A nurse is caring for a client who had total hip arthroplasty 2 days ago. Which of the following actions should the nurse take

Rationale:

A. Provide 60 mL (2 oz) of fluid intake every 5 min.: Following gastric bypass surgery, the stomach pouch is very small and cannot tolerate large or frequent volumes. Giving 60 mL every 5 minutes places the client at high risk for nausea, vomiting, dumping syndrome, and anastomotic complications. Fluid intake must be introduced slowly in small sips.

B. Ambulate the client 48 hr after the procedure.: Early ambulation is essential to prevent postoperative complications such as atelectasis, venous thromboembolism, and delayed return of bowel function. Waiting 48 hours is too long; clients should begin ambulating on the day of surgery or within the first 24 hours to promote circulation.

C. Provide a soft diet on the first postoperative day.: After gastric bypass surgery, the digestive system needs time to heal and cannot tolerate solid or semi-solid foods. Clients begin with clear liquids and progress gradually to pureed, soft, and then solid diets over several weeks.

D. Measure and compare abdominal girth daily.: Monitoring abdominal girth helps detect postoperative complications such as internal bleeding, leaks, or ileus, which may present with distention or increased abdominal size. Regular measurement provides early recognition of changes that require prompt intervention.

Rationale:

A. Strabismus: Strabismus, or misalignment of the eyes, is not a known adverse effect of timolol. Timolol primarily affects intraocular pressure and systemic cardiovascular parameters rather than eye muscle alignment.

B. Bradycardia: Timolol is a nonselective beta-adrenergic blocker that can be absorbed systemically even when administered as eye drops. One potential systemic adverse effect is bradycardia, as the medication can reduce heart rate and cardiac output, particularly in clients with preexisting heart conditions.

C. Conjunctivitis: While eye irritation or mild stinging can occur with timolol, conjunctivitis is not a typical adverse effect. Instructing clients to monitor for more common ocular side effects, such as burning or discomfort, is appropriate.

D. Hyperglycemia: Timolol does not typically cause hyperglycemia. Beta-blockers can sometimes mask hypoglycemia symptoms in diabetic clients but are not associated with raising blood glucose levels directly.