A nurse is reinforcing teaching about the prevention of deep vein thrombosis (DVT) with a group of newly licensed nurses. Which of the following interventions should the nurse include in the teaching?
Limit movement of the lower extremities.
Place sequential compression devices bilaterally.
Massage lower extremities daily.
Check for negative Homans' sign.
The Correct Answer is B
A. Limit movement of the lower extremities. Limiting movement increases the risk of venous stasis, which can lead to DVT. Regular movement and ambulation are encouraged to promote blood circulation.
B. Place sequential compression devices bilaterally. Sequential compression devices (SCDs) help promote venous return and prevent venous stasis, thereby reducing the risk of DVT.
C. Massage lower extremities daily. Massaging the legs is contraindicated in clients at risk for DVT because it can dislodge a clot and lead to pulmonary embolism.
D. Check for negative Homans' sign. The Homans' sign (pain in the calf on dorsiflexion of the foot) is not a reliable indicator of DVT and is no longer recommended as a standard assessment method.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "You will be prescribed medication that will keep you well for years to come." This response provides false reassurance. Although medications can help manage angina, it does not guarantee that the client will not experience future complications.
B. "Do you have family members who died from heart disease?" This question may not address the client's immediate emotional needs and could come off as dismissive of the client's fear.
C. "You should discuss these worries with your physician." This statement redirects the client's concerns to the physician rather than addressing the client's emotional needs and fears in the moment.
D. "Tell me more about these fears." This response is therapeutic and encourages the client to express his concerns and feelings, which is a key part of addressing fear and anxiety.
Correct Answer is B
Explanation
A. Fried fish sandwich and potato salad: Fried foods are high in unhealthy fats, which can increase cholesterol levels and are not recommended for clients after a myocardial infarction.
B. Baked turkey and salad: This is a healthy choice, as baked turkey is low in fat, and a salad provides nutrients without excessive fat or cholesterol, supporting heart health.
C. Biscuits with sausage gravy and sliced tomatoes: Biscuits and sausage gravy are high in saturated fats, which are not appropriate for a heart-healthy diet.
D. Barbecued ribs and canned baked beans: Barbecued ribs and canned baked beans may contain high levels of saturated fats, sugar, and sodium, which are not recommended for someone recovering from a myocardial infarction.
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