1. A 39-year-old patient returns from the OR after undergoing a right thoracotomy.

An I.V. solution of 5% dextrose in 0.45% sodium chloride solution is infusing.

Which type of I.V. solution is the patient receiving?
a. isotonic
b. hypotonic
c. hypertonic
2. Which of the following electrolytes maintains cell electroneutrality?
a. magnesium
b. chloride
c. potassium
3. Which of the following statements about solutes in diffusion is accurate?
a. They move from an area of lower concentration to an area of higher concentration.
b. They move against the concentration gradient.
c. They move from an area of higher concentration to an area of lower concentration.
4. Fluid volume and concentration is regulated by the interaction of aldosterone
and which other hormone?
a. antidiuretic hormone
b. thyroid-stimulating hormone
c. follicle-stimulating hormone
5. Phosphate is an electrolyte that's responsible for
a. maintaining bones and teeth.
b. activating intracellular enzymes.
c. maintaining serum osmolarity.
6. An 89-year-old patient with a history of heart failure has an I.V. solution
infusing through microdrip tubing. Microdrip tubing delivers how many drops per
minute?
a. 20 gtt/minute
b. 60 gtt/minute
c. 80 gtt/minute
7. An 85-year-old patient with a history of abdominal aortic aneurysm resection is
admitted to the ED with dehydration. Which of the following contraindicates
insertion of an I.V. catheter in his arm?
a. hemodialysis arteriovenous (AV) fistula
b. previous I.V. site
c. nondominant arm or hand
8. An 18-year-old patient is admitted to your unit with seizures. Although he has
an I.V. catheter in place withI.V. fluids infusing, you need to insert an intermittent-
infusion device to administer phenytoin. After gathering all of the necessary
equipment, you locate a site for insertion. Where should you place the tourniquet
in proximity to the intended venipuncture site?
a. 2 inches (5 cm) above the venipuncture site
b. 6 inches (15 cm) above the venipuncture site
c. 10 inches (25 cm) above the venipuncture site
9. Your patient with acute respiratory failure requires a central venous catheter
for total parenteral nutrition administration. You know that the right side of the
heart receives blood from the systemic circulation through which vein?
a. superior vena cava
b. cephalic vein
c. median cubital vein
10. Your patient has undergone numerous venipunctures for peripheral I.V.
placement and now requires central venous catheter placement. The health care
provider chooses the subclavian approach. What's an advantage of central lines
over peripheral lines?
a. decreased risk of pneumothorax
b. decreased risk of thrombus from chemical irritation
c. decreased risk of air embolus
11. If your supine patient can't perform Valsalva's maneuver while you change the
cap of a central venous catheter, which of the following can serve as an
alternative procedure?
a. Ask the patient to perform purse-lipped breathing.
b. Remove the cap during the inspiratory phase.
c. Remove the cap during the expiratory phase.
12. Your 37-year-old patient with acute leukemia has an implanted port. What type
of needle should you use to access it?
a. winged infusion set
b. coring needle
c. noncoring needle
13. The health care provider prescribes a dopamine infusion for a patient with
hypotension. To calculate the infusion rate, you must know the patient's weight in
kilograms. Your patient weighs 186 pounds. Which of the following operations
lets you translate this weight to kilograms?
a. divide by 2.2
b. divide by 3.4
c. divide by 4.5
14. You received a report on a 65-year-old patient who underwent resection of an
abdominal aortic aneurysm. The nurse told you that he has lactated Ringer's
solution infusing at 150 ml/hour. When you enter his room to perform your
assessment, you note that he's in respiratory distress. You check his blood
pressure and find that it's elevated. You also note bilateral jugular vein
distension. This patient is most likely experiencing
a. circulatory overload.
b. hypersensitivity.
c. systemic infection.
15. A patient with a history of coronary artery disease is ordered a transfusion of
one unit of packed red blood cells (RBCs) to treat a hemoglobin level of 8
grams/dl. As you administer the blood, you observe the patient closely,
remembering that a hemolytic reaction can occur when how much blood is
infused?
a. 10 ml
b. 50 ml
c. 100 ml
16. A patient with hemophilia A is admitted with bleeding after falling off his
bicycle. Which factor, known as the anti-hemophilic factor, should be
administered to this patient to control bleeding?
a. factor VIII
b. factor IX
c. factor X
17. Which complication may occur as a result of the accumulation of an iron-
containing pigment in a patient who received multiple transfusions?
a. hypothermia
b. potassium intoxication
c. hemosiderosis
18. Which of the following types of medications has a potential for damaging
tissue?
a. irritants
b. vesicants
c. nonvesicants
19. A 5-year-old is admitted to your unit with severe protein deficiency that isn't
accompanied by a calorie deficit. Which type of nutritional deficiency is this child
experiencing?
a. iatrogenic protein-energy malnutrition
b. kwashiorkor
c. marasmus

1. c. Dextrose 5% in 0.45% sodium chloride solution is a hypertonic I.V. solution.

2. c. Potassium maintains cell electroneutrality.
3. c. In diffusion, solutes move from an area of higher concentration to an area of
lower concentration.
4. a. Fluid volume and concentration is regulated by the interaction of two
hormones: antidiuretic hormone and aldosterone.
5. a. Phosphate is an electrolyte that's responsible for maintaining bones and teeth.
6. b. Microdrip tubing delivers 60 gtt/minute.
7. a. Never insert an I.V. catheter in an arm with an AV fistula.
8. b. Place the tourniquet about 6 inches (15 cm) above the venipuncture site.
9. a. The right side of the heart receives blood from the systemic circulation through
the superior and inferior vena cavae.
10. b. One advantage of central venous therapy is that the greater blood flow
through the central vessels dilutes concentrated solutions, decreasing the risk of
thrombus from chemical irritation.
11. c. If the patient can't perform Valsalva's maneuver, remove the cap during the
expiratory phase of the respiratory cycle.
12. c. To avoid damaging the port's septum, use a noncoring needle.
13. a. To convert a patient's body weight from pounds to kilograms, divide the
number of pounds by 2.2 because 2.2 pounds equals 1 kg.
14. a. Jugular vein distension, respiratory distress, and increased blood pressure,
along with crackles and a positive fluid balance, are signs of circulatory overload.
15. a. A hemolytic reaction can occur when as little as 10 ml has been infused.
16. a. Factor VIII is also referred to as antihemophilic factor and can be used to treat
a patient with hemophilia A to control bleeding associated with factor VIII
deficiency and to replace fibrinogen or factor VIII.
17. c. Hemosiderosis is the result of accumulation of an iron-containing pigment
called hemosiderin. It may be associated with RBC destruction in a patient who's
received many transfusions.
18. b. Vesicants can cause a reaction so severe that blisters form and tissue is
damaged or destroyed.
19. b. Kwashiorkor, which occurs most commonly in children, is a severe protein
deficiency that isn't associated with a caloric deficit.