A nurse is preparing to insert an IV catheter for a client following a right mastectomy.
Which of the following veins should the nurse select when initiating IV therapy?
The radial vein on the left wrist
The cephalic vein on the back of the right hand
The cephalic vein in the left distal forearm
The basilic vein in the right antecubital fossa
The Correct Answer is C
Choice A rationale:
The radial vein on the left wrist is not typically chosen for IV therapy. Additionally, proximity to the mastectomy site may be a consideration.
Choice B rationale:
The cephalic vein on the back of the right hand is not typically selected, especially following a right mastectomy. Choosing a vein on the affected side may increase the risk of complications.
Choice C rationale:
The cephalic vein in the left distal forearm is a suitable choice. It is on the opposite side of the mastectomy and allows for effective IV therapy.
Choice D rationale:
The basilic vein in the right antecubital fossa is on the affected side and may pose a higher risk of complications. Choosing a vein on the opposite side is generally preferred.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Providing brochures about the procedure may be helpful, but the immediate concern is the client's expressed lack of understanding.
Choice B rationale:
Notifying the provider is the first action to address the client's concerns and ensure that the client has a clear understanding of the surgery. The nurse should also document the client's statement and the provider's response in the medical record.
Choice C rationale:
Describing the surgery to the client is important, but the provider should be informed first to address the client's immediate concerns.
Choice D rationale:
Completing an incident report is not applicable in this context, as it involves a communication issue rather than an incident.
Correct Answer is D
Explanation
Choice A rationale:
The client's age is not a part of the measurement in the Braden scale.
Choice B rationale:
Each element in the Braden scale has a range from one to four points, except for friction and shear, which is scored from one to three points.
Choice C rationale:
The lower the score, the higher the risk of developing pressure injuries.
Choice D rationale:
The Braden scale is a tool that helps nurses assess the risk of developing pressure injuries in clients. It consists of six elements: sensory perception, moisture, activity, mobility, nutrition, and friction and shear.
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