A nurse is planning care for a client who is 6 hr. postoperative following a right knee arthroplasty. Which of the following interventions should the nurse include in the client's plan of care?
Apply warm, moist packs to the surgical site.
Massage the lower leg in smooth, long strokes.
Place a pillow under the client's surgical knee.
Use the continuous passive-motion machine intermittently.
The Correct Answer is D
Choice A Reason:
Applying warm, moist packs to the surgical site may not be indicated as it can potentially increase swelling and disrupt the surgical site.
Choice B Reason:
Massaging the lower leg in smooth, long strokes is generally not recommended in the early postoperative period, as it can disturb the surgical site and potentially lead to complications.
Choice C Reason:
When planning care for a client who is postoperative following a knee arthroplasty, placing a pillow under the surgical knee can be beneficial. This helps maintain proper alignment, reduces pressure on the surgical site, and promotes comfort and circulation. Elevating the leg slightly with a pillow can also help reduce swelling and minimize the risk of complications such as deep vein thrombosis (DVT).
Choice D Reason:
Using the continuous passive-motion (CPM) machine intermittently should be done as ordered by the healthcare provider and under their guidance. CPM is typically initiated early postoperatively, often within the first 24 hours after surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Decreased BUN (blood urea nitrogen) level is incorrect. While furosemide can lead to decreased BUN levels, it is not the primary indicator of its effectiveness. BUN levels can be influenced by various factors, including hydration status and kidney function.
Choice B Reason:
Increased urinary output is correct. Furosemide is a diuretic medication often prescribed to clients with heart failure to help manage fluid retention. One of the primary therapeutic effects of furosemide is increased urinary output, which indicates that the medication is effectively removing excess fluid from the body.
Choice C Reason:
Decreased hemoglobin level is incorrect. Furosemide is not directly associated with changes in hemoglobin levels. Hemoglobin levels reflect the oxygen-carrying capacity of the blood and are typically not affected by diuretic therapy.
Choice D Reason:
Increased weight of 0.91 kg (2 lb.) is incorrect. An increase in weight is not indicative of the medication's effectiveness. In fact, weight gain could be a sign of fluid retention and heart failure exacerbation, which would suggest that the medication may not be working optimally.
Correct Answer is C
Explanation
Choice A Reason:
Increasing the flow rate without healthcare provider guidance can be dangerous and should not be done without proper instruction.
Choice B Reason:
Synthetic blankets can generate static electricity, which poses a fire hazard in the presence of oxygen. Clients using oxygen therapy should be advised to use cotton or wool blankets that are less likely to generate static.
Choice C Reason:
"I will check my oxygen equipment at least once daily." This statement indicates an understanding of the importance of equipment safety and maintenance in home oxygen therapy. Regularly checking oxygen equipment for proper functioning is essential for the client's safety. It helps ensure that the oxygen delivery system is working correctly and that there are no issues with flow rate or oxygen concentration.
Choice D Reason:
Isopropyl alcohol is flammable and should not be used to clean oxygen equipment due to the risk of ignition in the presence of oxygen. Clients should use mild soap and water for cleaning nasal cannulas and other equipment.
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