A nurse is preparing to give change-of-shift report on a client who is 2 days postoperative following a total knee arthroscopy. Which of the following information should the nurse include in the report? (Select all that apply)

Preferred bath time.

Admission vital signs.

Time of last pain medication.

Steps required for dressing change.

Answer and Explanation

Correct Answer : C,D

The correct answers are C and D.

Choice A reason: Preferred bath time is a personal preference and comfort-related aspect of patient care. While it is important for overall patient satisfaction and care planning, it is not critical information for a change-of-shift report following a total knee arthroscopy. The focus in such reports is typically on clinical status, immediate care needs, and potential complications.

Choice B reason: Admission vital signs are the initial measurements taken upon the patient’s admission to the healthcare facility. These are baseline values that can be referenced later to note any significant changes. However, for a change-of-shift report, especially 2 days postoperative, the most current vital signs and any changes since surgery are more pertinent than the admission values.

Choice C reason: The time of the last pain medication is crucial information for a change-of-shift report. Pain management is a key aspect of postoperative care, particularly after procedures like total knee arthroscopy. Knowing when the last dose was administered helps the incoming nurse manage the patient’s pain effectively and anticipate when the next dose is due.

Choice D reason: The steps required for dressing change are essential to include in the change-of-shift report. Proper wound care and dressing changes are vital to prevent infection and ensure proper healing after surgery. Detailed instructions on the dressing change process help maintain consistency in care between different caregivers.

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Correct Answer is C

Explanation

Choice A rationale:

Massaging the affected extremity is contraindicated in a client with deep-vein thrombosis (DVT) Massaging the area can dislodge the blood clot, leading to embolism and potentially life-threatening complications.

Choice B rationale:

Administering aspirin for pain is not the appropriate action for a client with deep-vein thrombosis. Aspirin is not the primary treatment for DVT, and it does not address the underlying cause or prevent further clot formation.

Choice C rationale:

Initiating bed rest is the correct action for a client with deep-vein thrombosis. Bed rest helps to reduce the risk of clot dislodgement and embolism. The client should avoid unnecessary movement and keep the affected leg elevated to promote blood flow and prevent complications.

Choice D rationale:

Applying an ice pack to the affected extremity is not the recommended intervention for a client with deep-vein thrombosis. Cold application can cause vasoconstriction, potentially worsening the condition by reducing blood flow to the already affected area.

A. "Let's discuss this when we have more time.” B. "I wouldn't worry about this right now. C. "I can't imagine how difficult it would be to lose my hair.” D. "I will get you information about some head-covering options.” L. t's focus on your chemotherapy.”

Correct Answer is D

Explanation

Choice A rationale:

Delaying the discussion about managing hair loss when the client has expressed concern is not the best approach. The nurse should provide information and support when the client seeks it.

Choice B rationale:

Discouraging the client from worrying about hair loss at this moment is not empathetic. The client's concerns should be acknowledged and addressed.

Choice C rationale:

Expressing empathy and relating to the client's emotional experience is a good practice, but it does not directly answer the client's question about managing hair loss.

Choice D rationale:

Offering to get information about head-covering options indicates an understanding of the client's concerns and provides a proactive solution. It shows empathy and willingness to support the client during chemotherapy, where hair loss can be a significant emotional issue.

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A nurse is preparing to give change-of-shift report on a client who is 2 days postoperative following a total knee arthroscopy. Which of the following information should the nurse include in the report? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 12 hr postpartum and has deep-vein thrombosis of the left leg.The client is receiving anticoagulant therapy.Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is caring for a client who is to begin chemotherapy.The client asks the nurse about managing hair loss.Which of the following responses should the nurse make?

Correct Answer is D

Explanation

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