Which of the following is inappropriate advice by a nurse caring for a patient with total hip replacement?

BTSC Staff Nurse 1 August-2025

Medical Surgical Nursing

Easy

Appeared in: BTSC Staff Nurse 1 August-2025

Explanation

Advising a patient to keep their legs adducted (together) after a total hip replacement is incorrect and dangerous.
Adduction, along with internal rotation and flexion greater than 90 degrees, is a primary mechanism for prosthetic hip dislocation, especially following a posterior surgical approach.
The standard and safe practice is to maintain the operative leg in a position of abduction (apart) to ensure the femoral head remains securely in the acetabular cup.
An abduction pillow or wedge is commonly used to prevent the patient from inadvertently adducting or crossing their legs, particularly while in bed.

Option A: This is appropriate advice. A sudden inability to move the operated extremity is a critical sign of potential complications.
Option B: This is appropriate advice. Avoiding crossing the legs is a key hip precaution to prevent dislocation.
Option C: This is appropriate advice. Isometric exercises are beneficial for muscle strengthening without stressing the new joint.

Clinical Relevance

Nursing practice connection: Use the key finding related to Post-operative nursing care and precautions for a total hip replacement (THR) to guide bedside assessment, documentation, and the next nursing action.
Patient education on hip precautions is a critical nursing responsibility to prevent dislocation, a painful and costly complication that requires further medical intervention.
Nurses must not only teach these precautions but also consistently enforce them through correct patient positioning, use of assistive devices like abduction pillows, and assistance with mobility.
What if the patient had an anterior approach for their hip replacement? While all patients should be careful, the risk of posterior dislocation is much lower with an anterior approach. Therefore, the surgeon might allow for less restrictive precautions, such as not requiring an abduction pillow, though avoiding extreme positions is still wise.

How to Approach the Question

First, identify the negative framing of the question ('inappropriate advice'). This means you are looking for the one option that is incorrect, unsafe, or not recommended.
Next, recall the standard post-operative precautions for a total hip replacement. The main goal is to prevent dislocation.
Think about the key movements to avoid: Adduction (crossing the midline), internal rotation, and flexion beyond 90 degrees.
Evaluate each option against these principles: A) Reporting inability to move is a safety measure. B) Avoiding crossing legs prevents adduction. C) Gluteal isometrics strengthen muscles. D) Keeping legs adducted causes the movement you are trying to prevent.
The option that directly contradicts a core safety principle is the inappropriate advice. In this case, advising adduction is the incorrect action.

Concept Tested & Keywords

Concept Tested: Post-operative nursing care and precautions for a total hip replacement (THR)
Stem keywords: total hip replacement, inappropriate advice, nurse caring
Lead-in keywords: inappropriate
Negative lead-in flag: The question asks for an INAPPROPRIATE action, meaning three options are correct and one is incorrect.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 135-137