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    Ati lpn med surg cardiac proctored test

    Following admission, a client with a vascular occlusion of the right lower extremity calls the nurse and reports difficulty sleeping because of cold feet. Which of the following nursing actions should the nurse take to promote the client's comfort?

    Explanation & Rationale

    A. Obtain a pair of slipper socks for the client. Insulating the feet with nonconstricting slipper socks helps keep them warm without applying direct heat or pressure; this provides comfort while avoiding interventions that could harm ischemic tissue or dislodge a clot. B. Increase the client's oral fluid intake. Hydration is generally beneficial but will not immediately relieve local extremity cold sensation from arterial occlusion and is not the priority comfort measure here. C. Place a moist heating pad under the client's feet. Incorrect and unsafe. Applying local heat (especially moist heat) to an ischemic limb can cause tissue damage because of impaired sensation and perfusion; heating pads also risk burns and increased metabolic demand. D. Rub the client's feet briskly for several minutes. Incorrect and contraindicated. Vigorous massage may dislodge thrombi (risking embolization) and can further injure ischemic tissue.

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