A nurse in the orthopedic clinic is assisting with the care of a 68-year-old adult client who had a right total hip arthroplasty and experienced a PE during hospitalization. Based on the nurse's brief assessment, which findings indicate that the client is improving or progressing? (Select all that apply.)
Performing ADLs without assistance
Recent weight loss of 27 lbs
Walking independently with a cane
Right arm badly bruised
Left hip becoming more painful
No new report of shortness of breath or chest pain
SpO2 of 95% on RA
Hip incision healing with hairline scar
Correct Answer : A,C,F,G,H
Evaluating post-operative recovery for a total hip arthroplasty requires distinguishing between expected healing milestones and potential complications related to anticoagulation or nutritional status. Knowledge of surgical recovery timelines, respiratory stability following a pulmonary embolism, and signs of therapeutic drug toxicity is essential for accurate assessment.
Choice A rationale: Being able to perform activities of daily living independently indicates successful functional rehabilitation and improved mobility. This progress demonstrates that the surgical hip is stabilizing and that the client is regaining the muscle strength and coordination required for self-care.
Choice B rationale: A weight loss of 27 pounds in a short period since hospitalization is excessive and concerning rather than a sign of progress. Rapid weight loss in a post-surgical geriatric client can impair wound healing and suggest poor nutritional intake or underlying systemic issues.
Choice C rationale: Walking independently with a cane while maintaining full weight-bearing status is a key indicator of orthopedic recovery. It reflects adequate stability of the prosthetic joint and successful integration of physical therapy goals following the right total hip arthroplasty.
Choice D rationale: Reports of severe bruising on the arm while taking warfarin are signs of potential anticoagulant toxicity or an elevated international normalized ratio. This finding requires investigation of bleeding risk rather than being considered a positive sign of healing or progress.
Choice E rationale: Increased pain in the non-surgical left hip indicates the progression of degenerative joint disease in another area. While it identifies a future surgical need, it represents a decline in musculoskeletal health rather than an improvement in the current recovery.
Choice F rationale: The absence of new shortness of breath or chest pain suggests that the previously diagnosed pulmonary embolism is resolving and that no new thrombotic events have occurred. This respiratory stability is a primary indicator of successful medical management and recovery.
Choice G rationale: An oxygen saturation of 95% on room air is within the normal range and indicates that the client is maintaining adequate gas exchange without supplemental support. This finding confirms the resolution of the respiratory compromise associated with the earlier pulmonary embolism.
Choice H rationale: An incision that is healed with a hairline scar indicates excellent primary intention healing and a lack of infection. The resolution of the surgical wound is a fundamental requirement for the overall success of the total hip arthroplasty procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Educating a patient with atrial fibrillation requires applying knowledge of cardiac hemodynamics and the coagulation cascade. The nurse must focus on how ineffective atrial contractions lead to blood stasis, increasing the probability of clot formation and subsequent systemic embolization.
Choice A rationale
Atrial fibrillation does not directly cause hyperglycemia. While the stress of an acute arrhythmia might slightly elevate blood glucose due to cortisol release, it is not a primary complication or a major risk specifically linked to this rhythm.
Choice B rationale
Diabetic retinopathy is a microvascular complication resulting from chronic poor glucose control over many years. It is not exacerbated or caused by the onset of atrial fibrillation, which is a macrovascular and electrical conduction issue of the heart.
Choice C rationale
In atrial fibrillation, the atria quiver instead of contracting effectively, allowing blood to pool in the left atrial appendage. This stasis leads to thrombus formation; if a clot dislodges, it can travel to the brain.
Choice D rationale
Diabetic ketoacidosis is typically triggered by infection, insulin omission, or extreme physiological stress in Type 1 diabetics. While an arrhythmia is a stressor, the most specific and dangerous direct risk of atrial fibrillation remains systemic thromboembolism
Correct Answer is D
Explanation
Managing acute decompensated heart failure requires understanding perfusion pressure and cardiovascular hemodynamics. Knowledge of mean arterial pressure and vasopressor pharmacology is necessary. The priority is maintaining vital organ perfusion when the MAP falls below critical thresholds required for cellular oxygenation.
Choice A rationale
Fluid boluses can exacerbate pulmonary edema in acute decompensated heart failure. While MAP is low, adding volume increases preload, which a failing left ventricle cannot pump, leading to further respiratory distress and worsening of the cardiac crisis.
Choice B rationale
Intubation addresses respiratory failure and oxygenation but does not directly correct the primary hemodynamic issue of low perfusion pressure. While it may become necessary, the immediate priority is restoring MAP to ensure coronary and renal perfusion.
Choice C rationale
High Fowler's position assists with oxygenation by reducing venous return and decreasing pulmonary congestion. However, in the presence of a dangerously low MAP of 55 mm Hg, this position may further decrease cerebral and systemic perfusion.
Choice D rationale
A MAP below 60 to 65 mm Hg indicates inadequate organ perfusion. Norepinephrine provides potent vasoconstriction and minimal inotropy, raising systemic vascular resistance to increase the MAP quickly, thereby protecting the brain, heart, and kidneys from ischemia..
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