The student nurse is aware that IV fluids should hang for no longer than:

72 hours

48 hours

36 hours

24 hours

Answer and Explanation

The Correct Answer is D

Choice A reason: Hanging IV fluids for 72 hours increases bacterial contamination risk, as fluids provide a medium for microbial growth. Most protocols recommend changing bags every 24 hours to maintain sterility and prevent bloodstream infections.
Choice B reason: A 48-hour duration exceeds standard guidelines for IV fluid bags, risking microbial growth and contamination. Changing bags every 24 hours minimizes infection risk, ensuring patient safety during intravenous therapy.
Choice C reason: A 36-hour duration still poses a contamination risk, as IV fluids can harbor bacteria over time. Standard practice requires changing bags every 24 hours to prevent catheter-related bloodstream infections and ensure sterile delivery.
Choice D reason: IV fluids should hang no longer than 24 hours to minimize bacterial growth and contamination risks. This standard ensures sterility, reduces catheter-related infections, and maintains safe fluid administration for patient safety.

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Correct Answer is C

Explanation

Choice A reason: Scrubbing the spike with alcohol may not fully sterilize it after contact with a non-sterile surface. Contaminated tubing risks introducing bacteria into the bloodstream, leading to catheter-related infections or sepsis.
Choice B reason: Replacing the IV bag is unnecessary, as the bag was not contaminated. The spike, which contacts the bag’s sterile port, is the compromised component, requiring new tubing to ensure sterility.
Choice C reason: New IV tubing ensures sterility after the spike contacts a non-sterile surface. Contaminated tubing could introduce pathogens into the IV system, causing bloodstream infections. Replacing it maintains the sterile field for safe infusion.
Choice D reason: Wiping with Betadine may not adequately sterilize the spike after contamination. Betadine requires contact time and may leave residue. New tubing is the safest option to prevent infection during IV administration.

A. The initial site dressing is 3 days old. B. The PICC was inserted 4 weeks ago. C. A securement device is absent. D. Upper extremity swelling is noted.

Correct Answer is D

Explanation

Choice A reason: A 3-day-old dressing should be changed per protocol to prevent infection, but it is not an immediate emergency. Swelling indicates potential complications like thrombosis or infiltration, requiring urgent intervention to prevent severe outcomes.
Choice B reason: A PICC inserted 4 weeks ago is within normal duration for use, provided no complications arise. Routine monitoring is needed, but swelling is a more urgent finding, indicating possible vascular or catheter issues.
Choice C reason: An absent securement device risks catheter dislodgement, which is concerning but less urgent than swelling. Swelling may signal thrombosis or fluid extravasation, necessitating immediate action to prevent circulatory or tissue damage.
Choice D reason: Upper extremity swelling may indicate thrombosis, infiltration, or infection, which are serious PICC complications. Thrombosis can obstruct blood flow, risking embolism, while extravasation causes tissue damage. Immediate assessment is critical to ensure patient safety.

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The student nurse is aware that IV fluids should hang for no longer than:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to insert the spike end of the IV tubing into the IV bag, the tubing drops and the spike end hits the top of the medication cart. The nurse should take which action?

Correct Answer is C

Explanation

A nurse is assessing clients who have intravenous therapy prescribed. Which assessment finding for a client with a peripherally inserted central catheter (PICC) requires immediate attention?

Correct Answer is D

Explanation

A client is prescribed to receive IV therapy and had a mastectomy three years prior. What should the nurse do?

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The IV catheter hub is pink. What size IV jelco is it?

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The most common dressing used to cover an IV site is a transparent dressing. This dressing: