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Question

Difficulty: MediumBasic Care and Comfort

During the first postoperative day after a right total hip arthroplasty (posterior approach), a client requires assistance with repositioning and morning hygiene. Which action by the practical nurse (PN) is most appropriate to promote safety and comfort?

  1. A
    Elevate the head of the bed to 90 degrees while the client consumes their morning meal.
  2. B
    Massage the client's bilateral calves to relieve postoperative muscle aching.
  3. Maintain an abduction wedge between the client's legs when turning them onto their left side.Answer
  4. D
    Direct the unlicensed assistive personnel (UAP) to perform the client's scheduled neurovascular checks.

Answer

Maintain an abduction wedge between the client's legs when turning them onto their left side.
Following a total hip arthroplasty with a posterior approach, the client is at high risk for hip dislocation. Keeping the legs abducted using a wedge, especially when turning the client onto the unaffected side, prevents the operative leg from crossing the midline (adduction) and maintains proper joint alignment.

Step-by-Step Solution

1
Identify the surgical procedure and the associated physiological risks.
The client had a right total hip arthroplasty via a posterior approach, which carries a high risk of hip dislocation if the joint is flexed greater than 90 degrees or adducted.
Understanding specific postoperative mobility constraints is essential for providing safe basic care.
2
Evaluate each potential nursing intervention for safety and appropriateness.
Elevating the bed to 90 degrees causes dangerous flexion; massaging calves risks causing a pulmonary embolism; and delegating assessments is outside the UAP's scope of practice.
Actions that compromise safety, ABCs, or legal scope of practice must be eliminated.
3
Select the action that safely promotes comfort and mobility within the prescribed limits.
Using an abduction wedge while turning the client onto the unaffected side maintains proper joint alignment and prevents dislocation.
This action directly satisfies the requirement for safe positioning and comfort care.

Key Concept

Postoperative positioning and mobility precautions for total hip arthroplasty
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Topics

Basic Care and Comfort

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