Question help

Posted

Hey there. I came across this nclex type question and its confused me. Of course it's from a book with no answer key. I believe the answer would be 2 do to the knee gatch. However answer 1 seems like it might be the answer to prevent DVTs but I keep thinking it was only arthroplasty not a replacement. And he is ambulatory since he's at the office. Any help would be appreciated. Thanks in advance.

During a visit to the medical office a nurse collects data from a client who had a knee arthroplasty 1 week ago. Which of the following statements made by the client should concern the nurse most?

1. "I am so glad to off those blood thinners."

2. "I will keep a pillow under my knee when I am in bed."

3. "I am planing to use my wheelchair to help me get around."

4. "I plan to take Motrin instead of the prescribed Lortab for pain control."

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,674 Posts

Arthroplasty = replacement. What is the standard for post op care of a total knee patient?

nortonplusRN

Has 8 years experience. 62 Posts

Try to eliminate some answers first. Eliminate 3. Now which one is most concerning?

Out of the 3 left, which one can cause death?

Edited by nortonplusRN

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,674 Posts

Try to eliminate some answers first. Eliminate 3. Now which one is most concerning?

Out of the 3 left, which one can cause death?

Why would you eliminate answer 3?

purplegen1

42 Posts

Not taking the blood thinners could cause death do to a formation of a clot that could travel to the lung. But the knee gatch with the pillow can cut off circulation. And not taking the prescribed pain med is not life threating.

nortonplusRN

Has 8 years experience. 62 Posts

Not taking the blood thinners could cause death do to a formation of a clot that could travel to the lung. But the knee gatch with the pillow can cut off circulation. And not taking the prescribed pain med is not life threating.

There you go. That is the most concerning. NCLEX is an strategy test exam. By the way, Motrin is NSAIDS which can cause bleeding. [emoji106][emoji106]

Why would you eliminate answer 3?

Its less important than the pt developing clot which can turn to PE then death.

Edited by nortonplusRN

purplegen1

42 Posts

Thank you so much :yes: have been out of school for seven months and I feel like I have lost common sense and the ability to assess.

Edited by purplegen1
Misspelling

nortonplusRN

Has 8 years experience. 62 Posts

Thank you so much :yes: have been out of school for seven months and I feel like I have lost common sense and the ability to assess.

Your welcome. Good luck with your NCLEX.

For further reading, pls read this article.

Medscape: Medscape Access

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,674 Posts

1. "I am so glad to off those blood thinners."

Was the patient on anticoagulation preop? If not, the anticoagulation is only short term. There are other methods of DVT prevention other than medication. Those are often the better option as anticoagulation medications are not risk free.

2. "I will keep a pillow under my knee when I am in bed."

You mentioned concern due to the knee gatch. Unless the patient has a hospital bed at home, there is no knee gatch to be concerned about. A pillow under the knee is acceptable.

3. "I am planing to use my wheelchair to help me get around."

Is the patient wheelchair bound? The goal is to get these patients up and walking the day of or the day after surgery. That mobilization will help with DVT prevention, decrease risk of pneumonia, and decrease risk of other complications of immobility.

4. "I plan to take Motrin instead of the prescribed Lortab for pain control."

What is the patient's pain level? A week out from surgery, it is quite possible that the pain is quite manageable with OTC medications.

Thus, I would say the answer is 3. The whole goal of knee replacement is to increase mobility. A wheelchair contradicts the goal.

Edited by Rose_Queen
Auto cucumber strikes again!

RainMom

Specializes in PACU, pre/postoperative, ortho. Has 11 years experience. 1,102 Posts

Its less important than the pt developing clot which can turn to PE then death.

The significance of using a WC instead of ambulating (a week after surgery!) is that it also contributes to developing blood clots. Answers 1,2,3 & 4 all have to do with coagulation.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,674 Posts

Its less important than the pt developing clot which can turn to PE then death.

Except there are other methods of preventing DVT and PE than anticoagulation medications that are not risk free.

nortonplusRN

Has 8 years experience. 62 Posts

OP pls read the article i posted from medscape. This supports my answer. The NCLEX question asked for the most concerning statement. The pt stopped taking anticoagulant after only one week.

"Total Knee Arthroplasty. The duration of anticoagulation needed to prevent DVT after hospital discharge is an important aspect of care. Current guidelines recommend extending prophylaxis for 10 days after knee arthroplasty and for four to six weeks after hip arthroplasty and hip fracture surgery" from that article.

Edited by nortonplusRN