Nursing Acceleration Challenge Exam (NACE) PN-RN Practice Test

If a patient experiences coolness and swelling around the IV site, what immediate action should the nurse take?

1. Increase the IV flow rate.

2. Change the IV site.

3. Readjust the IV catheter.

4. Continue the infusion.

The correct answer is: Change the IV site.

When a patient exhibits coolness and swelling around the IV site, this typically indicates a potential infiltration, where IV fluid is leaking into the surrounding tissue rather than staying within the vein. In such cases, the best immediate action the nurse should take is to change the IV site. This prevents further complications that could arise from prolonged infiltration, such as tissue damage or discomfort for the patient. By relocating the IV to a new site, the nurse ensures that IV therapy can continue effectively while minimizing the risk of further complications. It also allows for the assessment of the original site to determine whether there is any damage or ongoing issue that needs to be addressed. Attempting to increase the IV flow rate, readjust the catheter, or continue the infusion might exacerbate the problem, potentially increasing discomfort for the patient and leading to further complications. Therefore, changing the IV site is the most appropriate and immediate action to ensure patient safety and effective treatment.