Which factor most increases the risk for complications in a patient undergoing total knee arthroplasty?
Use of herbal supplements.
Age under 40.
Vegetarian diet.
History of heart disease.
The Correct Answer is D
Choice A rationale
The use of herbal supplements can pose risks, such as increased bleeding if the patient takes ginkgo or garlic, or interactions with anesthesia. However, these are generally manageable through preoperative screening and temporary cessation of the supplements. While important, they do not represent the same level of systemic risk for major postoperative complications, such as myocardial infarction or heart failure, as a documented history of established cardiovascular disease does in the elderly population.
Choice B rationale
Being under age 40 is actually a protective factor rather than a risk factor for complications. Younger patients typically have better physiological reserves, faster healing rates, and fewer comorbidities compared to older adults. Most complications in total knee arthroplasty are associated with advanced age, which often brings decreased bone density and impaired cardiovascular function. Therefore, youth generally correlates with better outcomes and a lower likelihood of experiencing systemic complications during or after the surgical procedure.
Choice C rationale
A vegetarian diet is not a significant risk factor for surgical complications, provided the patient maintains adequate protein and iron intake for wound healing. While extreme nutritional deficiencies can impair recovery, most vegetarians meet their nutritional needs through varied food sources. Protein is essential for collagen synthesis, but a meat-free diet does not inherently predispose a patient to poor surgical outcomes unless it is poorly managed and results in severe anemia or protein-energy malnutrition.
Choice D rationale
A history of heart disease is a major risk factor for complications during and after total knee arthroplasty. The stress of surgery and anesthesia can strain the cardiovascular system, leading to arrhythmias, myocardial ischemia, or heart failure. Furthermore, heart disease often necessitates the use of anticoagulants, which complicates intraoperative bleeding management and postoperative DVT prophylaxis. Patients with cardiac issues have a reduced ability to compensate for the hemodynamic shifts that occur during major orthopedic operations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
On the Braden Scale, a total score of 10 to 12 represents a high risk for the development of pressure injuries. This scale assesses six subscales including sensory perception, moisture, activity, mobility, nutrition, and friction/shear. A lower score indicates a higher risk. At this level, aggressive preventive interventions are required immediately, such as frequent repositioning every two hours, using pressure-redistributing surfaces, and optimizing nutritional intake to protect the integrity of the skin and underlying tissues.
Choice B rationale
A Braden Scale score ranging from 15 to 18 is categorized as a mild risk for pressure injury development. While this score still necessitates some preventive measures, such as turning schedules and moisture management, it does not represent the high-risk category that requires the most intensive level of intervention. The nurse should still monitor the patient closely, but the urgency is lower than for a patient scoring in the 10 to 12 range or below.
Choice C rationale
Scores between 19 and 23 on the Braden Scale indicate that the patient is at a very low risk or is generally not at risk for developing pressure injuries. Patients in this range typically have good mobility, adequate nutrition, and intact sensory perception. While routine skin care and assessment remain part of standard nursing practice, specialized pressure-relief protocols are generally not indicated for this group unless their clinical status changes significantly or their mobility becomes suddenly impaired.
Choice D rationale
A score of 24 to 30 is not possible on the standard Braden Scale, as the maximum score is 23. The scale evaluates six categories with most having a maximum of 4 points and one having a maximum of 3 points. Therefore, any score above 23 is mathematically impossible. When using this assessment tool, nurses must be familiar with the correct scoring range to accurately identify patient risk and implement the appropriate evidence-based interventions for skin protection.
Correct Answer is D
Explanation
Choice A rationale
Wound dressing effectiveness is evaluated by observing the characteristics of the drainage, the condition of the wound bed, and the presence of granulation tissue or infection. While skin integrity is related, the Braden Scale is a predictive tool used before breakdown occurs. It does not provide a specific framework for measuring the healing progress of an existing wound or the performance of a particular dressing type in maintaining a moist environment.
Choice B rationale
Nutrition is one of the six subscales of the Braden Scale, rated from very poor to excellent based on intake. However, evaluating nutrition is only a component of the tool, not its primary purpose. The scale assesses how nutritional deficits contribute to the overall vulnerability of the skin. A comprehensive nutritional assessment would involve biochemical markers like prealbumin, which should normally be 15 to 36 mg per dL, rather than just a risk score.
Choice C rationale
Calculating fluid replacement is a hemodynamic intervention based on output, clinical signs of dehydration, or specific burn formulas. The Braden Scale focuses on moisture, sensory perception, activity, mobility, nutrition, and friction or shear. While adequate hydration is necessary for skin turgor and health, this specific scale is not designed to determine the milliliters of intravenous or oral fluids required to maintain a patient's circulating volume or electrolyte balance.
Choice D rationale
The primary purpose of the Braden Scale is to assess a patient's risk for developing pressure injuries. By scoring six specific categories, nurses can identify patients with a high degree of vulnerability and implement preventive interventions like frequent repositioning or pressure-redistribution surfaces. A lower total score indicates a higher risk for skin breakdown. This evidence-based tool allows for standardized communication among the healthcare team to protect the patient's integumentary system integrity.
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