A nurse is caring for a client who had a left hip arthroplasty. Which of the following interventions should the nurse use to prevent dislocation?
Encourage use of elastic stockings.
Monitor for shortening of the affected leg.
Avoid flexing the hips more than 60°.
Maintain foam wedge between legs.
The Correct Answer is D
A. Encouraging the use of elastic stockings is important for preventing deep vein thrombosis (DVT) postoperatively but does not directly prevent hip dislocation.
B. Monitoring for shortening of the affected leg is important to assess for complications such as dislocation or nerve injury, but it is not a preventive measure.
C. Avoiding flexion of the hips more than 60° is important to prevent dislocation, but the recommended limit is usually 90°, not 60°. It is crucial to keep the hip in an appropriate position to avoid excessive movement.
D. Maintaining a foam wedge between the legs is the most effective intervention to prevent hip dislocation. The wedge keeps the hips in proper alignment and prevents excessive internal rotation or adduction, which are common causes of dislocation after hip arthroplasty.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A WBC count of 20,000/mm3 is elevated, which suggests the presence of infection or inflammation. This is concerning and should be reported to the surgeon, as an infection or other underlying issue could delay or contraindicate surgery.
B. A potassium level of 3.8 mEq/L is within the normal range (3.5–5.0 mEq/L). It does not require immediate intervention and is not a concern for surgery.
C. A hematocrit of 40% is within the normal range for an adult female (typically 36–48%), so it does not require intervention.
D. A creatinine level of 0.9 mg/dL is normal for most adults (0.6–1.2 mg/dL), suggesting normal kidney function and not requiring any intervention.
Correct Answer is B
Explanation
A. Ankle pain after running a long distance could indicate overuse or strain, but it is more likely to suggest a muscle or tendon issue rather than a sprain.
B. Twisting the foot while running or changing direction quickly, as often happens in sports like baseball, is a common mechanism for an ankle sprain. Sprains occur when the ligaments are stretched or torn due to excessive force or twisting.
C. Being hit by another player in soccer could cause a contusion or fracture, but it is less likely to cause an ankle sprain unless there was a specific twisting or rolling of the ankle.
D. Dropping a weight on the lower leg is more likely to cause a contusion, fracture, or soft tissue injury rather than a sprain.
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