A nurse is teaching a client who has venous insufficiency due to deep-vein thrombosis. Which of the following Instructions should the nurse include in the teaching?
"Limit crossing your legs at your knees to 30 minutes at a time."
"Elevate the head of the bed when sleeping at night."
"Wash your graduated compression stockings in the washing machine."
"Put on your graduated compression stockings before getting out of bed."
The Correct Answer is D
A) Limit crossing your legs at your knees to 30 minutes at a time: Crossing the legs at the knees can restrict blood flow and increase venous pressure, which is detrimental to clients with venous insufficiency. It's generally advised to avoid crossing legs altogether rather than limiting it to 30 minutes.
B) Elevate the head of the bed when sleeping at night: Elevating the head of the bed does not significantly aid in improving venous return from the legs. Elevating the legs instead helps reduce venous pressure and promotes better circulation, which is more beneficial for venous insufficiency.
C) Wash your graduated compression stockings in the washing machine: Washing compression stockings in a washing machine can damage their elasticity and effectiveness. It's better to hand wash them and let them air dry to maintain their compression properties.
D) Put on your graduated compression stockings before getting out of bed: Putting on compression stockings before getting out of bed helps to prevent blood from pooling in the legs. This maximizes their effectiveness in reducing edema and promoting venous return throughout the day.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) "I can add lean turkey to a salad.": Lean turkey is a good source of heme iron, which is more easily absorbed by the body compared to non-heme iron found in plant-based sources. Including iron-rich foods like lean turkey in the diet helps address iron-deficiency anemia effectively.
B) "I should choose apples over strawberries.": Apples are not particularly high in iron compared to strawberries. While apples provide some nutrients, strawberries contain more vitamin C, which enhances iron absorption from other foods.
C) "I can take an iron supplement with milk to enhance the effect.": Milk and other dairy products can inhibit iron absorption due to their calcium content. It is recommended to take iron supplements with vitamin C-rich beverages like orange juice to enhance absorption.
D) "I should consume coffee or tea with my meals.": Coffee and tea contain compounds like polyphenols that can inhibit iron absorption when consumed with meals. It's better to avoid these beverages around meal times to improve iron absorption.
Correct Answer is D
Explanation
A) Bounding peripheral pulses: Metabolic acidosis typically does not cause bounding peripheral pulses. In metabolic acidosis, vasodilation might occur, but it usually leads to weaker, not bounding, pulses due to decreased cardiac output and blood pressure.
B) Hyperreflexia: Hyperreflexia is not commonly associated with metabolic acidosis. Instead, metabolic acidosis may cause symptoms like muscle weakness or fatigue due to the effect of acid-base imbalance on neuromuscular function.
C) Cool skin: While cool skin can sometimes be associated with poor perfusion in severe cases, it is not a direct manifestation of metabolic acidosis. Metabolic acidosis more commonly affects internal physiology rather than peripheral skin temperature directly.
D) Hypotension: Hypotension is a common manifestation of metabolic acidosis. The acidosis leads to vasodilation and decreased cardiac contractility, resulting in a drop in blood pressure. This is a critical sign for the nurse to monitor as it indicates the severity of the acid-base imbalance and its effect on the cardiovascular system.
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