The nurse needs to repeat a venipuncture. To minimize any patient harm, where should the nurse insert the needle?
a. In the same arm of the patient closer to the heart
b. In the left arm of a patient with a history of axillary surgery
c. In the right arm of patient with a right mastectomy
d. In the left arm of a patient with a left arte-riovenous shunt
A
The nurse can use the same extremity as before but must choose a site closer to the patient's heart to avoid leakage and patient discomfort. The nurse avoids inserting a needle into an extremity that had axillary surgery because this extremity is at high risk for vascular complications already. A mastectomy tends to impair lymphatic drainage and venous return from the affected side. Arteriovenous shunts and fistulas are delicate structures, so the nurse avoids any unnecessary manipulation of the arm.
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