A nurse is caring for a client who has a peripheral IV infusion and notes that the client's arm is edematous, cool, and tender at the catheter insertion site. Which of the following complications of IV therapy should the nurse suspect?
Nerve damage
Infection
Infiltration
Phlebitis
The Correct Answer is C
Choice A Reason:
Nerve damage is incorrect. Nerve damage typically presents with symptoms such as altered sensation, numbness, tingling, or shooting pain along the path of the nerve. The symptoms described in the scenario are more indicative of localized inflammation rather than nerve-related issues.
Choice B Reason:
Infection is incorrect. Infection at the insertion site can manifest with redness, warmth, tenderness, and possibly purulent drainage. While infection is a potential complication of IV therapy, the symptoms described might indicate a different issue.
Choice C Reason:
Infiltration is correct. Infiltration occurs when the IV fluid leaks into the surrounding tissues. Symptoms often include swelling, coolness, and tenderness at the site due to the fluid accumulating in the tissue instead of going into the vein. These symptoms align with the description provided.
Choice D Reason:
Phlebitis is incorrect. Phlebitis is the inflammation of a vein, typically presenting with redness, warmth, and tenderness along the vein's path.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Speech therapists, also known as speech-language pathologists, specialize in evaluating and treating swallowing difficulties (dysphagia) among other speech and language issues. They are trained to assess and provide therapies to improve swallowing function, ensuring safe and effective swallowing to prevent aspiration and related complications.
Choice B Reason:
Respiratory therapists primarily focus on the respiratory system and breathing issues. While they play a crucial role in managing respiratory problems, their expertise generally centers around respiratory treatments, ventilator management, and pulmonary function testing. They might assist if dysphagia leads to aspiration and subsequent respiratory complications, but the primary management of dysphagia itself falls within the scope of a speech therapist.
Choice C Reason:
Occupational therapists assist individuals in regaining independence in daily activities. While they may help with certain aspects of dysphagia management, their primary focus isn't specifically on evaluating and treating swallowing disorders. They might address related issues, such as adapting eating utensils or positioning during meals to assist the client, but they may not have the specialized training needed for direct dysphagia therapy.
Choice D Reason:
Physical therapists primarily focus on improving mobility, strength, and physical function. While they might address certain issues related to oral motor function or posture during eating that could affect swallowing, their expertise lies more in physical rehabilitation rather than the specialized treatment of dysphagia.
Correct Answer is C
Explanation
Choice A Reason:
Administer meperidine IM is incorrect. Reason why it's not the answer: Meperidine (Demerol) is not recommended in cases of malignant hyperthermia. It can potentially exacerbate the situation by further increasing muscle rigidity and potentially contributing to the hypermetabolic state. Meperidine can trigger additional release of calcium from the sarcoplasmic reticulum in muscles, worsening the symptoms.
Choice B Reason:
Instill a warm enema solution is incorrect. Reason why it's not the answer: Introducing warm solutions can exacerbate the client's condition by further increasing body temperature. Malignant hyperthermia is characterized by a dangerous increase in body temperature, and adding heat through an enema would only make the situation worse.
Choice C Reason:
Applying a cooling blanket is recommendable. Reason why it's the answer: A cooling blanket is a recommended intervention for managing malignant hyperthermia. Lowering the body temperature is crucial in preventing further complications associated with the high fever. Cooling blankets help dissipate heat from the body, aiding in rapidly reducing the dangerously elevated temperature associated with malignant hyperthermia.
Choice D Reason:
Ventilate client with 50% oxygen is incorrect. Reason why it's not the answer: While providing oxygen support might be necessary as part of managing the overall condition, ventilating with 50% oxygen specifically may not directly address the core issue of rapidly cooling the body during a malignant hyperthermia crisis. Ventilation may be required, but the immediate concern is to cool the body to prevent complications arising from the elevated body temperature.
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