The nurse is assessing a diabetic client for pain following right total knee replacement surgery

CE Connection

doi: 10.1097/01.NME.0000720284.10689.b2

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GENERAL PURPOSE: To gain knowledge about conditions that lead to the need for a TKR, complications associated with this procedure, and the appropriate preoperative and postoperative care for patients undergoing TKR surgery. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Describe the anatomy and physiology of the knee and conditions associated with the need for a TKR. 2. Summarize appropriate nursing care for patients who undergo TKR surgery, including identification of potential complications and preoperative and postoperative care.

1. Which type of joint is the knee?
1. cartilaginous
2. fibrous
3. synovial
2. Which part of the knee joint is enclosed in the tendon of the quadriceps femoris?
1. fibula
2. patella
3. tibia
3. Which component of the knee is lined with a synovial membrane that secretes fluid, providing lubrication and preventing friction with movement?
1. joint capsule
2. ligaments
3. menisci
4. The most common cause of chronic knee pain is
1. arthritis.
2. overuse syndrome.
3. sports injury.
5. Patients with OA typically have joint pain and stiffness that
1. decrease with activity and increase with rest.
2. increase with activity and decrease with rest.
3. remain constant during both activity and rest.
6. When evaluating the knee pain of patients with RA, the assessment findings may include
1. redness and swelling.
2. unilateral joint pain and stiffness.
3. pain during activity and no pain with rest.
7. Which best describes the goal of a TKR?
1. reduce joint inflammation
2. prevent cartilage deterioration
3. restore function and reduce pain
8. Indications for a TKR include
1. acute knee inflammation and swelling.
2. moderate pain and stiffness with activity.
3. moderate-to-severe pain when at rest.
9. When a TKR is completed, which parts of the knee joint are replaced?
1. the entire patella
2. the lower end of the tibia and top of the femur
3. the top of the tibia and lower end of the femur
10. Which is an important step in the preoperative care of the patient undergoing a TKR?
1. preoperative allogenic blood transfusion
2. preoperative education
3. preoperative mobility exercises
11. Which best describes the action that should be taken if bleeding is observed on the surgical dressing of a patient who has undergone a TKR?
1. change the dressing immediately
2. circle the area with a pen, then date and time it
3. reinforce the dressing with sterile gauze
12. While changing the dressing of a patient who has undergone a TKR, redness, edema, and warmth are observed, which indicate
1. infection.
2. normal healing.
3. wound dehiscence.
13. Which lab finding may suggest bleeding in patients who have undergone a TKR?
1. increased platelet count
2. increased white blood cell count
3. decreased hemoglobin and hematocrit
14. When checking the neurovascular status of a patient who has undergone a TKR, the mnemonic CMST can be used, with the “C” standing for
1. color.
2. coolness.
3. complications.
15. When the patient who has undergone a TKR is resting in bed, the nurse should encourage him or her to keep the operative leg
1. bent, with a pillow placed directly under the knee.
2. straight, with a pillow placed directly under the knee.
3. straight, with a pillow placed under the leg, but not directly under the knee.
16. Which is a complication associated with TKR?
1. blood clots
2. hypoglycemia
3. pulmonary edema
17. To help prevent infection in the patient undergoing a TKR, which I.V. antibiotic regimen is typically used?
1. start within 1 hour of surgery; discontinue 24 hours after surgery
2. start within 2 hours of surgery; discontinue 48 hours after surgery
3. start within 4 hours of surgery; discontinue 12 hours after surgery
18. Which patient is most at risk for a prosthetic joint infection following TKR?
1. Patient A who has OA
2. Patient B who needed a blood transfusion
3. Patient C who starts physical therapy shortly after surgery
19. If a patient who has undergone a TKR has an indwelling urinary catheter, it should be removed within
1. 2 days.
2. 3 days.
3. 4 days.
20. Along with increasing the risk of infection, prolonged wound drainage following TKR can
1. cause hyperglycemia.
2. delay wound healing.
3. increase the need for oxygen therapy.