A nurse in a clinic is teaching preventative measures with a female client who has a history of deep-vein thrombosis. Which of the following statements should the nurse include in the teaching?

"Sit with your legs in a dependent position when in a chair."

"Prevent dehydration by drinking at least 2.5 liters fluids each day."

"Massage your calves after sitting for 2 hours."

"Roll stretchy nylon stockings down to the upper part of your calves."

Answer and Explanation

The Correct Answer is B

A) "Sit with your legs in a dependent position when in a chair."
Sitting with legs in a dependent position can decrease blood flow and increase the risk of clot formation. It's important to elevate the legs when sitting to promote venous return and reduce the risk of deep-vein thrombosis (DVT).

B) "Prevent dehydration by drinking at least 2.5 liters fluids each day."
Staying well-hydrated helps maintain good blood circulation and prevents blood from becoming too viscous, reducing the risk of clot formation. Adequate fluid intake is crucial in preventing DVT.

C) "Massage your calves after sitting for 2 hours."
Massaging the calves is not recommended for someone with a history of DVT, as it may dislodge a clot. Instead, clients should be encouraged to move or stretch their legs regularly to improve circulation.

D) "Roll stretchy nylon stockings down to the upper part of your calves."
Proper use of compression stockings involves wearing them as prescribed, which typically means keeping them fully extended to ensure consistent pressure along the leg. Rolling them down can create a tourniquet effect and is not recommended.

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Correct Answer is D

Explanation

A. "The client is preoccupied with a supposed body defect.": This manifestation is more characteristic of body dysmorphic disorder rather than generalized anxiety disorder (GAD).

B. "The client compulsively bites fingernails.": Nail-biting is often associated with obsessive-compulsive disorder (OCD) or other stress-related behaviors rather than GAD.

C. "The client exhibits hoarding behaviors.": Hoarding is typically associated with obsessive-compulsive disorder (OCD) and not generalized anxiety disorder.

D. "The client puts off making decisions.": Individuals with generalized anxiety disorder often experience indecisiveness and procrastination due to excessive worry and fear of making the wrong choice. This is a common manifestation of GAD

A. Talking with the client's family to determine how the condition affects the client role B. Assessing the impact of the client's body image changes C. Giving the client printed information about when to use hot and cold therapy D. Consulting occupational therapy to provide assistive devices for self-care

Correct Answer is D

Explanation

A) Talking with the client's family to determine how the condition affects the client role:
Understanding the client's role within the family is important for comprehensive care, but it is not the most immediate priority in discharge planning. This information can be gathered once the client has the tools to manage their condition effectively.

B) Assessing the impact of the client's body image changes:
While body image is a significant concern for many clients with chronic conditions, it does not directly affect the immediate physical ability to manage daily activities and pain, which is crucial for someone with osteoarthritis.

C) Giving the client printed information about when to use hot and cold therapy:
Providing education on managing symptoms is essential, but simply giving printed information might not address the client's immediate need for practical assistance and adaptations necessary for self-care at home.

D) Consulting occupational therapy to provide assistive devices for self-care:
Ensuring the client has access to assistive devices through occupational therapy is the priority because it directly addresses their ability to perform activities of daily living independently and safely. This intervention can significantly improve the client’s quality of life and reduce the risk of complications.

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A nurse in a clinic is teaching preventative measures with a female client who has a history of deep-vein thrombosis. Which of the following statements should the nurse include in the teaching?

Nursing Test Bank

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