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    Ati rn vati comprehensive predictor proctored exam

    A nurse is caring for a client following insertion of a subclavian nontunneled percutaneous central venous catheter (CVC). The provider writes a prescription to initiate an IV infusion of Ringer's lactate at 150 mL per hr. Prior to starting the infusion, which of the following actions should the nurse take?

    Explanation & Rationale

    A. Apply oxygen at 3 L/min per nasal cannula: Oxygen administration is not a routine requirement after CVC insertion unless the client is experiencing respiratory distress or hypoxia. It is not necessary prior to starting an IV infusion. B. Review the chest x-ray report: After insertion of a subclavian CVC, a chest x-ray is required to confirm correct catheter placement and to rule out complications such as pneumothorax. Reviewing the report ensures it is safe to initiate IV fluids through the catheter. C. Flush the catheter with sterile water: Central lines should be flushed with saline, not sterile water, to maintain patency. Flushing with water can cause hemolysis and is unsafe. D. Obtain a peripheral blood glucose level: Blood glucose monitoring is not directly related to CVC insertion or initiation of IV fluids unless specifically indicated by the client’s medical condition. It is not a standard preparatory action for starting an infusion.

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