Nokea
A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management to begin?
- A. Before surgery
- B. When the client is taken to the postanesthesia care unit
- C. After the client returns to the room after surgery and receives pain medication
- D. Twenty-four hours after the procedure
Correct Answer: A
Rationale: Ideally, postoperative nursing management begins before surgery with demonstrations of deep-breathing and coughing exercises and descriptions and demonstrations of the incentive spirometer. Even if the client will have postoperative physical therapy, the nurse explains and helps the client practice active and isometric leg exercises. The nurse also describes other devices that may be used after surgery, such as intravenous infusions of fluid and blood, oxygen, a wound drain, elastic stockings, or roller bandages. It also is necessary to include a discussion of the possible use of traction or the CPM machine. The other options offered do not allow adequate time for instruction.
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The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?
- A. Antidysrhythmic therapy
- B. Antianginal therapy
- C. Antineoplastic therapy
- D. Anticoagulation therapy
Correct Answer: D
Rationale: Anticoagulation therapy and early ambulation are very important for clients who have knee or hip replacement to prevent thrombus formation. The other therapies are not indicated for the knee or hip arthroplasty.
The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?
- A. The leg will look as it did prior to the cast being applied.
- B. The leg will look moist and will have small bumps that will go away in a few days.
- C. The skin may be covered with a yellowish crust that will shed in a few days.
- D. The leg strength is enforced by the wearing of the cast.
Correct Answer: C
Rationale: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?
- A. Left hip arthroplasty
- B. Left hip arthroscopy
- C. Open reduction and internal fixation of the left hip.
- D. Closed reduction of the left hip.
Correct Answer: A
Rationale: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.
The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?
- A. Blood pressure of 140/90 mm Hg
- B. Crackles in the lung bases
- C. SUBJECT: Client complains of pain in the affected rib area when taking a deep breath
- D. Heart rate of 94 beats/minute
Correct Answer: B
Rationale: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minute is within normal range.
The nurse is caring for a client who had an amputation of the left leg above the knee. What position can the nurse place the client in several times per day to promote stump extension and prevent contractures?
- A. Supine
- B. Left lateral
- C. Prone
- D. Right lateral
Correct Answer: C
Rationale: Place the client with leg amputation in the prone position several times a day. This position promotes stump extension and prevents contractures. The other positions do neither of these things.