IV IV Therapy in Special Populations 1 — Questions and Answers
Question 1: Which vein is preferred for peripheral IV access in neonates and infants when scalp veins are unavailable?
- Femoral vein
- Antecubital fossa
- Dorsal hand or foot veins (Correct answer)
- Internal jugular vein
Correct answer: Dorsal hand or foot veins
Dorsal hand and foot veins are preferred peripheral IV access sites in neonates and infants due to their relative stability and accessibility.
Question 2: Why is it critical to use microbore (low-volume) IV tubing when infusing medications to neonates?
- To increase the infusion rate safely
- To minimize dead-space volume and prevent large unintended drug boluses during flushes (Correct answer)
- To reduce the risk of air embolism
- To comply with JCAHO standards only
Correct answer: To minimize dead-space volume and prevent large unintended drug boluses during flushes
Microbore tubing minimizes dead-space volume in pediatric IV lines, preventing inadvertent drug boluses when lines are flushed in neonates.
Question 3: Which IV solution is generally avoided in premature neonates due to the risk of kernicterus?
- Normal saline with 5% dextrose
- Lactated Ringer's solution
- IV solutions containing benzyl alcohol as a preservative (Correct answer)
- Potassium chloride-containing solutions
Correct answer: IV solutions containing benzyl alcohol as a preservative
Benzyl alcohol, used as a preservative in some IV solutions and medications, is toxic to premature neonates and is associated with 'gasping syndrome' and kernicterus.
Question 4: In elderly patients, which factor most significantly increases the risk of IV therapy complications such as fluid overload?
- Increased total body water
- Decreased cardiac and renal reserve (Correct answer)
- Enhanced venous tone and vessel elasticity
- Faster drug clearance rates
Correct answer: Decreased cardiac and renal reserve
Decreased cardiac and renal reserve in elderly patients impairs their ability to handle IV fluid loads, significantly increasing the risk of fluid overload.
Question 5: A pediatric patient requires IV medication, and the prescribed dose is weight-based. After calculating the dose, what is the nurse's next critical step?
- Dilute the medication in the largest volume available to reduce concentration
- Verify the calculated dose with a second nurse and confirm it does not exceed the maximum single dose (Correct answer)
- Administer via rapid IV push to minimize pain
- Round up to the nearest whole number for ease of preparation
Correct answer: Verify the calculated dose with a second nurse and confirm it does not exceed the maximum single dose
Weight-based pediatric IV medication doses must be independently verified by a second nurse and confirmed against maximum dose limits to prevent dosing errors.
Question 6: Which oncology patient receiving vesicant chemotherapy via peripheral IV requires the most vigilant site assessment?
- A patient with a large forearm vein selected 6 hours ago
- A patient with a hand vein insertion 30 minutes before infusion start (Correct answer)
- A patient with a freshly placed antecubital vein IV with confirmed blood return
- A patient receiving vesicant via a centrally confirmed PICC line
Correct answer: A patient with a hand vein insertion 30 minutes before infusion start
Peripheral hand vein IVs placed shortly before vesicant administration carry the highest risk of extravasation due to vein fragility and poor fixation; central access is strongly preferred.
IV IV Therapy in Special Populations 1
Which vein is preferred for peripheral IV access in neonates and infants when scalp veins are unavailable?