Joint Arthroplasty- Hip Replacement/ Knee Replacement/ Hip Prosthesis (Exam 4) under 'Osteoarthritis Surgery'

A nurse is providing discharge teaching for a client who had a left total hip arthroplasty. Which of the following client statements indicates the teaching was effective? A. "I should expect swelling of the affected leg for several weeks." B. "I should not cross my legs at the ankles or knees." C. "I will inspect my hip incision every other day for redness." D. "I can bend over at the hip to pick up objects."

B. "I should not cross my legs at the ankles or knees." The nurse should instruct the client to avoid crossing the legs at the knees or ankles because this can result in the dislocation of the femoral head. Do NOT flex the hip more than 90°. Do NOT bend at the hip to pick up objects on the floor. This can cause dislocation of the hip following surgery. Topic: Hip Replacement- Dislocation Precautions Main Topic: Osteoarthritis- Surgery Ref: ATI

A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis? A. Bulging in the area over the surgical incision B. Shortening of the right leg C. Sensation of warmth over the surgical incision D. Pallor following elevation of the right leg

B. Shortening of the right leg The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, an inability to move the extremity, and rotation of the hip internally or externally. Topic: Hip Replacement- Symptoms of Dislocation Complication Main Topic: Osteoarthritis- Surgery Ref: ATI

A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client indicates an understanding of the teaching? A. "I will wear a continuous movement machine on my knee for 24 hr a day." B. "I should avoid taking NSAID medications for pain after surgery." C. "I should wear elastic stockings on both of my legs." D. "I will begin exercising my legs the day after surgery."

C. "I should wear elastic stockings on both of my legs." The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as an understanding of the teaching. Topic: Knee Replacement Main Topic: Osteoarthritis- Surgery Ref: ATI

A nurse is providing preoperative teaching to a client who is scheduled for arthroplasty in the next month and may require a blood transfusion. The client expresses concern about the risk of acquiring an infection from the blood transfusion. Which of the following statements should the nurse share with the client? A. "Ask your provider to prescribe epoetin before the surgery." B. "You should ask your provider about taking iron supplements prior to the surgery." C. "Ask a family member to donate blood for you." D. "Donate autologous blood before the surgery."

D. "Donate autologous blood before the surgery." Autologous blood transfusion is the collection and reinfusion of the client's blood. With preoperative autologous blood donation, the blood is drawn from the client 3 to 5 weeks before an elective surgical procedure and stored for transfusion at the time of the surgery. Autologous blood is the safest form of blood transfusion because exclusive use of a client's own blood eliminates exposure to a transfusion-transmitted infection. Topic: Hip Replacement- PreOp Pt Teaching Main Topic: Osteoarthritis- Surgery Ref: ATI

A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT)? A. Aspirin B. Warfarin C. Ticagrelor D. Enoxaparin

D. Enoxaparin Prevent DVT's The nurse should anticipate the administration of enoxaparin for a client who is 12 hours postoperative following surgery. Enoxaparin is low-molecular-weight (LMW) heparin that is used to prevent a DVT by inhibiting the effects of antithrombin and thrombin. Topic: Hip Replacement- PostOp Med Main Topic: Osteoarthritis- Surgery Ref: ATI

A nurse in an acute care facility is planning care for a client who is alert but temporarily immobile due to a total hip arthroplasty. Which of the following interventions should the nurse plan to take to prevent a complication of immobility? A. Move the client from supine to a low Fowler's position every 2-3 hr to help prevent orthostatic hypotension B. Limit fluid intake to 1 L (33.8 oz) in 24 hr to help prevent dependent edema C. Encourage the client to turn from side to side every 3-4 hr to help prevent respiratory complications D. Instruct the client to perform foot and leg exercises every 1-2 hr while awake to help prevent thrombophlebitis

D. Instruct the client to perform foot and leg exercises every 1-2 hr while awake to help prevent thrombophlebitis Antiembolic exercises (e.g. flexion of the knees and rolls and pumps of the feet and ankles) every 1-2 hours help prevent thrombophlebitis, which is a complication of immobility. Topic: Hip Replacement- Immobility Complication Main Topic: Osteoarthritis- Surgery Ref: ATI

To prevent dislocation in a client on the first postoperative day after a right total hip replacement, the nurse should avoid positioning him: 1. with the right leg externally rotated. 2. in the left lateral decubitus position. 3. with the legs adducted. 4. in semi-Fowler's position.

3. with the legs adducted. To prevent dislocation following a total hip replacement, leg adduction should be avoided. Instead, the legs should be abducted. External rotation of the affected leg is appropriate as well as sitting at a 45-degree angle. Topic: Hip Replacement- Dislocation Precautions Main Topic: Osteoarthritis- Surgery Ref: NCLEX Made Easy

A nurse is planning care for a client following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan? A. Position the client with her legs adducted B. Internally rotate the client's affected hip C. Place a pillow between the client's legs D. Instruct the client to avoid flexing her hip more than 95º

C. Place a pillow between the client's legs The nurse should plan to place a pillow or a wedge between the client's legs to reduce the risk of hip dislocation. ABDUCTED position of legs to reduce the risk of hip dislocation. NO HIP INTERNAL ROTATION to reduce the risk of hip dislocation. AVOID flexing her hip > 90º to reduce the risk of hip dislocation. Topic: Hip Replacement Main Topic: Osteoarthritis- Surgery Ref: ATI

A nurse is caring for a client following a hip arthroplasty. The nurse places an abduction pillow on the client for which of the following purposes? A. To raise the bed linens off the client's feet to prevent plantar flexion B. To keep the client's heels off the bed to prevent pressure ulcers C. To position the client off the operative site while in bed D. To prevent dislocation of the hip during position changes or movement Topic: Hip Replacement- Dislocation Precautions Main Topic: Osteoarthritis- Surgery Ref: ATI

D. To prevent dislocation of the hip during position changes or movement. Following surgery, the nurse should use an abduction pillow to prevent dislocation of the new hip joint. The nurse should place the wedge-shaped pillow between the client's legs to prevent adduction beyond the midline of the body during position changes or client movement, which can lead to subluxation or total dislocation of the hip joint.

A client undergoes a total hip replacement. Which statement by the client indicates he requires further teaching? 1. "I'll need to keep several pillows between my legs at night." 2. "I'll need to remember not to cross my legs. It's such a bad habit." 3. "The occupational therapist is showing me how to use a 'sock puller' to help me get dressed." 4. "I don't know if I'll be able to get off that low toilet seat at home by myself."

4. "I don't know if I'll be able to get off that low toilet seat at home by myself." Indicates that the client has a poor understanding of the precautions required after a total hip replacement and that he needs further teaching. Remember: If you see the phrase further teaching or further instruction, you're looking for a wrong answer by the client. Topic: Hip Replacement- Dislocation Precautions Main Topic: Osteoarthritis- Surgery Ref: NCLEX Made Easy

A client undergoes a total hip replacement. Which statement by the client indicates he requires further teaching? 1. "I'll need to keep several pillows between my legs at night." 2. "I'll need to remember not to cross my legs. It's such a bad habit." 3. "The occupational therapist is showing me how to use a 'sock puller' to help me get dressed." 4. "I don't know if I'll be able to get off that low toilet seat at home by myself."

4. "I don't know if I'll be able to get off that low toilet seat at home by myself." Patient does not understand that they will use an ELEVATED TOILET SEAT. Topic: Hip Replacement- Dislocation Precautions Main Topic: Osteoarthritis- Surgery Ref: NCLEX Made Easy

The nurse is doing preoperative teaching with a client who's admitted for hip replacement surgery. Which statement by the client indicates the need for further preoperative teaching? 1. "I'll begin gait training within 48 hours." 2. "I'll rest in bed for 2 to 3 hours after surgery." 3. "I need to turn, cough, and breathe deeply every 2 hours." 4. "I should do muscle strengthening exercises in both legs."

2. "I'll rest in bed for 2 to 3 hours after surgery." After total joint replacement, few clients can get up 2 to 3 hours after surgery, although most are out of bed within 24 hours of surgery. The other options indicate that the client understands the nurse's preoperative teaching. Topic: Hip Replacement- Post Op Management Main Topic: Osteoarthritis- Surgery Ref: NCLEX Made Easy

A nurse is preparing a client who is postoperative following total hip arthroplasty for discharge. Which of the following statements indicates that the client understands the instructions? A. "I'll use alcohol pads to clean my incision each day." B. "When I'm doing my exercises, I'll include bent-leg raises." C. "I'll use a reacher to help me pick up anything I drop on the floor." D. "When I can walk without my walker, I can stop attending physical therapy."

C. "I'll use a reacher to help me pick up anything I drop on the floor." To prevent dislocation, the client must avoid flexing to 90° at the waist. Using a device that allows the client pick up objects from the floor without bending will help avoid this type of flexion. Topic: Hip Replacement- Dislocation Precautions Main Topic: Osteoarthritis- Surgery Ref: ATI