When assessing a patient for readiness for discharge post-hip arthroplasty, which criterion is most critical?
Ability to ambulate up and down stairs safely.
Independently managing pain without medication.
Wound site is completely healed.
Understands the need for a follow-up in six months.
The Correct Answer is A
Choice A rationale
Safety during mobility is the most critical factor for discharge after a major orthopedic procedure like a hip arthroplasty. The ability to navigate stairs safely demonstrates sufficient muscle strength, balance, and adherence to weight-bearing restrictions. This functional independence is vital to prevent falls and hip dislocations in the home environment. Without this skill, the patient is at high risk for readmission and serious injury, making it the priority assessment before leaving the facility.
Choice B rationale
While pain management is important, expecting a patient to be completely independent of all pain medication shortly after a total hip replacement is unrealistic. Most patients will require a combination of around-the-clock non-opioids and as-needed medications to maintain comfort and facilitate physical therapy. The goal is controlled pain that allows for movement, not the total absence of medication. Therefore, this is not a mandatory or realistic criterion for immediate discharge.
Choice C rationale
Complete healing of a surgical wound takes weeks or months as the tissue goes through the proliferative and remodeling phases. At the time of discharge, which is often a few days post-surgery, the incision should be clean, dry, and intact with no signs of infection like purulent drainage or excessive redness. Expecting a completely healed wound site before discharge is not standard practice and would unnecessarily prolong the hospital stay beyond what is medically required.
Choice D rationale
Understanding the need for follow-up care is an important part of the discharge teaching plan, but it is not as critical as the patient's immediate physical safety and mobility. While knowing to see the surgeon in six months is helpful for long-term monitoring of the prosthetic joint, it does not address the immediate postoperative risks the patient faces in the first few days at home. Physical stability and safety always take precedence over long-term scheduling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Maintaining a urine output of 30 to 50 mL per hour is the gold standard indicator that fluid resuscitation is effectively restoring organ perfusion. This volume suggests that the kidneys are receiving enough blood to maintain a normal glomerular filtration rate. In burn patients, adequate urine production confirms that the intravascular volume has been sufficiently replaced to overcome the massive fluid shifts and capillary leak syndrome that occur immediately following a significant thermal injury.
Choice B rationale
A heart rate greater than 120 beats per minute is usually an indicator of ongoing stress, pain, or hypovolemia rather than successful resuscitation. Tachycardia suggests that the heart is still working excessively hard to maintain cardiac output in the face of low blood volume. A successful resuscitation should ideally lead to a stabilization of the heart rate towards a more normal range, typically below 110 beats per minute, as the intravascular volume is restored and sympathetic drive decreases.
Choice C rationale
While some weight gain is expected during the acute phase of burn care due to the administration of large volumes of crystalloid fluids and subsequent edema, an increase of 5 percent is not a specific indicator of successful resuscitation. Excessive weight gain can actually signal fluid overload or third-spacing rather than effective intravascular volume replacement. The goal of resuscitation is to support vital organ function with the least amount of fluid necessary, avoiding complications like pulmonary edema.
Choice D rationale
Decreased peripheral pulses are a concerning sign that may indicate inadequate systemic perfusion or localized compartment syndrome due to circumferential burns and excessive edema. Successful fluid resuscitation should result in the maintenance or improvement of peripheral pulses, indicating that blood is reaching the distal extremities. If pulses are weakening, it suggests that the circulatory status is deteriorating or that fluid is accumulating in the interstitial spaces so severely that it is compressing the arterial flow.
Correct Answer is D
Explanation
Choice A rationale
Using an absorbent pad is a secondary measure that helps keep the bed linens clean but does not address the primary issue of skin protection. If the patient sits on a soiled pad, the moisture and fecal enzymes remain in direct contact with the skin, leading to maceration and chemical irritation. Relying solely on pads without frequent cleansing increases the risk of Incontinence-Associated Dermatitis, which can quickly progress to painful skin breakdown and secondary bacterial infections.
Choice B rationale
Increasing protein intake is beneficial for wound healing and maintaining skin integrity in the long term, but it is not an immediate intervention to prevent skin complications from fecal incontinence. While protein supports the structural strength of the dermis, it does not protect the epidermis from the external caustic effects of stool. Immediate nursing care must focus on external protection and hygiene to mitigate the chemical damage caused by feces, rather than focusing purely on systemic nutrition.
Choice C rationale
Standard lotions are often insufficient for protecting skin exposed to fecal incontinence because they lack the necessary barrier properties to repel moisture and caustic substances. Many lotions contain fragrances or alcohols that can further irritate compromised skin. While they may provide some hydration, they do not create the occlusive layer needed to block the destructive enzymes found in feces. A specialized moisture barrier is required to provide an effective shield against the harsh environment of incontinence.
Choice D rationale
Implementing frequent perineal care and applying a moisture barrier cream is the most effective intervention. Feces contains proteases and lipases that break down the skin barrier, leading to rapid irritation. Immediate removal of stool followed by the application of a barrier cream, typically containing zinc oxide or petrolatum, creates a physical shield. This prevents moisture from penetrating the skin and protects the acid mantle, significantly reducing the risk of maceration and subsequent development of pressure injuries.
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