What should be the next action by the nurse, once an ...

[nummyann]

What should be the next action by the nurse, once an over-the-needle catheter (ONC) has been inserted through the skin and into the vein?
 
  a. Loosen the stylet for removal
  b. Check for blood return in the flashback chamber
  c. Stabilize the catheter and release the tourniquet
  d. Advance the catheter until the hub rests at the insertion site

Question 2

The nurse is caring for a patient who has a chest tube connected to a water seal. The patient is not on a ventilator. Which of the following would the nurse consider normal?
 
  a. The fluid level in the water seal rises with inspiration.
  b. The fluid level in the water seal falls with inspiration.
  c. Constant bubbling occurs in the water seal.
  d. The fluid level in the water seal falls with expiration 3 days after insertion.

[amanda_14]

Answer to Question 1

B
Observe for blood return through the flashback chamber of the catheter or the tubing of the winged cannula, indicating that the bevel of the needle has entered the vein. Lower the needle until almost flush with the skin. Advance the catheter another to inch into the vein, and then loosen the stylet site on the ONC. Only after the catheter is advanced and is in its final position is the catheter stabilized with one hand while the tourniquet is released. Only after the blood and the needle are observed to advance another to inch into the vein is the stylet loosened. At that point, continue to hold the skin taut, and advance the catheter into the vein until the hub rests at the venipuncture site.

Answer to Question 2

A
Observe the water seal for intermittent bubbling from its U tube or for a rise and fall of fluid that is synchronous with respirations. (For example, in a nonmechanically ventilated patient, the fluid rises during inspiration, and the fluid level falls during expiration. When a patient is on a mechanical ventilator, the opposite occurs.) In a nonmechanically ventilated patient, the fluid rises during inspiration, and the fluid level falls during expiration. Constant bubbling in the water seal or a sudden, unexpected stoppage of water-seal activity is considered abnormal and requires immediate attention. After 2 to 3 days, tidaling or bubbling on expiration is expected to stop, indicating that the lung has reexpanded.

[nummyann]

Thank you

[amanda_14]

No problemo