Prepare: Fluid and Electrolytes

Osmolality

• Which of the following describes osmolality?

Important Terms

• Match the definition with the description:

Osmolality and Types of Fluid

• Match the correct osmolality to the types of fluid.

Self-Check: Tonicity

• To show an understanding of tonicity, think about the following equations and see if you can figure out what happens when you add fluids with different concentrations. Complete the following calculations:

Self-Check: Getting to the Cell

• The nurse has initiated an intravenous administration of fluids. Place the following in the order the fluid moves to the cell.

Self-Check: Diabetes Insipidus

• Consider this case. A 43-year-old client was hit by a car while riding their bicycle. The client sustained a head injury and was diagnosed with diabetes insipidus. This condition causes urination with limited filtration (urine is very dilute). The client’s brain has swelling, so they are losing dilute fluid into the brain and into urine. The client’s labs show the following:
• Which of the following would be most appropriate to help the client get better?

Self-Check: Osmotic and Hydrostatic

• Select the correct choices to complete the following statement. If particles are pushed from one compartment to the next regardless of the concentration of the different compartments, hydrostatic pressure is used. When particles are pulled to an area that has less of a concentration of those particles, it is called osmotic pressure.

Self-Check: Electrolyte Imbalance

• Which of the following will cause an electrolyte imbalance? Select all that apply.

Reflect: Fluid and Electrolytes

Patient Scenario – Heart Failure

• Sally, a 75-year-old female is admitted with heart failure. She has pitting edema to both lower extremities. Her labs show the following:
• Which of the following would be most appropriate to help her get better?

Electrolyte Abnormalities

• The healthcare provider orders a diuretic (furosemide 80mg IV) for Sally, who is in heart failure. Which of the following electrolyte abnormalities would you be most concerned about in the next two to four hours as the medication works?

Administering Potassium Chloride

• The healthcare provider prescribed potassium chloride 40 mEq/L to be given intravenously. Which is the safest way to give this?

Diuretics

• Sally continues to have issues with her heart failure. In monitoring her progress, which is the most accurate way to ensure she is improving and her diuretics are working?

Fluid Volume Status

• When unable to obtain lab testing or get information on fluid volume status, which of the following can be used as a clinical marker of volume status? Select all that apply.

Patient Scenario – Dizziness and Lightheadedness

• A 55-year-old client is admitted with dizziness and lightheadedness. At this time, there is little information available and the client is a poor historian.

Labs are not available at this time.

Which of the following would be safest to give to help the client get better?

Patient Scenario – Stabbing Victim

• A 36-year-old client was stabbed in a major artery. The client has been bleeding for the last 20 minutes slowly. The labs show the following:
• Which of the following would be most appropriate to help the client get better?

Patient Scenario – Football Practice

• A 26-year-old client was practicing in football gear on a hot day (110 degrees). The client passed out and was taken to the hospital emergency department. The labs show the following:
• Which of the following would be most appropriate to help the client get better?

Types of IV Fluids

Prepare: Types of IV Fluids

Hypertonic Solution

• Which of the following best describes a hypertonic solution?

Isotonic Solution

Which of the following best describes a isotonic solution?

Hypotonic Solution

• Which of the following best describes a hypotonic solution?

Self-Check: Using an Intravenous Fluid Pump

• Which of the following client diagnoses should you consider using an intravenous (IV) pump for more careful fluid monitoring? Select all that apply.

Self-Check: Avoiding Venous Inflammation

• Which medication should be given slowly to avoid venous inflammation?

Self-Check: Types of Intravenous Fluid

• Complete the following:

Self-Check: Bag Labels

• Using the drop-down menus, select what each of these items are on the bag label.

Self-Check: Bag Osmolality

• What is the osmolality of the following intravenous (IV) bag? Type in your answer:

Reflect: Types of IV Fluids

Tonicity

• Identify the tonicity of each of the following:

Intravenous Pumps

• Select which of the following clients you would use an IV pump to administer their IV fluids. Select all that apply.

Bag Identification

• Identify the following:

Input and Output Sheet

• Julie is on Normal Saline at 150mL an hour. She was admitted at 09:00. Complete the input and output sheet for the first 24 hours.

Intravenous Flow Sheet

• You started your shift at 07:00. At 10:30 you started a new bag of Normal Saline (1000mL) with no additives. At 18:30 you started a new bag of Normal Saline (1000mL) with no additives. Complete the IV Flow Sheet below accurately:

Bag Osmolality

• What is the osmolality of this intravenous (IV) bag?: 525 mOsmol/L

Intravenous Fluids

• Fred was stabbed with a knife. His bleeding is now under control, but he has lost a fair amount of blood. His blood pressure is 90/50, and his pulse rate is 130. Which of the following fluids would be appropriate based on its tonicity? Select all that apply.

Intravenous Fluids – Dehydration

• Amy was admitted to the Emergency Department with dehydration. Her sodium was 150 mEq/dl. Her blood pressure is 105/55, and her pulse rate is 105 bpm (beats per minute). Which of the following fluids would be appropriate based on its tonicity? Select all that apply.

Starting and Maintaining IV Sites

Prepare: Starting and Maintaining Intravenous Catheter Sites

Intravenous Catheter Gauge

Which of the following parts of the intravenous catheter does the "gauge" refer to?

Flash Chamber

Which of the following is the purpose of the flash chamber on an intravenous (IV) catheter?

Flushing with Saline

What is the purpose of flushing an intravenous (IV) line with normal saline? Select all that apply.

Self-Check: Gauge Selection

You have only six available intravenous (IV) catheters, one for each client below. Select the most appropriate IV gauge size for the best choice:

Self-Check: Latex Allergy

Nicole is allergic to latex. Identify which of the following items could contain latex? Select all that apply.

Self-Check: Patient Education

Which of the following statements indicates that Debra may need more education about her intravenous (IV) line?

Self-Check: A Second Intravenous Line

Doug is admitted for renal failure. He is on dialysis. He has been here four days and currently has an intravenous (IV) catheter in his right upper arm. He is in need of another. There is a sign in his chart that says “No blood pressures on left arm”.

Which of the following challenges can you anticipate in starting a second IV line on Doug? Select all that apply.

Self-Check: Intravenous Site Review

You are asked by a colleague to review the intravenous (IV) site below. Though it appears to be working, what are some concerns you might have? Select all that apply.

Reflect: Starting and Maintaining Intravenous Catheter Sites

Nursing Actions for an Intravenous Catheter

Doug is admitted for renal failure. He is on dialysis. He has been here four days and currently is in need of an intravenous (IV) catheter. There is a sign in his chart that says “No blood pressures on left arm”. He has an allergy to iodine. He currently is on no medication. Which of the following nursing actions would improve the possibility of a successful IV insertion for Doug? Select all that apply.

Prioritizing for Intravenous Catheter Insertion

You start thinking of your to do list for intravenous (IV) catheter insertion. Prioritize the following nursing actions as you plan to do them.

Possible VeinsYou are starting Douglas’ intravenous (IV) line. You place the tourniquet and look for a possible vein. Of the ones you have found, which one would be most ideal? You are starting Douglas’ intravenous (IV) line. You place the tourniquet and look for a possible vein. Of the ones you have found, which one would be most ideal?

Intravenous Catheter Insertion Review

You review your to do list for intravenous (IV) catheter insertion. Prioritize the following nursing actions as you plan to do them.

Dropped Supplies

During the intravenous (IV) catheter insertion, you accidentally dropped the needle and catheter onto the blanket. Which of the following is appropriate?

Checking Intravenous Sites

You are rounding and check your client's intravenous (IV) sites. Identify your assessment of this IV site:

Saline Locks

You are in Debra's room checking the patency of her saline lock by flushing it with normal saline. While flushing, you are unable to inject anything into the saline lock. Select the nursing actions you will take with this intravenous (IV) line. Select all that apply.

Inspecting Intravenous Catheter Sites

It is about midway through your shift, and you now are rounding and checking intravenous (IV) catheter sites on your clients. You review Gladys’ IV and note that it was started two days ago. Select the nursing actions you will take with this IV:

Venous Access Devices

Prepare: Venous Access Devices

The Distal Portion

Where is the distal portion of a central line ideally located after insertion?

Common Risks of Central Line Placement

What is the most common risk associated with central line placement?

Reducing Central Line Infection

Which of the following actions is used to reduce risk of central line infection? Select all that apply.

Self-Check: Central Access Devices

Which of the following clients would benefit from a central access device? Select that correct answers.

Self-Check: Dressing Changes

Doug has been in the hospital for renal failure. He had a dialysis catheter placed in his left subclavian area three days ago. Per hospital policy, a dressing change is needed. Which of the following actions will reduce the risk of catheter infection? Select all that apply.

Self-Check: Multiple Ports

Which of the following is true regarding central venous devices with multiple ports? Select all that apply.

Self-Check: Central Line Placement

Debra is admitted with severe pneumonia. Because of her high fever and positive blood cultures, sepsis is a concern. The medical resident has decided to place a central line because she will require additional medications. After placement, a chest xray is ordered. Which of the following best describes the reason for the x-ray? Select all that apply.

Self-Check: Peripherally Inserted Central Catheter Lines

Mari had a peripherally inserted central catheter (PICC) line placed last week. According to the policy; her central line dressing should be changed every 5-7 days. In addition, in line should be flushed after each access or every 24 hours if unused. The flush solution should be 0.9% sodium chloride 10 mL.

Reflect: Venous Access Devices

Supporting Insertion

Mari is a 63 year old female admitted to the hospital with osteomyelitis of the great toe. She has a history of diabetes. An MRI of the foot indicates she has advanced infection that has infiltrated the bone. She will need surgery for debridement, and antibiotic daily for two months. She currently has an IV in her right arm with NS running at 150ml/hr. Which of the following indications would best support insertion of a central venous access device?

Adverse Events with a Central Line

Mari will need a central line. The healthcare provider plans to insert this central venous access device in the left subclavian vein. In discussing the possible risks of insertion of a central line, which of the following possible adverse events could occur during or immediately after the procedure? Select all that apply.

Contaminated Devices

During the insertion of Mari's central line, you notice the healthcare provider contaminated the sterile field when the catheter touched the side of the bedside table. Which of the following actions might be appropriate? Select all that apply.

Verifying Placement

A chest x-ray completed after the insertion of a central venous catheter shows the tip is in the superior vena cava. The client denies dizziness, light headedness, shortness of breath, and significant pain. Based on the assessment, the nurse should make which conclusion?

Central Line Dressing Care

The procedure is completed and the x-ray has been verified for placement. The nurse now must do central line dressing care. Select the following steps and move them to the correct order:

Flushing the Central Line

The next day, just before flushing Mari's central line for the first time, you review the policy. Due to a computer error, the steps are listed in the wrong order. The IT department has asked you which order they should be in. Put the steps to the hospital's flushing policy in the correct order:

Needing a Special Intravenous Line

Mari said her healthcare providers are discussing her discharge and say that she will need antibiotics at home. They are discussing putting a "special IV" in, according to her. She says that her friend who is experiencing chemotherapy, has a portacath or implanted port. In discussing this option with her, which of the following statements are accurate. Select all that apply.

Peripherally Inserted Central Catheter Lines

Mari is being discharged home. Her central line was discontinued three days ago and a peripherally inserted central catheter (PICC) was placed for home antibiotic therapy. You are assessing her dressing today. Hospital policy says for the PICC line dressings to be changed every five to seven days. What would the appropriate nursing action be for this dressing?

Blood and Blood Administration

Prepare: Blood and Blood Administration

Type and Screen

• When a type and screen is ordered, which of the following does this indicate?

Blood Transfusion Tubing

• Which of the following is unique about blood transfusion tubing compared to regular IV tubing? Universal Donor

Which of the following blood types is considered a universal donor?

Self-Check: Blood Products

Blood Products

• All three of the clients below require a transfusion. Match the most appropriate blood product based on their individual case:

Self-Check: Refusing a Transfusion

Refusing a Transfusion

• Brianna is a Jehovah's Witness and states that she cannot have a transfusion of blood due to her beliefs. She has a significant liver laceration and her blood pressure is severely low. She is possibly going to die. She is currently alert and oriented and refuses the blood transfusion. Which of the following nursing actions should be taken next?

Self-Check: Transfusion Supplies for Packed Red Blood Cells

Transfusion Supplies for Packed Red Blood Cells

• You have an order to give two units of packed red blood cells (PRBCs). You currently have no stock on the unit and will need to order the supplies from the supply department. Please select which items you will need to give the PRBCs. Select all that apply

Self-Check: Blood or Blood Product Reactions

Blood or Blood Product Reactions

• Select the description that matches the type of blood or blood product reaction that can take place:

Self-Check: Reactions to Transfusions

Reactions to Transfusions

• Albert had a prostatectomy. During the procedure he lost a significant amount of blood. He is anemic with a hemoglobin level of 7.2 (normal 10-15). The surgeon has ordered 2 units of packed red blood cells to be given immediately. You started the blood at 13:00, and at 13:15 you note the following things: Flushing, itching, and a hives reaction.

Reflect: Introduction to Blood and Blood Administration

Laboratory Tests

• Lucas is a 20-year-old male who is having an aortic valve replacement surgery due to a congenital aortic valve defect. He is currently in preoperative holding and the nurse is verifying his orders. The surgeon says that he will likely need two to four units of packed red blood cells (PRBCs) blood. He is requesting that these be ready before surgery.

Which of the following lab tests would be anticipated to be ordered?

Patient Information Review

• Lucas undergoes an Aortic Valve Replacement. He is currently in ICU recovery. The surgeon has ordered the 2 units of PRBCs to be given over the next two hours. You review all the information above before proceeding with the transfusion.

Select the best action to take.

Lack of Clotting

• Lucas is in intensive care. The nurse notices a large amount of blood coming out of the chest tube from surgery. The nurse notifies the surgeon with concerns that the patient is not clotting. Laboratory testing shows a hemoglobin of 10g/dl (normal 12-17g/dl). His platelet count is 155,000 (normal 150,000 – 300,000). Which of the following blood products can the nurse anticipate giving?

Supplies Needed

• Lucas is recovering in a medical-surgical room. He has one peripheral intravenous (IV) site with antibiotics running for the next two hours. Review the provider order below. Also, click to review the facility’s administration policy.

Provider Orders

• 9/17/20XX 3 units of PRBCs stat-------Dr. Glory After reviewing the Provider Order and facility’s administration policy, which of the following equipment will be needed to start the next unit of packed red blood cells? Select all that apply.

Reaction to a Transfusion

• Lucas started his second unit of packed red blood cells. Here is what you see after 15 minutes. Based on the assessment and cues you have; you interpret the following:

Nursing Actions

• Lucas appears to be having an acute intravascular hemolytic reaction.

1. Select the correct steps you would perform (in no particular order) from the list of following nursing actions.
2. Select the answer option that best reflects the order of nursing actions you would perform.

Symptoms and Reactions

• Match the symptom to the type of blood transfusion reaction.

Purpose of Saving Supplies

• What is the purpose of saving all blood, tubing, and labelling after a blood transfusion reaction takes place?

Nursing Application for Fluids and Electrolytes

Prepare: Introduction to the Nursing Application of Fluids and Electrolytes

Hemolytic Reaction

• Which of the following can suggest an acute hemolytic reaction after starting a blood transfusion? Select all that apply.

Delayed Complications

• Delayed complications of a peripheral intravenous (IV) catheter include which of the following? Select all that apply.

Low Sodium and Serum Osmolality

• A client with a low sodium level and a low serum osmolality indicates which of the following?

Self-Check: Assessing Intravenous Needs

• Which of the following cues suggests the need for immediate intravenous (IV) access? Select all that apply.

Self-Check: Intravenous Needs

• Review the client record and then answer the following question: Given Deborah’s current situation, what would be the most appropriate intravenous (IV) access to obtain?

Self-Check: Assessing Fluids

• After reviewing the client’s record, choose which of the following fluids is appropriate as a bolus?

Self-Check: Fluids

• While Deborah improved with the fluid bolus, she is being prepped for surgery. The surgeon is planning a subclavian central line to be inserted before surgery. Deborah’s power of attorney asks about what the immediate potential complications of a subclavian central line insertion is. Which of the following is accurate? Select all that apply.

Self-Check: Intravenous Site Examination

• Deborah recovered from surgery well and central line was removed recently. She has a 20 gauge intravenous (IV) catheter that was placed in her left forearm. She rings the call bell and says that her IV site is hurting. It is currently a saline lock. Which of the following should be assessed based on her complaint? Select all that apply.

Reflect: Nursing Application: Fluid and Electrolytes

Intake and Output

• After reviewing Latika’s symptoms and her intake and output, which of the following could be suspected? Select all that apply..

Cause of Pain

Latika is started on the intravenous (IV) fluid noted in the picture. It is a 1000 mL bag going at 250 mL/hour through her peripheral IV. She is complaining of pain at the IV site. After reviewing the bag, which is the most likely cause of her pain?

Appropriate Fluids

• Fred was admitted with a ruptured abdominal aortic aneurysm. After surgery, his bleeding is now under control, but he has lost a fair amount of blood. His blood pressure is 90/50, and his pulse rate is 130 bpm (beats per minute). His hemoglobin is 7.0 and his hematocrit is low. Which of the following fluids would be appropriate based on the vitals, labs, and circumstances? Select all that apply.

Evaluate Intravenous Site

• Before starting the blood transfusion, you evaluate Fred’s IV site. Please select your assessment from the items below:

Matching Blood

• Fred was typed and crossmatched for 4 units of packed red blood cells. The blood is delivered to the unit and you are reviewing it in his room with another nurse. Which of the following units would you give based on the information?

Documenting Findings

• Fred started his first unit of packed red blood cells. His vital signs were normal. After 15 minutes he started complaining of chills. Indicate if each of the following assessment finding is normal or abnormal. Interpreting Assessment Cues.

Fred started his first unit of packed red blood cells. His vital signs were normal. Here is what you see after 15 minutes, after which he started complaining of chills. Based on the assessment and cues what is most likely occuring?

Nursing Actions

• Fred appears to be experiencing a febrile non-hemolytic reaction. Which of the following nursing actions would you would perform? Select all that apply.