Answer to Question 1
A
Use the most distal site in the nondominant arm, if possible. Select a well-dilated vein. Methods to foster venous distention include place the extremity in a dependent position if possible and stroke from distal to proximal below the proposed venipuncture site. Apply warmth to the ex-tremity for several minutes, for example, with a warm washcloth. Vigorous friction and multiple tapping of a vein, especially in older adults, can cause hematoma and/or venous constriction. Avoid vein selection in areas with tenderness, pain, infection, or wounds, or extremities affected by previous stroke (CVA), paralysis, mastectomy, or dialysis graft. Choose a site that will not interfere with the patient's activities of daily living (ADLs).
Answer to Question 2
A
The nurse used efficient care. Efficient care conserves effort and minimizes interruptions. One way to be efficient is by combining various nursing activities (i.e., doing more than one thing at a time). This takes practice. For example, during medication administration or while obtaining a specimen, combine therapeutic communication skills, teaching interventions, and assessment and evaluation. Effective care is doing the right things, whereas efficient care is doing things right. The nurse did not use resources (equipment, other staff nurses) or team communication (talking to other nursing personnel) in this scenario.
Client position when assessing jugular vein distention.
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