by NCINDASUN

I'm still plugging away at practicing questions. Some of them drive me crazy! For example:

A client who has clear lung sounds and unlabored breathing is receiving aminophylline IV. Which of the following would be the MOST appropriate nursing action if the client's IV infiltrates?

A) Apply warm soaks to the infiltration site, start an new IV, and continue IV medications. Didn't seem like a good plan

B) Wait two hours, reassess the client, and restart the IV if the client has wheezing or labored breathing. That's a no. Can't just stop and not tell Dr.

C) Restart the IV and contine the previous medication schedule. Sounded good to me as long as you use a different site

D) Call the physician and recommend that the IV medication be changed to PO. My first thought: If the Dr. wanted IV, why would I challenge that?

Turns out D is the answer, BUT: Davis says IV aminophylline should be avoided but if extravasation occurs, give local injection of 1% procaine and application of heat may relieve pain and promote vasodilation. So by this intervention A is also true.

How the heck am I supposed to work through a question like this? I can't win!

Re: How do you work thru practice questions from HELL!

I had chosen A.....but I understand your frustration. I'm plugging away in my last semester and doing the disks as well---some very frustrating indeed!

Re: How do you work thru practice questions from HELL!

I chose D but for a different reason then explain. My reason was this patient is showing no signs of diffculty with respirations and if the iv is causing problems this pt doesn't need to be on iv he can be on po pt seems stable.

Re: How do you work thru practice questions from HELL!

I also would recommend letter A, thers no sign of resp problem. if IV infiltration is the problem as i read in Saunders, u have to discontinued the IV first, coz warm packs won;t help if u don;t stop the IV first..

Re: How do you work thru practice questions from HELL!

Plese be careful here with posting quesitons taken directly from the study guides that are out there.

Now, to the matter at hand. Remember, you are the nurse directly taking care fo the patient all day. Caring for the patient is a collaborative effort with the different people caring for the patient. We each need to watch out for the patient, think of yourself as the traffic cop or the security guard for this paitent, you want what is safest for them.

Lungs are completely clear, and patient is not having any respiratory issues. Sometimes things will turn around very quickly for these patients, they do not need IV aminophyllin any longer than necessary. What are the side effects of the drug. It works as a diuretic, it was actually used in the olden days for that prupose, before the days of lasix, etc., it can cause an elevated heart rate in some patients.

Re: How do you work thru practice questions from HELL!

I actually chose D. I was looking at what was the safest thing for the patient. I don't know, to me, it seemed like the safest.

Mave.

Re: How do you work thru practice questions from HELL!

I would of chosen A..

My thought was that this was the first time in infiltrated, so I'd start a new IV. If it infiltrated again, I'll call the doctor and request a change to PO.

Oh well!

Re: How do you work thru practice questions from HELL!

If no respiratory issues and lungs are clear, then there is no reason for the med to be given IV. Think patient safety, as well.

Re: How do you work thru practice questions from HELL!

In the stem of the question it emphasize that this patient respirations were unlabor breathe sound clear so it really wasn't asking you what you were going to do to the infiltrated iv but this question was asking if you would start this pt on oral med or keep the iv meds.

Re: How do you work thru practice questions from HELL!

See what I mean? So many ways of looking at the questions. I appreciate Suzanne's reminder of the collaborative effort. The way D is written, there is no mention of stopping the infiltration. We were taught to never assume anything and that the answers had everything you needed in them.

Two days and counting. Heavy sigh.....