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An older client who was recently admitted to the sub-acute setting after having a knee replacement, is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement?

Allow the client to remain in bed but share that getting up will be required at least twice a day starting the next morning.

Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain.

Share with the client that it is important to get out of bed and that there is pain medication available if it does hurt.

Offer pain medication, administer the medication, and wait 30 minutes before getting her out of bed.

Answer and Explanation

The Correct Answer is D

Choice A reason: Allowing the client to remain in bed but sharing that getting up will be required at least twice a day starting the next morning is not an effective intervention, as it does not address the client's current pain or anxiety, and may increase the client's resistance or fear of mobilization.

Choice B reason: Using the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain is not an appropriate intervention, as it does not respect the client's autonomy or preference, and may cause more pain or injury to the knee or other joints.

Choice C reason: Sharing with the client that it is important to get out of bed and that there is pain medication available if it does hurt is not a sufficient intervention, as it does not provide the client with adequate pain relief or reassurance, and may imply that the client's pain is not taken seriously or validated.

Choice D reason: Offering pain medication, administering the medication, and waiting 30 minutes before getting her out of bed is the best intervention, as it provides the client with effective pain management, reduces the client's anxiety, and facilitates the client's mobilization and recovery.

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Correct Answer is C

Explanation

Choice A reason: Changing facial expression is not a likely action to be observed during the assessment, as PD causes reduced facial expression or mask-like face. The client may have difficulty blinking, smiling, or showing emotions.

Choice B reason: Frequent movement is not a likely action to be observed during the assessment, as PD causes slowed movement or bradykinesia. The client may have difficulty initiating, continuing, or completing movements.

Choice C reason: Resting hand tremors is a likely action to be observed during the assessment, as PD causes rhythmic shaking of the hands, fingers, or other body parts. The tremors usually occur when the affected limb is at rest and may decrease when the client is performing tasks.

Choice D reason: Fast movements is not a likely action to be observed during the assessment, as PD causes impaired movement or dyskinesia. The client may have involuntary, jerky, or twisting movements that are often unpredictable and uncontrollable.

Choice E reason: None of the above is not the correct answer, as there is one choice that is a likely action to be observed during the assessment.

A. Over-the-counter NSAIDs are generally harmless. B. Stool softeners and laxatives should be used with opioids. C. Opioids are less effective in older clients than in younger clients. D. The dose limit for acetaminophen is difficult to reach for older adults. E. None of the above.

Correct Answer is B

Explanation

Choice A reason: Over-the-counter NSAIDs are generally harmless is not a true statement, as NSAIDs can cause serious adverse effects in older adults, such as gastrointestinal bleeding, renal impairment, hypertension, and heart failure. NSAIDs should be used with caution and under medical supervision in older adults.

Choice B reason: Stool softeners and laxatives should be used with opioids is a true statement, as opioids can cause constipation in older adults, which can lead to discomfort, abdominal pain, fecal impaction, and bowel obstruction. Stool softeners and laxatives can help prevent and treat constipation and promote regular bowel movements.

Choice C reason: Opioids are less effective in older clients than in younger clients is not a true statement, as opioids can have the same or even greater analgesic effect in older adults, depending on the dose, route, and duration of administration. However, opioids can also cause more side effects in older adults, such as sedation, confusion, respiratory depression, and falls. Opioids should be used with caution and under medical supervision in older adults.

Choice D reason: The dose limit for acetaminophen is difficult to reach for older adults is not a true statement, as older adults may be more susceptible to acetaminophen toxicity, especially if they have liver disease, malnutrition, or chronic alcohol use. The dose limit for acetaminophen is 4 grams per day for adults, but it may be lower for older adults or those with risk factors. Acetaminophen should be used with caution and under medical supervision in older adults.

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An older client who was recently admitted to the sub-acute setting after having a knee replacement, is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement?

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