The nurse assessing a client's intravenous catheter site suspects a phlebitis based on which clinical findings?

Warmth and palpable cord along the vein

A raised ecchymotic painful area

Swelling and tenderness at the site

Blanching and coolness of surrounding skin

Answer and Explanation

The Correct Answer is A

A. These are indicative of inflammation within the vein, which is characteristic of phlebitis. Warmth is a common sign of inflammation, and the palpable cord suggests that the vein may be hardened or cord- like due to inflammation and irritation.
B. While this could indicate some form of vascular injury or extravasation, it is not a typical presentation of phlebitis. Phlebitis involves inflammation of the vein, which may cause redness, warmth, and tenderness along the course of the vein, but it typically does not manifest as a raised ecchymotic (bruised) area.
C. Swelling occurs due to inflammation within the vein, and tenderness is often present as a result of the irritation and inflammation. These symptoms are commonly observed in cases of phlebitis but are not specific.
D. These are not typical signs of phlebitis. Blanching (turning white) and coolness of the skin may suggest reduced blood flow to the area, which could occur in cases of ischemia or thrombosis but are not characteristic of phlebitis.

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Correct Answer is C

Explanation

C. This allows healthcare providers to quickly administer treatments without the need for repeated venipuncture, which can be beneficial in various medical situations where time and vein preservation are critical.
A. Peripheral intravenous saline locks are not typically used to accommodate highly irritating or hyperosmolar solutions. Saline locks are used to maintain venous access without continuous infusion, and they are generally used with isotonic solutions to prevent complications such as phlebitis or infiltration.
B. The access is not very reliable when used for drawing samples repeatedly.
D. While peripheral intravenous saline locks can be used for intermittent administration of IV antibiotics or other medications, they are not typically used for prolonged IV antibiotic administration.

A. Notify the physician B. Explain the procedure in simple terms C. Cancel the surgery until the problem is solved D. Witness the client's signature

Correct Answer is A

Explanation

A. This is crucial because informed consent is not just about signing a document; it's about ensuring that the client fully understands the procedure, including the risks, benefits, and alternatives. The physician can then re-evaluate the client's comprehension and provide further clarification if necessary. It is the responsibility of the healthcare team to ensure that the client is making an informed decision.
B. Explaining the procedure in simple terms may be part of the nurse's role, but it is essential that the physician is aware of any gaps in the client's understanding to address them appropriately.
C. Cancelling the surgery is not the immediate best action without first attempting to resolve the misunderstanding.
D. Witnessing the client's signature may be part of the nurse's role, but it is essential that the physician is aware of any gaps in the client's understanding to address them appropriately.

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The nurse assessing a client's intravenous catheter site suspects a phlebitis based on which clinical findings?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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