A nurse is preparing to administer a medication for a client through a nontunneled percutaneous central catheter. Which of the following actions should the nurse take?
Close the inline clamp.
Flush the catheter with 10 mL of 0.9% sodium chloride.
Apply a local anesthetic to the skin.
Don sterile gloves.
The Correct Answer is B
A. Closing the inline clamp is necessary when the catheter is not in use to prevent air embolism, but it is not a required step before administering medication. The nurse should focus on flushing and checking for patency before medication administration.
B. Flushing the catheter with 10 mL of 0.9% sodium chloride before and after medication administration helps maintain patency, prevents occlusion, and ensures the catheter is functioning properly. This step is essential to avoid complications such as clot formation.
C. Applying a local anesthetic is not needed for routine medication administration through a nontunneled percutaneous central catheter. Anesthetic use is typically reserved for procedures like catheter insertion or painful dressing changes.
D. Donning sterile gloves is not required for medication administration through a central line. Clean gloves are sufficient, while sterile technique is reserved for dressing changes and catheter insertions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Palpate the dorsalis pedis pulse: Assessing distal pulses ensures adequate circulation to the affected extremity. Impaired blood flow can indicate compartment syndrome or vascular compromise, which are serious complications following fracture stabilization. The nurse should also monitor capillary refill, skin temperature, and sensation.
B. Maintain the affected extremity in a dependent position: Keeping the extremity in a dependent position can increase swelling and venous congestion, leading to complications such as compartment syndrome. Elevation is recommended to minimize edema and promote venous return.
C. Wrap sterile gauze on the sharp point of the pins: The pin sites should be left uncovered to allow for proper monitoring of signs of infection or loosening. Instead, pin site care should be performed per facility protocol to reduce infection risk.
D. Adjust the clamps on the fixator frame: Adjusting the external fixator clamps is outside the nurse's scope of practice. Any modifications to the device should be performed by the orthopedic provider to prevent improper alignment and complications.
Correct Answer is A
Explanation
A. Apply an ice pack to the client's knee: Ice application helps reduce pain and inflammation by decreasing swelling around the surgical site. Cold therapy also numbs nerve endings, providing pain relief for clients after knee arthroplasty.
B. Place pillows under the client's knee: Elevating the knee with pillows can promote flexion contractures and is generally avoided after knee arthroplasty. Instead, the leg should be kept extended and supported to encourage proper alignment and prevent complications.
C. Perform range-of-motion exercises to the client's knee: While range-of-motion exercises are important for rehabilitation, they should be done at scheduled times and not during episodes of acute pain, as they could exacerbate discomfort.
D. Gently massage the area around the client's incision: Massaging near the incision site is not recommended, as it could disrupt healing tissue, increase pain, and pose a risk of infection.
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