54. The correct answer is D. The external jugular vein joins the subclavian vein at its\ midpoint. The internal vein is a deep vein that is covered by the muscles of the neck. It joins the subclavian vein at its proximal end.
105
55. The final dextrose concentration for peripheral parenteral nutrition should
NOT exceed
a. 5%.
b. 10%.
c. 20%.
d. 50%.
55. The correct answer is B. Peripheral veins generally cannot tolerate more than
900 mOsm per liter. Final concentrations of more than 10% dextrose contain more than 900 mOsm/L and are severely irritating to the smaller peripheral veins.
106
56. A two-year-old patient with a femoral CVAD has episodes of diarrhea. The dressing is noted to be soiled and nonocclusive. Which of the following is the most appropriate initial intervention?
a. obtain a physician’s order for antibiotics
b. place the CVAD in a new site
c. perform site care and dressing change
d. obtain stool and blood cultures
56. The correct answer is C. Maintaining a clean, dry occlusive dressing is one of the most important mechanisms to prevent infection.
107
57. Which of the following dextrose solutions is isotonic?
a. 2.5%
b. 5%
c. 10%
d. 20%
57. The correct answer is B. A 5% dextrose in watersolution is isotonic due to an osmolality of 253 mOsm/liter. A solution is isotonic when the osmolality falls between approximately 240 and 340 mOsm/liter.
108
58. A seven-year-old child with a peripheral IV site in the left arm asks if he can go to the pediatric play room. The nurse’s most appropriate response would be
a. no, absolutely not.
b. yes, when a nurse has time to go with you.
c. no, the catheter will have to be discontinued before you could go.
d. yes, as long as you follow the instructions on maintaining the catheter.
58. The correct answer is D. School-age children are able to understand explanations given about their catheters with frequent reminders. Additional tubing added to
the administration set may be required to prevent tension on the catheter when the child is mobile and ambulating.
109
59. Vancomycin is one of the most damaging antibiotics to patients’ veins because it is
a. an alkali.
b. concentrated.
c. given in high daily doses.
d. an acid.
59. The correct answer is D. An acid is the only correct answer that would contribute to damage to a patient’s veins. Vancomycin has a pH of 2.4-5, and pH is considered a factor when determining intravenous access. Medications with a pH less than 5 or greater than 9 are known to cause vascular damage; therefore, vancomycin is known to cause vascular damage.
110
60. The main drivers in the development of drug-resistant pathogens include which of the following?
a. Overuse of antimicrobials
b. Cost savings to pharmacology manufacturers
c. Patient non-compliance
d. Impaired renal function
60. The correct answer is A. VI. C. 2. Overuse of antimicrobials can lead to the development of resistance as pathogens are exposed to the drugs more frequently, allowing them to adapt and survive. Patient non-compliance, such as not completing a prescribed course of antibiotics, can also contribute to resistance by not fully eradicating the infection, allowing resistant strains to proliferate.
111
61. A nursing protocol calls for obtaining a baseline blood glucose prior to infusion and then rechecking every 2 to 4 hours after infusion. The nurse should monitor BUN and serum creatinine weekly, keep the patient supine during the infusion, and monitor BP every 15 minutes during the infusion. These protocols are appropriate for a patient receiving which of the following
medications?
a. foscarnet sodium (Foscavir)
b. ganciclovir sodium (Cytovene)
c. pentamidine isethionate (Pentam 300)
d. trimethoprim sulfamethoxazole (Bactrim)
61. The correct answer is C. Major side effects include hypoglycemia and hypotension.
112
62. Which of the following energy substrates is most commonly used in parenteral nutrition?
a. fat
b. protein
c. dextrose
d. electrolytes
62. Which of the following energy substrates is most commonly used in parenteral nutrition?
a. fat
b. protein
c. dextrose
d. electrolytes
113
63. Which of the following may be a cause of thrombocytopenia?
a. asplenia
b. macrolides
c. sepsis
d. mesothelioma
63. The correct answer is C. Sepsis is a serious, life-threatening infection that gets worse very quickly and, among many other things, includes blood clotting problems and decreased platelet count.
114
64. Urine alkalinization is important prior to administering high doses of which of the following drugs?
a. bleomycin sulfate (Blenoxane)
b. cisplatin (Platinol)
c. methotrexate sodium (Amethopterin)
d. thiotepa (Thioplex)
64. The correct answer is C. Methotrexate can crystallize and precipitate in acidic solution and can cause renal damage in the presence of urine with a low pH. Answers A, B, and
D are incorrect because these drugs are not associated with this type of response in an acidic environment.
115
65. Infiltration is the
a. inadvertent administration of a nonvesciant solution or medication into surrounding tissue.
b. inadvertent infiltration of vesicant solution or medication into surrounding
tissue.
c. intentional administration of a medication into the subcutaneous layer of the
skin.
d. intentional administration of a medication into the subarachnoid space.
65. The correct answer is A. Infiltration is the inadvertent administration of medication into surrounding tissues. This occurs when the catheter becomes dislodged, or the vein ruptures, causing solution to leak into the surrounding tissue.
116
66. The Infusion Nurses Society recommends administering continuous vasopressor infusions
a. via a large, distal, peripheral vein.
b. via the medial cubital vein.
c. via a Central Venous Access Device.
d. via the intraosseos route.
66. The correct answer is C. The most appropriate vascular access device is selected when initiating vasopressor administration to ensure prompt and effective medication delivery to minimize complications.
117
67. A potential complication of CVAD use is
a. air embolism.
b. myocardial infarction.
c. injury to pulmonary veins.
d. carotid aneurysm.
67. The correct answer is A. Air embolism is caused by the entry of a bolus of air into the vascular system. Conditions that can cause an air embolism include CVAD fracture, disconnection between CVAD injection caps and IV administration set, presence of a persistent catheter track following CVAD removal, deep inspiration during CVAD insertion/removal, or inadvertent infusion of air into the IV administration set.
118
68. Education for a patient diagnosed with hypermagnesemia should include
a. preventing injury due to hypotension or muscle weakness.
b. keeping an antacid available to prevent gastric acidity.
c. preventing constipation by the routine administration of a laxative.
d. restricting fluid intake.
The correct answer is A. Both hypotension and muscle weakness are clinical indications of hypermagnesemia and could be implicated in the injury of the patient. Answers B and C are incorrect because many antacids and laxatives contain magnesium, and their administration compounds the hypermagnesemia. Diuretics and 0.45% sodium chloride are often the treatment of choice to enhance
magnesium excretion in people with normal renal function. If fluids are restricted, the patient’s clinical picture may worsen; therefore, D is incorrect.
119
69. The law requires that medical device-related deaths be reported to which of
the following agencies?
a. Centers for Disease Control and Prevention (CDC)
b. US Food and Drug Administration (FDA)
c. Occupational Safety and Health Administration (OSHA)
d. US Pharmacopeia
69. The correct answer is B. Any product, such as food, medication, or a biological agent, and medical devices that contribute to a serious injury or death must be reported to the FDA. The CDC deals with disease monitoring and epidemiology; OSHA deals with employee health and safety issues; and US Pharmacopeia deals
with setting standards for medications.
120
70. Which fluid type would be inappropriate for a patient with a newly diagnosed bowel obstruction?
a. lactated Ringer’s
b. 5% dextrose in water
c. 0.9% sodium chloride
d. 5% dextrose in 0.45% sodium chloride with potassium chloride 20 mEq
70. The correct answer is B. A patient with a bowel obstruction develops hyponatremia. Treatment would include fluid replacement with sodium- containing fluids; therefore, 5% dextrose in water is not appropriate. The bowel reacts to obstruction by sequestering fluid in the distended bowel leading to third spacing of fluids. The 5% dextrose in water would contribute to further fluid overload in this patient.
121
71. Which of the following electrolytes is most commonly altered by the administration of cisplatin (Platinol)?
a. sodium
b. chloride
c. calcium
d. magnesium
71. The correct answer is D. Cisplatin can cause severe electrolyte disturbances— particularly in magnesium, resulting in depleted levels. It is common to add magnesium to hydration fluids prior to medication administration.
122
72. The investigation of serious adverse events should be done
a. on a monthly basis.
b. on a quarterly basis.
c. when 3 or more events occur.
d. promptly to ensure action and improve safety.
72. The correct answer is D. Investigate serious adverse events to ensure prompt action
and improve safety.
123
73. Which of the following serum levels is MOST indicative of visceral protein synthesis?
a. albumin
b. lipids
c. total lymphocyte count
d. nitrogen balance
73. The correct answer is A. Albumin is the major protein synthesized by the liver. This important visceral protein serves to maintain plasma oncotic pressure. Answer B is incorrect because lipids are not visceral proteins. Answer C is incorrect because total lymphocyte count is a measure of humoral immune competence. Answer D is incorrect because nitrogen balance is a measure of daily intake of nitrogen minus its excretion.
124
74. An eight-month-old infant is admitted with gastroenteritis and requires 24- 48 hours of intravenous hydration fluids. Which of the following would be the most appropriate infusion device for the initiation of this therapy?
a. peripherally inserted central catheter (PICC)
b. intraosseous needle
c. 20-gauge over-the-needle catheter
d. 22-gauge over-the-needle catheter
74. The correct answer is D. Because of the estimated length of the infusion, the peripheral route is the most appropriate access for this infant. The over-the- needle gauges most commonly used for children are 22 gauge and 24 gauge. The PICC is not appropriate because of the estimated length of the infusion. PICCs are recommended for therapy lasting longer than 4 weeks. The intraosseous needle is not appropriate because this route is for emergencies only
125
75. When planning metrics for performance evaluations, include process as well as
a. outcome measures.
b. cultural differences.
c. satisfaction surveys.
d. patient education.
75. The correct answer is A. Include process as well as outcome measures when planning metrics for performance evaluation.
126
76. Patient-specific risk factors for CR-BSI include all except
a. malnutrition.
b. poor skin integrity.
c. gender.
d. age.
76. The correct answer is C Patients who are malnourished often have decreased immune systems that increase the risk of CR-BSI. Breaks in the skin allow access for microorganisms to enter the bloodstream and increase risk of infection. Patients younger than six months and older than 65 years old have greater risk of developing a CR-BSI.
127
77. Cisplatin (Platinol) is ordered for a patient with ovarian cancer after reviewing the following laboratory values:
WBC 0.5/m3
Hgb 9.8 g/dL
Hct 30%
Platelets 60,000/mm3
The best nursing intervention is to
a. notify the physician.
b. hold the chemotherapy.
c. administer chemotherapy.
d. initiate infection precautions.
77. The correct answer is B. The patient is already experiencing neutropenia based on
the WBC of 0.5/m3 One of the side effects of cisplatin is myelosuppression.
Administering the cisplatin would result in lowering the WBC count even further.
128
78. A patient is admitted to the intensive care unit with acute renal failure. His urinary output for the last 24 hours is 50 mL. The nurse should observe for
a. hypercalcemia.
b. hyperkalemia.
c. metabolic alkalosis.
d. fluid volume deficit.
78. The correct answer is B. Hyperkalemia or potassium excess occurs when the serum potassiumlevelexceeds5.0mEq/L. The cause of hyperkalemia is primarily related to decreased excretion, increased intake or shift of potassium from the cells. It is most often associated with renal disease, leading to inadequate excretion.
129
79. When administering antineoplastic vesicant drugs via push through a PIVC, you should check for blood return every
a. 2-5mL
b. 5-10mL
c. 10mL
d. 20mL
79. The correct answer is A. Assess and verify blood return every 2-5mL for IV push, every 5 minutes during an infusion and upon completion. Remain with the patient during the entire short-term infusion.
130
80. Potassium is a necessary component in PN because
a. it is required to process glucose and amino acids.
b. it is not stored in the body.
c. it is diluted by large volumes of fluid.
d. it is flushed by amino acids through the kidneys.
80. The correct answer is A. Potassium is necessary to process glucose and amino acids in the body. Answer B is incorrect because potassium is the principle intracellular cation. Answer C is incorrect because sodium is the electrolyte removed from the body when a large amount of fluid is lost. Answer D is incorrect because amino acids have no effect on the renal excretion of potassium.
131
81. A nurse is caring for an elderly patient with a three-day history of fever and poor appetite. During the night, the patient suddenly becomes agitated and restless. On assessment, the patient’s skin is warm and very dry, sticky mucous membranes are noted, rales are detected, and blood pressure is 112/76 mm Hg. Laboratory results are:
Hct 53%
Sodium 166 mEq/L
Potassium 3.5 mEq/L
Glucose 75 mg/dL
Calcium 8.9 mg/dL
Magnesium 1.5 mEq/L
Which of the following electrolyte imbalances is present?
a. hypernatremia
b. hyponatremia
c. hyperkalemia
d. hypokalemia
81. The correct answer is A. The patient is displaying symptoms of hypernatremia. Assessment of a patient with hypernatremia reveals thirst and dry and sticky mucous membranes. The temperature is elevated, and the skin appears flushed. Correction depends on the cause and is directed toward decreasing the sodium to
normal.
132
82. A 12-month-old, 24-lb infant with pyelonephritis is to receive IV gentamicin sulfate (Garamycin). Vital signs are temperature 99°F, pulse 120, respiration 30, and BP 90/60 mmHg. Urine output has been 60 mL during the past four hours. The nurse should anticipate which of the following?
a. a change in antibiotic
b. obtaining a CBC and platelet count
c. continuing current plan of treatment
d. administration of hypertonic IV fluids
82. The correct answer is C. The patient is responding appropriately to the treatment.
133
83. The risk of infection is lower with the use of the
a. internal jugular vein.
b. femoral vein.
c. external jugular vein.
d. subclavian vein.
83. The correct answer is D. Subclavian catheter placements have lower risk of infection due to the concentration of skin flora and ease of maintaining an intact and sterile dressing than jugular or femoral placement.
134
84. A patient incurs radial nerve damage during the insertion of a short peripheral catheter. An unusual occurrence report would provide what?
a. back-up documentation for the medical record entry
b. an investigative tool for an occurrence
c. a method to select a corrective action
d. a problem resolution tool
84. The correct answer is B. The incident or unusual occurrence report is a record of potential or actual untoward event. The factual and objective recording of the event supports the organization’s risk management activities by allowing trending or pattern identification. The report allows the organization to determine the severity and potential impact of the event. No mention of the incident report is
made in the medical record, however, because the incident report then becomes discoverable if a lawsuit were to be filed.
135
85. When the drop factor for an administration set is 15, how many drops per minute are needed to administer 125mL/hour?
a. 8
b. 20
c. 31
d. 15
85. The Correct Answer is C.
136
86. When comparing frequency of central line dressing changes among institutions, a benchmark would provide what?
a. cost analysis
b. value analysis
c. stamp of approval
d. best practice
86. The correct answer is D. A benchmark can be defined as a best practice. The other choices are not benchmarks.
137
87. Edema is the result of excess fluid in the
a. interstitial space.
b. intracellular space.
c. intrathecal space.
d. intravascular space.
The correct answer is A. The interstitial space collects fluid because of increased capillary permeability, increased capillary hydrostatic pressure, or decrease plasma oncotic pressure from hypoalbuminemia or lymphatic obstruction. Any of these conditions facilitate the transfer of fluid to the interstitium.
138
88. An IV medication is ordered as a compounded solution of 1 g/500 mL of 5% dextrose in water to be infused at 40 mg/hour. How many mL/hour should be infused?
a. 10
b. 20
c. 30
d. 40
B. 20
139
89. The Infusion Nurses Society’s Infusion Therapy Standards of Practice recommends changing gauze dressings over central vascular access devices at least every
a. 24 hours.
b. 48 hours.
c. 72 hours.
d. 96 hours.
89. The correct answer is B. Change sterile gauze dressings every 2 days or earlier if dressing integrity is disrupted (eg, if damp, loose, or visibly soiled); note that a gauze dressing underneath a TSM dressing is considered a gauze dressing, unless the site is not obscured (eg, to support wings of an implanted VAD noncoring
needle).
140
90. All of the following have been implicated in the development of phlebitis
except
a. phenytoin.
b. vancomycin.
c. potassium chloride.
d. furosemide.
90. The correct answer is D. Common side effects of furosemide include hyponatremia, potassium depletion, and hypovolemia pH. Vancomycin, potassium chloride, and phenytoin have common side effects of venous irritation associated with IV
administration.
141
91. The addition of selenium to TNA is important to prevent
a. thrombocytopenia.
b. cardiomyopathy.
c. neutropenia.
d. nephrosis.
91. The correct answer is B. Selenium has been found to prevent cardiomyopathy in patients receiving long-term TNA, as it is an antioxidant and protects the cell membrane and hemoglobin from oxidative damage and hemolysis. Deficiencies result in muscle dysfunction (including cardiac muscle changes) and muscle pain.
142
92. It is appropriate to use a blood warmer in which of the following situations?
a. a newborn receiving an exchange transfusion
b. a child receiving 2 units of fresh frozen plasma
c. an adult receiving 20 units of platelets
d. an adult undergoing leukapheresis
92. The correct answer is A. Blood warmers should be used for newborn exchange transfusions to prevent complications of hypothermia.
143
93. If chemotherapy is administered without informed consent, the person administering the agent may be held liable for
a. negligence.
b. malpractice.
c. assault.
d. battery.
93. The correct answer is D. Battery is the actual physical contact with a person without his or her consent, or the actual carrying out of threatened physical harm. Negligence is a legal action brought by a plaintiff (patient). Malpractice is parallel in meaning with negligence, but it refers specifically to medical issues. Assault is the unjustifiable attempt to touch another person or the threat to do so in a way that the person believes it will occur, although there is no actual physical contact
with the person.
144
94. The recommended antiseptic for skin preparation in adults is
a. chlorhexidine.
b. poloxamer 188.
c. 70% alcohol.
d. povidone-iodine.
94. The correct answer is A. Studies performed have shown chlorhexidine to be the most effective agent for skin antisepsis for vascular access device use.
145
95. A continuous morphine sulfate infusion at a calculated dosage of 1.5 mg/hour is ordered for a patient. The physician has ordered 50 mg of morphine sulfate in 250 mL of 0.9% sodium chloride. The correct flow rate per hour is
a. 6.0 mL.
b. 7.5 mL.
c. 12.5 mL.
d. 19.0 mL.
B. 7.5 ml/hr
146
96. A patient with insulin hypersecretion experiences leg cramps, muscle weakness, dysrhythmias, and paresthesias. This is most likely due to
a. hypokalemia.
b. hypocalcemia.
c. hypernatremia.
d. hypermagnesemia.
96. The correct answer is A. The symptoms listed indicate hypokalemia.
147
97. Which of the following layers of the vein contains semi-lunar folds that form valves?
a. tunica media
b. tunica intima
c. tunica adventitia
d. tunica endothelia
97. The correct answer is B. Valves are hinge-like flaps formed from folds of the tunica intima. Venous valves are most abundant in the veins of the limbs, where upward flow of blood is opposed by gravity. The one-way valves prevent backflow
as blood travels toward the heart. The tunica media contains nerve fibers that control vasoconstriction and vasodilation. The tunica adventitia consists of connective tissue that provides support and protection. The tunica endothelia is not a layer of vein.
148
98. A patient’s laboratory values are: sodium 137 mEq/L, potassium 3.8 mEq/L, calcium 12.0 mg/dL, magnesium 1.6 mg/dL. Which of the following would
be expected?
a. weakness, paraesthesia, diarrhea, hypotension
b. irregular pulse, nausea, pedal edema, alopecia
c. increased reflexes, tremors, convulsions, tetany
d. muscular weakness, anorexia, arrhythmias, dysphagia
98. The correct answer is D. Muscular weakness, constipation, anorexia, and arrhythmia are signs associated with a low magnesium level of 1.6 mg/dL.
149
99. A patient is to receive an infusion of amphotericin B (Fungizone). The nurse notes a potassium of 2.5 mEq/L on the patient medical record. Which of the following should be the nurse’s initial action?
a. administer the amphotericin B as ordered
b. obtain an order for fluconazole (Diflucan) IV
c. hold the amphotericin B and contact the physician
d. administer the amphotericin B with potassium supplements
99. The correct answer is C. Amphotericin may cause nephrotoxicity manifested as hypokalemia. Amphotericin administration would be contraindicated with signs of
nephrotoxicity such as hypokalemia.
150
100. The smallest gauge catheter that can be used to administer blood or blood
products in the pediatric population is
a. 18-gauge.
b. 20-gauge.
c. 22-gauge.
d. 24-gauge.
100. The correct answer is D. In children, the use of smaller gauge needles for transfusion is acceptable. Studies have shown that 27 Gauge needles can be used to give packed red blood cells at a rate of up to 50mL/hr without significant hemolysis.
151
101. Which of the four blood types is considered the universal recipient?
a. O
b. A
c. AB
d. B
101. The correct answer is C. Blood group O is known as the “universal donor” because it has no antigens on its red blood cells and can therefore be safely given to any blood group. Blood Group AB is known as the “universal recipient” because it has no antibodies in its plasma and so can safely receive blood from any other blood group.
152
102. When attempting to withdraw a blood sample from a CVAD, the nurse is unable to obtain sufficient blood. The next nursing action would be to
a. notify the physician.
b. reposition the patient.
c. instill a thrombolytic agent.
d. obtain a peripheral venous sample.
102. The correct answer is B. Occasionally when CVADs are used to withdraw blood samples, it may be difficult to aspirate the blood. When this occurs, it is sometimes helpful to have the patient change position or cough. Answer A would be appropriate after having the patient change positions and you are still not able to withdraw the blood sample. Answer C would be appropriate after contacting the provider and obtaining an order to instill the thrombolytic agent. Answer D would be correct if you are able to withdraw a blood sample without difficulty.
153
103. A patient on long-term total nutrient admixture (TNA) has the sudden onset of paresthesia of the extremities, flaccid paralysis, listlessness, and mental confusions which nutrient would cause the complication?
a. Phosphorus
b. Magnesium
c. Calcium
d. Potassium
103. The correct answer is A. These symptoms are related to hyperphosphatemia and are only seen with this nutrient. Phosphorus needs to be discontinued and levels should
be monitored.
154
104. When starting a peripheral IV to administer a vesicant antineoplastic drug, which veins should you use?
a. Antecubital fossa veins
b. Dorsal hand veins
c. Anterior forearm veins
d. Wrist veins
104. The correct answer is C. Use the smallest size of adequate cannula in the largest vein available. Avoid the following sites: dorsal surface area of the hand, wrist and antecubital fossa.
155
105. A nurse should use which of the following techniques to minimize unsuccessful venipuncture attempts?
a. bedside radiology
b. modified Seldinger
c. bedside ultrasound
d. interventional radiology
105. The correct answer is C. Use of bedside ultrasound facilitates insertion, minimizes unsuccessful venipuncture. Visualization with use of bedside ultrasound aids in vein
identification and selection in patients with difficult vascular access.
156
106. A patient is to be discharged home with orders for vancomycin HCl (Vancocin HCl ) 1g every 12 hours for 10 days. Patient education related to potential side effects of this drug would include which of the following?
a. pulmonary fibrosis
b. pseudomembranous colitis
c. paraesthesias
d. hypotensive reaction
106. The correct answer is D. One of the major side effects of vancomycin is a hypersensitivity reaction.
157
107. A 5-year-old child is brought to the emergency department by his 16-year-old brother, who says that their parents are at work. The child’s temperature is 105°F. The physician orders IV hydration with 10% dextrose in 0.45% sodium chloride at 75 mL/hour. After consent is obtained, the nurse’s most appropriate initial action concerning the fluid order would be
to
a. question the order and obtain another.
b. initiate the infusion at 10 mL/hour.
c. start the fluid as ordered.
d. start 5% dextrose in 0.45% sodium chloride at 75 mL/hour.
107. The correct answer is A. In children with fluid-volume deficit, replacement of vascular volume is essential. These children require immediate infusion of fluids. Dextrose solutions should be omitted to prevent hyperglycemia, which may induce an osmotic diuresis, worsening the dehydration.
158
108. A patient has an elevated serum glucose level of 525 mg/dL. In treating this patient, the IV fluid that should be used initially is
a. dextran 40.
b. 5% dextrose in 0.45% sodium chloride.
c. 0.45% sodium chloride with potassium chloride 20 mEq/liter.
d. 0.9% sodium chloride.
108. The correct answer is D. A sodium chloride solution without potassium is indicated for fluid replacement in the diabetic patient with hyperglycemia.
159
109. A group of nurses has completed the infection prevention component of an institution’s infusion course. Which of the following is the best way to evaluate if new learned behaviors have been integrated into practice?
a. have participants complete an evaluation form at the end of the course.
b. check participants’ techniques when starting IVs 6 months after the course.
c. monitor the total number of patient infections 6 months after the course.
d. observe participants’ techniques when starting IVs at the end of the course.
109. The correct answer is B. Quality improvement activities identify actions needed to improve practice, processes, and/or systems. Observing participant’s techniques, after the completion of the education, captures what is actually happening and if the learned behaviors have been integrated into practice. It will also identify if additional education is needed.
160
110. What is the approximate percentage of body fluid volume and composition in an adult male 40 to 60 years of age?
a. 40%
b. 55%
c. 70%
d. 85%
110. The correct answer is B. The approximate body fluid volume for an adult is 50%-60%.
161
111. A 72-year-old patient is admitted to a hospital for congestive heart failure. Dobutamine HCl (Dobutrex) therapy was ordered. During administration of dobutamine HCl, which of the following medications is incompatible?
a. protamine sulfate
b. furosemide (Lasix)
c. bumetanide (Bumex)
d. dopamine HCl (Intropin)
111. The correct answer is B. Furosemide is not compatible with Dobutamine.
162
112. A patient who has group B blood has which of the following antibodies in
their plasma?
a. A antibody only
b. B antibody only
c. both A and B antibodies
d. neither A nor B antibodies
112. The correct answer is A. If you belong to the blood group B, you have B antigens on the surface of your red blood cells and A antibodies in your blood plasma.
163
113. For which of the following reasons would leucovorin calcium (Folinic Acid) be given as a rescue agent within 24-36 hours of a Methotrexate infusion?
a. reduce bone marrow toxicity
b. reduce the frequency of hand-foot syndrome
c. prevent diarrhea
d. provide antiemetic effects
113. The correct answer is A. The purpose of the leucovorin calcium (Folinic Acid) is as antineoplastic adjunct reducing the toxic effect of methotrexate on the bone marrow. Leucovorin limits methotrexate action on normal cells by competing with methotrexate for the same transport processes into the cell. Leucovorin given at the appropriate time rescues bone marrow and gastrointestinal cells from methotrexate.
164
114. A patient will continue infusion therapy for several more days secondary to a paralytic ileus and an elevated temperature. Which of the following would be the most appropriate vascular access device?
a. implanted port
b. tunneled and cuffed access device
c. subclavian nontunneled access device
d. PICC
114. The correct answer is D. The appropriate type of vascular access device, peripheral or central, is selected to accommodate the patient’s vascular access needs based on the prescribed therapy and length of treatment. The device selected should be the least invasive device for the prescribed therapy. Answers A, B, and C are more invasive devices and do not meet the criteria for the length of the prescribed therapy.
165
115. Which of the following is the most likely complication of heparin sodium administration?
a. neutropenia
b. thrombocytopenia
c. leukopenia
d. granulocytopenia
115. The correct answer is B. A, C and D are all variations of a low WBC count and heparin would not cause that. B is a low platelet count and that can be caused by anticoagulants, such as heparin.
166
116. A solution contains 20,000 units of heparin sodium in 250 mL of 0.9% sodium chloride. The heparin concentration per 1 mL is
a. 8 units.
b. 80 units.
c. 400 units.
d. 800 units.
116. The correct answer is B. Divide the number of units (20,000) by the number of mLs 250) of the solution to find the answer. 20,000 divided by 250 = 80.
167
117. When an implanted port is accessed, the needle should be changed at least every
a. 3 days.
b. 5 days.
c. 7 days.
d. 10 days.
117. The correct answer is C. The recommendation isto change the dressing and needle every 7 days.
168
118. A patient with purulent phlebitis has a positive semi-quantitative culture of\a catheter tip and a positive blood culture. This is an example of a
a. central line-associated bloodstream infection (CLABSI).
b. laboratory-associated infection (LAI).
c. cardiovascular system venous infection (CVS-VASC).
d. secondary bloodstream infection (BSI).
118. The correct answer is A. B is the result of an occupational exposure to infectious agents in the laboratory and can be caused by aerosol inhalation, percutaneous inoculation, direct contact ,or accidental ingestion. C are infections of the cardiac
system such as endocarditis, myocarditis, or pericarditis. These are caused by either bacterial, viral, or fungal agents, which eventually localize in the cardiac muscle. D is a bloodstream infection associated with a documented HAI at another site. A is the only correct response, as the catheter tip has a positive culture and the blood culture
169
119. A 2-year-old patient with a femoral CVAD has episodes of diarrhea. The dressing is noted to be soiled and non-occlusive. Which of the following is the most appropriate initial intervention?
a. obtain a physician’s order for antibiotics
b. place the CVAD in a new site
c. perform site care and dressing change
d. obtain stool and blood cultures
119. The correct answer is C. Maintaining a clean, dry occlusive dressing is one of the most important mechanisms to prevent infection. The most appropriate INITIAL intervention is to make sure the dressing is clean, dry and intact. A delay in this can result in a CVAD-associated infection.
170
120. As a means of data collection, patient satisfaction surveys
a. are an effective way to monitor performance improvement.
b. must be compared to other data sources to ensure accuracy.
c. include a rating scale with at least 5 elements to ensure validity.
d. need to be completed within 14 days following provision of service.
120. The correct answer is A. Measuring patient’s perceptions of the care they receive is an important component of the performance improvement program of any health care organization.
171
121. An infusion team is asked to develop a specific plan to eliminate deficiencies in a phlebitis prevention program due to increasing phlebitis rates after PICC insertions. Implementation of the plan would represent which of the following steps of the performance improvement process?
a. evaluation
b. data translation
c. documentation
d. corrective action
121. The correct answer is D. Corrective action can be a result of a trend in data that indicates concern. Corrective action typically follows data collection and translation in the performance improvement process.
172
122. Following the administration of mannitol (Osmitrol), it is most important to monitor the patient for which of the following?
a. decreased respiratory rate
b. increased urine output
c. signs of hypernatremia
d. signs of hyperkalemia
122. The correct answer is B. Precautions and monitoring include patients’ response to treatment and urinary output.
173
123. Quality assurance survey data indicate an increase in the incidence of skin abrasions around IV sites due to hair removal by shaving. What should the infusion nurse manager do to address this problem?
a. meet with the staff, change the standard, and direct them to comply
b. implement a program of discrete spot checks to identify non-compliant staff
c. meet with the staff to develop a plan or corrective action, including follow- up
assessment
d. implement a program of corrective action based on administrative directives
123. The correct answer is C. Quality changes are best achieved through the interaction and inclusion of the people tasked with carrying them out. Quality issues and corrective action plans should not be punitive or administrative directives in order for them to be most effective. They need to be inclusive of staff
and management.
174
124. An infusion pump constantly displays, “INTERNAL SYSTEMS MALFUNCTION.” According to the InfusionTherapyStandardsofPractice,
which of the following would be the appropriate intervention?
a. call the manufacturer’s hotline
b. silence the alarm and continue to use it
c. replace the pump and report the malfunction
d. repair the pump using the operational manual
124. An infusion pump constantly displays, “INTERNAL SYSTEMS
MALFUNCTION.” According to the InfusionTherapyStandardsofPractice,
which of the following would be the appropriate intervention?
a. call the manufacturer’s hotline
b. silence the alarm and continue to use it
c. replace the pump and report the malfunction
d. repair the pump using the operational manual
175
125. Dopamine HCl (Intropin) is administered primarily for the treatment of
a. hypotension.
b. hypertension.
c. atrial arrhythmias.
d. ventricular arrhythmias.
125. The correct answer is A. Dopamine is an inotropic agent and cardiac stimulant.
CRNI
flashcards
Decks in class (7)
# Cards
