A nurse is caring for a patient post-total hip arthroplasty. Which of the following findings requires immediate intervention?

The surgical dressing has a small amount of serosanguinous drainage.

The patient's hemoglobin dropped from 12 g/dL to 10 g/dL within 24 hours postoperatively.

The patient reports mild discomfort at the surgical site and rates pain as 4/10 on a pain scale.

The surgical extremity is cool to touch, pale, with weak pedal pulses compared to the contralateral limb.

Answer and Explanation

The Correct Answer is D

A. The surgical dressing has a small amount of serosanguinous drainage. Light serosanguinous drainage is expected postoperatively and does not require immediate intervention.
B. The patient’s hemoglobin dropped from 12 g/dL to 10 g/dL within 24 hours postoperatively. A mild drop in hemoglobin postoperatively is expected due to blood loss during surgery. This does not require immediate intervention.
C. The patient reports mild discomfort at the surgical site and rates pain as 4/10 on a pain scale. Mild discomfort is expected and can be managed with prescribed analgesics.
D. The surgical extremity is cool to touch, pale, with weak pedal pulses compared to the contralateral limb. These findings indicate impaired circulation or vascular compromise, which could suggest compartment syndrome or arterial occlusion. Immediate intervention is required to prevent limb ischemia.

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Correct Answer is D

Explanation

A. Medicate the client for pain: Pain management is essential after surgery; however, it is not the most critical action. Unrelieved pain could indicate a complication, such as compartment syndrome, which requires further assessment.

B. Direct the client to perform exercises of the ankle and toes: Performing ankle and toe exercises helps prevent complications such as venous thromboembolism (VTE) and promotes circulation, but it is not the priority over assessing for complications.

C. Instruct the client on the use of crutches: Teaching the client how to use crutches is important for mobility, but this is not the most immediate postoperative concern.

D. Perform neurovascular checks of the extremities: This is the most important intervention because neurovascular compromise (e.g., compartment syndrome) can occur after orthopedic surgery. Checking circulation, movement, and sensation (CMS) is critical for early detection of complications.

A. Increased hip range of motion and absence of pain B. Reports of hearing a "pop" at the time of pain onset C. Ability to bear weight on the affected leg without discomfort D. Symmetric leg length with normal alignment

Correct Answer is B

Explanation

A. Increased hip range of motion and absence of pain. A hip dislocation causes severe pain and reduced mobility, not increased range of motion. This option is incorrect.

B. Reports of hearing a "pop" at the time of pain onset. A "popping" sound often occurs when the prosthetic hip dislocates from the joint, making this a key symptom of hip dislocation.

C. Ability to bear weight on the affected leg without discomfort. A hip dislocation causes severe pain and functional impairment, making weight-bearing extremely difficult or impossible.

D. Symmetric leg length with normal alignment. A dislocated hip causes the affected leg to appear shortened and externally rotated, so symmetrical leg length would not be expected.

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A nurse is caring for a patient post-total hip arthroplasty. Which of the following findings requires immediate intervention?

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