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

Answer and Explanation

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.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Rotate the application site every week (Correct Answer): This is the correct advice. Rotating the application site helps prevent skin irritation and enhances absorption. It's common practice to apply the patch to a different, clean, and hairless area of the skin each time it is changed.
B. The transdermal patch releases nicotine rapidly into the bloodstream: This statement is incorrect. The transdermal nicotine patch is designed to release nicotine gradually over an extended period. It provides a steady, controlled release of nicotine to help manage withdrawal symptoms and cravings.
C. Leave the patch in place for 8 hr each day: The specific duration for wearing a nicotine patch can vary depending on the product. However, it's generally recommended to wear the patch for 16 to 24 hours, depending on the product's instructions. Leaving it on for 8 hours only may not provide adequate coverage for the entire day.
D. The transdermal patch can cause insomnia: While insomnia is a potential side effect of nicotine replacement therapy, including the patch, it is not a universal experience for everyone. Insomnia is more likely to occur if the patch is worn continuously, including during the night. Following proper usage guidelines, such as removing the patch before bedtime, can help minimize this side effect.

A. Simvastatin 40 mg PO at bedtime B. Morphine 4 mg IV every 4 hr PRN for pain C. Levothyroxine 100 mcg PO every morning D. Acetaminophen 500 mg every 4 hr PRN for fever

Correct Answer is B

Explanation

A. Simvastatin 40 mg PO at bedtime: This prescription is clear and specifies the medication (Simvastatin), the dose (40 mg), route (PO – oral), and timing (at bedtime). There is no need for clarification.
B. Morphine 4 mg IV every 4 hr PRN for pain: The need for clarification arises here because "PRN" (pro re nata) means "as needed," and prescribing an IV medication on an as-needed basis might need further clarification regarding the specific indications and circumstances for administering the medication.
C. Levothyroxine 100 mcg PO every morning: This prescription is clear and specifies the medication (Levothyroxine), the dose (100 mcg), route (PO – oral), and timing (every morning). There is no need for clarification.
D. Acetaminophen 500 mg every 4 hr PRN for fever: Similar to option B, there might be a need for clarification regarding the specific indications and circumstances for administering acetaminophen on an as-needed basis. However, in many cases, PRN for fever is reasonable, so it may not be as critical as in the case of an IV pain medication.

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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?

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