Mr. Singer has been placed on a regimen of bed rest and is scheduled for a hip replacement because of severe rheumatoid arthritis. Which of the following would be most important to include in the nursing care plan preoperatively?

Correct Answer: B

Rationale: The most important aspect to include in the nursing care plan preoperatively for Mr. Singer, who is scheduled for a hip replacement due to severe rheumatoid arthritis, is option B: Active and passive range-of-motion exercises. Engaging in these exercises before surgery can help maintain joint mobility, prevent stiffness, and improve overall postoperative outcomes. Option A: Adequate periods of rest may be important for recovery but focusing solely on rest without addressing joint mobility can lead to decreased range of motion and increased risk of complications post-surgery. Option C: Maintenance of adequate fluid and food is important for overall health but may not have a direct impact on the success of the hip replacement surgery. Option D: Frequent turning and repositioning is crucial for preventing pressure ulcers in immobile patients but does not address the specific need for joint mobility preoperatively in this case. Educational context: Preoperative nursing care plans are tailored to each patient's specific needs to optimize outcomes. In cases like Mr. Singer's, focusing on maintaining joint mobility through range-of-motion exercises is crucial for successful postoperative rehabilitation and recovery.

Correct Answer: B

Rationale: In this scenario, option B, which is palpating the muscles and joints, is the correct method to help a nurse identify swelling in a client who has experienced a musculoskeletal injury to her hip. Palpation involves using touch to feel for abnormalities such as swelling, tenderness, or warmth in the affected area. Swelling is often palpable due to the increase in fluid accumulation in the tissues surrounding the injury site. Option A, asking questions about pain severity, may provide information on the client's subjective experience but may not directly identify swelling. Option C, asking the client to move the injured area, could potentially exacerbate the injury or cause further damage if there is swelling present. Option D, observing for involuntary movements, is more relevant for assessing neurological issues rather than identifying swelling. In an educational context, it is crucial for nurses to understand the proper techniques for assessing musculoskeletal injuries to provide accurate care and treatment. Palpation is a fundamental skill that allows healthcare providers to gather important information about the client's condition, including identifying swelling, tenderness, or other abnormalities. By mastering palpation techniques, nurses can enhance their assessment skills and provide better care for clients with musculoskeletal injuries.

Correct Answer: A

Rationale: The correct answer is A) Withholding aspirin before the surgery. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet function and can prolong bleeding time. By withholding aspirin before surgery, the risk of excessive bleeding during and after the orthopedic procedure is reduced. Option B) Withholding antacids before the surgery is not directly related to reducing the risk of excessive bleeding. Antacids primarily work on reducing stomach acid and do not significantly impact bleeding risks in orthopedic surgeries. Option C) Encouraging the intake of red meat before the surgery is not recommended as it does not have a direct impact on bleeding risk. Red meat consumption is not a factor in reducing bleeding complications in orthopedic surgeries. Option D) Avoiding excess fluid intake before the surgery is also not directly related to reducing the risk of excessive bleeding. Maintaining adequate hydration is important for overall health but does not specifically address the issue of bleeding risk during orthopedic procedures. In an educational context, it is crucial for healthcare providers to understand the effects of different medications and dietary factors on surgical outcomes. By selecting the appropriate preoperative interventions, such as withholding aspirin in this case, healthcare professionals can optimize patient safety and surgical outcomes. This question highlights the importance of medication management in the perioperative period to minimize potential complications during surgery.

Correct Answer: C

Rationale: In the context of a client with lupus erythematosus, the correct instruction before performing range of motion (ROM) exercises would be to use moist heat (Option C). The rationale behind this is that moist heat helps to increase blood flow, relax muscles, and reduce joint stiffness, making it an ideal preparatory measure for ROM exercises in this population. Prescribed analgesics (Option A) may help manage pain but do not directly facilitate the effectiveness of ROM exercises. Cold packs (Option B) are more commonly used for acute injuries or inflammation, which may not be the case in clients with lupus. Braces or splints (Option D) are typically used for joint support or stabilization and are not directly related to preparing for ROM exercises. Educationally, it is important for nurses to understand the specific needs of clients with lupus when recommending pre-exercise strategies. Providing rationale and evidence-based instructions ensures that clients receive the most appropriate care tailored to their condition, ultimately promoting better outcomes and adherence to therapeutic interventions.

Correct Answer: D

Rationale: In this scenario, delegating the task of assisting the patient with ambulation to the nursing assistant is the most appropriate intervention. The rationale for choosing option D is based on the principle of task delegation according to the nursing scope of practice. Assisting a patient with ambulation involves direct physical support and monitoring for safety, which aligns with the responsibilities and capabilities of a nursing assistant. This task allows the nursing assistant to provide hands-on support to the patient while also freeing up the nurse to focus on other aspects of care. Options A and B involve more complex assessments and decision-making processes that require a higher level of training and expertise, typically performed by licensed healthcare professionals such as nurses or physical therapists. Identifying environmental factors and monitoring gait, balance, and fatigue level require critical thinking skills and specialized knowledge that exceed the scope of practice for a nursing assistant. Option C involves collaborating with physical therapy to provide the patient with a walker, which is also beyond the nursing assistant's role. Physical therapy interventions and equipment prescription are within the domain of physical therapists who have the expertise to assess the patient's needs and recommend appropriate assistive devices. In an educational context, understanding the appropriate delegation of tasks is crucial for providing safe and effective patient care. Nurses must assess the patient's condition, determine the appropriate interventions, and delegate tasks to other healthcare team members based on their scope of practice and level of training. This question highlights the importance of recognizing the roles and responsibilities of different healthcare team members in promoting patient safety and optimal outcomes.