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Patient Data

Chart is reviewed.
Which discharge education should the nurse provide the client? Select all that apply.

Do not take aspirin or any aspirin containing products.

When sitting, move and stretch the lower extremities several times each hour.

Keep the legs in a dependent position.

Smoking cessation is encouraged.

Report shortness of breath.

Perform range of motion exercises until able to resume normal activities.

Do not have anal intercourse.

Apply warm moist heat to fresh bruising.

Answer and Explanation

Correct Answer : A,B,D,E,F,G

Pulmonary embolism management transitions from acute anticoagulation to long-term prevention and risk factor modification. A pulmonary embolism occurs when a thrombus, often from a deep vein, obstructs pulmonary arterial flow, leading to ventilation-perfusion mismatch and potential right heart strain. Discharge education focuses on hemorrhage prevention while on anticoagulants, enhancing peripheral venous return to prevent stasis, and addressing modifiable factors like nicotine use that promote a prothrombotic state.

Rationale:

A. Avoiding aspirin is essential because it is an antiplatelet agent that increases the risk of bleeding when combined with anticoagulants. The concurrent use of multiple blood-thinning medications significantly elevates the potential for gastrointestinal hemorrhage or intracranial bleeding. Clients must be taught to screen over-the-counter medications for hidden salicylates to maintain pharmacological safety during the recovery period.

B. Moving and stretching the lower extremities prevents venous stasis, a primary component of Virchow’s triad. Frequent movement facilitates the skeletal muscle pump, which assists in pushing venous blood back toward the heart and prevents the formation of new thrombi. This is especially critical for a client with a recent lower extremity fracture and cast who has reduced mobility.

C. Keeping legs in a dependent position is contraindicated because it promotes venous pooling and increases the risk of deep vein thrombosis. The client should be encouraged to elevate the legs above the level of the heart to facilitate venous drainage and reduce generalized edema. Dependent positioning worsens stasis and creates an environment conducive to further clot formation.

D. Smoking cessation is highly encouraged because nicotine causes vasoconstriction and hypercoagulability, increasing the risk of recurrent thromboembolic events. This client has a significant smoking history, which likely contributed to the development of the pulmonary embolism post-surgery. Quitting smoking is a vital lifestyle modification to improve vascular health and prevent future life-threatening complications.

E. Reporting shortness of breath is a priority instruction as it may indicate a recurrent embolism or worsening pulmonary function. Since the client already experienced an acute event characterized by respiratory distress, he must be vigilant in recognizing early symptoms. Prompt reporting allows for immediate clinical evaluation and prevents the progression of potential pulmonary infarction or failure.

F. Performing range of motion exercises maintains joint flexibility and promotes circulation while the client is convalescing. These exercises help prevent the complications of immobility-induced stasis, which is a high risk given his recent ankle fracture and surgery. Consistent movement ensures that blood flow remains active in the unaffected and partially affected limbs to support recovery.

G. Avoiding anal intercourse is a specific safety precaution to prevent mucosal trauma and subsequent rectal bleeding while on anticoagulation therapy. The rectal mucosa is highly vascular and easily injured, leading to significant blood loss if the client's clotting ability is pharmacologically suppressed. This instruction is a necessary component of comprehensive education regarding the prevention of internal bleeding.

H. Applying warm moist heat to fresh bruising is contraindicated as it causes vasodilation and can worsen local bleeding and hematoma expansion. Instead, clients should apply cold compresses to new bruises to promote vasoconstriction and limit the size of the hemorrhage. Heat should only be used in later stages of healing once the initial clot has stabilized.

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Correct Answer is B

Explanation

Nutritional screening is a systematic process used to identify individuals at risk of protein-energy malnutrition and those who may benefit from specialized metabolic support. These tools evaluate physiological variables such as unintentional weight loss, recent dietary intake reductions, and the metabolic stress induced by the client's current pathology. For high-acuity patients, effective screening facilitates early nutritional intervention, which is statistically linked to reduced hospital stay durations and improved wound healing.

Rationale:

A. The Subjective Global Assessment is a comprehensive clinical tool used to assess nutritional status based on patient history and physical examination findings. While highly effective for identifying severe malnutrition, it is a more labor-intensive assessment rather than a rapid screening tool for predictive outcomes. It does not utilize the specific scoring system found in the NRS-2002 protocol.

B. The Nutritional Risk Screening 2002 is the gold standard for identifying mildly-to-moderately malnourished clients in the acute care setting. It incorporates a nutritional score and a severity-of-illness score, making it uniquely capable of predicting clinical outcomes for critically-ill patients. This tool is specifically designed to determine which hospitalized patients require a formal nutrition plan.

C. The Mini Nutritional Assessment is a specialized screening tool validated almost exclusively for the geriatric population aged 65 and older. It focuses on age-related factors like mobility, neuropsychological problems, and polypharmacy, which are not applicable to a 25-year-old client. It is not the primary instrument used for predicting outcomes in younger critically-ill populations.

D. The Malnutrition Screening Tool is a simplified, two-question instrument often used in outpatient or general hospital wards to identify risk quickly. While efficient, it lacks the scientific depth to categorize malnutrition severity or provide predictive data for intensive care scenarios. It is generally used for initial identification rather than detailed outcome prediction in critical illness.

A. Bruising over several areas of the body. B. Pain in weight bearing joints with use. C. Low grade fever and cough. D. Asymmetrical swelling of hand joints. E. Joints which are warm, red, swollen, and tender.

Correct Answer is ["A","C"]

Explanation

Brief introduction:

Rheumatoid arthritis is a chronic autoimmune disorder characterized by systemic inflammation of the synovial membranes. The use of adalimumab, a tumor necrosis factor (TNF) inhibitor, effectively reduces joint destruction but causes significant immunosuppression and potential hematologic suppression, increasing the risk for opportunistic infections and blood dyscrasias.

Rationale:

A. Bruising can indicate thrombocytopenia, a serious adverse effect of biologic therapy where the bone marrow fails to produce adequate platelets. This finding requires immediate reporting to the HCP to evaluate for hematologic toxicity and prevent life-threatening spontaneous hemorrhage or internal bleeding during adalimumab therapy.

B. Pain in weight-bearing joints with use is a hallmark of osteoarthritis, which is a degenerative rather than inflammatory condition. While clients with RA can have secondary joint wear, this finding does not represent the autoimmune exacerbation or medication-related toxicity that would necessitate an urgent change in the clinical treatment plan.

C. A low-grade fever and cough may signal a serious infection, such as tuberculosis or pneumonia, which can be fatal in immunosuppressed clients. Because TNF inhibitors mask the inflammatory response, these seemingly minor symptoms are critical indicators of a compromised immune system unable to contain a developing pathogen.

D. Asymmetrical swelling is not typical of RA, which is characterized by symmetrical involvement of the small joints. Asymmetry suggests localized trauma or degenerative changes rather than the systemic inflammatory process that defines rheumatoid arthritis, and it does not typically indicate an acute systemic flare-up.

E. Warm, red, swollen, and tender joints are expected findings during a rheumatoid arthritis flare and are consistent with the client’s reported concerns about the weather. While uncomfortable, these symptoms reflect the disease's natural progression and are less critical than the systemic signs of medication toxicity or infection.

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Patient Data Chart is reviewed. Which discharge education should the nurse provide the client? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse and a dietitian are completing a nutrition assessment for a 25-year-old client. Which nutritional screening tool is used to determine if the client is mildly-to-moderately malnourished and predict outcomes for critically-ill clients?

Correct Answer is B

Explanation

Correct Answer is ["A","C"]

Explanation

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Patient Data

Chart is reviewed.
Which discharge education should the nurse provide the client? Select all that apply.