The nurse is assigned to care for a client who is 2 days postoperative after an above-the-knee amputation of the right leg. The nurse plans to implement which measure to prevent hip contractures?

Maintain the client in a supine position.

Maintain a high-Fowler’s position when the client is in bed.

Elevate the stump on a pillow.

Position the client on the abdomen for 20 to 30 minutes twice a day.

Answer and Explanation

The Correct Answer is D

Choice D rationale

Positioning the client on the abdomen for 20 to 30 minutes twice a day helps prevent hip flexion contractures. This position stretches the hip flexor muscles, reducing the risk of contractures and promoting better range of motion.

Choice A rationale

Maintaining the client in a supine position does not effectively prevent hip flexion contractures. It is important to vary the client’s position to avoid stiffness and promote mobility.

Choice B rationale

Maintaining a high-Fowler’s position when the client is in bed can increase the risk of hip flexion contractures. This position keeps the hip flexed, which can lead to contractures over time.

Choice C rationale

Elevating the stump on a pillow can help reduce swelling but does not address the prevention of hip flexion contractures. The focus should be on positioning that stretches the hip flexors.

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Correct Answer is B

Explanation

Choice A rationale
Administering sodium polystyrene sulfonate helps to lower potassium levels by exchanging sodium ions for potassium ions in the intestines. However, it is not the first intervention because it takes time to work and does not address the immediate risk of cardiac arrhythmias caused by hyperkalemia.
Choice B rationale
Monitoring the client’s cardiac rhythm is the first intervention because hyperkalemia can cause life-threatening cardiac arrhythmias. Continuous cardiac monitoring allows for the early detection and treatment of these arrhythmias, which is crucial for the client’s safety.
Choice C rationale
Restricting dietary potassium intake is an important long-term management strategy for hyperkalemia, especially in clients with chronic kidney disease. However, it does not address the immediate risk of cardiac arrhythmias and is not the first intervention.
Choice D rationale
Preparing the client for hemodialysis is a definitive treatment for hyperkalemia, especially in clients with chronic kidney disease. However, it is not the first intervention because it takes time to arrange and initiate dialysis. Immediate cardiac monitoring is necessary to manage the acute risk of arrhythmias.

A. Hypocortisolism. B. Hyperinsulinemia. C. Iodide deficiency. D. Azotemia.

Correct Answer is C

Explanation

Choice A rationale
Hypocortisolism, also known as Addison’s disease, is characterized by insufficient production of cortisol by the adrenal glands. It does not typically cause goiter, which is an enlargement of the thyroid gland due to various causes such as iodine deficiency, autoimmune diseases, or nodules.
Choice B rationale
Hyperinsulinemia refers to an excess level of insulin in the blood, often associated with insulin resistance and type 2 diabetes. It is not related to the development of goiter.
Choice C rationale
Iodide deficiency is a common cause of goiter. The thyroid gland requires iodine to produce thyroid hormones. When there is a deficiency, the gland enlarges in an attempt to capture more iodine from the bloodstream.
Choice D rationale
Azotemia is an elevation of blood urea nitrogen (BUN) and serum creatinine levels, typically due to kidney dysfunction. It is not associated with the development of goiter.

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The nurse is assigned to care for a client who is 2 days postoperative after an above-the-knee amputation of the right leg. The nurse plans to implement which measure to prevent hip contractures?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with chronic kidney disease (CKD) who presents with hyperkalemia. Which of the following interventions should the nurse implement first?

Correct Answer is B

Explanation

A goiter is often associated with:

Correct Answer is C

Explanation

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