Correct Answer: C

Rationale: The correct answer is C: 'Limit intake of foods high in vitamin K'. Vitamin K can interfere with the effectiveness of warfarin, an anticoagulant medication commonly used to treat conditions like deep vein thrombosis (DVT). Patients on warfarin should maintain a consistent intake of vitamin K-rich foods and be monitored closely.

Choices A, B, and D are incorrect because avoiding foods high in vitamin C, increasing intake of green leafy vegetables, and avoiding dairy products are not essential dietary instructions for a client on warfarin therapy for DVT.

Correct Answer: D

Rationale: The correct answer is D. A left extremity capillary refill greater than 5 seconds indicates poor blood flow to the extremity, which is a sign of compromised circulation. This finding requires immediate intervention by the nurse to prevent complications such as tissue damage or necrosis.

Choices A, B, and C are important assessments but do not indicate an immediate need for intervention like the delayed capillary refill in choice D.

Correct Answer: B

Rationale: The correct instruction for a client with chronic venous insufficiency is to elevate their legs above heart level when resting. This position helps reduce venous pressure and edema, improving circulation. Avoiding compression stockings (choice
A) is incorrect as they are beneficial in managing chronic venous insufficiency. Applying heat packs (choice
C) is not recommended as heat can worsen edema. Limiting walking (choice
D) is not advisable as regular, gentle exercise like walking can actually help improve circulation in patients with chronic venous insufficiency.

Correct Answer: C

Rationale: The correct answer is C: 'Assist the child to develop effective communication.' Children with cerebral palsy often face challenges with communication skills.
Therefore, priority nursing interventions aim to help them improve their communication abilities.
Choice A is incorrect because while education is important, the priority for a child with cerebral palsy is to address immediate needs.
Choice B is incorrect as toileting, although important, is not the priority in this case.
Choice D is incorrect as ambulation may not be feasible or the most critical concern for a child with cerebral palsy.

Correct Answer: B

Rationale: Oxygen therapy can reduce the hypoxic drive in COPD patients, leading to increased PaCO2 levels while improving oxygenation (PaO2). In this case, the increase in PaO2 and PaCO2 is due to the reduction of the hypoxic drive by the supplemental oxygen.
Choice A is incorrect because hyperventilation would lead to decreased PaCO2.
Choice C is incorrect as the ABG values do not indicate respiratory alkalosis.
Choice D is incorrect as the ABG values do not support metabolic acidosis.