Diploma of Nursing - HLTENN007 Student Assessment: Tasks 1 & 2

This document presents a comprehensive student assessment addressing various aspects of intravenous (IV) medication administration and related nursing care. The assessment covers topics such as the scheduling of IV medications, the rationale for IV drug administration, and the protocols for blood/blood product transfusions, including storage and compatibility considerations. It explores patient education before IV fluid administration, including potential side effects, and discusses common sites for Jelco/cannula insertion and securing techniques. The assessment also delves into nursing considerations before IV medication administration, the '8 Rs' of medication administration, and procedures to prevent medication errors. Risk assessment before IV medication, storage of IV medications (including Schedule 8 drugs), and the monitoring of 'trough and peak' levels are also addressed. Furthermore, the document examines patient complaints of pain at the Jelco/cannula insertion site, the differences between isotonic, hypotonic, and hypertonic solutions, and the role of electrolytes in the human body. It also addresses electrolyte imbalances, replacement solutions, and acid-base imbalances, including laboratory findings in respiratory and metabolic disorders. The assignment is based on the HLTENN007 Administer and monitor medicines and intravenous medication module for a Diploma of Nursing program.

Running Head: STUDENT ASSESSMENT: TASKS 1 AND 2
STUDENT ASSESSMENT: TASKS 1AND 2.
Name
Institutional affiliation

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STUDENT ASSESSMENT: TASKS 1 AND 2
Q1. What drug schedule is medication which is administered IV? Refer to drugs and
poison schedules by law
IV medications are an example of prescription-only medicines. They are classified under the
schedule IV of the drugs and poisons schedule of Australia (Schipp, 2012). These drugs are
prepared for therapeutic use. Their administration, however, requires supervision from a
professional medical practitioner (used to mean a qualified doctor, nurse, pharmacist). The
efficacy and safety of these drugs require further assessment to determine their potential to cause
harm to the patient (Australian government therapeutic goods administration. Scheduling basics,
2011).
Q2. What is the rationale for a doctor to prescribe medication to be administered IV? Take
into consideration bioavailability of drugs?
The reasoning behind the prescription of medications that are administered by IV is to achieve
the desired therapeutic effect as quickly as possible. IV administration releases drugs directly
into the bloodstream where they are distributed and carried to their target site for action ( Keers
et al., 2013). Before the prescription, a doctor considers the following: the health status of the
patient, to determine whether a rapid response is needed, the properties of the medication, since
some medicines are only feasible when administered intravenously, the dosage, etc. (The
Nursing Times, 2007).
Q3. You are required to administer blood/blood product to a patient. What is the protocol
for this procedure? Including storage of blood. What fluids are not compatible with
blood/blood products?
To begin with, I will check the identity of the patient and the blood bag in the presence of a
doctor or another nurse, to eliminate any possibility of transfusion errors, such as blood group

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incompatibility. I will then inspect the guidelines for rate of transfusion, and then obtain the
blood or blood samples from storage and administer it immediately using a new sterile blood
administration set in accordance with the instructions given by Klein and Anstee (2014). I will
then follow the progress of the transfusion and record it accordingly. Before and after
transfusion, I will confirm that the accepted blood storage instrument is operating optimally and
then store the blood in the required conditions in a refrigerator blood bank (Epstein, 2012).
Q4. What education will you give to your patient before you commence IV fluid
administration? Including possible side effects?
I will tell the patient the circumstances under which an IV therapy is done, and why it is being
performed to them. I will also inform them that the catheter is held in place using a transparent
dressing to facilitate the observation and monitoring of the IV site. I will urge them to alert me or
any other attendant in case they feel itched at the IV site, or when the site becomes red, or it
swells. I will tell them that the swelling, redness, itching, bleeding, or pain are signs of
undesirable effects. Furthermore, I will say to them that, the IV pump has an alarm and informs
them the purpose of the signal. I will urge them not to reinsert the IV catheter back in place if it
is pulled out but should alert the doctor or myself immediately.
Q5. What are the common sites for jelco/cannula insertion? How are you going secure the
cannula in place?
The sites include metacarpal veins, the dorsal vein network axillary basilic vein scalp veins such
as occipital veins and posterior auricular vein, the antecubital fossa, and the dorsal venous arch
and venous plexus of the foot. The cannula will be held in place by using a sterile tape. It will be
attached to the skin in such a way that it does not cause discomfort to the patient, and also stays
in place( lopez and Reyes-Ortiz, 2010).

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STUDENT ASSESSMENT: TASKS 1 AND 2
Q6. What are the nursing considerations before IV medication administration?
Prior to an IV administration, the nurse in charge should be well informed on the patient’s
medical history (Dabliz and Levine, 2012). The considerations include allergic reaction to the
drug, possible local reaction, urticaria, dyspnea, angioedema, and nasal congestion (Carlson,
1986). The nurse ensures that the IV catheter is placed correctly, to avoid irritation and vascular
damage caused by the push drugs. The nurse should also confirm that the right dosage is
administered and monitor the patient since IV medications tend to act rapidly ( Trim and Roe,
2004).
Q7. What are the 8 Rs for IV medication administration?
The rights of medication administration are recommendations that have been put in place to
minimize medical errors. They are: right patient, which ensures that the is medication is given to
the right patient; the correct route, where the nurse checks the order appropriateness of the path
of drug administration and ensures that they can receive the medication by the ordered route; the
right time of administration; the correct documentation to eliminate confusion; the right reason;
the right dosage; the right medication; and right response, where the patient is monitored for the
desired outcome (Kuperman et al., 2001).
Q8. What is the checking procedure for IV medication administration to prevent
medication error?
The checking procedure is a guideline that helps nurses to avoid medication errors. To ensure no
mistakes occur during IV medication administration, ensure that; the five rights of medication
administration are followed, proper medication reconciliation procedures are followed, double-
check the process before drug administration, IV medications are appropriately stored before,
and after use, the needles and catheter tubing to be used are new and sterile, and document

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STUDENT ASSESSMENT: TASKS 1 AND 2
everything clearly, always have a drug guide and in the correct manner (Alsulami, Choonara and
Conroy, 2014)
Q9. Before you administer IV medication what risk assessment you need to perform?
Evaluation of risks is done to point out the causes of errors and to establish an appropriate
preventive mechanism. Risk assessment helps the nurse avoid human errors that often occur
during drug administration (Cohen, 2007). It is carried out prior to IV medication, to ensure that
the medication is administered successfully to prevent any form of discomfort or even death to
the patient. The following will be checked; the volume of the medication, drug compatibility, the
rate at which the medication will be administered, the type of solvent used, and the additives
included (Westbrook et al., 2011).
Q10. How are IV medications stored? Include schedule drug 8.
Medicines are poisons and must be treated as such. All medications come with an expiry date
and guidelines for appropriate storage. Conditions for storage such as temperature, humidity,
duration should be adhered to for proper drug storage. The storage requirements for each drug
are to be applied to that drug alone because different drugs have different constituents which
confer various properties to the drug. Schedule 8 drugs are controlled medications. These drugs
have a high likelihood of being abused and causing addiction and must be appropriately secured
from the reach of patients, medical practitioners, and visitors ( Ewen et al., 2015).
. Q11. IV medication has 100% availability, why may doctor prescribe to monitor “trough
and peak” of a particular IV medication? Explain what the terminology means? Give 2
examples of drugs which require trough and peak levels.
The trough phase is the lowest concentration of a drug in a patient’s blood. The peak on the other
hand refers to the highest level a drug in the patient’s blood. For adequate medical care,

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therapeutic agents must be monitored properly. A doctor will prescribe to monitor the trough and
peak of a particular medication to help in the evaluation of the dosage levels of the drugs to be
administered and to determine whether an IV medication is consistently within the therapeutic
range. To assess the concentration of a drug during the trough, a specimen is taken before drug
administration, whereas during the peak phase, specimen collection is dependent on the route of
administration. Examples of peak and trough drugs are phenobarbital and digoxin.
Q12. Your patient is complaining of pain at site of jelco/cannula insertion. What you going
to do? State your actions including documentation
Pain is an early symptom of phlebitis and is an indication that the peripheral intravenous cannula
(PIVC) has malfunctioned. In this situation, I will remove the PIVC. I will then consider
inserting another catheter, in case the patient is still in need of a cannula. I will then place the
arm on the pillow, so that it rests in an elevated angle, and apply hot or cold packs to relieve the
inflammation and also offer paracetamol to the patient. I will then continue to monitor the
progress of the patient and document the cause of the pain and the progress of the patient after
the corrective measure.
Q13. Explain the difference of these types of solutions and state reason why and when they
would be administered, give an example for each:
Isotonic Solution is a solution that contains the same amount of solutes and water relative to the
cell’s cytoplasm. Isotonic solutions are administered to increase the volume of the extracellular
fluid, for instance, after surgery, blood loss, dehydration, etc.
Hypotonic Solution: is a solution whose concentration is lower than that of the cell’s interior.
When placed into a hypotonic solution, the cell takes up water via osmosis and swells.
Hypotonic solutions are administered in circumstances of cell dehydration, to bring the osmotic

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pressure of the cytosol back to normal, for instance when a patient develops diabetic ketoacidosis
(McNab et al., 2014).
Hypertonic Solution: this solution contains a higher amount of solutes as compared to the
cell’s cytosol. The cell, therefore, loses water by osmosis and shrinks. Hypertonic solutions are
administered mainly in the intensive care unit (ICU) to curb the rising side effects of pulmonary
edema (Wang, 2015).
Q.14.What are electrolytes? Explain the importance they play in the human body
Electrolytes are charged minerals that are found in the fluids, e.g., blood, urine sweat, semen, etc.
they are formed when essential minerals dissolve in the fluids, making them charged. Examples
of electrolytes include sodium, calcium, potassium, chloride, phosphate, and magnesium. They
are obtained mainly through diet. Electrolytes serve the following functions in the body;
functioning of the nervous system, muscle function e.g., calcium is needed for muscle
contraction, ensure proper hydration especially sodium, which maintains the osmotic pressure of
the body. Electrolytes are also involved in the maintenance of a pH range that is optimum for the
functioning of body organs (Hoorn, 2017).
Q15. What is electrolyte imbalance? Where would you find the information and how can
the imbalance be corrected?
Electrolyte imbalance is the deviation of the amount of electrolytes in the body from the normal,
causing a lack of equilibrium ( Balci et al., 2013). Electrolyte imbalance is caused by many
factors, including sweat during exercise, diarrhea, vomiting, blood loss, in the urine, etc. the
clinical manifestations for electrolyte imbalance vary depending on the type of electrolyte
involved and the amount lost or gained. Examples are; general body weakness, bone disorders,
seizures, twitching, irregularity in the heartbeat, nervous system disorders, confusion, etc. the

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STUDENT ASSESSMENT: TASKS 1 AND 2
condition is corrected by restoring the level of the electrolyte in question to normal, e.g., by
administration via IV.
Q16. What is electrolyte replacement solution? Explain and give an example of a situation
where replacement solution would be required.
Electrolyte replacement solution is a solution that is prepared by dissolving the appropriate
amount of the desired mineral into a proper volume of water and administered either orally or via
injection. It is delivered in circumstances of low electrolyte levels to bring the level back to
normal. It is also used to correct dehydration. Electrolyte replacement therapy may be needed in
a situation of excessive diarrhea. Diarrhea causes both electrolyte imbalance and dehydration.
Supplementing the body with the replacement 6therapy helps alleviate the symptoms of
electrolyte imbalance and dehydration (Suempelmann, 2010).
Q.17 Explain acid base imbalance, including laboratory results. What are the laboratory
findings in respiratory acidosis/alkalosis, metabolic acidosis/alkalosis?
The acid-base imbalance is an anomaly in the normal equilibrium of acids and bases in the body,
which results in a deviation of the plasma pH out of the normal range. The normal plasma pH
range of the body is between 7.35 to 7.45. Laboratory results showing plasma pH below 7.35 or
above 7.45 indicates an acid-base imbalance. Acid-base imbalance causes either acidosis or
alkalosis. Acidosis and alkalosis can either be respiratory, which arises due to a problem in the
lungs, and metabolic, which arises due to a problem with the kidneys. Laboratory results for
respiratory acidosis are: excess CO2 retention, pH< 7.35, HCO3- > 28 mEq/L (if compensating),
and PaCO2 > 45 mm Hg. For respiratory alkalosis, the results are: excess CO2 excretion, pH >
7.45, HCO3- < 24 mEq/L (if compensating), PaCO2 < 35 mm Hg. The findings for metabolic
acidosis include HCO3- loss (acid retention), pH < 7.35, HCO3- < 24 mEq/L, and PaCO2 > 35

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STUDENT ASSESSMENT: TASKS 1 AND 2
mm Hg (if compensating), while those for alkalosis are: HCO3- retention (acid loss), pH > 7.45,
HCO3- > 28 mEq/L, and PaCO2 > 45 mm Hg (nurselearning.com, n.d).
Q18 What kind of documentation you need before you administer IV fluids/medications?
Before intravenous fluid administration can start a nurse must have necessary documents that are
required for the procedure to take place. The documents are; a record of the patient’s medical
history, laboratory results if any, and a document for monitoring and recording the progress of
the patient
Q19 Give an example and name of one drug from each group of medications that could be
administered IV:
 Beta-blockers: metoprolol, e.g., Toprol XL
 calcium channel blockers: verapamil, e.g., Calan
 Anti-hypertensives (other): enalapril
 Diuretics: Thiazide diuretics, e.g., metolazone
 Statins: lovastatin, e.g., altoprev
 Anticoagulants: thrombin inhibitors, e.g., Angiomax (Pro)
 Sedatives: benzodiazepines, e.g., Valium.
 Antidepressants: selective serotonin reuptake inhibitors (SSRIs), e.g., Prozac
(fluoxetine)
 Antipsychotics: antipsychotic drugs used to treat bipolar disorder, e.g., aripiprazole
 Antimicrobials: streptomycin
 Vitamins/minerals: prenatal plus

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STUDENT ASSESSMENT: TASKS 1 AND 2
 H2-inhibitors: Famotidine
 Proton pump inhibitors: esomeprazole, e.g., Nexium IV
 Antiemetic’s: antiemetic drugs for motion sickness, e.g., diphenhydramine
 Hypoglycemic agents: Sulfonylureas, e.g., glimepiride
 Respiratory medication: antihistamines, e.g., Allegra
 Analgesics: oxycodone, e.g., Roxicodone
 Narcotics: narcotic analgesics, e.g., morphine
 Steroids: corticosteroids, e.g., bethamethasone
 Anesthetics: barbiturates, e.g., methohexital
 Anticonvulsants: Depakene e.g., valproic acid.
Q20. Define following terms in one or two sentences:
· Drug toxicology is the study of adverse chemical substances and their effects on living
organisms.
· Anaphylactic reaction: is a severe allergic reaction to substances that occurs within minutes of
exposure to the allergen.
· Contraindications: are directives to medical practitioners not to administer a particular drug,
or undertake a certain procedure due to its potentially detrimental side effects to a patient’s
health.
· Precautions: precautions are measures which when taken, prevents harmful side effects of a
drug from occurring.
What is the difference between a side effect and an adverse reaction?

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STUDENT ASSESSMENT: TASKS 1 AND 2
A side effect is an undesirable symptom resulting from substance administration. Side effects
arise when a treatment goes beyond the desired effect. An adverse reaction, on the other hand, is
an unintended therapeutic event that is usually either unforeseen or arises from a dangerous
reaction of the body to the drug (leaman et al., 2010).
Q21. IV tubing must be changed every 72 hours. True or False?
True. A catheter set that remains attached to the patient continuously must be replaced after
every 72 hours to breaks in the closed administration system (Nursing 2007, 2007). The IV
system should also be replaced whenever there is a cause to believe that the sterility of the fluid
pathway has been compromised. Changing the Catheter ensures that the safety of the patient is
upheld, and also prevents any possibility of infections to people visiting the patient. Furthermore
replacing the IV tubing eliminates any chances of blockage of the tubing that will compromise
drug administration.
Q22. It is not necessary to wear gloves when discontinuing an IV since there is no risk of
exposure to blood or other body fluids. True or false?
False. A nurse must always be gloved when handling their patients, especially where body fluids
are involved. Wearing gloves protects both the nurse and the patients from infection from the
other. Discontinuing an IV leaves a wound on the patient, which allows the flow of blood from
the patient before clotting kicks in. Gloves also protect the nurse from contaminations on the IV
system.
Q23. In order to prevent needle, stick and exposure to blood borne pathogens, it is of
utmost importance that health care professionals dispose of all used IV catheters and
cannulas in the proper container. True or False?

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STUDENT ASSESSMENT: TASKS 1 AND 2
True. The IV tubing system must be disposed of correctly and in the right container, to prevent
contamination. Needles and other sharp objects must be disposed of in a separate container from
blunt objects (Pat Crellin, 2015). The containers should be appropriately labeled, to avoid any
confusion that may lead to contamination. Fluid wastes should be disposed of down the sink,
which should then be sterilized. Collected solid wastes including used gloves should be
incinerated.
Q24. The doctor orders an isotonic fluid for a patient. Which of the following is not an
isotonic fluid?
A) 0.9% Normal Saline
B) 5% dextrose in water
C) Lactated Ringer’s
D) 5% Dextrose in Lactated Ringer’s
(D) 5% Dextrose in Lactated Ringer’s is a hypertonic solution (Perry and Ostendorf, 2016). It
contains Sodium chloride USP, Sodium lactate, potassium chloride USP; calcium chloride
dehydrate USP and hydrous dextrose USP. Administration of 5% dextrose in lactated Ringer’s is
given to replenish electrolytes and calories. It also acts as a source of water for hydration. It
contains lactate that produces a metabolic alkalinizing effect. It is given to both adult and
pediatric patients and is inadvisable not to administer in conditions where sodium, potassium,
calcium, chloride, or lactate are detrimental to the health of the patient.
Q26 A patient is being admitted with dehydration due to nausea and vomiting. Which fluid
would you expect the patient to be started on?
A) 0.225 Saline
B) 5% Dextrose