A client asks the nurse about having a total knee arthroplasty to relieve joint pain. Which factor would place the client at the highest risk for impaired postoperative healing?

Choice A reason: Placing the client in a high-Fowler position may improve breathing but does not assess the cause of shortness of breath. Post-femur repair, pulmonary embolism (PE) is a risk due to fat emboli or thromboembolism, requiring objective data like oxygen saturation first.
Choice B reason: New-onset shortness of breath and tachypnea post-femur repair suggest possible pulmonary embolism or fat embolism syndrome. Documenting oxygen saturation provides objective data to assess hypoxia severity, guiding urgent interventions and communication with the healthcare provider for suspected life-threatening conditions.
Choice C reason: Starting oxygen therapy assumes hypoxia without confirmation. While it may be needed, assessing oxygen saturation first ensures the intervention is appropriate. Unwarranted oxygen administration could delay critical diagnostic steps for conditions like pulmonary embolism, which require anticoagulation or other therapies.
Choice D reason: Contacting the provider is important but secondary to assessing oxygen saturation, which provides critical data to report. Without objective findings, the nurse cannot convey the urgency or specifics of the client’s condition, potentially delaying life-saving interventions for suspected embolism.

Choice A reason: Abdominal assessment is less critical in RA and Sjögren syndrome, as these conditions primarily affect joints and exocrine glands, respectively. Gastrointestinal issues may occur with RA medications (e.g., NSAIDs), but they are not the primary concern compared to ocular complications.
Choice B reason: Oxygen saturation is not directly impacted by RA or Sjögren syndrome unless secondary complications like interstitial lung disease (rare in RA) are present. It is less relevant than ocular assessments for Sjögren syndrome’s hallmark dry eye complications.
Choice C reason: Breath sounds may be assessed in RA for rare pulmonary complications, but Sjögren syndrome primarily causes sicca symptoms (dry eyes and mouth). Respiratory issues are not the primary concern, making this less critical than ocular assessment.
Choice D reason: Sjögren syndrome causes reduced tear production, leading to dry eyes, which can result in corneal damage, infections, or vision loss. Assessing visual acuity is critical to detect early ocular complications, making it the most important assessment for this client’s condition.