A nurse is caring for a client who has deep-vein thrombosis and a new prescription for antiembolitic stockings.
Which of the following actions should the nurse take?
Massage the legs before applying the stockings.
Fold the stockings at the top if they are too long.
Measure the legs with a tape measure to determine stocking size.
Remove the stockings every 24 hr.
The Correct Answer is C
Choice A rationale:
Massaging the legs before applying the stockings is not advisable. Vigorous massage can dislodge clots in patients with DVT, leading to serious complications like pulmonary embolism. It is essential to handle the legs gently and follow the proper procedure for applying antiembolitic stockings.
Choice B rationale:
Folding the stockings at the top if they are too long is not recommended. Altering the stockings in this way can create uneven pressure, reducing their effectiveness in preventing DVT. It is crucial to choose the correct size of stockings to ensure proper compression and prevention of complications.
Choice C rationale:
Measuring the legs with a tape measure to determine the stocking size is the correct action. Proper sizing is essential to ensure the stockings fit the patient correctly and provide the appropriate level of compression. Ill-fitting stockings can be ineffective and may even cause harm, such as skin abrasions or impeded circulation.
Choice D rationale:
Removing the stockings every 24 hours is unnecessary unless there is a specific medical indication to do so. Continuous wear of antiembolitic stockings is generally recommended to provide consistent compression and prevent deep-vein thrombosis (DVT)
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The nurse should suggest, "Give your son a little gift from his new sister," as a strategy to help the preschool-age son adjust to having a new sibling. This approach involves a small token or gift given from the newborn to the older sibling. It helps create a positive association and fosters a sense of connection and acceptance between the siblings. The gift symbolizes the new baby's arrival and can help the older child feel special and valued during this transition.
Choice B rationale:
While spending alone time with the new sister is important, the statement, "Give your son plenty of 'alone time' with his sister," does not address the initial meeting concerns. Alone time is relevant once the siblings have established a bond, but the initial introduction requires a more structured approach to ensure a smooth transition.
Choice C rationale:
Planning for the son to meet his sister for the first time at home is not the most suitable strategy. Hospitals provide a controlled environment with healthcare professionals available, ensuring the safety and well-being of both the mother and the newborn. The initial meeting should occur in a setting where medical assistance is readily accessible in case of any unforeseen circumstances.
Choice D rationale:
Holding the daughter when the son first meets her is a common and natural practice but does not actively involve the son in the process. Providing a gift from the baby to the older sibling fosters a sense of participation and inclusion, making the older child feel more involved and excited about the new sibling's arrival.
Correct Answer is C
Explanation
Choice A rationale:
Massaging the legs before applying the stockings is not advisable. Vigorous massage can dislodge clots in patients with DVT, leading to serious complications like pulmonary embolism. It is essential to handle the legs gently and follow the proper procedure for applying antiembolitic stockings.
Choice B rationale:
Folding the stockings at the top if they are too long is not recommended. Altering the stockings in this way can create uneven pressure, reducing their effectiveness in preventing DVT. It is crucial to choose the correct size of stockings to ensure proper compression and prevention of complications.
Choice C rationale:
Measuring the legs with a tape measure to determine the stocking size is the correct action. Proper sizing is essential to ensure the stockings fit the patient correctly and provide the appropriate level of compression. Ill-fitting stockings can be ineffective and may even cause harm, such as skin abrasions or impeded circulation.
Choice D rationale:
Removing the stockings every 24 hours is unnecessary unless there is a specific medical indication to do so. Continuous wear of antiembolitic stockings is generally recommended to provide consistent compression and prevent deep-vein thrombosis (DVT)
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