A nurse is planning care for a client who is 6 hr postoperative following a right knee arthroplasty. Which of the following interventions should the nurse include in the client's plan of care?

Apply warm, moist packs to the surgical site.

Place a pillow under the client's surgical knee

Use the continuous passive-motion machine intermittently.

Massage the lower leg in smooth, long strokes.

Answer and Explanation

The Correct Answer is C

The correct answer is C.

Using the continuous passive-motion machine intermittently helps to prevent joint stiffness and promote circulation in the surgical leg. Applying warm, moist packs to the surgical site can increase inflammation and infection risk. Placing a pillow under the client's surgical knee can cause flexion contractures and impair healing. Massaging the lower leg in smooth, long strokes can dislodge a thrombus and cause a pulmonary embolism.

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Correct Answer is B

Explanation

The correct answer is B.

Hepatitis C is a contraindication for taking acetaminophen because it can cause hepatotoxicity and liver failure in clients who have liver disease. Cystitis, hypotension, and diabetes mellitus are not contraindications for taking acetaminophen.

A. The client fell because the assistive personnel did not place nonskid slippers on the client." B. The client does not appear to have any injuries resulting from the fall." C. "Client stated, 'I lost my balance and fell when I got out of bed to go to the bathroom'." D. "An incident report has been completed and sent to risk management."

Correct Answer is C

Explanation

The correct answer is C. The nurse should document factual and objective information about the incident, such as what the client said and what actions were taken by the nurse and other staff members. The nurse should not document opinions or assumptions about the cause of the fall, such as blaming the assistive personnel or stating that the client has no injuries without performing a thorough assessment. The nurse should also not document that an incident report was completed and sent to risk management, as this is confidential information that should not be part of the medical record.

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A nurse is planning care for a client who is 6 hr postoperative following a right knee arthroplasty. Which of the following interventions should the nurse include in the client's plan of care?

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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