Which intervention is important for preventing venous thromboembolism (VTE) in an immobile patient?

Encouraging frequent ambulation and leg exercises.

Administering sedatives to promote restfulness.

Applying cold compresses to the lower extremities.

Limiting fluid intake to prevent swelling.

Answer and Explanation

The Correct Answer is A

Encouraging frequent ambulation and leg exercises helps prevent venous stasis and promotes blood flow, reducing the risk of venous thromboembolism (VTE) in immobile patients.

Incorrect choices:

b. Administering sedatives can increase the risk of VTE by promoting immobility and reducing leg movement. It is not an appropriate preventive measure.

c. Applying cold compresses to the lower extremities does not directly prevent VTE. Warm compresses may be used to promote circulation, but prevention strategies primarily focus on mobilization and blood flow promotion.

d. Limiting fluid intake does not directly prevent VTE. Adequate hydration should be maintained to promote circulation and prevent complications such as dehydration and urinary tract infections.

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Correct Answer is A

Explanation

Offering fluids at room temperature can enhance the patient's comfort and promote adequate hydration in immobile patients.

Incorrect choices:

b. Limiting fluid intake to prevent incontinence is not appropriate as it can lead to dehydration. Adequate hydration should be maintained, and measures to manage incontinence should be implemented separately.

c. Providing a straw for easier drinking can facilitate fluid intake, but it may not be suitable for all patients or situations. Individualized assessment and patient preference should be considered.

d. Continuous intravenous fluids may not be necessary for all immobile patients and should be based on specific indications determined by the healthcare provider. Oral intake should be encouraged unless contraindicated.

A. Supine position with the head of the bed elevated. B. Prone position with the head turned to the side. C. Lateral position with the affected side down. D. Semi-Fowler's position with the knees slightly flexed.

Correct Answer is D

Explanation

The semi-Fowler's position with the knees slightly flexed promotes lung expansion by allowing the diaphragm to descend fully and reducing the risk of respiratory complications in immobile patients.

Incorrect choices:

a. The supine position with the head of the bed elevated may cause the diaphragm to be restricted, limiting lung expansion and potentially leading to respiratory complications.

b. The prone position is not suitable for immobile patients and may increase the risk of pressure ulcers and respiratory difficulties.

c. The lateral position with the affected side down may compromise lung expansion and increase the risk of respiratory complications in immobile patients.

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Which intervention is important for preventing venous thromboembolism (VTE) in an immobile patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which intervention should the nurse implement to maintain adequate hydration in an immobile patient?

Correct Answer is A

Explanation

Which position should the nurse use for a patient who is immobile to promote lung expansion and prevent respiratory complications?

Correct Answer is D

Explanation

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Which intervention is important for preventing venous thromboembolism (VTE) in an immobile patient?