Select words from the choices below to fill in each blank in the following sentence.

To further evaluate the client, the nurse anticipates the client will need

____

and

____

.

A) Place the client in Sims' position for catheter insertion: Sims' position (side-lying position) is not typically used for central venous catheter insertion. The client is usually placed in a supine or Trendelenburg position to help facilitate insertion and decrease the risk of air embolism during the procedure.

B) Prepare the client for a chest x-ray to verify catheter placement: After the insertion of a central venous catheter, a chest x-ray is routinely performed to verify the correct placement of the catheter in the superior vena cava or right atrium. This is essential to ensure the catheter is properly positioned and to check for complications like pneumothorax or inadvertent placement in the lung.

C) Use clean technique when changing the catheter dressing: When changing the dressing for a central venous catheter, sterile technique is required, not clean technique. Sterile technique minimizes the risk of infection, which is a major concern when caring for central venous access devices.

D) Verify the amount of TPN solution the client is receiving every 4 hr: While it is important to monitor the amount of TPN being infused and assess for complications, verifying the exact amount every 4 hours is not a standard procedure. Typically, TPN is managed and adjusted by the healthcare provider based on lab results, weight, and clinical status, but constant monitoring of the solution is not required.

A) Assist the client with range-of-motion exercises of the hands:
This task is appropriate for the assistive personnel (AP) as it is a routine, non-invasive intervention that can help maintain mobility and prevent contractures in the hands. The AP can assist with range-of-motion exercises, following proper technique, and reporting any abnormalities to the nurse. This falls within the AP's scope of practice and can be delegated to them effectively.

B) Determine the circulation status of the affected extremities every hr:
Assessing circulation is a nursing responsibility and requires clinical judgment to identify signs of impaired circulation, such as color changes, pulse, or temperature of the skin. This task cannot be delegated to an AP, as it requires a nurse’s skill to interpret findings and take appropriate action.

C) Instruct the client's family about the purpose of mitten restraints:
Educating the client's family about the use of mitten restraints is a responsibility of the nurse, not the AP. This involves assessing the family’s understanding, providing relevant information, and answering any questions they may have. Only licensed healthcare professionals are responsible for providing education about the purpose and use of restraints.

D) Evaluate the need for the client to remain in mitten restraints:
Evaluating the necessity of restraints involves assessing the client's condition, safety, and overall care needs. This requires critical thinking and professional judgment and should be performed by the nurse, not the AP. The nurse must determine if the restraints continue to be necessary or if they can be removed, ensuring the client’s safety and dignity.