Author Question: A client, with a BMI of 35, is recovering from total hip replacement surgery and is experiencing ... (Read 116 times)

rayancarla1 · **on:** Jun 25, 2018

A client, with a BMI of 35, is recovering from total hip replacement surgery and is experiencing pain exacerbated with movement and states to the nurse, I live alone. How will I ever be able to return to my home?

Based on this data, which is the priority nursing diagnosis for this client?
A) Imbalanced Nutrition: More than Body Requirements
B) Acute Pain
C) Impaired Physical Mobility
D) Ineffective Coping

Question 2

The family of a client with cirrhosis of the liver asks what symptoms they need to look for while the client is being cared for in their home.

Which manifestation should the nurse teach the family that indicates that the client is experiencing portal hypertension?
A) Muscle wasting
B) Hypothermia
C) Bleeding gums
D) Hemorrhoids

verrinzo · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Answer: B

The priority nursing diagnosis is Acute Pain. Unless the pain is controlled, the client will not be able to participate in interventions to address the nursing diagnosis of Impaired Physical Mobility. The diagnoses of Ineffective Coping and Imbalanced Nutrition can be addressed after Acute Pain and Impaired Physical Mobility have been addressed.

Answer to Question 2

Answer: D

Obstruction to portal blood flow causes a rise in portal venous pressure, resulting in splenomegaly, ascites, and dilation of collateral venous channels predominately in the paraumbilical and hemorrhoidal veins and the cardia of the stomach, and extending into the esophagus. Bleeding gums indicate insufficient vitamin K production in the liver. Muscle wasting is commonly associated with the poor nutritional intake seen in clients with cirrhosis. Hypothermia is an unrelated finding.