Difficulty: Medium
Average Score: 65%
Simulated
A nurse is assessing a client who is receiving a peripheral IV infusion and notes infiltration of fluid into the tissues surrounding the insertion site. Which of the following actions should the nurse take?
Correct answer
B
Rationale
The correct action is to elevate the extremity. Elevating the extremity helps to reduce swelling and limit further infiltration by promoting fluid return to the central circulation. Applying pressure to the IV site may cause tissue damage. Slowing the infusion rate might not stop the infiltration. Flushing the IV catheter would not address the issue of fluid infiltration.