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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
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.
Correct Answer is A
Explanation
A. Troponin is a protein found in cardiac muscle cells. When there is damage to the heart muscle, such as during a myocardial infarction (heart attack), troponin is released into the bloodstream. Therefore, elevated troponin levels in the blood indicate myocardial injury or damage.
B. Troponin is not an enzyme; it is a protein. While there are enzymes such as creatine kinase (CK) and lactate dehydrogenase (LDH) that can indicate damage to various tissues including heart and skeletal muscles, troponin specifically indicates cardiac muscle damage.
C. Troponin is not involved in oxygen transport. Hemoglobin, found in red blood cells, is the protein responsible for oxygen transport in the body.
D. Troponin is not a lipid; it is a protein. Lipids include substances like cholesterol and triglycerides. Troponin levels do not reflect the risk for coronary artery disease; rather, they indicate acute damage to the heart muscle.
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