A nurse is monitoring a client’s peripheral IV infusion of a vesicant medication and observes swelling and coolness of the skin at the insertion site. After stopping the infusion, which of the following actions should the nurse take next?

Notify the provider.

Apply a warm, moist compress.

Aspirate fluid remaining in the catheter.

Remove the IV catheter.

Answer and Explanation

The Correct Answer is D

A. Notify the provider. While notifying the provider is important, it is not the immediate next step after stopping the infusion. The priority is to prevent further damage by removing the IV catheter.
B. Apply a warm, moist compress. This action may be appropriate depending on the type of vesicant, but it is not the immediate next step. The priority is to remove the IV catheter to prevent further extravasation.
C. Aspirate fluid remaining in the catheter. This action can help to remove any remaining vesicant from the tissue, but it is not the immediate next step. The priority is to remove the IV catheter.
D. Remove the IV catheter. This is the correct next step after stopping the infusion. Removing the catheter helps to prevent further leakage of the vesicant into the surrounding tissue, minimizing the risk of tissue damage.

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Correct Answer is D

Explanation

A. Famotidine is an H2 receptor antagonist used to treat conditions like ulcers and gastroesophageal reflux disease (GERD). It does not contain sulfonamide and is generally safe for patients with sulfonamide allergies.
B. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and anti-inflammatory purposes. It does not contain sulfonamide and is not contraindicated for patients with sulfonamide allergies.
C. Metronidazole is an antibiotic used to treat various infections, including those of the gastrointestinal tract and the reproductive system. It does not contain sulfonamide and is safe for patients with sulfonamide allergies.
D. Glyburide is a sulfonylurea used to treat type 2 diabetes by increasing insulin production in the pancreas. It contains sulfonamide and can cause allergic reactions in patients with sulfonamide allergies, making it contraindicated.

A. Taking a high-ceiling diuretic B. Taking an HMG-CoA reductase inhibitor C. Having a 10-year history of COPD D. Having a prolapsed mitral valve

Correct Answer is A

Explanation

A. Taking a high-ceiling diuretic, such as furosemide, can lead to hypokalemia (low potassium levels), which increases the risk of digoxin toxicity. Low potassium levels enhance the effects of digoxin on the heart, making toxicity more likely.
B. Taking an HMG-CoA reductase inhibitor (statin) is not directly related to digoxin toxicity. Statins are used to lower cholesterol levels and do not significantly interact with digoxin.
C. Having a 10-year history of COPD does not predispose a client to digoxin toxicity. COPD affects the respiratory system and is not directly related to digoxin metabolism or excretion.
D. Having a prolapsed mitral valve is a cardiac condition but does not specifically increase the risk of digoxin toxicity. The primary concern with digoxin toxicity is electrolyte imbalances, particularly potassium levels.

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A nurse is monitoring a client’s peripheral IV infusion of a vesicant medication and observes swelling and coolness of the skin at the insertion site. After stopping the infusion, which of the following actions should the nurse take next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a sulfonamide allergy. Which of the following medications should the nurse identify as contraindicated?

Correct Answer is D

Explanation

A nurse is caring for a client who is taking digoxin to treat heart failure. Which of the following factors predisposes this client to developing digoxin toxicity?

Correct Answer is A

Explanation

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