An adult patient developed a complication with his IV and it had to be removed yet continued IV fluids were needed. Which site would be most appropriate for the nurse to choose?
Proximal to the previous IV site
Distal to the previous IV site
In the antecubital fossa
In the foot
The Correct Answer is A
Rationale:
A. When restarting an IV after a complication, the nurse should choose a vein above (proximal to) the old site to ensure good blood flow and avoid infiltrated or irritated tissue.
B. Distal to the previous IV site is not appropriate because fluids may leak into damaged tissue from the prior IV.
C. The antecubital fossa is avoided for routine IV therapy as it restricts arm movement and increases risk of dislodgement.
D. The foot is generally avoided in adults due to higher risk of infection and impaired circulation.
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Related Questions
Correct Answer is B
Explanation
Rationale:
A. Manually occlude the tracheostomy with sterile gauze would obstruct the airway completely and is unsafe.
B. Insert a spare tracheostomy is correct because the priority is to re-establish the patient’s airway immediately. A spare tracheostomy tube of the same size (and one size smaller) should always be kept at the bedside.
C. Press the emergency response button may be necessary if reinsertion is unsuccessful, but it is not the first action.
D. Place the patient on a facemask delivering 100% oxygen is not effective because the tracheostomy stoma is the patient’s airway, and oxygen delivery via face mask would not ventilate the lungs.
Correct Answer is C
Explanation
Rationale:
A. The unit manager is not responsible for interpreting prescriber orders and should not be relied upon for this task.
B. The unit secretary is not qualified to interpret medical orders.
C. The nurse must call the prescriber directly to clarify any unclear or illegible order. Administering medication without a clear order is unsafe and could result in serious errors.
D. Pharmacists can clarify medication details but cannot interpret illegible handwriting; the prescriber must provide clarification.
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