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A nurse is preparing to discontinue a client's intravenous infusion. Identify the sequence the nurse should follow to remove the IV catheter. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Apply pressure to the venipuncture site with sterile gauze.

Perform hand hygiene.

Clamp the IV tubing.

Withdraw the catheter from the client's vein.

Remove the dressing and tape from the venipuncture site.

Answer and Explanation

The Correct Answer is B,E,C,A,D

Correct order:

Perform hand hygiene.
Remove the dressing and tape from the venipuncture site.
Clamp the IV tubing.
Apply pressure to the venipuncture site with sterile gauze.
Withdraw the catheter from the client's vein.

Rationale:

Hand hygiene is the first step to prevent infection before touching any equipment or the client.
Removing the dressing and tape is done after hand hygiene to expose the IV insertion site, preparing it for removal.
Clamping the IV tubing helps stop the infusion and prevents blood from flowing out when the catheter is removed.
Applying pressure with sterile gauze helps to prevent bleeding and hematoma formation after the catheter is removed.
Withdrawing the catheter should be the final step to complete the procedure.

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Correct Answer is C

Explanation

A. "Cervical cancer screenings should begin at age 40.": Screenings start at age 21, not 40.
B. "Plan to continue cervical cancer screenings for the rest of your life.": Screenings can stop after age 65 if the client has had adequate prior screening and no high-risk factors.
C. "You should get a Papanicolaou (Pap) test and human papillomavirus test every 5 years.": Current guidelines recommend Pap and HPV co-testing every 5 years for women aged 30–65.
D. "If you are immunized against human papillomavirus, you don't need cervical cancer screenings.": HPV vaccination reduces risk but does not eliminate the need for routine screening.

A. Current medication prescriptions B. Primary health problem C. Number of family members who have visited D. Admission vital signs from 1 week ago E. Scheduled times for dressing changes

Correct Answer is ["A","B","E"]

Explanation

A. Current medication prescriptions: Ensures continuity of care and proper medication administration in the ICU.
B. Primary health problem: Provides the ICU team with context about the client’s current condition and reason for transfer.
C. Number of family members who have visited: This is not clinically relevant to the client's care.
D. Admission vital signs from 1 week ago: Historical vitals are not as critical as current or recent findings.
E. Scheduled times for dressing changes: Provides critical information about ongoing wound care needs.

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A nurse is preparing to discontinue a client's intravenous infusion. Identify the sequence the nurse should follow to remove the IV catheter. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Nursing Test Bank

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