IV Medication Administration & Management 2 — Questions and Answers
Question 1: A patient is ordered vancomycin 1g IV over 60 minutes. After 10 minutes, the patient develops flushing and erythema on the neck and face. What is the most likely cause?
- Allergic reaction requiring epinephrine
- Red Man Syndrome due to rapid infusion rate (Correct answer)
- Extravasation of vancomycin
- Anaphylaxis requiring immediate discontinuation
Correct answer: Red Man Syndrome due to rapid infusion rate
Red Man Syndrome is a non-allergic infusion reaction caused by too-rapid vancomycin infusion, presenting as flushing and erythema on the face, neck, and upper torso.
Question 2: When reconstituting a powdered medication for IV administration, which action is most appropriate?
- Shake vigorously to ensure complete dissolution
- Inject diluent directly onto the powder and gently swirl (Correct answer)
- Use sterile water for injection for all medications
- Reconstitute at room temperature regardless of storage requirements
Correct answer: Inject diluent directly onto the powder and gently swirl
Diluent should be injected onto the powder and the vial gently swirled to prevent foaming and ensure proper dissolution without damaging the medication.
Question 3: A nurse is preparing to administer an IV piggyback (IVPB) antibiotic. The primary line is running NS at 100 mL/hr. What must be verified before hanging the IVPB?
- The primary line must be clamped completely during IVPB infusion
- The IVPB bag must hang higher than the primary bag for gravity flow (Correct answer)
- The IVPB must contain the same solution as the primary line
- A new IV site must be established for IVPB administration
Correct answer: The IVPB bag must hang higher than the primary bag for gravity flow
The IVPB bag must be hung higher than the primary bag so gravity preferentially infuses the piggyback medication, allowing the primary line to resume automatically when the IVPB is complete.
Question 4: Which IV medication requires protection from light during administration?
- Normal saline
- Potassium chloride
- Nitroprusside sodium (Correct answer)
- Heparin sodium
Correct answer: Nitroprusside sodium
Nitroprusside sodium is highly photosensitive and must be wrapped in opaque material during administration to prevent degradation and toxic cyanide byproduct formation.
Question 5: A patient receiving IV morphine via PCA pump reports inadequate pain control. The nurse notes the PCA has a 4-hour lockout limit. What is the correct next step?
- Override the lockout to give additional doses
- Administer an IV bolus of morphine without a physician order
- Contact the prescriber to reassess and potentially modify the PCA order (Correct answer)
- Discontinue PCA and switch to oral opioids
Correct answer: Contact the prescriber to reassess and potentially modify the PCA order
The nurse must contact the prescriber to reassess pain management and obtain a modified order; independently overriding PCA lockouts or giving unauthorized boluses is unsafe practice.
Question 6: When calculating IV flow rate using gravity tubing, a nurse needs to infuse 250 mL over 2 hours using tubing with a drop factor of 15 gtt/mL. What is the correct flow rate?
- 15 gtt/min
- 31 gtt/min (Correct answer)
- 62 gtt/min
- 125 gtt/min
Correct answer: 31 gtt/min
Flow rate = (250 mL × 15 gtt/mL) ÷ 120 min = 3750 ÷ 120 = 31.25, rounded to 31 gtt/min.
Question 7: A nurse is administering IV calcium gluconate to a patient with hypocalcemia. Which concurrent IV medication requires special precaution?
- Normal saline
- Sodium bicarbonate (Correct answer)
- Dextrose 5% in water
- Lactated Ringer's solution
Correct answer: Sodium bicarbonate
Calcium gluconate and sodium bicarbonate must never be co-administered or mixed in the same line because they form an insoluble calcium carbonate precipitate.
IV Medication Administration & Management 2
A patient is ordered vancomycin 1g IV over 60 minutes.
After 10 minutes, the patient develops flushing and erythema on the neck and face.
What is the most likely cause?