A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first?

Choice A reason: Removing the PICC line is not a nursing action to be taken independently unless there is a clear order or life-threatening complication. Premature removal may compromise vascular access and delay treatment. Choice B reason: Measuring the circumference of both arms is a non-invasive, objective assessment that helps determine the extent of swelling and potential complications such as thrombosis or infiltration. It provides baseline data for further evaluation and is the appropriate first step. Choice C reason: Notifying the provider is important, but it should follow initial assessment. The nurse must gather relevant data to report accurately, including measurements and symptoms. Choice D reason: Applying a cold pack may be contraindicated depending on the cause of swelling. Without a clear diagnosis, such as thrombophlebitis or infiltration, this intervention could worsen the condition.