A nurse is planning care for a client who has quadriplegia. Which of the following actions should the nurse take to prevent a pulmonary embolism (PE)? (Select all that apply.)
Perform passive range of motion exercises.
Place pillows under the client's knees when in bed.
Assess legs for redness.
Apply elastic compression stockings
Massage the calves every shift
Correct Answer : A,C,D
A. Perform passive range of motion exercises. Passive range of motion exercises help maintain circulation and reduce venous stasis, which is crucial for preventing pulmonary embolism in clients who are immobile.
B. Place pillows under the client's knees when in bed. Placing pillows under the knees can actually promote venous stasis and increase the risk of a pulmonary embolism. It is better to keep the legs flat to encourage circulation.
C. Assess legs for redness. Regular assessment of the legs for redness, swelling, or warmth helps in the early detection of deep vein thrombosis (DVT), which can lead to pulmonary embolism if not addressed.
D. Apply elastic compression stockings. Elastic compression stockings promote venous return from the legs to the heart and help prevent DVT, thereby reducing the risk of pulmonary embolism.
E. Massage the calves every shift. Massaging the calves can dislodge a thrombus and potentially lead to a pulmonary embolism. Instead, interventions should focus on preventing thrombus formation.
Free Nursing Test Bank
- Free Pharmacology Quiz 1
- Free Medical-Surgical Quiz 2
- Free Fundamentals Quiz 3
- Free Maternal-Newborn Quiz 4
- Free Anatomy and Physiology Quiz 5
- Free Obstetrics and Pediatrics Quiz 6
- Free Fluid and Electrolytes Quiz 7
- Free Community Health Quiz 8
- Free Promoting Health across the Lifespan Quiz 9
- Free Multidimensional Care Quiz 10
View Related questions
Correct Answer is C
Explanation
A. Vitamin K: Vitamin K is used for anticoagulant reversal, not for acetaminophen toxicity.
B. Flumazenil: Flumazenil is a benzodiazepine antagonist and is not indicated for acetaminophen overdose.
C. Acetylcysteine: Acetylcysteine is the antidote for acetaminophen toxicity, helping to replenish glutathione stores and prevent liver damage.
D. Atropine: Atropine is used for bradycardia or certain poisoning but is not relevant for acetaminophen toxicity.
Correct Answer is ["C","D","E"]
Explanation
A. Stimulate production of androgens: The kidneys do not stimulate androgen production. Androgens are produced primarily by the adrenal glands and gonads.
B. Stimulate production of white blood cells: The kidneys do not stimulate white blood cell production. This is mainly a function of the bone marrow.
C. Excrete various drugs and drug metabolites: The kidneys play a key role in filtering and excreting drugs and drug metabolites, helping to remove them from the body.
D. Produce urine: The primary function of the kidneys is to filter blood and produce urine, which is then excreted to remove waste products and maintain fluid balance.
E. Regulate acid/base balance: The kidneys are essential in maintaining acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate, which helps regulate the pH level in the body.