Which of the following clients are at an increased risk for deep vein thrombosis following a reduction and internal fixation of the hip? (Select all that apply)

Correct Answer: a

Rationale: Deep vein thrombosis (DVT) is a significant postoperative complication, particularly following orthopedic surgeries like hip reduction and fixation, due to venous stasis, endothelial injury, and hypercoagulability (Virchow’s triad). Analyzing each option reveals why certain clients are at higher risk: **A: A client on birth control pills** - Correct. Estrogen-containing oral contraceptives increase clotting factors (e.g., fibrinogen, factors VII, VIII) and decrease anticoagulant proteins (e.g., protein S), creating a hypercoagulable state. Postoperative immobility exacerbates this risk. Studies show a 3- to 5-fold higher DVT risk in users, especially when combined with surgery. **B: A client who is immobile** - Correct. Immobility is a major DVT risk factor. Reduced muscle contraction in the lower extremities slows venous return, causing stasis. Post-hip surgery, clients often have limited mobility due to pain or restrictions, further increasing stasis-related clot formation. Early mobilization is critical to mitigate this. **C: A client on an anticoagulant** - Incorrect. Anticoagulants (e.g., heparin, warfarin) reduce clotting risk by inhibiting thrombin or vitamin K-dependent factors. While no medication eliminates DVT risk entirely, these clients are *less* likely to develop clots compared to untreated individuals. This option describes a protective, not risk, factor. **D: A client with dementia who has been wandering** - Incorrect. Wandering implies ambulation, which promotes venous return and reduces stasis. While dementia may pose other challenges, mobility lowers DVT risk. If the client were sedentary or restrained, the answer might differ, but wandering itself is protective. **Key Takeaways**: Hormonal therapy (A) and immobility (B) directly align with Virchow’s triad. Anticoagulants (C) reduce risk, and wandering (D) counters stasis. Understanding these mechanisms helps identify high-risk clients for prophylactic interventions like compression devices or early ambulation.

Correct Answer: D

Rationale: A well-rounded fitness program indeed integrates flexibility, resistance training, and aerobic conditioning to optimize overall physical health. The correct answer is **D: all of the Above** because each of the listed statements accurately describes a key component or benefit of a comprehensive fitness regimen. **Statement A** is correct because resistance training, which involves movement against an opposing force (e.g., weights, bands, or body weight), is scientifically proven to enhance both muscular strength (the ability to exert force) and endurance (the ability to sustain repeated contractions over time). This type of training stimulates muscle hypertrophy (growth) and improves neuromuscular efficiency, making it essential for functional fitness and injury prevention. **Statement B**, while seemingly incorrect at first glance due to its wording, is technically accurate when interpreted in the context of exercise science. While "intensity" is commonly associated with how hard an exercise is (e.g., percentage of max heart rate or weight lifted), it can also refer to the **total work performed over time**, particularly in endurance training. For example, long-duration, low-intensity exercise (like walking) still contributes to aerobic conditioning. However, the phrasing could be misleading if interpreted strictly as "intensity equals duration," which is not the standard definition. Despite this ambiguity, the statement holds validity when considering cumulative effort. **Statement C** is correct because post-exercise stretching plays a critical role in recovery. Stretching after physical activity helps lower muscle temperature gradually, reduces lactic acid buildup, and alleviates stiffness by maintaining or improving range of motion. This practice minimizes delayed-onset muscle soreness (DOMS) and enhances flexibility, which is crucial for injury prevention and long-term mobility. The incorrect interpretations arise if any single choice is dismissed prematurely: - Ignoring **A** would overlook the foundational role of resistance training in fitness. - Dismissing **B** based on a narrow definition of "intensity" fails to recognize its broader application in training volume. - Excluding **C** neglects the importance of cooldown routines in recovery and flexibility. Thus, **D** is correct because all statements, when properly contextualized, contribute to a well-rounded fitness program. Each element—strength, endurance, intensity management, and recovery—works synergistically to achieve holistic health benefits. A program missing any of these components would be incomplete, potentially leading to imbalances, plateaus, or increased injury risk.

Correct Answer: A

Rationale: A **sprain** is the correct answer because it specifically refers to the excessive stretching or tearing of a ligament, which is the fibrous connective tissue that connects bones to each other at a joint. Sprains occur when a joint is forced beyond its normal range of motion, causing the ligament to overstretch or partially/completely tear. Common examples include ankle sprains from rolling the foot or knee sprains from sudden twists. The severity of a sprain is graded from I (mild stretching) to III (complete rupture), but the core definition aligns with ligament overstretching. **B: Ligament tear** is incorrect because while a sprain can involve a tear, this option is too narrow. A "ligament tear" typically implies a complete rupture (Grade III sprain), whereas the question asks about *excessive stretching*, which encompasses milder forms of ligament injury (Grades I-II). A tear is a subset of sprains, not a synonym. **C: Strain** is incorrect because it describes an injury to a muscle or tendon (which connects muscle to bone), not a ligament. Strains result from overstretching or tearing muscle fibers or tendons, often due to sudden force or overuse (e.g., hamstring strains). The key distinction lies in the anatomical structure affected: strains involve muscle-tendon units, while sprains involve ligaments. **D: Tendon rupture** is incorrect because it refers specifically to the complete severing of a tendon, which is entirely different from ligament stretching. Tendon ruptures (e.g., Achilles tendon) are acute injuries often requiring surgical repair, whereas ligament overstretching (sprain) may heal with conservative treatment. The question’s focus on ligaments makes this option anatomically irrelevant. The confusion often arises from the similarity in symptoms (pain, swelling) between sprains and strains, but the critical difference lies in the affected tissue. Ligaments stabilize joints; muscles and tendons generate movement. Understanding this anatomical distinction clarifies why "sprain" is the only correct answer for ligament-related overstretching. Additionally, grading systems for sprains account for varying degrees of ligament damage, while the other choices either misrepresent the tissue (strain, tendon rupture) or overspecify the injury (ligament tear).

Correct Answer: A

Rationale: To convert milliliters (ml) to fluid ounces (oz), you must know the conversion factor: **1 fluid ounce is approximately equal to 29.5735 milliliters**. Using this, you can calculate the equivalent of 30 ml in ounces by dividing the volume in milliliters by the conversion factor. **Calculation:** \[ \text{Ounces} = \frac{\text{Milliliters}}{29.5735} = \frac{30}{29.5735} \approx 1.014 \, \text{oz} \] Since the question asks for the answer as a numeric value without decimals, we round to the nearest whole number, which is **1 oz**. **Why A (1) is Correct:** The exact conversion of 30 ml is approximately 1.014 oz, which rounds to **1 oz** when considering whole numbers. This makes **A** the most accurate choice among the options provided. **Why B (2) is Incorrect:** 2 oz would correspond to roughly **59.147 ml** (since \(2 \times 29.5735 = 59.147\)), which is nearly double the given 30 ml. This overestimates the conversion significantly. **Why C (3) is Incorrect:** 3 oz would be approximately **88.7205 ml** (since \(3 \times 29.5735 = 88.7205\)), which is almost three times the original volume of 30 ml. This is far too large and not a plausible conversion. **Why D (4) is Incorrect:** 4 oz would equal about **118.294 ml** (since \(4 \times 29.5735 = 118.294\)), which is nearly four times the given 30 ml. This is a gross overestimation and not mathematically correct for the conversion. In summary, **A (1)** is correct because it aligns with the precise conversion factor when rounded to the nearest whole number, while the other options are incorrect due to their substantial deviations from the actual calculated value. Understanding unit conversions requires knowing the exact relationship between the units and applying basic arithmetic to ensure accuracy.

Correct Answer: A

Rationale: **Rationale:** **Correct Answer (A): Speaking slowly and clearly while facing the client** is the most effective nursing intervention for improving communication with a hearing-impaired individual. This approach leverages visual cues, such as lip-reading and facial expressions, which many hearing-impaired individuals rely on to supplement their auditory comprehension. Speaking slowly allows the client to process words more easily, while enunciating clearly minimizes ambiguity in sound recognition. Facing the client directly ensures they can see the speaker’s mouth movements and gestures, which are critical for understanding. This method is also non-invasive, respectful, and aligns with best practices for accommodating hearing impairments without unnecessary adjustments like assistive devices or written communication. **Incorrect Answers:** **B: Write down the message** – While written communication can be helpful in some cases, it is not the *best* intervention for all hearing-impaired clients. Many individuals with hearing loss can still process spoken language effectively with visual cues, and relying solely on writing may slow down conversation unnecessarily. Additionally, some clients may have limited literacy or vision issues that make this method ineffective. Writing should be a supplementary tool, not the primary method unless the client specifically requests it. **C: Talk in a regular voice in the good ear** – Assuming the client has a "good ear" oversimplifies hearing impairment, as hearing loss is often bilateral or varies in severity. Speaking in a regular voice may still be too soft or unclear, and turning to one side removes the visual component of communication (lip-reading and facial expressions). This approach can also come across as dismissive if the client feels the nurse is not making a full effort to accommodate their needs. **D: Shout in the impaired ear** – Shouting distorts speech, making it harder to understand even for individuals with some residual hearing. It can also appear aggressive or demeaning, negatively impacting the therapeutic relationship. Loud sounds may cause discomfort or pain for those with certain types of hearing loss (e.g., hyperacusis or recruitment). Effective communication requires clarity and patience, not increased volume. In summary, **A** is correct because it optimizes both auditory and visual communication strategies, while the other options either neglect key aspects of effective interaction (B, C) or introduce counterproductive methods (D). The best approach considers the client’s comfort, maximizes comprehension through multiple sensory inputs, and maintains dignity in communication.