LIPINCOT EXERCISE 5

Epidural analgesic administration:

 Results During the first 24 hours after the start of the infusion, how often should you monitor the patient's vital signs and oxygen saturation level, carbon dioxide level, or both?

	Every 2 hours, then every 4 hours
	Every 2 hours for 8 hours, then every 4 hours for 8 hours
	Every hour for 8 hours, then every 8 hours
	Every hour

Rationale: Monitor the patient every hour during the first 24 hours to ensure patient safety and minimize potential adverse reactions to the medication or infusion.

Epidural analgesics are administered into the:

	subarachnoid space.
	muscle.
	spinal cord.
	epidural space.

Rationale: Epidural analgesics are administered into the epidural space and are then diffused into the cerebrospinal fluid.

When documenting this procedure, in addition to noting the medication, route, and dose administered, what should you document?

	The patient's response to treatment.
	The patient's response to treatment and vital signs.
	The patient's response to treatment and vital signs, catheter patency, and the condition of the dressing and insertion site.
	The condition of the insertion site.

Rationale: You must document the patient's response to treatment and vital signs, catheter patency, and the condition of the dressing and insertion site.

During epidural administration, you should notify the doctor immediately if the patient's respirations are:

	less than 16 breaths/minute or systolic blood pressure is less than 90 mm Hg.
	more than 18 breaths/minute or systolic blood pressure is less than 100 mm Hg.
	less than 10 breaths/minute or systolic blood pressure is less than 90 mm Hg.
	less than 14 breaths/minute or systolic blood pressure is more than 150 mm Hg.

Rationale: If a patient's respirations are less than 10 breaths/minute or systolic blood pressure is less than 90 mm Hg, it could indicate serious complications or adverse reactions that may require immediate intervention.

Which drugs should you have readily available during epidural medication administration?

	Naloxone and ephedrine
	Diphenhydramine and nalmefene
	Alteplase and epinephrine
	Vasopressin and heparin

Rationale: Naloxone and ephedrine must always be on hand during epidural medication administration for emergency situations.

Home use of epidural anesthesia is considered only when:

	the patient agrees to abstain from illicit drugs and alcohol.
	the patient is younger than age 65.
	the patient consents to daily visits with a home care nurse.
	the patient is in hospice care.

Rationale: Alcohol and illicit drugs potentiate opioid action and should be avoided by a patient using epidural anesthesia at home.

A patient's most recent blood pressure was 82/44 mm Hg. The doctor is planning on inserting an epidural catheter this afternoon. You understand that:

	this is acceptable as long as IV fluids are administered continuously.
	this patient would not be a candidate for the epidural.
	only certain medications can be administered if the patient's blood pressure is this low.
	you would need to strictly monitor the patient's blood pressure throughout the epidural therapy.

Rationale: The patient has hypotension, which contraindicates epidural anesthesia.

Subcutaneous injection: 

Results A patient is receiving insulin via a non-needle catheter system. How often should you change the system's catheter?

	Every 5 days
	Every 2 days
	Weekly
	Daily

Rationale: You should change the system's catheter every 2 to 3 days.

You're collecting equipment for administration of a subcutaneous injection. Which piece of equipment is optional?

	Gloves
	Patient's medication record
	Antiseptic pads
	Insulin syringe

Rationale: An insulin syringeis considered optional for administration of a subcutaneous injection.

How far away from the umbilicus should you inject heparin?

	1"
	1½"
	2"
	½"

Rationale: The preferred site for a heparin injection is the lower abdominal fat pad, 2″ beneath the umbilicus, between the right and left iliac crests.

What size syringe should you use for a subcutaneous injection?

	5- to 10-mL
	0.5- to 1-mL
	1- to 3-mL
	3- to 5-mL

Rationale: You should use a 1- to 3-mL syringe for a subcutaneous injection.

You note that a patient has a scar on her abdomen. How far away from the scar should you administer a subcutaneous injection?

	At least 3" away
	At least 1" away
	At least 2" away
	At least 1½" away

Rationale: Don't administer any injections within 2" of a scar.

What is the preferred site for heparin injection?

	Lateral upper arms and thighs
	Upper back
	Lower abdominal fat pad
	Upper hips

Rationale: The preferred site for heparin injection is the lower abdominal fat pad, just below the umbilicus.

You must always inject heparin at what angle of insertion?

	30 degrees
	60 degrees
	90 degrees
	45 degrees

Rationale: You must always inject heparin at a 90-degree angle.

You note that a patient bruises easily. How long should you apply ice to a site after a subcutaneous injection to minimize local hemorrhage?

	5 minutes
	15 minutes
	20 minutes
	10 minutes

Rationale: Apply ice to the site for the first 5 minutes after the injection to minimize local hemorrhage.

What volume of solution is typically administered by subcutaneous injection?

	0.1 to 0.5 mL
	0.5 to 2 mL
	3.5 to 4.5 mL
	2.5 to 3.5 mL

Rationale: A volume of 0.5 to 2 mL of solution is typically administered by subcutaneous injection.

What gauge needle should you use for a subcutaneous injection?

	22G to 24G
	24G to 26G
	20G to 22G
	25G to 27G

Rationale: You should use a 25G to 27G needle for a subcutaneous injection.

How long should you leave a needle in place after an injection of heparin?

	15 seconds
	20 seconds
	5 seconds
	10 seconds

Rationale: Leave the needle in place for 10 seconds after injection of heparin, and then withdraw it.

What is the most appropriate angle of insertion for a subcutaneous injection?

	0 or 15 degrees
	45 or 90 degrees
	15 or 30 degrees
	30 or 45 degrees

Rationale: Insert the needle for a subcutaneous injection at a 45- or 90-degree angle.

What size fat fold should you grasp when administering a subcutaneous injection?

	2"
	½"
	1"
	¾"

Rationale: Grasp the skin around the injection site, forming a 1" fat fold.

What complication can develop if you don't rotate injection sites?

	Lipodystrophy
	Septicemia
	Sterile abscesses
	Extensive bruising

Rationale: You can minimize lipodystrophy by rotating injection sites.

Extravasation management:

 Results What should you do first if you suspect extravasation?

	Wash the site with warm, soapy water.
	Immobilize and elevate the affected extremity to reduce further dissemination of the vesicant.
	Apply pressure to the site.
	Stop the infusion.

Rationale: If you suspect extravasation, you should immediately stop the infusion because the degree of injury to local tissue is related to the vesicant's properties and concentration and the amount of drug extravasated.

Extravasation is the escape of which type of drug into the surrounding tissue?

	Vesicant
	Cardioactive
	Any IV drug
	Any drug

Rationale: Extravasation is the escape of a vesicant drug into the surrounding tissue.

When should you check the site for extravasation?

	Every 4 hours
	Only when swelling occurs
	Whenever the site is in use for an infusion
	Regularly and whenever a patient reports unusual sensations

Rationale: Check the site for extravasation regularly and whenever the patient reports unusual sensations, such as pain, pruritus, swelling, and warmth.

Which antidote is approved for treating cisplatin extravasation?

	Carbon dioxide
	Dimethyl sulfoxide
	Sodium bicarbonate
	Phentolamine

Rationale: Dimethyl sulfoxide is an approved antidote for extravasation of such alkylating agents as cisplatin.

What causes extravasation?

	Drug alkalinity
	Drug acidity
	Puncture or leakage around the site
	Injury to the site

Rationale: Extravasation is caused by a punctured vein or leakage around the venipuncture site.