Chapter 23 Skills in Clinical Nursing 8th Edition by Audrey J. Berman- Shirlee Snyder

Chapter 23 Skills in Clinical Nursing 8th Edition by Audrey J. Berman- Shirlee Snyder

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE.  Choose the one alternative that best completes the statement or answers the question.

• The nurse tests the client for Homans’ sign by: 1)

1. Pointing the toes
2. Having the client point the toes up toward the
3. Flexing the toes as wide apart as
4. Rotating the

Answer: B

Explanation: A)       Homan’s sign is tested when the client dorsiflexes the foot. It is considered positive if the client reports deep pain with this movement. Lack of pain is considered a negative Homan’s sign, and this is the normal finding.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

1. Homan’s sign is tested when the client dorsiflexes the It is considered positive if the client reports deep pain with this movement. Lack of pain is considered a negative Homan’s sign, and this is the normal finding.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

1. Homan’s sign is tested when the client dorsiflexes the It is considered positive if the client reports deep pain with this movement. Lack of pain is considered a negative Homan’s sign, and this is the normal finding.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

1. Homan’s sign is tested when the client dorsiflexes the It is considered positive if the client reports deep pain with this movement. Lack of pain is considered a negative Homan’s sign, and this is the normal finding.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Objective: Learning Outcome 23-1: Define the key terms used in the skills of promoting circulation.

• Which of the following are classified as venous thromboembolisms? Select all that 2)

1. Deep vein thrombosis
2. Pulmonary embolism
3. Coronary artery thrombosis
4. Fat emboli
5. Aortic aneurysm

Answer: A, B, D

Explanation: A)       Deep vein thrombosis, pulmonary embolism, and fat emboli are all classified as

venous thromboembolisms. A coronary artery thrombosis is an arterial

thromboembolism, not a veinous thromboembolism. Aortic aneurysm is not a thromboembolism but a weakening of the aortic artery.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

 

1. Deep vein thrombosis, pulmonary embolism, and fat emboli are all classified as

venous thromboembolisms. A coronary artery thrombosis is an arterial

thromboembolism, not a veinous thromboembolism. Aortic aneurysm is not a thromboembolism but a weakening of the aortic artery.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

1. Deep vein thrombosis, pulmonary embolism, and fat emboli are all classified as

venous thromboembolisms. A coronary artery thrombosis is an arterial

thromboembolism, not a veinous thromboembolism. Aortic aneurysm is not a thromboembolism but a weakening of the aortic artery.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

1. Deep vein thrombosis, pulmonary embolism, and fat emboli are all classified as

venous thromboembolisms. A coronary artery thrombosis is an arterial

thromboembolism, not a veinous thromboembolism. Aortic aneurysm is not a thromboembolism but a weakening of the aortic artery.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

1. Deep vein thrombosis, pulmonary embolism, and fat emboli are all classified as

venous thromboembolisms. A coronary artery thrombosis is an arterial

thromboembolism, not a veinous thromboembolism. Aortic aneurysm is not a thromboembolism but a weakening of the aortic artery.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

Objective: Learning Outcome 23-1: Define the key terms used in the skills of promoting circulation.

• The client is scheduled for surgery, and has a history of venous stasis What strategies 3) would the nurse consider to reduce the risk of postoperative venous stasis? Select all that apply.

1. Pneumatic compression device
2. Sequential compression device
3. Antiembolism stockings
4. Getting the client out of bed as soon as possible
5. Keeping the legs lower than the level of the heart

Answer: A, B, C, D

Explanation: A)      Pneumatic and sequential compression devices help to compress the legs, improving venous return to the heart. Antiembolism stockings exert external

pressure to compress the veins of the legs, decrease venous pooling in the

extremities, and facilitate return of blood to the heart. Getting the client out of bed as soon as possible contributes to improving venous return by exercising the muscles, which squeeze the veins and improves blood return. Lowering the legs below the level of the heart would increase venous stasis, while elevating the legs will improve venous return.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

 

1. Pneumatic and sequential compression devices help to compress the legs, improving venous return to the Antiembolism stockings exert external pressure to compress the veins of the legs, decrease venous pooling in the extremities, and facilitate return of blood to the heart. Getting the client out of bed as soon as possible contributes to improving venous return by exercising the muscles, which squeeze the veins and improves blood return. Lowering the legs below the level of the heart would increase venous stasis, while elevating the legs will improve venous return.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

1. Pneumatic and sequential compression devices help to compress the legs, improving venous return to the Antiembolism stockings exert external pressure to compress the veins of the legs, decrease venous pooling in the extremities, and facilitate return of blood to the heart. Getting the client out of bed as soon as possible contributes to improving venous return by exercising the muscles, which squeeze the veins and improves blood return. Lowering the legs below the level of the heart would increase venous stasis, while elevating the legs will improve venous return.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

1. Pneumatic and sequential compression devices help to compress the legs, improving venous return to the Antiembolism stockings exert external pressure to compress the veins of the legs, decrease venous pooling in the extremities, and facilitate return of blood to the heart. Getting the client out of bed as soon as possible contributes to improving venous return by exercising the muscles, which squeeze the veins and improves blood return. Lowering the legs below the level of the heart would increase venous stasis, while elevating the legs will improve venous return.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

1. Pneumatic and sequential compression devices help to compress the legs, improving venous return to the Antiembolism stockings exert external pressure to compress the veins of the legs, decrease venous pooling in the extremities, and facilitate return of blood to the heart. Getting the client out of bed as soon as possible contributes to improving venous return by exercising the muscles, which squeeze the veins and improves blood return. Lowering the legs below the level of the heart would increase venous stasis, while elevating the legs will improve venous return.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Objective: Learning Outcome 23-2: Describe two measures to help prevent venous stasis.

 

• The nurse receives an order to apply a sequential compression Which of the following 4) would cause the nurse to question this order?

1. Weak popliteal and pedal pulses bilaterally
2. Diagnosis of breast cancer
3. Diagnosis of Hodgkin’s lymphoma with enlargement of the femoral lymph nodes
4. Heart rate of 110 beats per minute

Answer: A

Explanation: A)      The client with weak pulses in the lower extremities has reduced blood flow to the legs. Applying a sequential compression device could obliterate arterial flow and stop perfusion to the legs, so the order should be questioned. The other diagnosis and assessment findings would not impact the use of the compression device. Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

1. The client with weak pulses in the lower extremities has reduced blood flow to the Applying a sequential compression device could obliterate arterial flow and stop perfusion to the legs, so the order should be questioned. The other diagnosis and assessment findings would not impact the use of the compression device. Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

1. The client with weak pulses in the lower extremities has reduced blood flow to the Applying a sequential compression device could obliterate arterial flow and stop perfusion to the legs, so the order should be questioned. The other diagnosis and assessment findings would not impact the use of the compression device. Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

1. The client with weak pulses in the lower extremities has reduced blood flow to the Applying a sequential compression device could obliterate arterial flow and stop perfusion to the legs, so the order should be questioned. The other diagnosis and assessment findings would not impact the use of the compression device. Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Planning

Objective: Learning Outcome 23-3: Identify indications and contraindications for applying antiemboli

stockings and sequential compression devices