The practical nurse (PN) is evaluating a client who is admitted to the hospital with a diagnosis of cholelithiasis. Which finding should the practical nurse (PN) report to the charge nurse?

Choice A reason: Facial pallor, particularly around the lips, could indicate anemia or poor perfusion, but it is not the most urgent finding in this context. Polycythemia vera typically involves an overproduction of red blood cells, which can actually result in a ruddy complexion rather than pallor. While pallor should be monitored, it does not require immediate reporting compared to other potential complications of polycythemia vera.
Choice B reason: An increased heart rate over the last 4 hours could be a sign of various conditions, such as dehydration, fever, or cardiovascular stress. However, in the context of polycythemia vera, it is not as immediately concerning as symptoms that might indicate thrombotic complications, which are a common and serious risk for these patients. Tachycardia should be monitored, but it is not the most critical finding needing immediate attention.
Choice C reason: Dark brown stools could indicate the presence of digested blood, suggesting gastrointestinal bleeding. While this is an important finding that requires further investigation, it is not as immediately life-threatening as signs of deep vein thrombosis (DVT) in a client with polycythemia vera. Bleeding risks do exist with this condition, but the urgency of DVT symptoms demands prompt intervention to prevent further complications, such as a pulmonary embolism.
Choice D reason: Right lower leg redness and edema are classic signs of deep vein thrombosis (DVT). Clients with polycythemia vera are at increased risk for thrombotic events due to the hyperviscosity of their blood. Reporting this finding immediately is critical, as DVT can lead to serious complications, including pulmonary embolism, which can be life-threatening. Early detection and intervention are essential in managing thrombotic risks in polycythemia vera patients.

Choice A reason: Placing the client in the left lateral recumbent position with the right leg supported in proper alignment is not the best choice for reducing swelling and promoting comfort in a client with a fractured right tibia and fibula. While supporting the leg in proper alignment is important, the left lateral recumbent position does not provide optimal elevation of the affected limb. Elevation is crucial to reduce swelling and promote venous return, which can help decrease edema and discomfort.
Choice B reason: Placing the client in the dorsal recumbent position with the right leg elevated on two pillows is the most appropriate choice. This position allows the right leg to be elevated above the level of the heart, which helps reduce swelling by promoting venous return and lymphatic drainage. Elevation also decreases the hydrostatic pressure in the lower extremity, which can help minimize edema and improve comfort. This position ensures that the leg is properly supported and aligned, which is essential for optimal healing.
Choice C reason: Placing the client in the supine position with a footboard and a trochanter roll to the right leg is not the best choice for reducing swelling. While using a footboard and a trochanter roll can help maintain proper alignment and prevent external rotation of the leg, it does not provide the necessary elevation to reduce swelling. Elevation is a key component in managing edema and promoting comfort in clients with fractures.
Choice D reason: Placing the client in the right lateral position with a pillow between the legs is not an appropriate choice for reducing swelling in a client with a fractured right tibia and fibula. The right lateral position does not allow for proper elevation of the affected limb, which is essential for reducing swelling and promoting venous return. Additionally, this position may place pressure on the injured leg, causing discomfort and potentially compromising the healing process.