A client, who is receiving intravenous chemotherapy into a peripheral vein, says that the arm burns terribly in and around the intravenous site. What is the nurse's best first action?

Slow the rate of infusion

Apply a warm compress to the site

Discontinue the infusion

Check for blood return

Answer and Explanation

The Correct Answer is C

A. Slowing the rate of infusion may provide some temporary relief, but it does not address the underlying issue and may worsen the situation.
B. Applying a warm compress may soothe discomfort but is not the priority action when a burning sensation is reported, which could indicate potential extravasation.
C. Discontinuing the infusion is the best first action to prevent further damage to the tissue and to assess for complications such as infiltration or extravasation.
D. Checking for blood return can help assess the patency of the IV line, but the priority is to stop the infusion immediately to prevent complications.

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Correct Answer is C

Explanation

A. Using a commercial medicine to remove a corn is not recommended, as it can cause skin damage and infection; diabetic clients should seek professional care for such issues.
B. Soaking feet daily in cool water can lead to skin maceration and should generally be avoided; it is better to wash and dry feet gently.
C. Utilizing a mirror to examine the soles of the feet indicates proper awareness and self-care, as diabetic clients need to monitor for any injuries or changes that could lead to complications.
D. Cutting nails in a concave manner is incorrect; nails should be cut straight across to prevent ingrown toenails.

A. Applies pressure to all injection sites for 5 minutes B. Monitors telemetry every hour during therapy C. Ensures the client has a fluid intake of 3000 to 5000 mL/day D. Assists the client in all ambulatory activities

Correct Answer is C

Explanation

A. Applying pressure to injection sites helps reduce bleeding but does not directly prevent tumor lysis syndrome.
B. Monitoring telemetry is important for patients with potential cardiac issues but is not specifically related to preventing complications from tumor lysis syndrome.
C. Ensuring a high fluid intake of 3000 to 5000 mL/day helps dilute electrolytes and reduce the risk of acute kidney injury and other complications associated with tumor lysis syndrome, making this the most crucial intervention.
D. Assisting the client in ambulatory activities may support their overall well-being but does not address the prevention of tumor lysis syndrome.

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A client, who is receiving intravenous chemotherapy into a peripheral vein, says that the arm burns terribly in and around the intravenous site. What is the nurse's best first action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse teaches a diabetic client how to perform foot care. Which action by the client would indicate that they can correctly perform foot care?

Correct Answer is C

Explanation

Which intervention is most important for the nurse to implement to prevent complications from tumor lysis syndrome during chemotherapy?

Correct Answer is C

Explanation

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