Which nursing action is most helpful in promoting circulation in a client with chronic venous insufficiency?

Limit intake of chips and pretzels.

Encourage mountain biking.

Elevate lower extremities.

Restrict fluid intake to water.

Answer and Explanation

The Correct Answer is C

A.   Chips and pretzels are high in sodium, which can contribute to fluid retention and exacerbate symptoms of CVI. While reducing sodium intake can help manage fluid retention and swelling, it is not the most direct action for promoting circulation itself. It’s more of an adjunctive measure that can support overall management of CVI but does not directly improve venous circulation.
B.   Mountain biking is an intense physical activity that may not be suitable for all clients with chronic venous insufficiency, especially if they have significant symptoms or mobility issues. High-impact exercises can potentially exacerbate symptoms or lead to injury. Low-impact activities are generally recommended to improve circulation and manage CVI.
C.   Elevating the lower extremities is a highly effective measure for promoting circulation in clients with chronic venous insufficiency. It helps reduce venous pressure and promotes the return of blood to the heart, thereby alleviating swelling and discomfort. This action is directly beneficial in managing CVI.
D.   Restricting fluid intake to water alone does not directly address the underlying issues of venous insufficiency. While managing overall fluid intake can be part of a comprehensive plan to prevent excessive fluid retention, it is not the most direct or effective action for promoting circulation compared to elevating the legs.

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Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}

Explanation

Based on the information collected, the client is likely experiencing Hypoxia related to Tonic clonic seizure

Rationale

The severe drop in oxygen saturation and the observation of violent jerking movements are consistent with a tonic-clonic seizure, which can be precipitated or exacerbated by significant hypoxia.

A. Place protective padding between the client and bed rails. B. Provide privacy for the client during the event. C. Observe the client's behavior during the event. D. Record the client's level of consciousness after the event.

Correct Answer is A

Explanation

A. Placing protective padding between the client and bed rails is a safety measure to prevent injury during a seizure. This action helps protect the client from head or body trauma if they hit the bed rails or any surrounding surfaces during the seizure.
B. Providing privacy is important for maintaining the client’s dignity during a seizure, but it is not the most immediate concern. The primary focus during a seizure should be on ensuring the client’s safety and monitoring the event. Privacy can be considered once the immediate safety and medical needs are addressed.
C. Observing the client's behavior during the seizure is essential for documentation and subsequent medical evaluation. It helps in identifying the type, duration, and characteristics of the seizure, which is crucial for diagnosis and treatment. However, observation alone does not address immediate safety needs or interventions required during the seizure.
D. Recording the client's level of consciousness after the seizure is important for assessing the postictal state and the extent of recovery. This information is valuable for understanding the impact of the seizure and guiding further medical care. However, during the seizure, immediate actions should focus on ensuring safety and managing the seizure itself.

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Which nursing action is most helpful in promoting circulation in a client with chronic venous insufficiency?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}

Explanation

The nurse observes a client who begins to exhibit continuous jerking movements, is unable to speak, and is incontinent of urine during the event. Which action is most important for the nurse to take?

Correct Answer is A

Explanation

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