When assessing both lower extremities (BLE) of a client who has chronic venous insufficiency, the nurse identifies bilateral stasis dermatitis and an ulcer on the medial surface of the left ankle. To promote effective self-care, which client teaching should the nurse provide?
Apply compression stockings before ambulation.
Soak feet to soften nails before trimming.
Keep legs dependent to promote blood flow.
Medicate inflamed skin areas with an antibiotic ointment.
The Correct Answer is A
Choice A: Applying compression stockings before ambulation is a key aspect of self-care for a client with chronic venous insufficiency. Compression stockings help improve venous return and reduce edema.
Choice B: Soaking feet to soften nails before trimming is not a specific intervention for chronic venous insufficiency and should be done with caution in individuals with open ulcers.
Choice C: Keeping legs dependent to promote blood flow is not advisable in chronic venous insufficiency, as it can worsen venous pooling and edema.
Choice D: Medicating inflamed skin areas with an antibiotic ointment may be part of wound care but does not address the primary intervention of using compression stockings for chronic venous insufficiency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: CPR is important but should be performed in conjunction with defibrillation. Since two defibrillation shocks have already been administered, the next step should be another shock.
Choice B : Obtaining an arterial blood gas sample is not the immediate priority when the client is in ventricular fibrillation. Defibrillation should be continued.
Choice C: Performing the third defibrillation shock is the next appropriate step in the advanced cardiac life support (ACLS) algorithm for ventricular fibrillation.
Choice D: Administering an IV bolus of epinephrine may be part of the ACLS protocol, but it is typically administered after defibrillation attempts.
Correct Answer is B
Explanation
Choice A: Praising the client for weight loss without knowing the underlying cause may not be appropriate. Rapid and unexplained weight loss can be a sign of underlying health issues.
Choice B: Advising the client to schedule an appointment with a healthcare provider is the most appropriate action. Rapid and unexplained weight loss should be evaluated by a healthcare professional to identify any potential underlying health concerns.
Choice C: Advising the client to begin taking a multivitamin daily does not address the underlying cause of the weight loss and may not be the most appropriate action.
Choice D: Documenting the client's reason for using the herb is important but should be accompanied by further evaluation and intervention by a healthcare provider due to the significant weight loss.
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