A nurse is reinforcing teaching to a client who has peripheral venous disease about management of symptoms. Which of the following client statements indicates to the nurse an understanding of the teaching?

“I will decrease my activity to prevent added stress on my legs."

“I will need to massage my legs frequently to prevent a buildup of fluid."

“I will inspect my legs every day for changes in color, size, and temperature."

“I will keep my legs in a dependent position."

Answer and Explanation

The Correct Answer is C

A. Decreasing activity is not advisable; clients with peripheral venous disease should engage in regular, moderate exercise to improve venous circulation.
B. Massaging the legs is not recommended as it can exacerbate venous insufficiency and potentially lead to complications such as thrombosis.
C. Inspecting the legs daily for changes in color, size, and temperature is crucial for early detection of complications and indicates an understanding of self-monitoring.
D. Keeping the legs in a dependent position can worsen venous pooling; the client should elevate their legs when resting to promote venous return.

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Correct Answer is A

Explanation

A. Autonomic dysreflexia is often triggered by a noxious stimulus, such as bladder distention. Preventing bladder distention by ensuring regular bladder emptying can help prevent the condition.
B. Elevating the client's head is a response to autonomic dysreflexia but does not prevent it from occurring.
C. Providing analgesia for headaches addresses a symptom of autonomic dysreflexia but does not prevent it.
D. Monitoring for elevated blood pressure is important in detecting autonomic dysreflexia once it has started, but it does not prevent it.

A. Apply a cooling blanket B. Monitor daily weight C. Provide opioid medications on an as needed basis D. PTT levels

Correct Answer is B

Explanation

A. A cooling blanket is not typically needed unless there is a fever or postoperative temperature dysregulation, which is not a standard intervention in this case.
B. Monitoring daily weight is essential following valve replacement to detect fluid retention or heart failure, which can indicate compromised cardiac function.
C. Opioid medications may be necessary, but they should be prescribed according to the client’s pain needs rather than a routine intervention.
D. PTT levels are usually monitored for clients on anticoagulants, but since the client has a biologic valve, anticoagulation therapy is not always required as with mechanical valves.

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A nurse is reinforcing teaching to a client who has peripheral venous disease about management of symptoms. Which of the following client statements indicates to the nurse an understanding of the teaching?

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Naxlex Comprehensive Predictor Exams

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