Canadian Nursing Health Assessment: A Best Practice Approach 2nd Edition, by Tracey TEST BANK

Chapter 31: Assessing Individuals Who Are Obese 1. The nurse is having difficulty palpating a vein when preparing to insert an intravenous catheter into a client’s arm who has a body mass index of 38 kg/m2.

Which actions would the nurse take to increase the likelihood of successful intravenous catheter insertion? Select all that apply.

A. Ask client to keep arm flexed while assessing for vein location.

B. Apply a warm compress to the client’s arm for 10-20 minutes.

C. Apply a blood pressure cuff to use as in place of a tourniquet.

D. Use bright lighting to better visualize the client’s skin and veins.

E. Rub and slap surface of the client’s skin to encourage venous dilation.

Answer: B, C, D Rationale: Due to additional adipose tissue venipuncture and intravenous catheter placement can be more challenging in the client with obesity. Strategies to make veins easier to palpate and visualize include extending the arm to stretch the skin and thin the adipose layer rather than flexing the arm which would make locating a vein more difficult. Warm compresses can encourage vasodilation and make veins easier to palate. Using a blood pressure cuff in place of a tourniquet allows the nurse to better adjust the occlusion pressure which can prevent veins from collapsing. The nurse should also take the time to establish good lighting to increase the chances of successfully locating a vein. Slapping or rubbing the client’s skin is not a recommended approach and does not promote dilation of the vessel.

Question format: Choice Multiple Chapter: 31 Cognitive Level: Apply Client Needs: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 44, Common Laboratory and Diagnostic Testing