A nurse is inserting an IV catheter for an older client in preparation for an outpatient procedure. Which of the following veins should the nurse select?

A. Administer an analgesic PO: Administering an analgesic by mouth may not provide immediate relief for the pain at the insertion site of the IV catheter. Oral medications typically take time to be absorbed and reach therapeutic levels in the bloodstream, which may delay pain relief. Additionally, oral analgesics are not specifically targeted to the site of pain and may not adequately address localized discomfort associated with IV insertion.
B. Administer a local anesthetic: Administering a local anesthetic, such as lidocaine, is the most appropriate action to alleviate pain at the insertion site of the IV catheter. Local anesthetics block nerve impulses in the area where they are applied, temporarily numbing the site and providing rapid pain relief. The nurse can apply a topical local anesthetic cream or spray directly to the skin around the insertion site or infiltrate lidocaine into the subcutaneous tissue near the catheter insertion site to minimize discomfort for the client.
C. Request a prescription for placement of a central venous access device: Requesting a prescription for a central venous access device, such as a central venous catheter or peripherally inserted central catheter (PICC), is not indicated solely based on the client's report of pain at the insertion site of the IV catheter. Central venous access devices are typically reserved for clients requiring long-term intravenous therapy, frequent blood draws, or administration of vesicant or irritating medications. The decision to insert a central venous access device should be based on the client's specific clinical needs and the assessment of venous access options by the healthcare provider.
D. Remove the catheter and insert another of a different size: Removing the IV catheter and inserting another of a different size solely due to pain at the insertion site may not be necessary and could cause additional discomfort and trauma to the client. The nurse should assess the insertion site for signs of complications, such as infiltration, phlebitis, or infection, before considering catheter removal and replacement. If the IV catheter is appropriately positioned and functioning well, the nurse should focus on managing the client's pain at the current insertion site using appropriate interventions, such as administering a local anesthetic, rather than immediately removing the catheter.

Answer: D

Rationale:

A. The American Hospital Association requires accredited facilities to have protocols in place requiring medication reconciliation: The American Hospital Association does advocate for medication reconciliation as part of safety protocols, but the primary focus of medication reconciliation is not solely based on AHA requirements. It is more about improving patient safety and preventing errors.

B. The nurse who performs medication reconciliation is demonstrating the ethical principle of veracity: While medication reconciliation involves accurate and truthful communication, it primarily serves to ensure safety and accuracy in medication management rather than directly demonstrating the ethical principle of veracity.

C. The International Council of Nurses Code of Ethics stipulates that the nurse performs medication reconciliation when a client is admitted to a facility, is transferred to another facility, and when a client is discharged from a facility: Although medication reconciliation is crucial at these points of care transition, the International Council of Nurses Code of Ethics does not explicitly mandate this process.

D. The purpose of medication reconciliation is to prevent adverse medication reactions: Medication reconciliation aims to ensure accurate medication lists and prevent errors, which in turn helps prevent adverse medication reactions. This aligns with the primary goal of the process, which is to enhance medication safety.