Following a motor vehicle accident, a client with chest trauma receives a chest tube to relieve a hemothorax. Two hours following the chest tube insertion, the nurse observes the water level in the water-seal chamber is rising during inspiration and falling during expiration. Which action should the nurse implement?

Choice A reason: Irregular ulcer shapes and severe edema are characteristic of venous ulcers, which are caused by impaired venous return and increased capillary pressure. Venous ulcers are usually located near the medial malleolus and have a shallow depth.

Choice B reason: Hairless lower extremities and cool feet are signs of arterial insufficiency, which reduces blood flow and oxygen delivery to the tissues. Arterial ulcers are usually located on the toes, heels, or lateral malleoli and have a deep, punched-out appearance.

Choice C reason: Black ulcers and dependent rubor are also signs of arterial insufficiency, indicating tissue necrosis and inflammation. Dependent rubor is a reddish-blue color of the lower extremity that occurs when the leg is lowered below the level of the heart.

Choice D reason: Absent pedal pulses and shiny skin are also signs of arterial insufficiency, indicating reduced blood flow and atrophy of the skin. The skin may also be dry, scaly, or cracked.

Choice A reason: Returning for periodic liver function studies is an important instruction for a client with gouty arthritis who is taking colchicine and indomethacin. These medications can cause liver toxicity, which can manifest as jaundice, abdominal pain, nausea, vomiting, and dark urine. The nurse should advise the client to monitor for these signs and symptoms, and to have regular blood tests to check the liver enzymes and function.

Choice B reason: Massaging joints to relax muscles and decrease pain is not a recommended instruction for a client with gouty arthritis who has acute inflammation of the right ankle and great toe. Massage can increase the blood flow and pressure to the affected joints, which can worsen the pain and swelling. The nurse should advise the client to avoid touching or moving the inflamed joints, and to apply ice packs or cold compresses to reduce the inflammation.

Choice C reason: Limiting use of mobility equipment to avoid muscle atrophy is not a necessary instruction for a client with gouty arthritis who has acute inflammation of the right ankle and great toe. Mobility equipment such as crutches, walkers, or canes can help the client to ambulate safely and comfortably, and to prevent further injury or damage to the affected joints. The nurse should encourage the client to use mobility equipment as needed, and to perform gentle range of motion exercises when the inflammation subsides.

Choice D reason: Substituting natural fruit juices for carbonated drinks is not a helpful instruction for a client with gouty arthritis who is taking colchicine and indomethacin. Fruit juices can contain high amounts of fructose, which can increase the uric acid levels in the blood and trigger gout attacks. Carbonated drinks are not a major risk factor for gout, unless they contain high-fructose corn syrup or alcohol. The nurse should advise the client to drink plenty of water, and to avoid foods and beverages that are high in purines, such as organ meats, seafood, beer, and wine.