When using nicotine gum, what action must the client take to break the outer shell effectively?

A. Hypertonic: Hypertonic solutions have a higher solute concentration than human blood, causing water to move out of cells and leading to cellular shrinkage. These solutions are used in specific clinical situations such as reducing cerebral edema. They do not match normal plasma osmolality.

B. Hyperosmolar: Hyperosmolar refers to a solution with increased total osmoles per liter, which may or may not be equal to blood concentration. This term describes osmotic strength rather than equivalence to plasma. It does not specifically indicate the same solute concentration as blood.

C. Isotonic: Isotonic solutions have the same solute concentration and osmotic pressure as human blood plasma. They do not cause net fluid movement into or out of cells, maintaining normal cell size and function. Common examples include 0.9% normal saline and lactated Ringer’s.

D. Hypotonic: Hypotonic solutions have a lower solute concentration than blood, causing water to move into cells and potentially leading to cellular swelling. These fluids are used cautiously due to the risk of edema. They do not match plasma solute concentration.

A. Blistering or ulceration near the insertion site: Vesicant extravasation causes tissue injury due to leakage of the drug into surrounding tissue. Local findings may include blistering, ulceration, swelling, erythema, and pain at or near the IV site. These changes reflect direct cellular damage and require immediate intervention.

B. Notifying the provider promptly: Extravasation of a vesicant is a medical urgency that requires provider notification for further management. Specific antidotes, imaging, or surgical consultation may be indicated depending on the drug involved. Timely communication helps limit tissue necrosis and long-term complications.

C. Stopping the infusion immediately: Immediate discontinuation of the infusion prevents further leakage of the vesicant into surrounding tissue. The IV catheter is typically left in place initially to allow aspiration of the drug or administration of an antidote if prescribed. This step is critical to reduce the extent of tissue injury.

D. Continuing infusion at a slower rate: Slowing the infusion allows continued exposure of tissue to the vesicant and increases the risk of severe injury. Vesicant extravasation requires cessation, not adjustment, of the infusion rate

E. Continue infusion with no action: Failure to intervene allows ongoing tissue damage and increases the risk of necrosis, infection, and loss of function. Vesicant extravasation requires immediate assessment and intervention. No-action approaches are inappropriate and dangerous.