Difficulty: Medium
Average Score: 82%
Simulated
A nurse is assisting with the care of a client who is receiving IV fluids. Which of the following findings should the nurse report immediately?
Correct answer
A
Rationale
Swelling at the IV site: Swelling indicates possible infiltration or extravasation, requiring immediate cessation of the infusion. Generated rationale: IV infiltration can cause tissue damage or infection if not addressed promptly, necessitating urgent reporting.