A nurse is contributing to the plan of care for a client who is admitted with deep vein thrombosis (DVT) of the left leg. Which of the following interventions should the nurse include in the plan?

Apply ice to the extremity.

Administer vasodilating medications.

Restrict oral fluids.

Monitor platelet levels.

Answer and Explanation

The Correct Answer is D

Choice A reason : Applying ice to the extremity is not a standard intervention for DVT. Ice is typically used to reduce inflammation and pain, but in the case of DVT, the priority is to prevent the clot from growing and embolizing. The use of warmth, not cold, may be recommended to help reduce discomfort and swelling.

Choice B reason : Administering vasodilating medications is not a typical intervention for DVT. Vasodilators are used to widen blood vessels and improve blood flow, but they do not address the risk of clot formation or embolization associated with DVT. The mainstay of medical treatment for DVT is anticoagulant therapy, which helps to prevent further clotting.

Choice C reason : Restricting oral fluids is not an intervention for DVT. Adequate hydration is important in the management of DVT as it can help to prevent blood from thickening and reduce the risk of further clot formation. There is no indication to restrict fluids unless there is another underlying condition that requires it.

Choice D reason : Monitoring platelet levels is an important intervention in the care of a client with DVT, especially if they are receiving anticoagulant therapy. Anticoagulants can affect platelet function and count, and monitoring is necessary to ensure safe levels and prevent complications such as bleeding or thrombocytopenia.

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Correct Answer is C

Explanation

Choice A reason : Keeping the client in a high-Fowler's position for 6 hours post-cardiac catheterization is not recommended. After a femoral approach, it's important to keep the leg straight and the patient flat or with the head slightly elevated to prevent bleeding from the catheter insertion site. High-Fowler's position could increase the risk of bleeding and is not conducive to maintaining pressure at the arterial access site.

Choice B reason : Allowing the patient to ambulate around the room immediately after the procedure is contraindicated. The patient is typically required to remain on bed rest with the affected leg straight to prevent bleeding and ensure proper healing of the arterial puncture site. Ambulation is usually restricted for several hours post-procedure.

Choice C reason : Checking pedal pulses every 15 minutes is a critical action following cardiac catheterization via the femoral artery. It ensures that there is adequate blood flow to the extremity and helps to identify any complications such as occlusion or bleeding early. Adequate perfusion is indicated by strong and equal pedal pulses.

Choice D reason : Performing passive range-of-motion exercises for the affected extremity immediately after cardiac catheterization is not recommended. The affected leg should remain straight without bending at the hip to prevent bleeding from the catheter site. Passive range-of-motion could disrupt the vascular integrity at the puncture site and increase the risk of bleeding.

A. a: Cough B. b: Bradycardia C. c: Constipation D. d: Headache

Correct Answer is B

Explanation

Choice A reason: Cough is not commonly associated with atenolol. Atenolol is a beta-blocker used to treat hypertension and is less likely to cause respiratory side effects compared to some other classes of antihypertensive medications.

Choice B reason: Bradycardia, or a slower than normal heart rate, is a well-documented adverse effect of atenolol. Atenolol works by blocking beta-1 receptors in the heart, which can reduce the heart rate. Normal heart rate ranges for infants (1 to 11 months old) are 80-160 beats per minute (BPM), and for toddlers (1-2 years old), it's 80-130 BPM. Bradycardia would be defined as a heart rate below these normal ranges. It is important for patients starting atenolol to monitor their pulse regularly and report any significant decrease in heart rate to their healthcare provider.

Choice C reason: While constipation can be a side effect of many medications, it is not a common adverse effect of atenolol. Atenolol does not typically affect the gastrointestinal system to the extent that it causes constipation.

Choice D reason: Headache is not a typical adverse effect of atenolol. While headaches can occur for a variety of reasons, they are not directly linked to the pharmacological action of atenolol on the cardiovascular system.

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A nurse is contributing to the plan of care for a client who is admitted with deep vein thrombosis (DVT) of the left leg. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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