A client receiving IV medications develops a painful, warm, and red streak along the arm near the IV site. The nurse should recognize these symptoms as potential signs of which complication of IV therapy?
Phlebitis
Infiltration
Thrombophlebitis
Fluid overload
The Correct Answer is C
A) This choice is incorrect because phlebitis typically presents with redness and warmth around the insertion site, but it does not cause a painful, red streak along the arm.
B) This choice is incorrect because infiltration is characterized by swelling and blanching of the skin near the IV site, not a painful, red streak.
C) This choice is correct. The client's symptoms of a painful, warm, and red streak along the arm near the IV site are indicative of thrombophlebitis, which is the inflammation of a vein associated with the formation of a blood clot.
D) This choice is incorrect because fluid overload is not associated with a painful, warm, and red streak along the arm.
Questions
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) This choice is incorrect because receiving a potassium-containing solution is not associated with hypokalemia, but rather with the risk of hyperkalemia due to the increased potassium intake.
B) This choice is correct. Clients with chronic kidney disease are at risk of hyperkalemia, and receiving a potassium-containing solution through IV therapy can further elevate potassium levels.
C) This choice is incorrect because IV therapy with a potassium-containing solution is not related to hypocalcemia.
D) This choice is incorrect because IV therapy with a potassium-containing solution is not associated with hyponatremia.
Questions
Correct Answer is C
Explanation
A) This choice is incorrect because Type I (Immediate) hypersensitivity reactions typically involve immediate symptoms like hives, facial swelling, and difficulty breathing, not fever, rash, and elevated liver enzymes.
B) This choice is incorrect because Type II (Cytotoxic) hypersensitivity reactions involve antibodies attacking specific cells or tissues, leading to cell destruction. Elevated liver enzymes may occur in some drug-induced cytotoxic reactions, but they are not commonly associated with fever and rash.
C) This choice is correct. The client's symptoms of fever, rash, and elevated liver enzymes are potential signs of a Type III (Immune Complex-Mediated) hypersensitivity reaction. In this type of hypersensitivity, immune complexes formed by antibodies and antigens deposit in tissues and trigger inflammation, which can affect multiple organs, including the liver.
D) This choice is incorrect because Type IV (Delayed) hypersensitivity reactions occur 24 to 72 hours after exposure to an allergen and are mediated by T cells, leading to localized skin reactions like contact dermatitis. They are not associated with fever and elevated liver enzymes.
Questions
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