IV Medication Administration & Management 3 — Questions and Answers
Question 1: A patient's IV site shows coolness, pallor, and swelling around the insertion site. The infusion pump does not alarm. What condition is present?
- Phlebitis grade 2
- Infiltration (Correct answer)
- Air embolism
- Catheter occlusion
Correct answer: Infiltration
Infiltration occurs when IV fluid leaks into surrounding tissue, causing coolness, pallor, and swelling; pumps often do not alarm with infiltration because resistance is low in soft tissue.
Question 2: Which statement about IV push (IVP) medication administration is correct?
- All IVP medications can be administered over 1 minute
- IVP medications should always be diluted in 50 mL NS before administration
- Rate of IVP administration is medication-specific and must be verified in a drug reference (Correct answer)
- IVP is contraindicated in central venous catheters
Correct answer: Rate of IVP administration is medication-specific and must be verified in a drug reference
Each IVP medication has a specific safe administration rate that must be verified in a drug reference, as giving too rapidly can cause adverse effects including cardiac arrhythmias.
Question 3: A patient is receiving IV amphotericin B. Which premedication strategy is commonly used to reduce infusion-related reactions?
- Administering IV lorazepam 30 minutes before infusion
- Premedication with acetaminophen, diphenhydramine, and hydrocortisone (Correct answer)
- Giving IV metoprolol to reduce heart rate before infusion
- Administering IV furosemide to prevent fluid overload
Correct answer: Premedication with acetaminophen, diphenhydramine, and hydrocortisone
Acetaminophen, diphenhydramine, and hydrocortisone are commonly given as premedications before amphotericin B to reduce fever, chills, and rigors associated with infusion.
Question 4: When titrating a vasopressor infusion, a nurse should primarily adjust the rate based on which parameter?
- Patient-reported comfort level
- Urine output alone
- Mean arterial pressure (MAP) per the prescribed target (Correct answer)
- Heart rate only
Correct answer: Mean arterial pressure (MAP) per the prescribed target
Vasopressor titration is guided by achieving the prescribed MAP target, as MAP reflects end-organ perfusion pressure and is the primary hemodynamic goal.
Question 5: A nurse discovers two IV bags labeled with the same patient name but different medication concentrations. What is the priority action?
- Administer the lower concentration first as a safety measure
- Use the most recently prepared bag as it is likely more accurate
- Hold both bags and verify the correct order with the pharmacy and prescriber (Correct answer)
- Check the patient's chart and administer the concentration that matches the current dose
Correct answer: Hold both bags and verify the correct order with the pharmacy and prescriber
When medication discrepancies exist, both bags must be held while the nurse clarifies the correct concentration with pharmacy and the prescriber to prevent a medication error.
Question 6: Which IV medication must be administered through a central line only due to its high osmolarity and vesicant properties?
- Normal saline 0.9%
- Potassium chloride 40 mEq/L in NS
- Dextrose 50% (D50W) (Correct answer)
- Magnesium sulfate 2g in 50 mL NS
Correct answer: Dextrose 50% (D50W)
Dextrose 50% has extremely high osmolarity (~2,525 mOsm/L) and is a vesicant that causes severe tissue necrosis with extravasation, requiring central line administration.
Question 7: A patient on continuous heparin infusion has an aPTT result of 180 seconds (therapeutic range 60-100 seconds). Per protocol, what action should the nurse take?
- Increase the heparin rate by 20%
- Continue the current rate and recheck in 6 hours
- Hold the infusion per protocol and notify the prescriber (Correct answer)
- Administer protamine sulfate immediately without an order
Correct answer: Hold the infusion per protocol and notify the prescriber
An aPTT of 180 seconds is supratherapeutic, indicating excess anticoagulation; per protocol the infusion should be held and the prescriber notified to reassess and adjust.
IV Medication Administration & Management 3
A patient's IV site shows coolness, pallor, and swelling around the insertion site.
The infusion pump does not alarm.
What condition is present?