A nurse is caring for an 8-month-old infant who is receiving intravenous (IV) fluids via a 24-gauge catheter.
Which of the following statements by the client's mother indicates that the nurse should check the site for signs of infiltration?.
"There's blood backing up my baby's IV tubing.”.
"There's a long red streak up my baby's arm.”.
"The tape is coming off the IV needle.”.
"My baby's fingers are looking swollen.”. .
The Correct Answer is D
Choice A rationale:
Blood backing up in the IV tubing indicates a problem with the IV line, not necessarily infiltration.
Choice B rationale:
A long red streak up the arm could indicate phlebitis, not infiltration.
Choice C rationale:
Loose tape could cause the IV needle to dislodge, but it doesn’t directly indicate infiltration.
Choice D rationale:
Swelling around the IV site is a common sign of infiltration.
So, the correct answer is D. “My baby’s fingers are looking swollen.”.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["10"]
Explanation
Step 1 is to calculate the number of tablets needed to administer 225 mg of desipramine. This is done by dividing the prescribed dose (225 mg) by the strength of each tablet (75 mg). So, 225 mg ÷ 75 mg/tablet = 3 tablets.
So, the correct answer is 3 tablets.
Correct Answer is A
Explanation
Choice A rationale:
Withholding the dose if having a fine hand tremor is not recommended. Hand tremors are a common side effect of lithium, but they can be managed by adjusting the dose.
Choice B rationale:
Avoiding foods with a high tyramine content is not necessary for lithium users. This dietary restriction is typically associated with certain antidepressants, not lithium.
Choice C rationale:
Limiting daily fluid intake is incorrect. Lithium can cause increased thirst and urination, so it’s important to maintain adequate hydration.
Choice D rationale:
Following a low-sodium diet is not advised. Both salt and fluid can affect the levels of lithium in your blood, so it’s important to consume a steady amount every day.
So, the correct answer is, none of the above.
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