A nurse is assessing a client for possible deep vein thrombosis (DVT). Which clinical manifestation is most indicative of DVT?
Chest pain and shortness of breath.
Warmth and redness over the affected area.
Pedal edema and bilateral leg pain.
Weak pedal pulses and cool extremities.
The Correct Answer is B
A) This choice is incorrect because chest pain and shortness of breath are more indicative of a potential pulmonary embolism, a serious complication of DVT. While DVT can lead to a pulmonary embolism, the primary manifestation of DVT is related to the affected limb.
B) This choice is correct. Warmth and redness over the affected area, typically the calf or thigh, are common clinical manifestations of DVT. The warmth is due to the inflammatory response caused by the blood clot formation.
C) This choice is incorrect because pedal edema and bilateral leg pain are non-specific findings and can be caused by various conditions, not just DVT. They are not specific enough to diagnose DVT on their own.
D) This choice is incorrect because weak pedal pulses and cool extremities are not typically associated with DVT. These findings suggest potential arterial insufficiency rather than venous thrombosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) This choice is correct. Gender is a non-modifiable risk factor for DVT, with women generally having a higher risk than men. Hormonal changes, such as those associated with pregnancy, oral contraceptives, and hormone replacement therapy, can contribute to the increased risk in women.
B) This choice is incorrect because obesity is a modifiable risk factor for DVT, not a non-modifiable one. Clients can work to achieve and maintain a healthy weight to reduce their risk.
C) This choice is incorrect because smoking history is a modifiable risk factor for DVT. Clients can quit smoking to decrease their risk of blood clot formation.
D) This choice is incorrect because a sedentary lifestyle is a modifiable risk factor for DVT. Clients can engage in regular physical activity to reduce their risk.
Correct Answer is B
Explanation
A) This choice is incorrect because palpating the pulses in the extremities primarily assesses arterial blood flow, not venous thrombosis. While pulse assessment is essential, it is not the priority for identifying DVT-related manifestations.
B) This choice is correct. Measuring calf and thigh circumference can help identify possible DVT by comparing the affected leg's size to the unaffected one. DVT can cause localized swelling in the affected limb.
C) This choice is incorrect because auscultating the lungs for crackles is not a specific assessment for DVT. Crackles may be present in pulmonary edema, which can be a complication of DVT, but they do not directly assess the presence of a blood clot in the veins.
D) This choice is incorrect because performing a capillary refill test is primarily used to assess peripheral perfusion and is not specific to DVT assessment.
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