A nurse is caring for a client who reports an area of redness, warmth, tenderness, and pain in the right calf.
The nurse anticipates which of the following orders when notifying the provider of this finding?
Obtain impedance plethysmography.
Apply cold therapy to the affected leg.
Obtain a venous duplex ultrasound.
Monitor Homan's sign.
The Correct Answer is C
Choice A rationale:
Impedance plethysmography is a test that uses electrical signals to measure blood flow and can be used to detect deep vein thrombosis (DVT). However, it is not the first-line diagnostic tool for DVT.
Choice B rationale:
Cold therapy can help reduce inflammation and pain, but it is not a diagnostic measure for DVT.
Choice C rationale:
Venous duplex ultrasound is the most common test used to diagnose DVT. It uses sound waves to create pictures of the blood flowing through the veins in the leg.
Choice D rationale:
Homan’s sign is a physical examination finding that was traditionally used to diagnose DVT, but it is not reliable or specific.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Applying a cold pack to the client’s upper arm would not be the first action to take. It may help reduce swelling, but it does not address the underlying issue.
Choice B rationale:
Measuring the circumference of both upper arms is the correct first action. This will provide objective data about the extent of the swelling, which can then be reported to the healthcare provider.
Choice C rationale:
Removing the PICC line is not the first action to take. This should only be done under the direction of a healthcare provider.
Choice D rationale:
Notifying the provider who inserted the PICC line is important, but it should be done after gathering all necessary data, including measuring the arm circumference.
Correct Answer is B
Explanation
Choice A rationale:
Turning the client’s head to the side is important to prevent aspiration, but it should be done after documenting the time the seizure began.
Choice B rationale:
The first action when a client begins having a tonic-clonic seizure is to document the time the seizure began. This helps in determining the duration of the seizure, which is critical information for the healthcare team.
Choice C rationale:
Loosening the clothing around the client’s waist is important for the client’s comfort and safety during a seizure, but it should be done after documenting the time the seizure began.
Choice D rationale:
Checking the client’s motor strength is not the first action to take when a client begins having a tonic-clonic seizure.
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