The nurse is evaluating a client for possible deep vein thrombosis (DVT). Which assessment should the nurse perform?

Inspect for distention of peripheral veins

Observe for change in breathing pattern

Palpate the volume of pedal pulses

Assess for inflammation of the calves

Answer and Explanation

The Correct Answer is D

Choice A reason: Inspecting peripheral vein distention assesses superficial thrombosis, not deep vein thrombosis (DVT), which occurs in deep veins like the femoral. DVT presents with calf inflammation, not visible vein distention, making this assessment less specific for diagnosing the condition’s classic signs.

Choice B reason: Observing breathing pattern changes detects pulmonary embolism, a DVT complication, not DVT itself. Calf inflammation is a primary DVT sign, and breathing changes are secondary, making this assessment irrelevant for initial DVT evaluation, focusing on systemic rather than localized findings.

Choice C reason: Palpating pedal pulses assesses arterial flow, not venous thrombosis. DVT causes calf inflammation and swelling, not pulse changes, unless severe. This assessment is less relevant, as DVT primarily affects venous return, making calf inflammation the priority for diagnosis.

Choice D reason: Assessing calf inflammation is critical, as DVT causes unilateral swelling, redness, and warmth due to venous obstruction. This classic sign, often with pain, directly indicates thrombus formation, making it the most specific assessment for diagnosing DVT and guiding anticoagulation therapy.

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Correct Answer is A

Explanation

Choice A reason: Avoiding wine, beer, and coffee is critical, as alcohol and purine-rich beverages increase uric acid, triggering gout attacks. These exacerbate hyperuricemia, worsening toe inflammation. This dietary restriction prevents recurrent flares, making it a key instruction for managing gouty arthritis effectively.

Choice B reason: Taking pain medication after exercising joints is incorrect, as exercise during a gout attack worsens inflammation. Pain relief should precede activity, and rest is advised during flares, making this instruction harmful, as it risks exacerbating the client’s toe pain.

Choice C reason: Replacing table salt with substitutes is irrelevant to gout, as salt does not affect uric acid metabolism. Gout management focuses on reducing purines and alcohol, and salt substitutes may contain potassium, unrelated to inflammation, making this instruction ineffective.

Choice D reason: Encouraging active range of motion during a gout attack increases joint stress, worsening inflammation. Rest is recommended during acute flares, and mobility is introduced later, making this instruction counterproductive, as it risks prolonging pain and delaying recovery.

A. Take a multivitamin that contains vitamin B6 B. Use a space heater to keep hands warm C. Keep both hands elevated during work breaks D. Obtain wrist splints to wear during work

Correct Answer is D

Explanation

Choice A reason: Taking vitamin B6 is sometimes suggested for nerve health, but evidence for carpal tunnel syndrome relief is weak. Splinting maintains neutral wrist position, directly reducing median nerve compression, making this instruction less effective for managing work-related pain and functional impairment.

Choice B reason: Using a space heater to keep hands warm may improve comfort but does not address median nerve compression in carpal tunnel syndrome. Splinting prevents wrist flexion, directly relieving pressure, making warmth a secondary, less effective intervention for job-related pain.

Choice C reason: Elevating hands during breaks reduces swelling but does not prevent nerve compression during work. Wrist splints maintain neutral positioning, directly alleviating carpal tunnel symptoms, making elevation less effective, as it does not address repetitive strain causing job performance issues.

Choice D reason: Obtaining wrist splints is critical, as they keep wrists neutral, reducing median nerve compression in carpal tunnel syndrome. Worn during work, splints alleviate pain and improve function, directly addressing job performance issues, making this the most effective instruction for symptom management.

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The nurse is evaluating a client for possible deep vein thrombosis (DVT). Which assessment should the nurse perform?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who is experiencing a first gouty arthritis attack reports excruciating pain in the right great toe. The nurse inspects the inflamed joint and administers ibuprofen 800 mg PO as prescribed. Which instruction should the nurse include in the discharge teaching?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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