A nurse is collecting data about an IV infusion site on an infant’s left hand.
Which of the following findings should the nurse identify as an indication of an infiltration?
Edema in the palm of the hand.
Absence of blanching at the insertion site.
Warmth around the insertion site.
Blood in the IV tubing.
The Correct Answer is A
Choice A rationale
Edema in the palm of the hand is a sign of IV infiltration. IV infiltration occurs when IV fluids or medications leak into the surrounding tissues outside the intended vein. This can cause swelling or edema, which is a common sign of infiltration.
Choice B rationale
Absence of blanching at the insertion site is not necessarily an indication of an infiltration. Blanching (whitening of the skin) can occur due to various reasons, including pressure on the site or a reaction to the IV fluid or medication. However, it is not a definitive sign of infiltration.
Choice C rationale
Warmth around the insertion site is not a definitive sign of an infiltration. While warmth can occur due to inflammation or infection, it is not a specific sign of infiltration.
Choice D rationale
Blood in the IV tubing is not a definitive sign of an infiltration. While blood can back up into the IV tubing due to various reasons, including a blocked or kinked catheter, it is not a specific sign of infiltration.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
While the genitourinary system can be affected in individuals with Down syndrome, it is not the most commonly affected body system. Down syndrome is a genetic condition where a person is born with an extra chromosome. This can affect how their brain and body develop, leading to both physical and mental challenges.
Choice B rationale
The reproductive system is not the most commonly affected body system in individuals with Down syndrome. While individuals with Down syndrome can have reproductive health issues, these are not as common as issues with other body systems.
Choice C rationale
The gastrointestinal system can be affected in individuals with Down syndrome, but it is not the most commonly affected body system. Some individuals with Down syndrome may experience gastrointestinal issues such as constipation or gastroesophageal reflux disease.
Choice D rationale
The cardiovascular system is the most commonly affected body system in individuals with Down syndrome. Almost half of babies with Down syndrome have congenital heart disease (CHD), the most common type of congenital anomaly. CHD can lead to high blood pressure in the lungs, an inability of the heart to effectively and efficiently pump blood, and cyanosis (blue-tinted skin caused by reduced oxygen in the blood)3.
Correct Answer is ["6"]
Explanation
Step 1 is to set up the equation to solve for the unknown, which is the volume in mL. The equation is (300 mg ÷ 250 mg) × 5 mL.
Step 2 is to perform the calculation: (300 mg ÷ 250 mg) × 5 mL = 6 mL. So, the nurse should administer 6 mL of amoxicillin oral solution.
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