The nurse is assisting with patients in an orthopedic unit. Which is an important factor to remember when caring for patients after a total hip replacement?

Place three pillows between the legs, one distal and three proximal.

Side-lying position is permitted with a pillow between the legs.

Sitting in a bedside chair is permitted if the legs are elevated.

A triangular pillow is used between the legs to avoid adduction.

Answer and Explanation

The Correct Answer is D

A. Place three pillows between the legs, one distal and three proximal: This is incorrect and excessive. Using three pillows in this manner can lead to improper leg positioning and discomfort.
B. Side-lying position is permitted with a pillow between the legs: While side-lying is allowed, the pillow is to prevent adduction of the legs, not just any pillow placement. It must specifically keep the hips aligned.
C. Sitting in a bedside chair is permitted if the legs are elevated: While sitting is often encouraged, elevating the legs too high can risk hip dislocation or improper alignment. The patient should sit in a way that maintains proper hip angles and alignment.
D. A triangular pillow is used between the legs to avoid adduction: A triangular or abduction pillow helps keep the legs in an appropriate position, preventing the legs from crossing and reducing the risk of hip dislocation post-surgery.

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Correct Answer is A

Explanation

A. Assist the patient to turn to her side: This is the priority action to prevent aspiration of vomitus, which can be a serious complication for stroke patients who may have impaired swallowing and a reduced gag reflex.
B. Give an antiemetic as ordered: While important, administering an antiemetic should come after ensuring the patient’s safety and preventing aspiration.
C. Perform a test for blood on the emesis: This is not the immediate priority. Preventing aspiration is the first concern.
D. Call for an aide to get suction set up: Suction may be necessary if the patient is at risk of aspiration, but the first step is to turn the patient to prevent choking and aspiration.

A. tPA is not delivered for hemorrhagic stroke. B. The total effects of ischemia are not currently known. C. Too much time has passed since the symptoms began. D. The patient's symptoms have progressed too quickly.

Correct Answer is A

Explanation

A. tPA is not delivered for hemorrhagic stroke: This is correct. tPA is a thrombolytic medication used for ischemic strokes, not haemorrhagic strokes, as it would exacerbate bleeding.
B. The total effects of ischemia are not currently known: While assessing the extent of ischemia is important for ischemic stroke, it is irrelevant here because the stroke is hemorrhagic.
C. Too much time has passed since the symptoms began: The time window is important for tPA in ischemic strokes, but in this case, the type of stroke (haemorrhagic) is the determining factor.
D. The patient's symptoms have progressed too quickly: The progression of symptoms does not affect the decision to use tPA; the contraindication is solely due to the hemorrhagic nature of the stroke.

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The nurse is assisting with patients in an orthopedic unit. Which is an important factor to remember when caring for patients after a total hip replacement?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient recently admitted with a stroke. The patient is experiencing nausea and begins to vomit. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

Correct Answer is A

Explanation

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