TEST BANK
Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy
Lisa A. Gorski
7th Edition Table of Contents
Chapter 01 An Overview of Professional Practice Issues and Infusion Therapy 1
Chapter 02 Infection Prevention and Occupational Risks 5
Chapter 03 Fundamentals of Fluid and Electrolyte Balance 12
Chapter 04 Parenteral Solutions 23
Chapter 05 Infusion Equipment 25
Chapter 06 Peripheral I.V. Catheters-Initiation and Maintenance of Peripheral Infusion Therapy 29
Chapter 07 Phlebotomy Techniques 40
Chapter 08 Central Vascular Access 42
Chapter 09 Complications of Infusion Therapy-Peripheral and Central Vascular Access Devices 50
Chapter 10 Infusion Medication Safety, Methods, and Routes 58
Chapter 11 Transfusion Therapy 64
Chapter 12 Parenteral Nutrition 72 Chapter 1: An Overview of Professional Practice Iss ues and Infusion Therapy Multiple Choice Identify the choice that best completes the stateme nt or answers the question. ____ 1. A nurse is attempting to initiate I.V. ther apy for a client diagnosed with gastroenteritis. Th e client is combative and resists the nurse’s efforts to sta rt the I.V. Which action by the nurse would result in an intentional tort? a. Failure to document the client’s combativeness b. Refusing to wear gloves while starting the I.V. c. Failure to report the client’s combativeness to a p hysician d. Starting an I.V. on a coherent client against the c lient’s wishes ____ 2. A nurse who is caring for clients understan ds that he or she should provide care that meets at least the minimum standards of practice for nursing. Whic h phrase regarding standards of practice is most accurate? a. Standards of practice focus on the care provider and define needed activities and behaviors. b. Standards of practice focus on the recipient of care and describe the outcomes of care. c. Standards of practice are written laws enacted by t he legislature. d. Standards of practice are the result o f the performance of a function or process. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 1. A nurse is caring for multiple clients in a rehabilitation facility. During the shift, the nur se notes that several medical devices are not functioning pr operly. According to the Safe Medical Devices Act, which problems should be reported to the U.S. Food and Drug Administration (FDA)? SELECT ALL THAT APPLY. a. Outdated medication b. Misleading packaging c. Cracked or leaking I.V. solution bag d. Defective infusion pump tubing ____ 2. A new infusion clinic is being started. The nursing supervisor of the new clinic must conform to specific standards of practice when developing nurs ing policies and procedures for the new program. To which organizational standards of pract ice must the nurse manager adhere? SELECT ALL THAT APPLY. a. Centers for Disease Control and Prevention (CDC) gu idelines b. Infusion Nurses Society (INS) standards c. American Medical Association (AMA) standards d. Oncology Nursing Society (ONS) standards ____ 3. A staff nurse is serving on a hospital’s qu ality-assurance task force. On which quality-assura nce models is the task force most likely to focus? SELE CT ALL THAT APPLY. a. Standards of care ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
1 | P a g e b. Standards of practice c. Performance improvement d. Continuou s quality improvement ____ 4. A nurse is planning for the discharge of a hospitalized client. The nurse reviews the client’s plan of care to determine whether all client outcomes were achieved. Which methods should the nurse use to evaluate the client’s outcomes? SELECT ALL THAT APPLY. a. Collect data to determine whether standards were me t. b. Identify controllable or uncont rollable variables. c. Determine the cause of the problem by comparing actual care with established standards. d. Re-evaluate to determine whether corrective acti on is effective and improvement in service is obtained. e. Contact The Joint Commission (JC AHO) Web site for standards. ____ 5. While caring for a client, a nurse administ ers an incorrect dose of medication, causing the cl ient to become ill. The nurse reports the incident to the n urse manager on the unit. The nurse manager then notifies risk management. Which risk-managemen t strategies should be used by the nurse in this situation? SELECT ALL THAT APPLY. a. Documentation b. Physical assessment c. Unusual occurrence reports d. Professional liability insurance ____ 6. When nurses provide care to clients, nursin g actions are governed by established standards of nursing care, as well as both state and federal law s. Which are sources of law? SELECT ALL THAT APPLY. a. Constitution b. Statutes c. State Nurse Practice Acts d. Joint Commission standards ____ 7. A new infusion clinic is being started. The nursing supervisor of the new clinic must conform to specific standards of practice when developing nurs ing policies and procedures for the new program. To which organizational standards of pract ice must the nurse manager adhere? SELECT ALL THAT APPLY. a. Centers for Disease Control and Prevention (CDC) gu idelines b. Infusion Nurses Society (INS) standards c. American Medical Association (AMA) standards d. Oncology Nursing Society (ONS) standards ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
2 | P a g e Chapter 1: An Overview of Professional Practice Iss ues and Infusion Therapy Answer Section MULTIPLE CHOICE 1. ANS: D Intentional torts include assault and battery, fals e imprisonment, using restraints as a form of false imprisonment, defamation of character, and breach o f confidentiality. Reference: Cockburn, T., & Madden, B. (2006). Inten tional torts claims in medical cases. J Law Med, 13(3), 311–335. PTS: 1 KEY: Cognitive Level: Application 2. ANS: A Standards of practice are criteria for measuring pe rformance against the optimal achievable degree of clinical excellence. These standards are formula ted to communicate expectations of nursing practice. Agencies are influential in developing st andards of practice. PTS: 1 KEY: Cognitive Level: Application MULTIPLE RESPONSE 1. ANS: B, C, D Misleading packaging, cracked or leaking I.V. solut ions bags, and defective infusion pump tubing should all be reported to the FDA because these pro blems indicate product integrity issues. Ensuring that medical devices in domestic commercia l distribution are safe and effective for their intended purposes is a professional responsibility. Outdated medication should be discarded and reported to the facility pharmacy. Reference: U.S. Food and Drug Administration, MedWa tch. (2005). Voluntary reporting by health professionals. Retrieved from www.fda.gov/medwatch/report/hcp.htm March 11, 2013. PTS: 1 KEY: Cognitive Level: Application 2. ANS: A, B, D The nurse manager must adhere to the guidelines of the CDC, INS, and ONS. The AMA does not provide guidelines for nursing standards of practic e. Reference: The Joint Commission PTS: 1 KEY: Cognitive Level: Application 3. ANS: A, C, D The task force is most likely to focus on standards of practice, performance improvement, and continuous quality improvement. These quality-assur ance models focus on the recipients of care. Standards of practice focus on the provider, and de fine the activities and behaviors needed to achieve patient outcomes. Reference: Phillips, L. (2010). Manual of I.V. therapeutics : Evidence-based infusion therapy (5th ed.). Philadelphia, PA: F.A. Davis. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
3 | P a g e PTS: 1 KEY: Cognitive Level: Application 4. ANS: A, B, C, D Methods used to collect and determine outcomes for clients parallel the nursing process. Collection, identification, problem solving, and re -evaluation are part of the nursing process. TJC is a nonprofit organization that accredits health-c are facilities and works to improve client care and safety. Reference: Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). St. Louis, MO: Mosby/Elsevier. PTS: 1 KEY: Cognitive Level: Application 5. ANS: A, C, D A complete written account of care given to the cli ent, written unusual occurrence reports, and professional liability insurance to protect the nur se are risk-management strategies. Reference: Alexander, M., & Webster, H. K. (2010). Legal issues of infusion nursing. In M. Alexander, A. Corrigan, L. Gorski, J. Hankins, & R. Perucca (Eds.), Infusion nursing: An evidence-based approach (pp. 49–59). St. Louis, MO: Saunders Elsevier. PTS: 1 KEY: Cognitive Level: Application 6. ANS: A, B, C The constitution, statutes, and state Nurse Practic e Acts all provide laws that govern nursing practice. The Joint Commission, along with the Amer ican Nurses Association and specialty organizations, establishes standards of nursing car e. Reference: Alexander, M., & Webster, H. K. (2010). Legal issues of infusion nursing. In M. Alexander, A. Corrigan, L. Gorski, J. Hankins, & R. Perucca (Eds.), Infusion nursing: An evidence-based approach (pp. 49–59). St. Louis, MO: Saunders Elsevier. PTS: 1 KEY: Cognitive Level: Application 7. ANS: A, B, D The nurse manager must adhere to the guidelines of the CDC, INS, and ONS. The AMA does not provide guidelines for nursing standards of practic e. PTS: 1 KEY: Cognitive Level: Application ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
4 | P a g e Chapter 2: Infection Prevention and Occupational Ri sks Multiple Choice Identify the choice that best completes the stateme nt or answers the question. ____ 1. During a hospital orientation, a newly hire d nurse learns that infectious waste must be incine rated as mandated by the Environmental Protection Agency (EPA). The nurse understands that the main focus of the EPA is on: a. risk-assessment strategies. b. performance -improvement strategies. c. quality management. d. occupational safety. ____ 2. A healthy individual comes in contact with a rhinovirus while out in the community. Which actions constitute the first line of nonspecific de fense mechanisms against the invading infection? a. Phagocytosis and a complement cascade b. Leukocytes and proteins c. Physical and chemical barriers d. Immune system and phagocytes ____ 3. A nurse is teaching a client who is immunos uppressed about ways to help the client to avoid infections. The nurse teaches the client that the p urpose of the immune system is to provide: a. the body with antigens. b. a way to inhibit the formation of antibodies to antigens. c. a way for the organism to move from the source to t he host. d. the body with a way to recognize and destroy invadi ng antigens. ____ 4. A nurse is caring for a hospitalized client who has a health-care–associated infection. The nu rse understands that the links in the chain of infectio n consist of: a. organism, inflammation, and infection. b. disease, the organism, and the host. c. agent, the host, and transmission. d. host, signs, and symptoms. ____ 5. A hospitalized client has acquired an infus ion-related infection. Which is the most appropriat e intervention for a nurse to implement when caring f or a client who has an infusion-related infection? a. Monitoring for signs and symptoms of sepsis b. Monitoring for dysrhythmias c. Use of full -barrier protection d. Educating the client on good hand hygiene technique s ____ 6. A client with active tuberculosis (TB) is a dmitted to a hospital. A nurse implements transmiss ion- based precautions when caring for the client becaus e the nurse is concerned about the dissemination of the disease. Which statement best describes dissemination? a. The movement of an organism from source to the host b. Produced within or caused by factors within the org anism c. The replication of organisms in the tissue of the h ost Environment ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
5 | P a g e d. The movement of microorganisms from an individual i nto the immediate ____ 7. A nurse on an intensive care unit is caring for a febrile client with a central venous cathete r whose blood pressure is steadily dropping. The nurse susp ects septicemia. Which microorganism is responsible for most cases of septicemia related to infusion? a. Mycobacterium b. Yersinia c. Coagulase -negative staphylococci d. Salmonella Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 1. A nurse teaches a client newly diagnosed wi th HIV about the immune system. Which organs should the nurse include when discussing the client ’s immune system? SELECT ALL THAT APPLY. a. Thymus b. Bone marrow c. Heart d. Lungs ____ 2. A new client diagnosed with AIDS is being s een in a hospital clinic. Which characteristics sho uld a nurse anticipate when assessing a client with imm unosuppression? SELECT ALL THAT APPLY. a. Frequent infections b. Infections that are more severe than usual c. Incomplete response to treatment d. Leukocyte count of 5,000 to 10,000 ____ 3. A nurse is caring for a client who has an I .V. access. With which sources of contamination sho uld the nurse be concerned when attempting to reduce th e client’s risk of infection? SELECT ALL THAT APPLY. a. Skin b. Air c. Entry ports d. Mucous membranes ____ 4. A nurse is preparing to initiate I.V. thera py on a client admitted with dehydration. Which precannulation antiseptic agents are acceptable for the nurse to use, according to the Infusion Nurses Society’s Standards of Practice, to cleanse the client’s skin? SELECT ALL THAT APPLY. a. 70% isopropyl alcohol b. Povidone -iodine c. 2% chlo rhexidine gluconate d. Hydrogen peroxide ____ 5. A new client, diagnosed with AIDS, is being seen in a hospital clinic. Which characteristics s hould a nurse anticipate when taking the health history o f a client with immunosuppression? SELECT ALL THAT APPLY. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
6 | P a g e a. Frequent infections b. Infections that are more severe than usual c. Incomplete response to treatment d. Infections that are usually from common sources ____ 6. A nurse teaches a client, newly diagnosed w ith HIV, about the immune system. Which organs should the nurse include when discussing the client ’s immune system? SELECT ALL THAT APPLY. a. Thymus b. Bone marrow c. Heart d. Lungs ____ 7. A physician writes an order for a nurse to begin administering I.V. fluids to a client diagnos ed with hepatitis A. While implementing this order, to whic h occupational risks is the nurse exposed? SELECT ALL THAT APPLY. a. Latex allergy b. Chemical exposure c. Needlestick injuries d. Back injury ____ 8. A nurse is preparing to administer I.V. che motherapy for a client diagnosed with cancer. Which are potential occupational risks associated with I. V. therapy? SELECT ALL THAT APPLY. a. Falls b. Latex allergy c. Chemical exposure d. Needlestick injuries ____ 9. A home-care nurse provides education regard ing basic infection control to the parents of a chi ld with HIV infection. Which instructions should be in cluded in the nurse’s education? SELECT ALL THAT APPLY. a. Carefully wash all fresh fruits and vegetables. b. Wash bottles, nipples, and pacifiers in the dishwas her. c. Immediately discard any unused food and formula. d. Cleanse the inside of the nipple of the bottle w ith salt and rinse well if it becomes slimy . ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
7 | P a g e Chapter 2: Infection Prevention and Occupational Ri sks Answer Section MULTIPLE CHOICE 1. ANS: A The EPA is one agency that performs risk assessment . Risk assessment takes different approaches depending on what information is available. Some as sessments look back to try to assess effects after an event. Other assessments look forward to a nticipate effects before a new product is approved for use. Reference: U.S. Environmental Protection Agency. (2 009). Hospital/medical/infectious waste incinerators. Retrieved from www.epa.gov/ttn/atw/129/hmiwi/rihmiw i.html, March 10, 2013. PTS: 1 KEY: Cognitive Level: Application 2. ANS: C The first lines of defense for healthy human hosts, to protect themselves from environmental microbes, are the physical (skin, mucous membrane, epiglottis, respiratory tract cilia, and sphincter) and chemical barriers (tears, gastric ac idity, and vaginal secretions). Mechanical barriers also provide a line of defense. PTS: 1 KEY: Cognitive Level: Application 3. ANS: D Appropriate immune response occurs when the immune system recognizes and destroys invading antigens. PTS: 1 KEY: Cognitive Level: Application 4. ANS: C The nurse understands that the client’s infection r esults from interaction between an infectious agent and a susceptible host. This interaction, cal led transmission, occurs by means of contact between the agent and the host. Three interrelated factors—the agent, the host, and transmission—represent the chain of infection. Reference: Siegel, J. D., Rhinehart, E., Jackson, M ., et al. (2007). Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Retrieved from www.cdc.gov/ncidod/dhq/pdf/isolation2007.pdf PTS: 1 KEY: Cognitive Level: Application 5. ANS: A Sepsis is a serious complication of infusion therap y. Signs and symptoms, such as fluctuating fever, profuse sweating, nausea and vomiting, abdom inal pain, tachycardia, and hypotension, should be reported immediately to the physician. PTS: 1 KEY: Cognitive Level: Application 6. ANS: D Dissemination is a shedding of microorganisms. Cult ures of air samples, surfaces, and objects reveal dissemination or shedding of microorganisms. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy, 7th Ed. (Gorski, 2019)
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