A nurse is caring for a client who is receiving intravenous therapy and observes redness and inflammation along the vein. The nurse should identify this finding as which of the following complications of IV therapy?
Infiltration
Extravasation
Venous spasm
Phlebitis
The Correct Answer is D
A. Infiltration:
Infiltration refers to the inadvertent administration of a non-vesicant solution into the surrounding tissue. It is characterized by swelling, pallor, and coolness at the infusion site, but redness and inflammation along the vein are not typical signs of infiltration.
B. Extravasation:
Extravasation occurs when a vesicant solution (a substance that can cause tissue damage) infiltrates into the surrounding tissue. It can cause tissue damage and necrosis. While inflammation is a concern with extravasation, it is not the primary sign, and redness may occur later.
C. Venous spasm:
Venous spasm involves the constriction of the blood vessel, leading to decreased blood flow. It is not typically associated with redness and inflammation along the vein.
D. Phlebitis:
This is the correct answer. Phlebitis refers to inflammation of a vein, and it is characterized by redness, warmth, and tenderness along the course of the vein. Phlebitis can be caused by various factors, including irritants in the infused solution, mechanical trauma, or infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. BUN 15 mg/dL (Blood Urea Nitrogen):
BUN is a measure of kidney function, and an elevated BUN may suggest impaired kidney function. However, it is not a specific marker for azathioprine adverse effects.
B. WBC 3,000/mm² (White Blood Cell count):
This is the correct answer. Azathioprine can suppress bone marrow function, leading to leukopenia (low white blood cell count). A WBC count of 3,000/mm² indicates a lower-than-normal white blood cell count, which can increase the risk of infection.
C. Hct 45% (Hematocrit):
Hematocrit measures the percentage of red blood cells in the blood. While it can be affected by various factors, it is not a specific marker for azathioprine adverse effects.
D. Platelets 250,000/mm²:
Platelets are involved in blood clotting, and a platelet count of 250,000/mm² is within the normal range. Azathioprine is not typically associated with adverse effects on platelet counts.
Correct Answer is C
Explanation
A. Weight loss:
Weight lossis not typically associated with methimazole use. In fact, hyperthyroidism (such as in Graves’ disease) can lead to unintentional weight loss due to increased metabolism. Methimazole helps normalize thyroid function, but it doesn’t directly cause weight loss.
B. Increase in pulse rate:
While an increased pulse rate is a symptom of hyperthyroidism, the goal of methimazole treatment is to normalize thyroid function and, consequently, decrease the pulse rate over time.
C. Increased sleeping:
Increased sleeping:Methimazole works by inhibiting the production of thyroid hormones (T3 and T4) in the thyroid gland. It helps normalize thyroid function by reducing excessive hormone synthesis.As thyroid hormone levels decrease due to methimazole, the client’s metabolic rate may slow down. This can lead to feelings of fatigue and increased need for rest, resulting in more sleep.
D. Warmer skin:
Warmer skin is a symptom of hyperthyroidism. With effective treatment using methimazole, the normalization of thyroid function should lead to improved thermoregulation, potentially reducing the sensation of warmer skin.
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