While assessing a client who is receiving continuous IV therapy via his left forearm, a nurse notes that the site is red, swollen, and painful and that the surrounding tissues are hard. Which of the following actions should the nurse take first?

Discontinue the existing IV line.

Initiate a new IV line in the other extremity.

Apply a hot pack to the irritated site.

Determine if the client needs to continue IV therapy.

Answer and Explanation

The Correct Answer is A

A. The first action should be to discontinue the existing IV line to prevent further damage and reduce the risk of complications, such as phlebitis or infiltration.
B. Initiating a new IV line is necessary, but it should be done after addressing the issue with the current IV site.
C. Applying a hot pack might help with comfort, but addressing the cause of the irritation (discontinuing the IV) is more critical first.
D. Determining if the client needs to continue IV therapy is important but should follow the immediate step of addressing the current IV site issue.

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Correct Answer is D

Explanation

A. Holding the client's arms and legs can cause injury and does not help in managing the seizure. The focus should be on protecting the client from harm.
B. Moving the client back to bed during a seizure can be dangerous and increase the risk of injury. It's best to manage the seizure where the client is.
C. Inserting a tongue blade or any object into the client's mouth can cause injury to the teeth or oral cavity and is not recommended during a seizure.
D. Placing the client on his side helps maintain an open airway and prevents aspiration, which is crucial during a seizure to ensure the client’s safety.

A. Prednisone B. Montelukast C. Propranolol D. Theophylline

Correct Answer is C

Explanation

A. Prednisone is a corticosteroid commonly used to reduce inflammation and manage asthma exacerbations. Its use is appropriate for controlling severe symptoms.

B. Montelukast is a leukotriene receptor antagonist used for long-term control of asthma. It helps to prevent asthma symptoms and is appropriate for ongoing management.

C. Propranolol is a non-selective beta-blocker that can exacerbate asthma by blocking beta-2 receptors in the lungs, leading to bronchoconstriction. It is contraindicated in asthma patients and requires clarification.

D. Theophylline is a bronchodilator used for asthma management. It is appropriate for helping to relax and open the airways.

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While assessing a client who is receiving continuous IV therapy via his left forearm, a nurse notes that the site is red, swollen, and painful and that the surrounding tissues are hard. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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Correct Answer is C

Explanation

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