The nurse is planning care for a client recovering from orthopedic surgery. Interventions should be included to address which contributing factor to deep vein thrombosis development?
Smoking
Hypertension
Obesity
Immobility
The Correct Answer is D
A. Smoking: Although smoking is a risk factor for cardiovascular diseases and can contribute to thrombosis, it is not the most immediate factor in the context of post-surgical immobility.
B. Hypertension: While hypertension is a significant cardiovascular risk factor, it is less directly related to deep vein thrombosis compared to immobility.
C. Obesity: Obesity can increase the risk of DVT, but immobility, especially after surgery, is a more direct and immediate contributing factor.
D. Immobility: Immobility is a critical factor in the development of deep vein thrombosis, particularly in postoperative clients who may be bedridden or have limited mobility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Fifth intercostal space, left midclavicular line: The apical impulse, or point of maximal impulse (PMI), is typically palpated at the fifth intercostal space, left midclavicular line, where the apex of the heart is closest to the chest wall.
A. Fourth intercostal space, left sternal border: This location is not typically used for palpating the apical impulse; it is more relevant for auscultating heart sounds.
B. Second intercostal space, left sternal border: This location is used for auscultating the aortic and pulmonic valves.
D. Third intercostal space left axillary line: This is not a standard location for palpating the apical impulse.
Correct Answer is B
Explanation
A. Diverticulosis: Murphy's sign is not used to diagnose diverticulosis.
B. Acute Cholecystitis: Murphy's sign is a clinical test used to identify acute cholecystitis. It is positive when the patient experiences pain upon palpation of the gallbladder area during inhalation.
C. Appendicitis: Murphy's sign is not associated with appendicitis; instead, other signs such as McBurney’s point tenderness are used.
D. Nephrolithiasis: Murphy's sign is not indicative of nephrolithiasis; kidney stones are assessed through other signs and symptoms.
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