A nurse is caring for a school-age child following a femoral venous cardiac catheterization. Which of the following actions should the nurse take?

Perform a sterile dressing change 8 hr after the procedure.

Keep the affected extremity straight for 4 hr.

Assess the pulses above the catheterization site.

Maintain NPO status for 24 hr following the procedure.

Answer and Explanation

The Correct Answer is B

A. Perform a sterile dressing change 8 hr after the procedure: Dressing changes are typically done only if the dressing becomes wet, soiled, or loose. Routine dressing changes soon after the procedure can increase the risk of bleeding or infection and are generally avoided during the initial recovery period.

B. Keep the affected extremity straight for 4 hr: Keeping the affected leg straight helps prevent bleeding and hematoma formation at the catheter insertion site by minimizing movement and pressure on the femoral vein. This immobilization period is critical to allow proper healing and reduce complications.

C. Assess the pulses above the catheterization site: It is important to assess pulses distal to the insertion site (e.g., in the foot) to monitor for signs of impaired circulation or vascular compromise. Assessing pulses above the site does not provide information about distal blood flow or potential complications.

D. Maintain NPO status for 24 hr following the procedure: NPO status is usually required only for a few hours before the procedure to reduce aspiration risk. After the catheterization, the child is typically allowed to resume oral intake once fully awake and stable, making prolonged NPO unnecessary.

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Correct Answer is C

Explanation

A. Calling the guardian to obtain verbal consent may not be necessary if the adolescent is legally able to consent to reproductive health services, depending on state laws. The nurse should understand the legal requirements regarding consent for minors.

B. Encouraging the adolescent to wait until after the procedure to ask questions undermines informed consent and can increase anxiety. The adolescent should be encouraged to ask questions before the procedure to ensure understanding and comfort.

C. Witnessing the adolescent's signature on the consent form is an appropriate nursing action, confirming that the adolescent has voluntarily agreed to the procedure after receiving adequate information.

D. Rescheduling the procedure until guardian consent is obtained is not always required if the adolescent has legal authority to consent. The nurse should verify legal guidelines rather than automatically delay care.

A. Ask the child to hold their breath while the IV catheter is placed. B. Place the IV catheter on the dominant arm. C. Apply vapocoolant spray before the IV insertion. D. Explain the procedure to the child in detail.

Correct Answer is C

Explanation

A. Ask the child to hold their breath while the IV catheter is placed: This technique is not appropriate for a preschool-age child. Breath-holding may increase anxiety and is more applicable to older children or adults during procedures such as injections or venipuncture.

B. Place the IV catheter on the dominant arm: The non-dominant arm is usually preferred for IV insertion to reduce interference with the child's movement and play, and to prevent dislodgement of the catheter during activity.

C. Apply vapocoolant spray before the IV insertion: Vapocoolant sprays provide topical analgesia and can reduce the pain and anxiety associated with IV placement. This is especially helpful for young children like preschoolers and is recommended for pain management.

D. Explain the procedure to the child in detail: Preschoolers benefit from simple, age-appropriate explanations rather than detailed medical descriptions. Using clear, brief explanations or play-based preparation is more effective for their developmental level.

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