A nurse in a clinic is teaching preventative measures with a female client who has a history of deep-vein thrombosis. Which of the following statements should the nurse include in the teaching?

"Sit with your legs in a dependent position when in a chair."

"Prevent dehydration by drinking at least 2.5 liters fluids each day."

"Massage your calves after sitting for 2 hours."

"Roll stretchy nylon stockings down to the upper part of your calves."

Answer and Explanation

The Correct Answer is B

A) "Sit with your legs in a dependent position when in a chair."
Sitting with legs in a dependent position can decrease blood flow and increase the risk of clot formation. It's important to elevate the legs when sitting to promote venous return and reduce the risk of deep-vein thrombosis (DVT).

B) "Prevent dehydration by drinking at least 2.5 liters fluids each day."
Staying well-hydrated helps maintain good blood circulation and prevents blood from becoming too viscous, reducing the risk of clot formation. Adequate fluid intake is crucial in preventing DVT.

C) "Massage your calves after sitting for 2 hours."
Massaging the calves is not recommended for someone with a history of DVT, as it may dislodge a clot. Instead, clients should be encouraged to move or stretch their legs regularly to improve circulation.

D) "Roll stretchy nylon stockings down to the upper part of your calves."
Proper use of compression stockings involves wearing them as prescribed, which typically means keeping them fully extended to ensure consistent pressure along the leg. Rolling them down can create a tourniquet effect and is not recommended.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A) Provide instruction on pelvic muscle exercises:
Pelvic muscle exercises are beneficial for urinary incontinence but are not a standard intervention for treating pyelonephritis. Pyelonephritis focuses on managing infection and inflammation of the kidneys rather than strengthening pelvic muscles.

B) Administer skeletal muscle relaxants every 6 hr:
Skeletal muscle relaxants are not typically used in the treatment of pyelonephritis. The focus should be on antibiotics to treat the infection and analgesics for pain relief, rather than muscle relaxants.

C) Encourage fluid intake:
Increasing fluid intake helps flush bacteria from the urinary tract, which can aid in reducing the infection and promoting kidney health. Proper hydration is crucial for clients with pyelonephritis to help manage symptoms and prevent further complications.

D) Monitor vital signs every 8 hr:
While monitoring vital signs is important, it should be done more frequently than every 8 hours, especially in the acute phase of pyelonephritis, to promptly identify any signs of worsening infection or sepsis.

A. Antimicrobial medication can decrease the severity of symptoms. B. Postherpetic nerve pain can occur in older adult clients. C. Lesions often occur inside the oral cavity of clients who have this infection. D. Cellulitis is a common manifestation in clients who have this infection.

Correct Answer is B

Explanation

A. Antimicrobial medication can decrease the severity of symptoms.: Antiviral medications, rather than antimicrobial ones, are used to reduce the severity and duration of herpes zoster (shingles). They work best when started within 72 hours of the rash appearing.

B. Postherpetic nerve pain can occur in older adult clients.: Postherpetic neuralgia (PHN) is a common complication of herpes zoster, especially in older adults. It is characterized by persistent pain in the area where the shingles rash occurred.

C. Lesions often occur inside the oral cavity of clients who have this infection.: Herpes zoster typically causes a painful rash that appears on one side of the body, often in a band or strip, rather than inside the oral cavity. Oral lesions are more characteristic of herpes simplex virus infections.

D. Cellulitis is a common manifestation in clients who have this infection.: Cellulitis is not a typical manifestation of herpes zoster. Herpes zoster is characterized by a vesicular rash and pain along a dermatomal distribution, not by cellulitis.

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A nurse in a clinic is teaching preventative measures with a female client who has a history of deep-vein thrombosis. Which of the following statements should the nurse include in the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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