A nurse is instructing a school-age child who has asthma about the use of a peak expiratory flow meter.

Which of the following instructions should the nurse include in the teaching?

The correct answer is choice D. The nurse should choose a vein that is palpable and straight for IV catheter insertion.

This will facilitate the insertion of the catheter and reduce the risk of complications such as infiltration, phlebitis, or hematoma. A straight vein will also allow the catheter to be inserted up to the hub, which reduces the risk of contamination along the length of the catheter.

Choice A is wrong because selecting a site on the client’s dominant arm can interfere with the client’s mobility and increase the risk of dislodging the catheter. The nurse should choose a site on the client’s non-dominant arm, preferably on the hand or forearm.

Choice B is wrong because applying a tourniquet below the venipuncture site will impede blood flow and make it harder to locate a suitable vein. The nurse should apply a tourniquet above the venipuncture site, about 10 to 15 cm from the insertion site.

Choice C is wrong because elevating the client’s arm prior to insertion will decrease venous filling and make it harder to palpate a vein. The nurse should lower the client’s arm below the level of the heart to increase venous distension.

Normal ranges for IV catheter size and insertion angle depend on several factors, such as the type and duration of therapy, the condition and size of the vein, and the age and preference of the client.

In general, smaller gauge catheters (20 to 24) are preferred for peripheral IV therapy, and larger gauge catheters (14 to 18) are used for rapid fluid administration or blood transfusion. The insertion angle can vary from 10 to 30 degrees, depending on the depth and location of the vein.

safety followed by the client’s pain.

The nurse should first address the client’s safety because it is the most basic and essential need according to Maslow’s hierarchy of needs. The client may be at risk of abuse or neglect from his adult child, as evidenced by the bruises, body odor, unclean clothes, low BMI, and submissive behavior. The nurse should assess the client for signs of physical or emotional abuse and report any suspicions to the appropriate authorities. The nurse should also provide a safe and supportive environment for the client and encourage him to express his feelings and concerns.

The nurse should then address the client’s pain because it is a physiological need that affects the client’s comfort and well-being. The client rates his pain as 8 on a 0 to 10 scale and is not moving his right arm. The nurse should assess the client’s arm for signs of injury, such as swelling, deformity, or bleeding. The nurse should also administer analgesics as prescribed and monitor the client’s response to pain relief. The nurse should also provide non-pharmacological interventions, such as ice packs, elevation, or distraction.

The other choices are less urgent than safety and pain. The client’s abrasions are superficial and do not pose a significant risk of infection or bleeding. The client’s hygiene is important but not a priority at this time. The client’s BMI indicates that he is underweight, but this is a chronic condition that requires long-term nutritional intervention. The client’s heart rate is slightly elevated but not alarming, and may be due to pain, anxiety, or dehydration.