Exam 5 Ch15

17問 • 3年前

問題一覧

1. A nurse is caring for a client who has just had a central venous access line inserted. What action will the nurse take next?

b. Ensure that an x-ray is completed to confirm placement.

2. A nurse assesses a client who has a radial artery catheter. Which assessment will the nurse complete first?

d. Skin color and capillary refill

3. A nurse teaches a client who is being discharged home with a peripherally inserted central catheter (PICC). Which statement will the nurse include in this client’s teaching?

a. “Avoid carrying your grandchild with the arm that has the central catheter.”

4. A nurse is caring for a client who is receiving an epidural infusion for pain management. Which assessment finding requires immediate intervention from the nurse?

b. Report of headache and stiff neck

5. A nurse assesses a client who had an intraosseous catheter placed in the left leg. Which assessment finding is of greatest concern?

d. The client’s left lower extremity is cool to the touch.

6. A nurse is assessing clients who have intravenous therapy prescribed. Which assessment finding for a client with a peripherally inserted central catheter (PICC) requires immediate attention?

d. Upper extremity swelling is noted.

7. A nurse assesses a client’s peripheral IV site, and notices edema and tenderness above the site. What action will the nurse take next?

d. Stop the infusion of intravenous fluids.

8. While assessing a client’s peripheral IV site, the nurse observes a streak of red along the vein path and palpates a 1.5 inch (4-cm) venous cord. How will the nurse document this finding?

a. “Grade 3 phlebitis at IV site”

9. A new nurse is caring for a client receiving drug therapy via a smart pump. What statement by the new nurse demonstrates the need for more instruction on this technology?

a. “I don’t need to manually calculate IV infusion rates with smart pumps.”

10. A nurse prepares to insert a peripheral venous catheter in an older adult. What action will the nurse take to protect the client’s skin during this procedure?

d. Place a washcloth between the skin and tourniquet.

11. A nurse delegates care to an assistive personnel (AP). Which statement will the nurse include when delegating hygiene for a client who has a vascular access device?

d. “Use a plastic bag to cover the extremity with the device.”

12. A nurse teaches a client who is prescribed a central vascular access device and is transferring to a skilled facility for long-term treatment. Which statement will the nurse include in this client’s teaching?

c. “Ask all providers to vigorously clean the connections prior to accessing the device.”

13. A nurse is caring for a client with a peripheral vascular access device who is experiencing pain, redness, and swelling at the site. After removing the device, what action will the nurse take to relieve pain?

b. Place warm compresses on the site.

14. A nurse assesses a client who was started on intraperitoneal therapy 5 days ago. The client reports abdominal pain and “feeling warm.” For which complication of this therapy will the nurse assess the client?

d. Infection

15. A medical-surgical nurse is concerned about the incidence of complications related to IV therapy, including bloodstream infection. Which intervention will the nurse suggest to the management team to make the biggest impact on decreasing complications?

a. Initiate a dedicated team to insert access devices.

16. A nurse prepares to flush a peripherally inserted central catheter (PICC) line with 50 units of heparin. The pharmacy supplies a multidose vial of heparin with a concentration of 100 units/mL. Which of the syringes shown below will the nurse use to draw up and administer the heparin?

D. refer to picture

17. A home care nurse prepares to administer intravenous medication to a client. The nurse assesses the site and reviews the client’s chart prior to administering the medication and notes it to have been inserted 4 months ago. The site has no redness, warmth, or swelling and flushes easily. What action does the nurse take?

b. Administer the prescribed medication.

NUR 170 exam 4

V Farris · 50問 · 3年前

NUR 170 exam 4