A nurse is providing teaching to a patient with chronic venous insufficiency. Which of the following should be included in the teaching plan? (Select all that apply.)

Walking is contraindicated and bed rest as much as possible is recommended

Dangle" legs on the side of the bed several times per day

Avoid sitting or standing for prolonged periods

Elevate legs above heart level for 20-30 minutes. 4-5 times per day

Use compression stockings to decrease swelling

Answer and Explanation

Correct Answer : C,D,E

A) Walking is contraindicated and bed rest as much as possible is recommended:
. Walking is actually highly recommended for patients with chronic venous insufficiency (CVI). Gentle, regular physical activity, such as walking, helps improve circulation and reduce the risk of blood pooling in the lower extremities. Bed rest is not typically recommended unless the patient has severe symptoms like ulcers or active infection. In fact, staying active can promote better venous return and prevent worsening of CVI.

B) Dangle legs on the side of the bed several times per day:
. Dangling the legs can exacerbate venous stasis (blood pooling in the veins), which worsens symptoms of chronic venous insufficiency. Instead of dangling the legs, patients should focus on elevating the legs to reduce swelling and improve venous return. Dangle the legs only if advised by a healthcare provider for specific reasons, such as short periods of time to encourage blood flow after immobility.

C) Avoid sitting or standing for prolonged periods:
. One of the key recommendations for managing chronic venous insufficiency is to avoid prolonged sitting or standing. Remaining in one position for too long can cause blood to pool in the lower extremities, leading to increased swelling, pain, and discomfort. It’s important to encourage frequent position changes and movement, such as standing up or walking around if sitting, or sitting down to rest if standing for prolonged periods.

D) Elevate legs above heart level for 20-30 minutes, 4-5 times per day:
. Elevating the legs above heart level is a key intervention for patients with chronic venous insufficiency. This helps reduce swelling by promoting venous return and decreasing the pressure in the veins. Elevating the legs for 20-30 minutes, several times a day (4-5 times) can help alleviate symptoms and prevent further complications, such as ulcers and skin changes.

E) Use compression stockings to decrease swelling:
. Compression stockings are a cornerstone of managing chronic venous insufficiency. They help improve venous return, prevent blood from pooling in the lower legs, and reduce swelling. The stockings should be properly fitted and worn throughout the day (except when sleeping) to provide continuous support and minimize the risk of complications associated with CVI, such as venous ulcers.

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Correct Answer is B

Explanation

A. Pernicious anemia:
Pernicious anemia is primarily caused by a deficiency in vitamin B12, often due to a lack of intrinsic factor needed for absorption in the gut. It typically presents with symptoms like weakness, fatigue, and neurological manifestations such as numbness or tingling. However, the client’s presentation does not suggest a vitamin B12 deficiency or neurological signs. Additionally, pernicious anemia is not typically associated with heavy menstrual periods,
which are more indicative of blood loss anemia.

B. Blood loss anemia:
Blood loss anemia is the most likely diagnosis in this case, especially in the context of heavy menstrual periods, which can cause significant blood loss over time. The client’s hemoglobin level of 6.9 g/dL indicates severe anemia, which is consistent with the cumulative effects of chronic blood loss. This type of anemia results from a decrease in red blood cell count due to bleeding, which can lead to symptoms like weakness, fatigue, and pallor.

C. Sickle cell anemia:
Sickle cell anemia is a genetic condition characterized by abnormally shaped red blood cells, which can lead to hemolysis and episodes of pain. While it can cause symptoms like fatigue and weakness, sickle cell anemia typically presents earlier in life and is more associated with episodes of severe pain and organ damage. Additionally, the patient’s history does not mention episodes of pain or other hallmark signs of sickle cell disease, such as swelling in the hands or feet or recurrent infections.

D. Aplastic anemia:
Aplastic anemia occurs when the bone marrow fails to produce enough blood cells, including red blood cells, white blood cells, and platelets. It presents with symptoms like weakness, fatigue, frequent infections, and bruising. Although this client does have anemia, the lack of additional signs (such as petechiae, infections, or bleeding) makes this diagnosis less likely. Aplastic anemia is also usually diagnosed with bone marrow biopsy, which is not suggested by this client's presentation.

A. I will notify my doctor before taking any other medications’’ B. "I should talk to my doctor about other methods of contraception in addition to my current oral contraceptives. C. "I'll be glad when I can stop taking this medicine after my seizures are controlled’’ D. I have made an appointment to see my dentist next week.’’

Correct Answer is C

Explanation

A) "I will notify my doctor before taking any other medications:"
Phenytoin interacts with many medications, both prescription and over-the-counter. It is crucial for the client to inform their doctor before starting any new medications, including herbal supplements, as phenytoin may have significant drug interactions that could alter its effectiveness or increase the risk of side effects.

B) "I should talk to my doctor about other methods of contraception in addition to my current oral contraceptives:"
Phenytoin can decrease the effectiveness of oral contraceptives, leading to an increased risk of unintended pregnancy. It is important for clients to discuss alternative or additional methods of contraception, such as non-hormonal methods or alternative hormonal birth control, with their healthcare provider to prevent pregnancy while taking phenytoin.

C) "I'll be glad when I can stop taking this medicine after my seizures are controlled:"
Phenytoin is typically a lifelong medication for managing seizures, even if the seizures are well-controlled. Stopping the medication without a doctor's approval can lead to seizure recurrence. Seizure control does not always mean stopping medication, and clients need to understand the importance of continuing the prescribed treatment regimen, even after achieving stability.

D) "I have made an appointment to see my dentist next week:"
Phenytoin can cause gingival hyperplasia, which increases the need for regular dental checkups. It is recommended that clients taking phenytoin see a dentist regularly to manage this potential side effect and maintain oral health.

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A nurse is providing teaching to a patient with chronic venous insufficiency. Which of the following should be included in the teaching plan? (Select all that apply.)

Nursing Test Bank

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A nurse is caring for a young female adult client who reports weakness, fatigue, and heavy menstrual periods. The client has a hemoglobin level of 6.9 g/dL. The nurse suspects which of the following types of anemia?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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