A nurse is teaching a class about providing care within the legal stope of practice to a group of nurses. The nurse should include that which of the following procedures is outside the legal scope of practice for an RN?

A. A client who has a right peripherally inserted central catheter (PICC):
When a client has a right-sided PICC, it's essential to measure blood pressure in the left arm. This is because the PICC line can interfere with accurate blood pressure readings on the right side due to the placement of the cuff and potential obstruction of blood flow. Measuring blood pressure in the left arm provides a more accurate assessment of systemic blood pressure.

B. A client who had a right hemisphere stroke:
While clients with a right hemisphere stroke may have various neurological deficits, there is no specific indication to measure blood pressure in the left arm based solely on this condition.

C. A client who had blood drawn from the right antecubital area 1 hr ago:
Blood drawn from the antecubital area typically does not affect blood pressure measurements in the same arm. Therefore, there is no need to measure blood pressure in the opposite arm in this situation.

D. A client who had dialysis and is using an arteriovenous shunt in the left lower forearm:
While clients with arteriovenous shunts may have altered blood flow dynamics, the use of a shunt in the left lower forearm does not necessarily require blood pressure measurements to be taken in the opposite arm. Blood pressure measurement should be performed on the side without the shunt unless contraindicated for other reasons.

A. Initiate IV access on the palmar side of the client's wrist. - This option is not recommended because veins on the palmar side of the wrist are smaller and more prone to infiltration and nerve damage. The dorsal aspect of the hand or forearm is typically preferred for peripheral IV access due to larger veins and decreased risk of complications.
B. Choose the client's dominant arm for IV access whenever possible. - While it may be convenient to select the dominant arm for IV access, it is not always the best choice. Factors such as previous venipunctures, condition of veins, and patient comfort should be considered when selecting the site for IV insertion.
C. Select a site proximal to previous venipuncture sites. - This is the correct action. Choosing a site proximal (above) to previous venipuncture sites helps preserve veins and reduces the risk of venous sclerosis or phlebitis. It allows for better vein integrity and decreases the likelihood of complications associated with repeated punctures in the same area.
D. Insert a larger gauge IV catheter to prevent phlebitis. - Inserting a larger gauge IV catheter is not necessary to prevent phlebitis. In fact, using a larger gauge catheter may increase the risk of phlebitis and other complications. The appropriate gauge of the catheter depends on the client's condition, the type of fluids or medications to be administered, and the condition of the veins.