The nurse is reviewing laboratory test results for the client ...

[tuffie]

The nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which of the following nursing actions is focused on the consequence of low albumin levels?
 
  1. Evaluating for asterixis
  2. Inspecting for petechiae
  3. Palpating for peripheral edema
  4. Evaluating for decreased level of consciousness

Question 2

A pregnant client is seen in the health care clinic. During the prenatal visit, the client informs the nurse that she is experiencing pain in her calf when she walks. Which of the following is the ap-propriate nursing action?
 
  1. Instruct the client to avoid walking.
  2. Assess for signs of venous thrombosis.
  3. Tell the client that this is normal during pregnancy.
  4. Instruct the client to elevate her legs consistently throughout the day.

[CharlieArnold]

Answer to Question 1

3

Rationale: Albumin is responsible for maintaining the osmolality of the blood. When there is a low albumin level, there is decreased osmotic pressure, which in turn can lead to peripheral edema. Evaluating for asterixis, inspecting for petechiae, and evaluating for decreased level of consciousness are incorrect and are not associated with a low albumin level.

Answer to Question 2

2

Rationale: If a woman complains of calf pain during walking, it could be an indication of venous thrombosis of the lower extremities. The appropriate nursing action would be to check for the presence of additional signs of venous thrombosis. It is not appropriate to tell the mother that this is normal during pregnancy. Ambulation is a necessary exercise, and the woman should be en-couraged to ambulate during pregnancy. Although it is important to elevate the legs during pregnancy, elevating the legs consistently is not the appropriate nursing action.

[tuffie]

Thanks

[CharlieArnold]

Welcome