A nurse is reinforcing teaching with a newly licensed nurse who is caring for a client who has AIDS.The nurse should instruct the newly licensed nurse to clean spills of the client's blood with a solution of water and which of the following cleaning agents?

Choice A rationale

Infiltration occurs when IV fluid leaks into the surrounding tissue, causing edema, coolness, and tenderness at the insertion site. This can lead to discomfort and complications if not promptly addressed.

Choice B rationale

Nerve damage from IV therapy usually presents as pain, numbness, or tingling rather than edema and coolness. It results from inadvertent injury to a nerve during catheter insertion or from prolonged pressure on a nerve.

Choice C rationale

Phlebitis is inflammation of the vein, characterized by redness, warmth, and tenderness along the vein. It does not typically cause coolness or extensive edema.

Choice D rationale

Infection at the catheter insertion site usually presents with redness, warmth, and purulent discharge, rather than coolness and edema. Tenderness can be present, but other signs of infection would also be observed.

Choice A rationale: Allergy to penicillin can be a contraindication for administering cefazolin because of potential cross-reactivity between penicillins and cephalosporins. This client’s documented allergy to penicillin with symptoms of rash and throat swelling is significant and raises concern for a potential allergic reaction to cefazolin.

Choice B rationale: Elevated WBC count indicates an ongoing infection or inflammation, which is not a contraindication for cefazolin. Instead, it suggests the need for an antibiotic like cefazolin to manage the infection.

Choice C rationale: Prescription for furosemide is relevant because combining cephalosporins like cefazolin with diuretics like furosemide can increase the risk of nephrotoxicity. It’s important to consider the client’s renal function and monitor for potential kidney damage.

Choice D rationale: Fever >38.3°C is an indication for antibiotic therapy, not a contraindication. The elevated temperature suggests an infection that needs to be treated, making cefazolin appropriate in this context.