Difficulty: Medium
Average Score: 73%
Simulated
The nurse is changing the subclavian dressing of a client who is receiving total parenteral nutrition. When assessing the catheter insertion site, the nurse noticed the presence of a yellow drainage from around the sutures that are anchoring the catheter. Which actions should the nurse take first?
Correct answer
C
Rationale
Obtaining a culture identifies potential infection, applying a sterile dressing maintains cleanliness, and monitoring prevents complications.