A nurse is assessing a client who is 1 day postoperative following a total knee arthroplasty. The client is scheduled for physical therapy in 45 min. Which of the following questions should the nurse ask first?
“Have you used an incentive spirometer today?"
"What is your current pain level on a scale of 0 to 10?"
"Have you informed your family of your physical therapy schedule?"
"Would you like to bathe before or after physical therapy?"
The Correct Answer is B
A. While the use of an incentive spirometer is crucial for preventing respiratory complications such as atelectasis, this question is less urgent in the context of preparing for physical therapy. The immediate priority should be to assess the client’s readiness for physical therapy, including their pain level and comfort, rather than focusing on the spirometer use.
B. Assessing the client's current pain level is crucial because pain management directly impacts the
client’s ability to participate in physical therapy effectively. Ensuring that the client’s pain is adequately controlled will help in achieving a more successful therapy session and in preventing discomfort or additional complications during the therapy.
C. While informing family members about the physical therapy schedule might be important for planning family support and involvement, it is not as urgent as ensuring the client is physically ready for the therapy session.
D. This question addresses personal preference regarding bathing but is not as critical as assessing the client’s pain level or immediate readiness for physical therapy. While personal hygiene is important, it should not take precedence over addressing pain management and ensuring the client is prepared for physical therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This statement indicates that the client may have difficulty with activities of daily living (ADLs), such as bathing, due to their rheumatoid arthritis. An occupational therapist can help by providing adaptive techniques or tools to make these tasks easier, thus making this an appropriate referral need.
B. While this statement reflects a common issue for clients with rheumatoid arthritis, it primarily points to a need for pain management and potentially medication adjustments, which are more typically addressed by a rheumatologist or a pain specialist rather than an occupational therapist.
C. This statement is related to nutritional needs and weight management. A dietitian or nutritionist would be the most appropriate professional to help with meal planning and maintaining a healthy weight rather than an occupational therapist.
D. Difficulty with stairs is related to mobility and functional limitations. An occupational therapist can assist by assessing the client’s home environment and recommending modifications or adaptive devices to improve safety and mobility, making this an appropriate reason for referral.
Correct Answer is D
Explanation
A. This is a standard intervention for phototherapy, as it helps to protect the eyes from excessive light exposure.
B. Check the neurovascular status every 4 hr of a child who had a hip spica cast placed 6 hr ago. This is a necessary intervention to monitor for potential complications, such as compartment syndrome, after a cast is applied.
C. Administer a bronchodilator two times a day for child who has cystic fibrosis. This is a common treatment for cystic fibrosis, as bronchodilators help to open the airways and improve breathing.
D. This is an inflammatory bowel disease characterized by inflammation of the large intestine. During an exacerbation, the goal is to reduce inflammation and promote healing. While a low-fiber diet may be helpful during an acute exacerbation to reduce bowel irritation, a high-protein diet is not recommended.
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