Which client with chronic obstructive pulmonary disease (COPD) will the nurse assess first?

Choice A reason: Air embolism occurs when air enters the bloodstream, not from vesicant extravasation. Vesicants, like chemotherapy drugs, cause local tissue damage when leaking outside the vein, leading to necrosis, not vascular occlusion, making air embolism an incorrect complication in this context.

Choice B reason: Tissue necrosis is a primary complication of vesicant extravasation, as these medications (e.g., chemotherapy agents) are toxic to tissues outside the vein. Leakage causes severe damage, leading to cell death, ulceration, and potential tissue loss, making this the critical complication to identify and manage.

Choice C reason: Edema may occur with extravasation due to fluid leakage but is not the primary concern with vesicants. Vesicant extravasation causes severe tissue damage, leading to necrosis rather than just swelling, making edema a less specific and severe complication in this scenario.

Choice D reason: Thrombus formation is a risk with intravenous catheters but not a direct result of vesicant extravasation. Vesicants cause chemical damage to tissues, leading to necrosis, not clot formation, making thrombus an incorrect choice for vesicant extravasation’s primary effect.

Choice A reason: Administering medications that promote fluid retention, like vasopressin, worsens hypervolemia by increasing water reabsorption, exacerbating edema and hypertension. This is contraindicated, as the goal is fluid removal, making this an incorrect intervention for managing excess fluid volume in hypervolemia.

Choice B reason: Administering diuretics is the priority in hypervolemia, promoting renal excretion of excess fluid, reducing edema, pulmonary congestion, and hypertension. Diuretics like furosemide correct fluid overload, preventing complications like heart failure exacerbation, making this the most critical intervention for immediate fluid management.

Choice C reason: Encouraging increased fluid intake worsens hypervolemia by adding to excess fluid, increasing pulmonary edema and heart failure risks. The goal is to remove fluid, not add it, making this inappropriate compared to diuretics, which directly address fluid overload in this condition.

Choice D reason: Monitoring daily weights tracks fluid status but is not an intervention. While useful for assessing treatment response, it does not reduce fluid volume like diuretics, which prevent complications, making weight monitoring a supportive, not primary, action in hypervolemia management.