• NCLEX Pretest
  • Time Used 0:00:00

The patient has experienced an extravasation of norepinephrine in the right forearm. It is cool to the touch, firm, and pale. Distal to peripheral pulses are not well felt and the fingertips are dusky. Which order does the nurse clarify with the provider?

Incorrect

  • Apply warm packs to the entire arm
  • Infiltrate the area with phentolamine mesylate
  • Insert peripherally inserted central catheter under fluoroscopy
  • Avoid further IV sticks or blood pressure monitoring in the right arm

Rationale

Applying warm packs to the site of an extravasation can lead to long term complications due to the increase in metabolic demand of the tissue that is ischemic because of the alpha-adrenergic extravasation. Orders to infiltrate the area with phentolamine mesylate (an alpha-adrenergic blocker used in the treatment of norepinephrine extravasations), insertion of a PICC line under fluoroscopy (which would decrease the risk of future peripheral IV extravasations), and avoidance of further IV sticks or blood pressure monitoring in the right arm are all appropriate orders and do not require clarification.

  • Category: Pharmacological and Parenteral Therapies
  • Difficulty: 7
  • Tags: Cardiovascular Communication & Documentation Medication and Blood Products Nursing Interventions Routes of Administration Tissue Integrity

Question 17 of 30

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