A nurse identifies an extravasation of a vesicant solution at a client's peripheral IV catheter's insertion site. Identify the sequence in which the nurse should perform the following actions.
(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)
Disconnect the tubing from the catheter.
Remove the IV catheter.
Aspirate the solution from the catheter.
Stop the infusion.
Attach a syringe to the catheter.
The Correct Answer is D,A,E,C,B
The nurse should first stop the infusion (D) to prevent further infiltration of the vesicant solution. Next, the nurse should attach a syringe to the catheter (E) to prepare for aspiration.
Following this, the nurse should aspirate the solution from the catheter (C) to remove as much of the vesicant as possible. After aspiration, the nurse should disconnect the tubing from the catheter (A), ensuring that no additional vesicant is administered. Finally, the nurse should remove the IV catheter (B) to prevent any further exposure to the vesicant.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. This range represents the normal serum magnesium level. It is important for maintaining neuromuscular function and other vital processes in the body.
A. This range is too low for normal serum magnesium levels. Magnesium levels below this range can indicate hypomagnesemia, which can lead to symptoms such as muscle cramps, tremors, and cardiac arrhythmias.
C. This range is too high for normal serum magnesium levels. Elevated magnesium levels (hypermagnesemia) can occur in conditions such as renal failure or excessive magnesium intake, leading to symptoms like weakness, decreased reflexes, and in severe cases, cardiac arrest.
D. While this range is broader and includes the correct normal range (1.3-2.1 mEq/L), it also includes values that are below and above normal. Values below 1.3 mEq/L can indicate hypomagnesemia, while values above 2.1 mEq/L can indicate hypermagnesemia.
Correct Answer is A
Explanation
A. Using a filter needle is indeed a recommended practice when withdrawing medication from an ampule. This is because filter needles are designed to prevent glass particles from being drawn into the syringe after breaking the ampule.
B. Ampules should not be bent to open them. The proper method involves using a gauze or an ampule opener to snap the neck of the ampule away from the body. Bending the ampule can lead to shards of glass, risking injury to the nurse or contamination of the medication.
C. The ampule should be tapped gently to ensure all medication is in the lower portion before opening.
D. Withdrawing medication from the center of the ampule is the correct action because it ensures that the needle does not touch the broken glass edges, which could contaminate the medication or dull the needle.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.