Total Hip Replacement (27 Questions)

1. Mme. Caroline Roy, 69 years old, is postoperative day 1 following a right total hip replacement using a posterior approach for osteoarthritis.

Her medical orders include:
*weight bearing as tolerated
*hip precautions
*physiotherapy referral, and analgesia PRN

While assisting her to sit in a chair, the nurse notices that Mme. Roy bends forward to reach her slippers, flexing her hip beyond 90 degrees. She denies pain and says she feels stable. Vital signs are stable, and the surgical dressing is dry and intact.

Question:
What is the priority nursing intervention? *
2. Mr. Jean-Paul Tremblay, 73 years old, is postoperative day 0 following a left total hip replacement.

Orders include:
*abduction pillow while in bed
*neurovascular checks q4h
*VS q4h

During the night shift, the nurse finds the abduction pillow removed because the patient states it is uncomfortable. His legs are crossed at the ankles. He denies pain, and vital signs are stable.

Question:
What is the most appropriate nursing action? *
3. Mme. Lise Fournier, 66 years old, is postoperative day 2 following a right total hip replacement.

Orders include:
*neurovascular assessment q4h and early mobilization.

During assessment, the nurse notes that the operative leg is cool to touch, with decreased pedal pulses and increased pain compared to earlier. The patient reports numbness in her toes. Vital signs show HR 108 and BP 138/84.

Question:
What is the priority nursing action? *
4. Mr. Alain Bouchard, 71 years old, is postoperative day 1 following a left total hip replacement. He is eager to become independent. Orders include assist with transfers and physiotherapy consultation. When preparing to stand, he attempts to twist his torso and pivot on the operated leg. The nurse is assisting him with a walker. Pain is 4/10 and controlled.

Question:
What instruction should the nurse reinforce? *
6. Mr. Philippe Martel, 68 years old, is postoperative day 4 following a right total hip replacement. While turning in bed without assistance, he suddenly experiences severe hip pain. The nurse notices that his right leg appears shortened and externally rotated. He is unable to move the leg and appears distressed.

Question:
What is the priority nursing action? *
7. Mme. Julie Moreau, 62 years old, is postoperative day 1 after a total hip replacement. Orders include scheduled acetaminophen, opioids PRN, and physiotherapy twice daily. She refuses to participate in physiotherapy, stating pain is 7/10. Vital signs are stable, and she last received acetaminophen 6 hours ago.

Question:
What is the most appropriate nursing action? *
8. Mr. Luc Pelletier, 70 years old, is postoperative day 5 following a total hip replacement. The nurse notes increasing redness and warmth around the incision, with mild drainage. The patient reports chills and increasing pain at the surgical site. Vital signs show temperature 38.3°C.

Question:
What is the priority nursing action? *
9. Mme. Denise Lavoie, 74 years old, is postoperative day 2 after a right total hip replacement. While seated, the nurse notices she is sitting in a low chair with her knees higher than her hips. She states she is comfortable and denies pain.

Question:
What is the most appropriate nursing intervention? *
10. Mr. André Côté, 65 years old, is preparing for discharge 6 days after a total hip replacement. He will return home alone. Orders include home physiotherapy, hip precautions, and follow-up appointment. He asks what movement he should avoid most at home.

Question:
Which instruction is most important to reinforce? *
11. Mme. Claire Beaulieu, 72 years old, is postoperative day 2 following a right total hip replacement using a posterior approach. Medical orders include hip precautions, abduction pillow while in bed, and physiotherapy daily. During a routine room check, the nurse notices that Mme. Beaulieu’s legs are crossed at the knees while she is resting in bed. She denies pain and states she feels comfortable. The incision dressing is clean and dry.

Question:
What is the nurse’s initial intervention? *
12. Mr. Daniel Fortin, 68 years old, is postoperative day 3 following a left total hip replacement. He asks the nurse how he should sleep once he returns to bed at night. Orders include hip precautions and use of pillows for positioning. He is alert, pain is controlled, and vital signs are stable.

Question:
What is the most appropriate recommendation? *
13. Mme. Louise Morin, 75 years old, is postoperative day 4 following a right total hip replacement. While turning in bed without assistance, she suddenly reports severe hip pain. The nurse observes that her right leg appears shortened and externally rotated. She is unable to move the leg and appears anxious. Vital signs show HR 110 and BP 150/86.

Question:
What does the nurse suspect is occurring? *
14. Mr. Patrick Gervais, 70 years old, is postoperative day 1 following a total hip replacement. During breakfast, the nurse prepares to assist him with eating. He is seated in bed and wants to lean forward to reach his tray. Hip precautions are in place.

Question:
How should the nurse initially position the patient during meals? *
15. Mme. Sylvie Côté, 74 years old, is postoperative day 2 after a right total hip replacement. She chooses to sit in a low armchair because she finds it comfortable. The nurse notices that her hips are flexed deeply, with her knees higher than her hips.

Question:
What is the priority nursing action? *
16. Mr. René Lapointe, 69 years old, is postoperative day 1 following a left total hip replacement. He asks how he should turn while lying in bed. Orders include hip precautions and assist with repositioning.

Question:
What instruction should the nurse provide? *
17. Mme. Monique Paquette, 71 years old, is postoperative day 1 after a right total hip replacement. She attempts to get out of bed quickly without assistance, swinging both legs over the side at once.

Question:
What is the most appropriate nursing intervention? *
18. Mr. Éric Dumas, 67 years old, is postoperative day 3 following a left total hip replacement. While sitting in a chair, the nurse notices he has crossed his ankles. He states he is comfortable and unaware of any restrictions.

Question:
What should the nurse do first? *
19. Mme. Hélène Bergeron, 76 years old, is postoperative day 1 after a total hip replacement. She requests a bedpan. The nurse notes that hip precautions are ordered.

Question:
What is the most appropriate nursing action? *
20. Mr. Lucien Roy, 65 years old, is preparing for discharge after a total hip replacement. He verbalizes understanding of most instructions but asks which movement is the most important to avoid during the first weeks at home.

Question:
Which instruction should the nurse emphasize? *
21. Mr. Alexandre Pelletier, 72 years old, is postoperative day 1 following a right total hip replacement using a posterior approach. Medical orders include weight bearing as tolerated, assist with ambulation using a walker, hip precautions, and physiotherapy referral. His pain is controlled at 3/10 after receiving prescribed analgesia. Vital signs are stable, and he is motivated to walk to the bathroom with nursing assistance.
As the nurse prepares to ambulate Mr. Pelletier for the first time, he appears slightly unsteady when standing and places most of his weight on the walker. The nurse must choose the safest position to provide support and prevent a fall.

Question:
Where should the nurse position themself during ambulation? *
22. Mme. Véronique Simard, 74 years old, is postoperative day 1 following a left total hip replacement (posterior approach). Medical orders include weight bearing as tolerated, hip precautions, and assist with transfers using a gait belt. Her pain is well controlled after analgesia, and vital signs are stable. The nurse prepares to assist her from the bed to a chair for the first time. Mme. Simard appears slightly weak on her operative side but is cooperative and follows instructions.

Question:
Where should the nurse position themself during the bed-to-chair transfer? *
23. Mr. Stéphane Gauthier, 69 years old, is postoperative day 4 following a right total hip replacement. Physiotherapy has progressed him from a walker to a cane for short distances. Medical orders include assist with ambulation as needed and reinforce safe use of assistive devices. The nurse observes Mr. Gauthier preparing to walk independently and notices he is unsure which hand should hold the cane.

Question:
What instruction should the nurse provide? *
24. Mme. Isabelle Cormier, 76 years old, is postoperative day 2 following a right total hip replacement. While ambulating in the hallway with a walker and gait belt, she suddenly becomes dizzy and begins to lose balance. The nurse is positioned slightly behind her on the operative side. Mme. Cormier’s knees begin to buckle.

Question:
What is the nurse’s priority action? *
25. Mme. Danielle Picard, 78 years old, is postoperative day 2 following a left total hip replacement. Her medical orders include elastic compression stockings, early ambulation, and anticoagulant therapy. During morning care, she asks the nurse why she must continue wearing the elastic stockings, stating that they feel tight and uncomfortable. She remains mostly in bed except for short walks with physiotherapy. Vital signs are stable, and there are no signs of active bleeding.

Question:
What is the primary purpose of elastic stockings for this patient? *
26. Mr. François Leblanc, 71 years old, is postoperative day 1 following a right total hip replacement. His medical orders include enoxaparin (Lovenox) 40 mg SC daily, compression stockings, and early mobilization. He asks the nurse why he is receiving Lovenox instead of “a stronger blood thinner.” His renal function is normal, and there is no history of bleeding disorders.

Question:
What is an advantage of Lovenox for this patient compared with other anticoagulants? *
27. Mme. Johanne Tremblay, 75 years old, is postoperative day 3 following a total hip replacement. She is receiving enoxaparin 40 mg SC daily for thromboprophylaxis. Her medical history includes mild anemia. During assessment, she reports increased fatigue. The nurse notes mild bruising at previous injection sites.

Question:
What should the nurse prioritize monitoring in this patient? *