A nurse is reinforcing teaching with a client who is 24 hr postoperative following a total hip arthroplasty. Which of the following instructions should the nurse include in the teaching?
Perform range of motion by adducting the hip.
Sit in a straight-backed chair.
Cleanse the surgical incision with hydrogen peroxide.
Apply moist heat to the incision while in bed.
The Correct Answer is B
Choice A reason: Performing range of motion by adducting the hip is an incorrect instruction for a client who had a total hip arthroplasty. Adduction is moving the leg toward the midline of the body, which can cause dislocation of the prosthesis. The nurse should instruct the client to perform range of motion by abducting (moving away from midline), flexing (bending), and extending (straightening) the hip as prescribed by physical therapy.
Choice B reason: Sitting in a straight-backed chair is a correct instruction for a client who had a total hip arthroplasty. This position helps to maintain proper alignment and stability of the hip joint and prevents excessive flexion or rotation that can cause dislocation. The nurse should also instruct the client to avoid crossing legs, bending forward more than 90 degrees, or twisting at the waist.
Choice C reason: Cleansing the surgical incision with hydrogen peroxide is an incorrect instruction for a client who had a total hip arthroplasty. Hydrogen peroxide is a harsh agent that can damage healthy tissue and delay healing. The nurse should instruct the client to cleanse the incision with mild soap and water or as directed by the provider and keep it dry and covered with sterile dressing.
Choice D reason: Applying moist heat to the incision while in bed is an incorrect instruction for a client who had a total hip arthroplasty. Moist heat can increase swelling, inflammation, and infection risk at the incision site. The nurse should instruct the client to apply ice packs or cold compresses to the incision as needed to reduce pain and swelling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not a statement that indicates acceptance, but rather denial or grief. The client is expressing a desire to return to their previous state and ignoring the reality of their situation. The nurse should acknowledge the client's feelings and provide emotional support and education.
Choice B reason: This is not a statement that indicates acceptance, but rather unrealistic or magical thinking. The client is expecting an impossible outcome and avoiding the facts of their condition. The nurse should explain the function and care of the ileostomy and clarify any misconceptions.
Choice C reason: This is a statement that indicates acceptance, as well as coping and resilience. The client is demonstrating a willingness to adapt to their new situation and seek help from others who have similar experiences. The nurse should praise the client's positive attitude and provide information and resources about support groups.
Choice D reason: This is not a statement that indicates acceptance, but rather avoidance or dependency. The client is showing a lack of interest or involvement in their self-care and relying on their partner to perform the tasks for them. The nurse should encourage the client's participation and independence and teach them how to empty and change the bag.
Correct Answer is D
Explanation
Choice A reason: This is not a therapeutic effect of aprepitant because aprepitant is not an analgesic drug that can relieve pain. Aprepitant is an antiemetic drug that can prevent nausea and vomiting caused by chemotherapy or surgery.
Choice B reason: This is not a therapeutic effect of aprepitant because aprepitant does not affect the balance or vestibular system that can cause dizziness. Aprepitant works by blocking the action of substance P, a neurotransmitter involved in nausea and vomiting.
Choice C reason: This is not a therapeutic effect of aprepitant because aprepitant does not affect the cardiac rhythm or conduction that can cause dysrhythmias. Aprepitant has a low risk of interacting with other drugs that can affect the heart, such as warfarin or digoxin.
Choice D reason: This is a therapeutic effect of aprepitant because aprepitant can prevent nausea and vomiting caused by chemotherapy or surgery by blocking the action of substance P, a neurotransmitter involved in nausea and vomiting. The nurse should monitor the client's oral intake, hydration status, and weight and report any signs of dehydration or malnutrition.
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