The nurse is caring for a client with a history of deep vein thrombosis. Which intervention should the nurse include in the care plan?

Encourage early ambulation

Apply warm compresses to the leg

Restrict fluid intake

Elevate the affected leg

Answer and Explanation

The Correct Answer is D

Choice A reason: Early ambulation prevents stasis but is contraindicated in acute deep vein thrombosis, as it risks dislodging the clot, causing pulmonary embolism. Leg elevation reduces swelling and promotes venous return, making it the priority intervention to manage acute DVT safely.

Choice B reason: Warm compresses may increase blood flow but are not standard for deep vein thrombosis, as they risk clot dislodgement. Leg elevation reduces edema and venous pressure, improving circulation without mobilizing the clot, making it the preferred intervention for DVT management.

Choice C reason: Restricting fluid intake is inappropriate, as hydration prevents blood viscosity increases that exacerbate deep vein thrombosis. Leg elevation directly reduces swelling and promotes venous return, addressing the primary issue of venous stasis, making it the priority over fluid restriction.

Choice D reason: Elevating the affected leg reduces edema and venous pressure in deep vein thrombosis by promoting venous return to the heart. This decreases clot propagation risk and alleviates pain, making it a key intervention to manage acute DVT effectively and prevent complications.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A reason: Using a soft foam collar may reduce skin irritation but risks dislodging the tracheostomy tube if not secured properly. Leaving old ties in place until new ones are secure ensures tube stability, preventing accidental decannulation, which is critical in early tracheostomy care.

Choice B reason: Knots close to the tracheostomy tube increase pressure on the skin, risking irritation or necrosis. This is incorrect, as ties should allow slight movement. Maintaining old ties until new ones are secure prevents tube displacement, prioritizing airway safety during the procedure.

Choice C reason: Leaving old ties in place until new ones are secure prevents tracheostomy tube dislodgement, a life-threatening risk. This ensures continuous airway patency during tie changes, especially in fresh tracheostomies, making it the safest and most critical action to maintain tube stability.

Choice D reason: Placing knots laterally reduces irritation but does not address the risk of tube dislodgement during tie changes. Keeping old ties in place until new ones are secure is the priority, as it ensures the tube remains stable, preventing airway compromise.

A. Reduce dietary sodium intake B. Increase saturated fat consumption C. Limit physical activity D. Encourage smoking cessation only if symptomatic

Correct Answer is A

Explanation

Choice A reason: Reducing dietary sodium lowers blood pressure in hypertension by decreasing vascular fluid volume and vasoconstriction. Sodium restriction (e.g., <2.3 g/day) reduces cardiac workload, preventing complications like heart failure, making it the priority lifestyle modification for effective blood pressure control.

Choice B reason: Increasing saturated fat consumption worsens hypertension by promoting atherosclerosis and vascular stiffness. Sodium reduction is critical, as it directly lowers blood volume and pressure, reducing cardiovascular risk, making it the priority over dietary fat adjustments in hypertension management.

Choice C reason: Limiting physical activity is incorrect, as exercise lowers blood pressure by improving vascular elasticity. Sodium reduction is the priority, as it directly reduces fluid retention and vasoconstriction, providing immediate blood pressure control, making it essential for hypertension management.

Choice D reason: Smoking cessation is beneficial but not the primary focus unless active smoking is confirmed. Sodium reduction directly lowers blood pressure by decreasing fluid volume, making it the priority lifestyle change, as it addresses hypertension’s core mechanism more effectively.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is caring for a client with a history of deep vein thrombosis. Which intervention should the nurse include in the care plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is securing a tracheostomy tube for a client post-procedure. Which action should the nurse take to ensure proper tracheostomy care?

Correct Answer is C

Explanation

The nurse is caring for a client with a history of hypertension. Which lifestyle modification should the nurse emphasize?

Correct Answer is A

Explanation

The nurse is caring for a client with a new diagnosis of epilepsy who is prescribed phenytoin. Which teaching point should the nurse emphasize?

The nurse is assessing a client with suspected hepatitis. Which finding is most indicative of this condition?

Which technique should the nurse use when assessing for early signs of rheumatoid arthritis?

The nurse is caring for a client with a history of Parkinson’s disease. Which intervention should the nurse prioritize?

The nurse is caring for a client with a history of gout. Which dietary recommendation should the nurse emphasize?

A client receives a prescription for ophthalmic ketorolac. Prior to administering the medication, the nurse should review the electronic medical record for which condition?

The nurse notes that a client has been receiving hydromorphone every six hours for four days. Which assessment is most important for the nurse to complete?

The nurse is caring for a client with a history of depression who is prescribed a selective serotonin reuptake inhibitor (SSRI). Which side effect should the nurse monitor for?