A nurse is providing discharge instructions to a client who developed deep-vein thrombosis (DVT) postoperatively and is prescribed anticoagulant therapy. Which of the following instructions should the nurse include?
Wearing loose, non-constricting stockings
Applying cool compresses to her legs
Taking an NSAID tablet daily
Flexing her knees and feet frequently
The Correct Answer is D
A. Wearing loose, non-constricting stockings: This instruction is not recommended for a client with DVT. Compression stockings, which are snug-fitting, may be prescribed to prevent DVT, but loose stockings would not provide the necessary compression.
B. Applying cool compresses to her legs: Cool compresses are not typically recommended for DVT. Warm compresses may be used to improve blood circulation, but cold compresses may not be suitable.
C. Taking an NSAID tablet daily: Nonsteroidal anti-inflammatory drugs (NSAIDs) are not typically recommended for individuals with DVT, especially when on anticoagulant therapy, as they may increase the risk of bleeding.
D. Flexing her knees and feet frequently: This is the correct answer. Encouraging the client to flex her knees and feet frequently helps promote blood circulation and reduces the risk of venous stasis, which can contribute to the formation of blood clots. It is a beneficial measure for clients with DVT.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Remove the catheter: Removing the catheter may not be the immediate priority. The nurse should focus on preventing further air entry into the circulation and addressing the symptoms.
B. Replace the infusion system: While ensuring that the infusion system is intact is important, it is not the primary action needed to manage an air embolism.
C. Prepare for chest tube insertion: Chest tube insertion is not the primary intervention for an air embolism. The focus should be on preventing the progression of the embolism and providing supportive care.
D. Place the client on his left side in Trendelenburg position: This is the correct answer. Placing the client on the left side in Trendelenburg position is a maneuver used to trap air in the right atrium, preventing it from traveling to the pulmonary artery. The left side position helps to prevent the air from traveling to the right ventricle and into the pulmonary artery, reducing the risk of further complications.
Correct Answer is C
Explanation
pH 7.22: Indicates acidosis (normal range: 7.35-7.45).
PaCO2 68 mm Hg: Elevated partial pressure of carbon dioxide, suggesting respiratory acidosis (normal range: 35-45 mm Hg).
Base excess -2: Indicates a mild metabolic acidosis.
PaO2 78 mm Hg: Within the normal range (80-100 mm Hg), indicating adequate oxygenation.
Saturation 80%: Below the normal range (95-100%), suggesting some degree of hypoxemia.
Bicarbonate 26 mEq/L: Elevated bicarbonate levels, suggesting metabolic compensation for the respiratory acidosis.
Therefore, the client is experiencing respiratory acidosis with partial metabolic compensation (mild metabolic acidosis).
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