A nurse is providing education to a client with deep vein thrombosis (DVT) about potential complications. Which symptom should the nurse instruct the client to report immediately?

Mild leg swelling after prolonged standing.

Redness and warmth at the site of the affected leg.

Occasional cramping in the unaffected leg.

Mild fatigue and generalized body aches.

Answer and Explanation

The Correct Answer is B

A) This choice is incorrect because mild leg swelling after prolonged standing may be expected, especially in clients with a history of DVT. It is not a critical symptom to report immediately.

B) This choice is correct. Redness and warmth at the site of the affected leg could indicate an inflammatory response or progression of the clot. These signs may be indicative of a potential complication, such as an infection or extension of the clot, and should be reported immediately for further evaluation and intervention.

C) This choice is incorrect because occasional cramping in the unaffected leg may not be directly related to the DVT. While any changes in leg symptoms should be reported to the healthcare provider, this symptom is less urgent than redness and warmth in the affected leg.

D) This choice is incorrect because mild fatigue and generalized body aches are non-specific symptoms and may not be directly related to DVT. While it is essential to report any new or concerning symptoms, redness and warmth in the affected leg are more indicative of potential complications related to DVT.

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Correct Answer is A

Explanation

A) This choice is correct. Prolonged sitting or standing in one position can lead to reduced blood flow and stasis, increasing the risk of DVT. Encouraging regular movement and changing positions can help prevent clot formation.

B) This choice is incorrect because massaging the legs may not be suitable for everyone and is not a primary preventive measure for DVT. While it can aid in improving blood circulation, it should be done cautiously and not as a standalone preventive action.

C) This choice is incorrect because increasing the intake of vitamin K-rich foods is not a preventive measure for DVT. Vitamin K is involved in the clotting process, but it does not directly impact the risk of DVT.

D) This choice is incorrect because taking over-the-counter pain medications for leg discomfort does not prevent DVT. While pain management may be necessary for symptomatic relief, it does not address the underlying risk factors for DVT.

A. Monitoring the client's prothrombin time (PT) and international normalized ratio (INR). B. Assessing the client's liver function regularly. C. Administering heparin via a central venous catheter. D. Monitoring the client's activated partial thromboplastin time (aPTT).

Correct Answer is D

Explanation

A) This choice is incorrect because monitoring prothrombin time (PT) and international normalized ratio (INR) is more relevant to monitoring oral anticoagulant therapy (e.g., warfarin) and not intravenous heparin therapy.

B) This choice is incorrect because while liver function tests may be important for some medications, they are not the priority for clients on intravenous heparin therapy. Heparin is primarily eliminated by the kidneys.

C) This choice is incorrect because while administering heparin via a central venous catheter is possible, it is not the priority action for safe administration. Monitoring the client's response to heparin therapy is more important.

D) This choice is correct. Monitoring the client's activated partial thromboplastin time (aPTT) is the priority action when administering intravenous heparin. The aPTT reflects the client's response to heparin and helps adjust the dosage to achieve the desired therapeutic effect while minimizing the risk of bleeding.

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A nurse is providing education to a client with deep vein thrombosis (DVT) about potential complications. Which symptom should the nurse instruct the client to report immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing education to a client at risk of deep vein thrombosis (DVT). What is the most crucial instruction the nurse should include in the client's teaching plan?

Correct Answer is A

Explanation

A nurse is caring for a client receiving intravenous (IV) heparin therapy for deep vein thrombosis (DVT). What is the nurse's priority action to ensure safe administration of the medication?

Correct Answer is D

Explanation

A client with deep vein thrombosis (DVT) is prescribed compression stockings. What is the nurse's best explanation for the purpose of using compression stockings?

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A nurse is assessing a client for possible deep vein thrombosis (DVT). Which clinical manifestation is most indicative of DVT?

A client is admitted to the hospital with a suspected deep vein thrombosis (DVT). Which question should the nurse ask during the health history to identify potential risk factors for DVT?

A nurse is caring for a client with suspected deep vein thrombosis (DVT). Which diagnostic test is used to assess blood flow and detect clots in the deep veins of the legs non-invasively?

A client with deep vein thrombosis (DVT) is being discharged from the hospital. What should the nurse include in the client's discharge teaching to promote ongoing preventive measures?

A client with deep vein thrombosis (DVT) is prescribed enoxaparin, a low molecular weight heparin (LMWH). What is the nurse's priority action before administering the medication?