A nurse is preparing to insert an IV catheter for a client.
Which of the following actions should the nurse plan to take?
Choose a vein that is palpable and straight.
Select a site on the client's dominant arm.
Apply a tourniquet below the venipuncture site.
Elevate the client's arm prior to insertion.
The Correct Answer is A
Choice A rationale:
Choosing a palpable and straight vein is essential for a successful IV insertion. A vein that is easily palpable and visible helps ensure that the catheter can be inserted smoothly, reducing the risk of complications such as infiltration or extravasation. Additionally, selecting a straight vein makes the insertion process easier and less painful for the client.
Choice B rationale:
Selecting a site on the client's dominant arm is not a requirement for IV insertion. The choice of arm depends on the individual client's condition, vein accessibility, and the healthcare provider's preference. Both arms can be used for IV insertion based on the client's specific needs.
Choice C rationale:
Applying a tourniquet below the venipuncture site helps distend the veins, making them more visible and accessible. This technique can aid in locating suitable veins for insertion. However, it is crucial to release the tourniquet once the vein is accessed to prevent complications such as thrombosis or hematoma.
Choice D rationale:
Elevating the client's arm prior to insertion can cause veins to collapse, making it more challenging to insert the IV catheter. Gravity can assist in distending the veins, so the arm should be positioned at or slightly below the level of the heart during IV insertion to maintain adequate blood flow.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Placing the client's hands in warm water is a method to stimulate urination and is appropriate for clients experiencing difficulty voiding.
Choice B rationale:
Performing a fundal massage is incorrect choice in this scenario.
Choice C rationale:
Administering a benzodiazepine is not appropriate for this situation. Benzodiazepines are a class of medications primarily used for anxiety, insomnia, and seizures. There is no indication for the use of benzodiazepines in this case, as the client's inability to urinate is likely related to a physiological issue postpartum, not anxiety or seizures.
Choice D rationale:
Placing an ice pack on the client's perineum is not the correct intervention for this situation. Ice packs on the perineum are typically used to reduce swelling and relieve pain after childbirth. However, the client's inability to urinate suggests a potential issue within the urinary system, and a fundal massage to promote uterine contractions would be more appropriate.
Correct Answer is C
Explanation
Choice A rationale:
Expressing concern about another shift's holiday hours does not necessarily involve interpersonal conflict. It may reflect dissatisfaction but doesn't involve direct conflict between individuals.
Choice B rationale:
A personal difficulty with caring for clients who have HIV could be a challenge for the nurse, but it's not an example of interpersonal conflict. It represents a personal struggle rather than a conflict with another individual.
Choice C rationale:
Insulting comments directed at a nurse by another nurse represent interpersonal conflict. Such behavior involves a direct clash of personalities and can create a hostile work environment, affecting the nurse's well-being and job performance. Addressing this type of conflict is crucial for maintaining a positive work atmosphere.
Choice D rationale:
Submitting a complaint about another department's handoff reporting might indicate dissatisfaction or concerns about workflow, but it's not necessarily an interpersonal conflict. It could be a communication issue or a difference in professional opinion rather than a direct clash between individuals.
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