A nurse is initiating IV therapy for client who had a right-sided mastectomy. In which of the following locations should the nurse place a catheter?

Wrist

Most proximal site

Cordlike vein

Left arm

Answer and Explanation

The Correct Answer is D

Choice A rationale: The wrist might not be the optimal site for IV catheter placement following a mastectomy due to potential limitations in venous access and increased risk of complications.
Choice B rationale: The most proximal site is not a specific location and may vary depending on the client's condition and anatomy.
Choice C rationale: The nurse should also avoid placing a catheter in a cordlike vein because they are more prone to infiltration, phlebitis, and nerve damage.
Choice D rationale: The left arm is the safest site to avoid complications such as lymphedema, infection, or thrombosis.

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Correct Answer is D

Explanation

Choice A rationale: Recurrent headaches might indicate the need for acetaminophen rather than warranting a provider notification.
Choice B rationale: Low blood pressure (BP 92/60 mm Hg) is not a contraindication for acetaminophen use.
Choice C rationale: Hypothyroidism might not directly impact the administration of acetaminophen.
Choice D rationale: Acetaminophen is metabolized by the liver and can cause hepatotoxicity in high doses or in clients who have liver impairment. A history of alcohol use disorder can indicate chronic liver damage and increase the risk of adverse effects from acetaminophen. Therefore, the nurse should notify the provider before administering the medication to this client.

A. Increased blood pressure B. Hypertonia C. Wheezing D. Urinary retention

Correct Answer is C

Explanation

Choice A rationale: While increased blood pressure can occur in various conditions, it might not specifically indicate anaphylaxis to penicillin.

Choice B rationale: Hypertonia might not directly correlate with anaphylaxis and could be caused by other factors.

Choice C rationale: Wheezing is a critical sign of anaphylaxis, a severe allergic reaction to penicillin. Reporting wheezing to the provider is crucial for immediate intervention to prevent further complications associated with anaphylaxis.

Choice D rationale: Urinary retention is not a typical manifestation of anaphylaxis to penicillin and might not be directly linked to the allergic reaction.

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A nurse is initiating IV therapy for client who had a right-sided mastectomy. In which of the following locations should the nurse place a catheter?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing a client's medical record before administering acetaminophen 650 mg PO every 6 hr. Which of the following findings indicates a need for the nurse to notify the provider?

Correct Answer is D

Explanation

A nurse is assessing a client who is receiving penicillin IV. For which of the following findings should the nurse report to the provider as a manifestation of anaphylaxis?

Correct Answer is C

Explanation

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