A nurse is assisting in the care of a client who is postoperative following a hip arthroplasty in the orthopedic unit. The primary health care provider has prescribed pain management and positioning strategies to prevent complications.
Complete the following sentence by using the lists of options.
The client is at risk for developing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
The correct answer is Constipation / Opioid use.
Constipation is a common side effect of opioid use. The client is receiving oxycodone for pain management, which can slow down the digestive system, leading to constipation.
Pressure injuries, also known as pressure ulcers or bedsores, are a risk due to prolonged immobility. This is especially relevant for a client who is postoperative and has limited movement. However, this was not selected as the primary condition based on the given clues.
Hypoglycemia (low blood sugar) is not directly indicated by the client's current medications or conditions. The client is receiving IV dextrose, but there is no indication of a risk of hypoglycemia in the provided information.
Confusion can occur in clients with cognitive impairments or due to medication side effects, but it is not specifically indicated as a primary risk in this case.
Dysrhythmias (abnormal heart rhythms) can be caused by imbalances in potassium or sodium levels, among other factors, but there is no evidence of such imbalances or related symptoms in this client’s case.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B,A,C,D,E
Explanation
Choice A rationale
Unlocking and removing the inner cannula is the first step. It allows access to the inner cannula for cleaning and ensures that the tracheostomy tube remains patent.
Choice B rationale
Pouring 2.54 cm (1 in) of 0.9% sodium chloride solution into the sterile basin provides the necessary solution for cleansing the inner cannula and stoma site, helping to maintain sterility and prevent infection.
Choice C rationale
Scrubbing the inside and outside of the inner cannula with a small brush ensures that any mucus or debris is removed, reducing the risk of infection and maintaining clear airways.
Choice D rationale
Wiping the inside of the inner cannula with a folded pipe cleaner helps to remove any remaining debris or solution, ensuring that the inner cannula is thoroughly cleaned.
Choice E rationale
Cleansing the stoma site with 0.9% sodium chloride solution helps to remove any mucus or debris from the site, maintaining hygiene and reducing the risk of infection.
Correct Answer is D
Explanation
Choice A rationale
Keeping the client's room well lit is not typically beneficial for pain management and may even be counterproductive for clients who need rest or reduced sensory stimuli to manage pain effectively.
Choice B rationale
Encouraging the client to abstain from distracting activities is not recommended. Distraction techniques, such as engaging in activities, can be effective in reducing the client's perception of pain.
Choice C rationale
Ensuring that the client's room is kept at a cool temperature may not be effective for pain relief and might cause discomfort, especially if the client prefers warmth.
Choice D rationale
Playing music in the client's room can serve as a distraction and has been shown to reduce the perception of pain. Music therapy can induce relaxation, reduce anxiety, and create a calming environment.
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