Elsevier/Evolve - Applying Elastic Stockings

1. When preparing to apply elastic stockings, why does the nurse assess for skin discoloration? A. To identify the potential risk for deep vein thrombosis (DVT) B. To identify improper patient positioning C. To select the proper stocking size D. To determine whether a sequential compression device is needed

A - To identify the potential risk for deep vein thrombosis (DVT) Rationale: The nurse assesses for skin discoloration because it is one possible indicator of deep vein thrombosis (DVT). Improper patient positioning is not a rationale for why the nurse assesses for skin discoloration. The selection of proper stocking size would be done after the nurse assesses for skin discoloration. Determining whether the use of a sequential compression device is needed is not why the nurse assesses for skin discoloration.

2. Which condition is not associated with venous stasis, part of Virchow's triad? A. Pregnancy B. Obesity C. Anxiety D. Immobility

C - Anxiety Rationale: Pregnancy, obesity, and immobility can all cause pooling of blood in the lower extremities. Anxiety is not associated with blood stasis.

3. Why does the nurse remove the patient's elastic stockings at least once per shift? A. To permit the skin to breathe. B. To wash the legs with a disposable bath product. C. To air out the stockings and allow sweat to evaporate. D. To check the skin for irritation or breakdown.

D. To check the skin for irritation or breakdown. Rationale: The nurse removes the patient's elastic stockings at least once per shift to check the skin for irritation or breakdown. Although proper skin care is important, the nurse does not remove the elastic stockings once per shift to permit the skin to breathe or to allow sweat to evaporate. The legs do not need to be washed once every shift.

5. After determining the proper size stocking and assessing the patient's circulatory status, a nurse delegates the application of elastic stockings to nursing assistive personnel (NAP). The nurse discovers that the NAP has been using moisturizer on the patient's legs before applying the stockings. What is the best action by the nurse? A. Explain that moisturizer may cause excessive skin softening, which can lead to skin breakdown. B. Instruct NAP to use a small amount of cornstarch or powder. C. Ask the patient if he or she is allergic to the moisturizer. D. Inspect the patient's skin for color variations.

B - Instruct NAP to use a small amount of cornstarch or powder. Rationale: Using a small amount of cornstarch or powder will decrease friction and make the stockings easier to apply. A moisturizer applied to the legs may not cause skin breakdown, but putting it on the patient's skin just before applying elastic stockings will make them harder to apply. Sensitivity to moisturizer may cause skin breakdown. An allergy to the moisturizer should have been identified before the moisturizer was applied to the legs. Skin color variations are not related to the use of moisturizers before applying elastic stockings. Skin color variations are associated with changes in peripheral circulation, or pathologic conditions. The nurse should have inspected the skin for color variations prior to delegating the application of elastic stockings.

4. Why might the nurse choose not to apply a pair of prescribed elastic stockings to a patient's legs? A. The patient will have a scheduled bath in a few hours. B. The patient says they are too tight. C. The patient's skin is irritated. D. The patient has become fully ambulatory.

C - The patient's skin is irritated. Rationale: Elastic stockings should not be applied if the skin of the legs is irritated. A scheduled bath would not be a reason to postpone application of the stockings. The patient is likely to find them uncomfortable, but careful measurement of the legs ensures that he or she is given the proper size. Incompetent venous values or decreased venous circulation may necessitate the need for elastic stockings even though the patient is fully ambulatory.