A nurse is preparing to insert an IV catheter for an adult client.
Which of the following actions should the nurse take?
Choose the most proximal site on the extremity selected.
Apply a cool compress for several minutes before insertion of the IV catheter.
Place the tourniquet below the proposed insertion site.
Place the extremity in a dependent position.
The Correct Answer is D
The nurse should place the extremity in a dependent position before inserting an IV catheter.
This helps to dilate the veins and make them more visible and easier to access.
Choice A is wrong because the nurse should choose a site that is distal to the most proximal site on the extremity selected.
This helps to preserve more proximal sites for future use if needed.
Choice B is wrong because applying a cool compress before insertion of an IV catheter can cause vasoconstriction and make it more difficult to access the vein.
Instead, a warm compress can be applied to help dilate the veins.
Choice C is wrong because the tourniquet should be placed above, not below, the proposed insertion site to help dilate the vein and make it easier to access.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Change the tubing set every 72 hr:Continuous enteral feeding tubing sets should generally be changed every 24 hours to reduce the risk of bacterial contamination. Changing every 72 hours is too long and increases infection risk.
B. Aspirate residual volume every 4 hr:Aspiration of residual volume every 4 hours is standard practice when providing continuous enteral feedings. This ensures the client is tolerating the feedings and helps prevent aspiration or overfeeding. Large residual volumes may indicate poor gastric emptying.
C. Flush the tubing with 10 mL of water every 2 hr:The tubing should be flushed with 30 mL of water every 4-6 hours (depending on protocol), not just 10 mL, to maintain tube patency and prevent clogging.
D. Heat the formula to 40.5° C (105° F):Formula should not be heated to such a high temperature. It should be administered at room temperature to avoid discomfort and potential damage to the gastrointestinal tract.
Correct Answer is ["C","D","E"]
Explanation
“I need to have a fire escape plan with my family,” “I will use the grab bars when getting in and out of the bathtub,” and “I need to check my medications for expiration dates” are all important home safety measures.
Choice A is wrong because setting the hot water heater to 140 degrees Fahrenheit is too high and can increase the risk of scalding.
The recommended temperature for a hot water heater is 120 degrees Fahrenheit.
Choice B is wrong because applying tape over frayed areas of electrical cords is not a safe solution.
Frayed electrical cords should be replaced to prevent electrical hazards.
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