A nurse is applying antiembolic stockings for a client who is postoperative. Which of the following actions should the nurse take?

Have the client point his toes before inserting his foot into the stocking.

Remove the stockings once every 24 hr.

Elevate the client's legs for 5 min prior to applying the stockings.

Roll the top of the stocking down so it fits snugly above the client's calf

Answer and Explanation

The Correct Answer is C

A. Having the client point his toes before inserting his foot into the stocking is incorrect. The nurse should instruct the client to keep the foot in a neutral position to avoid unnecessary pressure on the toes or veins.

B. Removing the stockings once every 24 hr is incorrect. Antiembolic stockings should typically be removed and reapplied at least once per shift to allow for skin assessment and hygiene. They should not remain on for 24 hours continuously.

C. Elevating the client's legs for 5 min prior to applying the stockings is correct. Elevating the legs helps promote venous return by reducing swelling in the lower extremities. This makes the application of antiembolic stockings more effective and more comfortable for the client.

D. Rolling the top of the stocking down so it fits snugly above the client's calf is incorrect. The stockings should be applied smoothly and without folds to avoid restricting circulation. The top should not be rolled down as it can create pressure points

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Correct Answer is D

Explanation

A. Arms raised above her head with her legs elevated on pillows: This is not an appropriate position for a lumbar puncture. The positioning is not ideal for access to the lumbar region and would be uncomfortable for the client.

B. Prone with her arms at her side and her legs extended: While this position may be used for certain procedures, it is not the most appropriate position for a lumbar puncture, which requires specific spinal positioning to access the subarachnoid space effectively.

C. Trendelenburg with her body in Sims' position: Trendelenburg involves positioning the client with the head lower than the feet, which is not necessary for a lumbar puncture and could interfere with the procedure. The Sims' position is more suited for certain other procedures.

D. Head flexed to the chest and her knees pulled up to the abdomen: This is correct. The client should be in a fetal position, with the head flexed toward the chest and the knees pulled up toward the abdomen. This position helps to widen the intervertebral spaces and facilitates easier access for the lumbar puncture.

A. Communicate with personnel about the need for prophylaxis. B. Place a mask on the client. C. Contact those who live with the client. D. Notify the local health department.

Correct Answer is B

Explanation

A. "Communicate with personnel about the need for prophylaxis" is incorrect. While it is important to consider prophylaxis for those who may have been exposed to tuberculosis, the first priority is to minimize the risk of transmission from the client to others.

B. "Place a mask on the client" is correct. Placing a mask on the client is the first step in preventing the spread of tuberculosis. This helps contain respiratory droplets that could transmit the bacteria to others.

C. "Contact those who live with the client" is incorrect. While it is important to contact close contacts to assess their risk, this action comes after implementing infection control measures, such as placing a mask on the client.

D. "Notify the local health department" is incorrect. While the health department must be notified about a tuberculosis diagnosis, the immediate priority is to protect others from exposure by masking the client and using appropriate isolation precautions.

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A nurse is applying antiembolic stockings for a client who is postoperative. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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