a nurse is caring for a client who is postoperative following a hip replacement which of the following interventions should the nurse implement to pre
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Nursing Elites

ATI LPN

ATI Comprehensive Predictor PN

1. A client is postoperative following a hip replacement. Which of the following interventions should the nurse implement to prevent dislocation of the prosthesis?

Correct answer: C

Rationale: Placing a pillow between the client's legs is beneficial after hip replacement surgery to maintain proper alignment and prevent dislocation of the prosthesis. This position helps keep the hip in a neutral position, reducing the risk of dislocation. Encouraging the client to bend at the waist (Choice A) can increase the risk of hip dislocation. Maintaining the client in a high-Fowler's position (Choice B) and avoiding placing a pillow under the client's knees (Choice D) do not directly address the need to maintain proper alignment of the hip joint to prevent dislocation.

2. A client needs a 24-hour urine collection initiated. Which of the following client statements indicates an understanding of the procedure?

Correct answer: C

Rationale: Choice C is correct because it demonstrates the client's understanding of the procedure, which involves discarding the first urine of the day at the specified time and then saving all subsequent urine for the next 24 hours. Choices A, B, and D do not reflect an understanding of the correct procedure. Choice A is incorrect because bowel movements are not part of a 24-hour urine collection. Choice B is incorrect as it does not specify discarding the first urine. Choice D is incorrect as it mentions filling up the bottle quickly, which is not the correct way to collect a 24-hour urine sample.

3. Which of the following is a key consideration when caring for a client with heart failure on fluid restriction?

Correct answer: B

Rationale: When caring for a client with heart failure on fluid restriction, weighing the client daily is crucial to monitor fluid balance accurately. This helps healthcare providers assess if the client is retaining excess fluids, which can worsen heart failure. Encouraging the client to drink more fluids (choice A) contradicts the goal of fluid restriction. Limiting intake of fruits and vegetables (choice C) is not a specific guideline for managing fluid restriction in heart failure. Monitoring fluid intake only during meals (choice D) is insufficient as fluid balance needs to be monitored consistently throughout the day.

4. A client with moderate anxiety disorder is being taught stress management techniques by a nurse. Which response by the client indicates an understanding of the teaching?

Correct answer: B

Rationale: The correct answer is B because imagining oneself in a calm place is a relaxation technique that helps reduce anxiety. Walking, meditating every other week, or cutting back on caffeine intake may have their benefits, but they are not as directly related to the immediate management of anxiety as the visualization technique described in option B.

5. A patient is being educated about a clear liquid diet. Which of the following should the nurse instruct the patient to avoid?

Correct answer: D

Rationale: The correct answer is D: Orange sherbet. A clear liquid diet consists of liquids that are transparent and easily digestible. Orange sherbet, being a frozen dessert, is not a clear liquid and should be avoided. Choices A, B, and C are all acceptable in a clear liquid diet. Lemon-lime sports drinks, ginger ale, and black coffee are clear liquids that can be included in the diet as they are transparent and leave little residue in the gastrointestinal tract, unlike orange sherbet.

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