While Preparing to Insert a Peripheral IV Line, the Nurse

While preparing to insert a peripheral IV line, the nurse notices scarring near the client's left axilla.  The client confirms a history of left breast cancer and modified radical mastectomy.  Which actions should the nurse take?  Select all that apply.

A) Advance the entire stylet into the vein upon venipuncture
B) Insert the IV line into the most distal site of the right arm
C) Place an appropriate precaution sign above the bed
D) Review the medical record for history of mastectomy
E) Teach the client to keep the left arm in a dependent position

Correct Answer:

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