the nurse is planning care for a post operative client after a total hip arthroplasty what is the priority nursing intervention

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. The nurse is planning care for a post-operative client after a total hip arthroplasty. What is the priority nursing intervention?

A. Observe client for changes in mental status
B. Use aseptic technique for wound care and emptying of drains
C. Keep the client's heels off the bed
D. Perform neurovascular assessments per protocol

Correct answer: D

Rationale:

2. What is correct about a nursing diagnosis?

A. It is a human response to disease, injury, or other stressors.
B. It remains constant as long as the disease is present.
C. It is a way to identify pathology.
D. It is a disease, illness, or injury.

Correct answer: A

Rationale: A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems or life processes. Choice A is correct because it identifies nursing diagnosis as related to human responses to health conditions or life processes. Choice B is incorrect because nursing diagnoses can change as the patient's condition changes. Choice C is incorrect because a nursing diagnosis is about responses, not just identifying pathology. Choice D is incorrect because a nursing diagnosis is not the same as a disease, illness, or injury; it is a statement about the patient's response to these conditions.

3. To promote independence, which of these is the best intervention to implement?

A. Perform the client’s activities of daily living for them.
B. Speak directly in front of the client so they can read your lips well.
C. Give the client their washcloth and toothbrush and leave the room.
D. Allow the client to perform the activities of daily living they are able to do.

Correct answer: D

Rationale: The correct answer is to allow the client to perform the activities of daily living they are able to do. This intervention promotes independence by encouraging clients to maintain their functional abilities. Choice A is incorrect as performing the client's activities of daily living for them does not empower independence. Choice B is irrelevant to promoting independence. Choice C is not actively promoting independence as it involves leaving the client alone without any guidance or support.