The postpartum patient has developed thrombophlebitis in her right leg. Which finding requires immediate intervention? The patient:
1.
2. Develops pain and swelling in her left lower leg.
3. Appears anxious, and describes pressure in her chest.
4. Becomes upset that she can't go home yet.
Correct Answer: 3
Rationale 1: This is a risk factor for the development of thrombophlebitis, but neither a predictor nor an indication of complications.
Rationale 2: Development of bilateral thrombophlebitis is a complication, but not the top priority.
Rationale 3: Anxiety and sudden onset of chest pain or pressure might indicate pulmonary embolus, which is a life-threatening complication of thrombophlebitis. This is the most abnormal finding, and requires immediate intervention.
Rationale 4: Although the nurse provides patient care with the aim of keeping patients satisfied and comfortable, becoming upset is a psychosocial issue, and far less important than development of a pulmonary embolus.
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