A nurse is caring for a client who is at 37 weeks of gestation and experiences a spontaneous rupture of membranes before labor has begun. Which of the following actions should the nurse take?

Rationale:
A. Select a vein on the back of the hand: Veins on the dorsum of the hand are more fragile in older adults and have less subcutaneous tissue, increasing the risk of infiltration or phlebitis. Larger veins on the forearm are preferred for safer and more stable IV access.

B. Apply a tourniquet firmly above the insertion site: Excessive tourniquet pressure can damage fragile veins and impair circulation in older adults. The tourniquet should be applied gently enough to distend the vein without causing bruising or discomfort.

C. Clean the site using vigorous friction: Vigorous scrubbing can irritate or damage delicate skin in older adults. The site should be cleansed using gentle, circular motions with appropriate antiseptic solution to reduce infection risk without causing trauma.

D. Use a 22-gauge catheter for insertion: A 22-gauge catheter provides an appropriate balance between ease of insertion and adequate flow rate for older adult clients. Smaller-gauge catheters minimize trauma to fragile veins while still allowing effective IV therapy.

Rationale:
A. Encourage the client to eat a large meal in the evening: Clients with myasthenia gravis experience progressive muscle weakness, especially later in the day. Eating large evening meals increases the risk of fatigue and aspiration because muscle strength is reduced after activity.

B. Recommend the client eat within 45 min of taking cholinesterase-inhibitor medication: Cholinesterase inhibitors, such as pyridostigmine, enhance neuromuscular transmission and improve muscle strength. Eating within 45 minutes of taking the medication ensures optimal swallowing ability and reduces the risk of aspiration by aligning mealtime with peak effect.

C. Recommend the client extend their neck to facilitate swallowing: Extending the neck actually increases the risk of aspiration by opening the airway. Clients should be instructed to flex the neck slightly forward while swallowing to close the airway and promote safe swallowing mechanics.

D. Encourage the client to contact an occupational therapist to learn techniques of avoiding aspiration: While an occupational therapist can provide helpful adaptive techniques, primary aspiration prevention teaching should come directly from the nurse and speech-language pathologist.