A nurse is preparing to insert an IV catheter for an adult client. Which of the following actions should the nurse take?

Place the tourniquet above the proposed insertion site.

Place the extremity in a dependent position.

Choose the most proximal site on the extremity selected.

Apply a cool compress for several minutes before insertion of the IV catheter.

Answer and Explanation

The Correct Answer is A

Choice A reason:
When preparing to insert an IV catheter, placing the tourniquet above the proposed insertion site helps facilitate venous distension and makes it easier to locate a suitable vein for the catheter insertion. This technique helps to improve visibility and access to the vein.
Choice B reason:
Placing the extremity in a dependent position (lower than the heart) can increase venous pressure and make it more difficult to insert the catheter.
Choice C reason:
Choosing the most proximal site on the extremity is not always necessary or appropriate. Veins distal to the proposed insertion site should be considered first, as they tend to be smaller and less accessible.
Choice D reason:
Applying a cool compress is not typically done before IV catheter insertion. It might cause vasoconstriction and make it more difficult to access a suitable vein.

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Free Nursing Study Resources

Correct Answer is ["A","B","C","D"]

Explanation

a small amount of serosanguineous drainage,

Lung sounds are diminished in posterior lobes,

pain as 8 on a scale of 0 to 10,

Blood pressure 168/84 mm Hg

A. "New dressing applied as prescribed; no drainage on old dressing." B. "Client premedicated with MSO, sub prior to dressing change." C. "The wound seems clean and does not appear to be infected." D. "No changes noted to the wound from previous nursing notes."

Correct Answer is A

Explanation

Choice A reason:
"New dressing applied as prescribed; no drainage on old dressing. “This entry provides clear and concise information about the action taken (applying a new dressing as prescribed) and the assessment of the old dressing (no drainage present). It accurately reflects the dressing change process and the status of the wound.
Choice B reason:
"Client premedicated with MSO, sub-prior to dressing change." This entry is incorrect because it provides information about the client being premedicated, but it doesn't specifically address the dressing change or the pressure injury.
Choice C reason:
"The wound seems clean and does not appear to be infected." While this entry provides an assessment of the wound's cleanliness and potential infection, it lacks specific details about the dressing change itself.
Choice D reason:
"No changes noted to the wound from previous nursing notes." This entry focuses on comparing the wound to previous notes but doesn't provide information about the current dressing change or assessment.

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A nurse is preparing to insert an IV catheter for an adult client. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","B","C","D"]

Explanation

A nurse is documenting a dressing change for a client who has a pressure injury. Which of the following entries by the nurse demonstrates correct documentation?

Correct Answer is A

Explanation

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