A nurse is attempting to flush the IV saline lock for a client. The client reports pain above the catheter site. Which of the following actions should the nurse take?

Apply a warm compress to the IV site.

Remove the IV saline lock.

Inject the solution more slowly while flushing the IV saline lock.

Apply firm pressure to the plunger of the syringe during the NV flush to improve patency.

Answer and Explanation

The Correct Answer is B

A. Apply a warm compress to the IV site: While warm compresses can sometimes help alleviate discomfort associated with certain IV complications, such as phlebitis or infiltration, they should not be applied until the cause of the pain is identified. In this case, removing the IV saline lock is the priority action to assess the site properly.

B. Remove the IV saline lock: Pain above the catheter site during flushing may indicate infiltration or phlebitis, both of which require intervention. Removing the IV saline lock allows the nurse to assess the site for signs of complications such as swelling, redness, or coolness to the touch. Once removed, the nurse can then determine the appropriate course of action, such as reinserting the IV at a different site, applying warm compresses, or notifying the healthcare provider if further evaluation or treatment is necessary.

C. Inject the solution more slowly while flushing the IV saline lock: Injecting the solution more slowly may reduce discomfort during flushing, but it does not address the underlying cause of the pain. If there is infiltration or another issue with the IV site, continuing to flush slowly could exacerbate the problem.

D. Apply firm pressure to the plunger of the syringe during the IV flush to improve patency: Applying firm pressure to the plunger of the syringe during flushing is not appropriate when the client reports pain above the catheter site. This action could potentially force fluid into surrounding tissues, worsening infiltration or causing additional discomfort. It is essential to address the pain and assess the IV site before attempting to flush the saline lock again.

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Correct Answer is D

Explanation

A) Disenfranchised grief:
Disenfranchised grief occurs when a person's loss is not socially recognized or supported, such as the death of a pet or an ex-spouse. The client's situation does not indicate disenfranchised grief.

B) Anticipatory grief:
Anticipatory grief happens before an impending loss, such as when a loved one is terminally ill. The client is grieving after the loss, not before it.

C) Prolonged grief:
Prolonged grief, also known as complicated grief, involves intense, persistent, and disabling grief symptoms that interfere with normal functioning. The client’s decreasing grief and positive outlook indicate that they are not experiencing prolonged grief.

D) Uncomplicated grief:
Uncomplicated grief, also known as normal grief, is the natural response to loss. It includes a range of emotions and reactions that typically diminish over time as the individual adapts to the loss. The client’s decreasing grief severity and forward-looking attitude towards spending time with their grandchildren are characteristic of uncomplicated grief.

A. "It might help if I tried sleeping only on my back." B. "I’ll sleep better if I take a sleeping pill at night," C. "If could lose about 50 pounds, I might stop having so many apneic episodes." D. " I’ll get a humidifier to run at my bedside at night."

Correct Answer is C

Explanation

A. "It might help if I tried sleeping only on my back."
Sleeping on the back can actually worsen obstructive sleep apnea because gravity can cause the tongue and soft tissues to obstruct the airway more easily. The recommended position to reduce apneic episodes is to sleep on the side.

B. "I’ll sleep better if I take a sleeping pill at night."
Taking a sleeping pill can relax the muscles of the throat, which might worsen sleep apnea by increasing the likelihood of airway obstruction during sleep.

C. "If I could lose about 50 pounds, I might stop having so many apneic episodes."
Weight loss is a key factor in reducing the frequency and severity of obstructive sleep apnea. Excess weight, particularly around the neck, can increase the risk of airway obstruction during sleep.

D. "I’ll get a humidifier to run at my bedside at night."
While a humidifier can make the air more comfortable to breathe, it does not directly reduce the number of apneic episodes. It might help with symptoms like dry mouth or nasal congestion but is not a primary treatment for obstructive sleep apnea.

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A nurse is attempting to flush the IV saline lock for a client. The client reports pain above the catheter site. Which of the following actions should the nurse take?

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Correct Answer is D

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