The nurse is caring for a client who has returned to the nursing unit from the post anesthesia care unit (PACU) 40 minutes ago following an above the knee amputation (AKA) of the right leg. In which position should the nurse place the client at this time?
Prone with arms elevated
Supine with the stump flat on the bed
Supine with the stump supported on pillows
Reverse Trendelenburg
The Correct Answer is C
A. While positioning a patient prone can help with certain surgical recovery situations, it is not typically used immediately after an above-the-knee amputation. Additionally, elevating the arms may not provide any benefit and could cause discomfort.
B. This position can increase the risk of contractures in the residual limb, especially with an above-the- knee amputation. Keeping the stump flat may also lead to swelling and discomfort.
C. This position allows for proper elevation of the stump, which can help reduce swelling and promote healing. Supporting the stump on pillows prevents the risk of contractures and maintains the limb in a neutral position. It provides comfort and stability while facilitating blood flow.
D. While this position can help with venous return and reduce the risk of complications such as orthostatic hypotension, it is not specifically beneficial for an above-the-knee amputation recovery. It may not adequately address the need for proper stump support and elevation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
A. Insulin glargine is a long-acting insulin that provides a steady release of insulin without a pronounced peak. This characteristic helps reduce the risk of hypoglycemia compared to shorter-acting insulins, making it an important point to educate the client on.
B. It is important for individuals with diabetes to monitor their blood glucose levels before and after exercise, as physical activity can significantly affect glucose levels. This practice helps the client avoid hypoglycemia during and after exercise, especially if they are on insulin.
C. Clients should monitor their blood glucose levels more frequently than weekly, especially if they are on insulin. Daily monitoring is typically recommended, especially if there are changes in diet, activity level, or medications. Weekly checks may not provide adequate insight into glucose control.
D. Partially correct but not a primary focus for immediate discharge teaching. While monitoring for microalbuminuria is important for long-term kidney health, it is not typically a direct action related to daily management. This would be part of routine assessments rather than immediate discharge instructions.
E. Rotating injection sites is crucial to prevent lipodystrophy and ensure consistent absorption of insulin. Educating the client on proper injection techniques, including site rotation, is essential for effective insulin management.
Correct Answer is A
Explanation
This is the expected peak time for regular insulin. After administration, insulin will generally reach its maximum effectiveness in lowering blood glucose within this timeframe, making it crucial for the client to eat or take carbohydrates to prevent hypoglycemia.
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