A nurse caring for a client following a total knee arthroplasty. The client reports a pain level of 6 on a pain scale of 0 to 10. Which of the following Interventions should the nurse take?

Gently massage the area around the client's incision.

Apply an ice pack to the client's knee.

Perform range of motion exercises to the client's knee.

Place pillows under the client's knee.

Answer and Explanation

The Correct Answer is B

Choice A rationale: Gently massaging the area around the client's incision might be contraindicated after knee surgery due to the potential for increased pain and disruption of the surgical site.
Choice B rationale: Applying an ice pack is appropriate for managing postoperative pain and reducing inflammation after knee surgery.
Choice C rationale: Performing range of motion exercises might be appropriate but should be done cautiously and within the limits advised by the surgical team.
Choice D rationale: Placing pillows under the client's knee may provide comfort but might not directly address the reported pain level.

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Correct Answer is B

Explanation

Choice A rationale: Right upper quadrant pain is expected in acute pancreatitis and should be managed, but it does not necessarily indicate an immediate need for intervention.
Choice B rationale: Crackles in bilateral lower lobes indicate potential fluid overload and may require intervention, such as adjusting the rate of TPN or administering diuretics.
Choice C rationale: An elevated capillary blood glucose level is a common finding in patients receiving TPN and may be managed with insulin, but it does not require immediate intervention.
Choice D rationale: An elevated WBC count is expected in acute pancreatitis and may not require immediate intervention unless other signs of infection are present.

A. Peripheral pulses 2+ bilaterally B. Creatinine 0.8 mL/dL C. Weight gain 1.1 kg (2.4 lb) in 24 hr D. Urine specific gravity 1.045

Correct Answer is C

Explanation

Choice A rationale: Peripheral pulses 2+ bilaterally are generally expected and not indicative of acute kidney failure.
Choice B rationale: A creatinine level of 0.8 mL/dL is within the normal range and would not be a cause for concern in the context of acute kidney failure.
Choice C rationale: Weight gain of 1.1 kg (2.4 lb) in 24 hours is a significant finding that may indicate fluid retention and impaired kidney function, requiring reporting to the provider.
Choice D rationale: Urine specific gravity of 1.045 indicates concentrated urine, which may occur in dehydration but is not specific to acute kidney failure.

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A nurse caring for a client following a total knee arthroplasty. The client reports a pain level of 6 on a pain scale of 0 to 10. Which of the following Interventions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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