A nurse is preparing a client for a hip arthroplasty. For which of the following reasons should the nurse assess the client's vital signs?

To determine how the client will tolerate the procedure

To establish a baseline for postoperative assessment

To prevent postoperative hypotension

To assess the client's pain level

Answer and Explanation

The Correct Answer is B

A.   Vital signs, including blood pressure, heart rate, respiratory rate, and temperature, provide baseline information about the client's cardiovascular and respiratory status. This assessment helps predict how well the client might tolerate the surgical procedure under anesthesia and monitor for any deviations during the procedure.
B.   Establishing baseline vital signs before surgery provides a comparison point for monitoring the client's recovery and identifying any postoperative complications. Changes in vital signs postoperatively can indicate potential issues such as bleeding, fluid imbalance, or respiratory compromise.
C.   Monitoring blood pressure before surgery helps identify clients at risk for intraoperative hypotension, particularly important during induction of anesthesia and throughout the surgical procedure. Establishing baseline blood pressure levels guides intraoperative management to maintain hemodynamic stability.
D.   While vital signs are important for assessing physiological status, they do not directly assess pain. Pain assessment involves asking the client about their pain experience, location, intensity, and factors that alleviate or exacerbate pain. Vital signs can indirectly reflect pain if pain causes changes in heart rate or blood pressure, but they are not specific indicators of pain.

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Correct Answer is D

Explanation

A. Respiratory alkalosis is characterized by a high pH (alkaline) and a low PaCO2 (<35 mm Hg). The ABG results provided show a pH of 7.3 (which is acidic) and a PaCO2 of 50 mm Hg (which is elevated). Therefore, these results do not indicate respiratory alkalosis.
B. Metabolic acidosis is characterized by a low pH (<7.35) and a decreased bicarbonate (HCO3-). The ABG results show a pH of 7.3 (acidic), which aligns with metabolic acidosis. However, the PaCO2 of 50 mm Hg is elevated, which typically indicates respiratory compensation for the metabolic acidosis.
C. Metabolic alkalosis is characterized by a high pH and an elevated bicarbonate (HCO3-). The ABG results show a pH of 7.3 (acidic), which does not suggest metabolic alkalosis.
D. Respiratory acidosis is characterized by a low pH and an elevated PaCO2 (>45 mm Hg). The ABG results provided show a pH of 7.3 (acidic) and a PaCO2 of 50 mm Hg (elevated). These findings are consistent with respiratory acidosis, where the elevated PaCO2 indicates retention of carbon dioxide, leading to acidosis.

A. The client has a fever. B. The client has possible hemorrhage or bleeding. C. The client has chronic obstructive pulmonary disease (COPD). D. The client has calcium channel blocker medicate prescribed.

Correct Answer is D

Explanation

A. Fever can cause tachycardia (increased heart rate) rather than bradycardia. It is not typically associated with slowing of the heart rate unless there are other complicating factors such as severe infection or medication side effects.
B. Significant blood loss can lead to hypovolemia (low blood volume), which can result in bradycardia as a compensatory mechanism to maintain blood pressure. However, the blood pressure in this scenario is

normal (120/80), which makes severe hemorrhage less likely unless compensated by fluid resuscitation or other factors.
C. COPD can cause chronic hypoxia and respiratory acidosis, which can lead to chronic respiratory compensation and potentially bradycardia. However, COPD alone is less likely to cause bradycardia in the absence of severe exacerbation or other complicating factors.
D. Calcium channel blockers (CCBs) are medications commonly prescribed for conditions such as hypertension, angina, and arrhythmias. They work by blocking calcium channels in cardiac and smooth muscle cells, resulting in decreased heart rate and vasodilation. Bradycardia is a known side effect of CCBs, especially when taken in excess or in combination with other medications that affect heart rate.

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A nurse is preparing a client for a hip arthroplasty. For which of the following reasons should the nurse assess the client's vital signs?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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