Which of the following activities should be avoided by a patient scheduled for a total ankle replacement surg… - RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

Medical & Surgical Nursing

Easy

Appeared in: RRB Nsg. Superintendent - 29 April 2025 (Shift-3rd)

Explanation

The primary instruction after a total ankle replacement (TAR) is to avoid bearing weight on the operated leg for a prescribed period, often several weeks.
This non-weight-bearing (NWB) period is crucial for osseointegration, the process where the bone grows into the implant, ensuring its stability and long-term success.
Premature weight bearing can cause the implant to shift, loosen, or fail, and can also compromise the healing of the surgical incision and surrounding soft tissues.

Option B: While avoiding heavy lifting is a general post-operative guideline to prevent overall strain, it is not the most critical or specific restriction for ensuring the success of an ankle implant.
Option C: The ankle is a hinge joint, primarily moving in flexion and extension. Abduction is not a primary movement of the ankle joint itself, so specific exercises or restrictions related to it are not standard post-operative instructions for TAR.
Option D: Sleeping on the back is not an activity to be avoided. In fact, it is often encouraged because it facilitates elevating the leg on pillows, which is a key intervention to reduce swelling and pain after surgery.

Visual 1: Diagram - Showing the components of a total ankle replacement implant and how it fits into the tibia and talus. This helps visualize why bone ingrowth (osseointegration) is necessary.
Visual 2: Infographic - Illustrating correct and incorrect post-operative positions for TAR, contrasting a patient correctly using a knee scooter or crutches (non-weight bearing) with an incorrect image of a patient standing on the operated foot.
Visual 3: Chart - A comparative chart showing the primary post-operative precautions for total ankle, total hip, and total knee replacements to highlight the differences.

Clinical Relevance

Nursing practice connection: Use the key finding related to Post-operative care and restrictions following total ankle replacement surgery to guide bedside assessment, documentation, and the next nursing action.
Patient education is a critical nursing responsibility. The nurse must ensure the patient and their family understand the rationale behind non-weight bearing to promote compliance and prevent complications like implant failure.
Nurses must assess the patient's ability to use assistive devices (crutches, walker, knee scooter) safely before discharge to ensure they can remain non-weight bearing at home.
What if? If the patient was undergoing a total HIP replacement instead, the most critical activity to avoid would be adduction (crossing the legs) and flexing the hip more than 90 degrees, as this could cause the new hip joint to dislocate.

How to Approach the Question

First, identify the core subject of the question: post-operative care for a 'total ankle replacement'.
Next, analyze the question's directive, which is to identify an activity that should be 'avoided'.
Recall the key principles of post-operative care for major joint surgeries, especially those involving lower extremities. The primary goal is to protect the new implant and allow for healing.
Evaluate each option: 'Bearing weight' directly stresses the ankle joint. 'Lifting heavy objects' is a general restriction. 'Abduction exercise' is not a primary ankle movement. 'Sleeping on the back' is generally safe and often recommended.
Compare the specificity and criticality of the options. The most direct and significant risk to an ankle implant is premature weight bearing. Therefore, avoiding this activity is the most important instruction.

Concept Tested & Keywords

Concept Tested: Post-operative care and restrictions following total ankle replacement surgery.
Stem keywords: total ankle replacement surgery, avoided
Lead-in keywords: Which

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