A nurse is caring for a client who is postoperative.
For which of the following findings should the nurse suspect the client is experiencing a deep-vein thrombosis?
Numbness of the affected extremity.
Muscle spasms.
Warmth of the affected extremity.
Absent pedal pulse.
The Correct Answer is C
Choice A rationale
Numbness of the affected extremity is not a classic symptom of deep-vein thrombosis (DVT). DVT primarily affects venous circulation, causing symptoms like pain, swelling, and warmth, rather than sensory deficits like numbness, which are more indicative of nerve involvement or arterial issues.
Choice B rationale
Muscle spasms are not a hallmark sign of DVT. They are typically associated with muscular or neuromuscular issues. DVT symptoms are more focused on vascular changes such as pain, swelling, and increased warmth in the affected area due to impaired venous return.
Choice C rationale
Warmth of the affected extremity occurs due to localized inflammation caused by clot formation in the vein. The body’s inflammatory response to the thrombus leads to vasodilation and increased blood flow to the area, resulting in the sensation of warmth upon palpation.
Choice D rationale
An absent pedal pulse is not indicative of DVT, as this condition involves venous, not arterial, circulation. A missing pulse suggests arterial occlusion or peripheral vascular disease, distinct from venous thromboembolism like DVT.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Cabbage contains dietary fiber, approximately 1.2 g per 75 g. However, its fiber content is lower compared to other options, limiting its effectiveness in preventing constipation.
Choice B rationale
Strawberry yogurt has negligible fiber content, as yogurt is primarily a dairy product. While it supports gut health through probiotics, it is not a significant fiber source.
Choice C rationale
Brown rice provides moderate fiber, approximately 1.6 g per 105 g. Though beneficial, it is still lower in fiber content than green peas.
Choice D rationale
Green peas are high in dietary fiber, with approximately 4.4 g per 80 g. This fiber content promotes bowel regularity by adding bulk and facilitating gut motility. .
Correct Answer is A
Explanation
Choice A rationale
Cracks at the corners of the mouth, or cheilosis, are often associated with nutritional deficiencies like iron or vitamin B deficiencies. Monitoring for these cracks helps diagnose and treat the underlying condition.
Choice B rationale
A reddened tongue is typically associated with vitamin B12 deficiency or other conditions but not cheilosis. It can help identify a different deficiency or condition.
Choice C rationale
Pale conjunctiva is an indicator of anemia but does not specifically correlate with cheilosis. It suggests reduced hemoglobin levels due to iron deficiency.
Choice D rationale
Brittle fingernails may result from chronic iron deficiency anemia but are not directly related to cheilosis. They serve as additional evidence of prolonged anemia.
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