The nurse is caring for a client with a double lumen peripherally inserted central catheter (PICC) line on the right upper extremity, that flushes easily but does not have a blood return. Normal saline is infusing through one port and a vasopressor agent is infusing through the other port.
Which intervention(s) should the nurse implement? Select all that apply.
Stop the infusions and insert an antecubital IV catheter.
Continue Infusions as long as catheter flushes easily.
Aspirate and flush the line until a blood return is obtained.
Observe the extremity for signs of infiltration.
Acquire consent for a new PICC line insertion.
Correct Answer : B,D
A. Stopping the infusions and inserting a new catheter may not be necessary at this point unless complications develop.
B. As long as the catheter is flushing easily and the infusions are not causing complications (such as infiltration), it is appropriate to continue using it.
C. Aspirating and flushing the line until a blood return is obtained may cause damage to the catheter or further complications.
D. Monitoring for signs of infiltration is crucial, as the inability to aspirate a blood return may indicate a partial occlusion or other issues with the PICC line.
E. Replacing the PICC line may not be necessary unless more severe complications are observed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A. Bradykinesia (slowness of movement) is a hallmark symptom of Parkinson's disease and will directly affect the client's mobility, requiring intervention to assist with movement and prevent falls.
B. Stooped posture is common in Parkinson's disease and can contribute to impaired balance and increase the risk of falls, making interventions for posture and mobility necessary.
C. Orthostatic hypotension is not specifically a mobility issue, but it can affect the client's overall safety and risk for falls. It may require monitoring and interventions to address blood pressure changes, but it is not as directly related to mobility as the other symptoms.
D. Shuffling, propulsive gait is a typical motor symptom of Parkinson's disease and increases the risk of falls, necessitating planning for interventions to improve gait and balance.
E. Muscular rigidity is another classic symptom that can limit the client's mobility, causing difficulty with movement, and requires interventions to improve range of motion and reduce stiffness.
Correct Answer is B
Explanation
A. Frequency that the problem occurs is important for understanding the issue but does not ensure that the evidence gathered is relevant to the specific clinical question.
B. Relevance to the situation is the most critical factor in evidence-based practice. The evidence must directly apply to the client’s condition, treatment, or intervention to support sound decision-making.
C. Past experience with similar problems can guide nursing judgment but is not a substitute for current, research-based evidence.
D. Related personal values may influence decision-making but should not be prioritized over scientifically validated evidence.
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