309 Q4 update
What instructions should the nurse provide when the client is allowed out of bed after an above the knee amputation?
Keep the hip in extension and alignment.
A client is in skin traction while awaiting surgery for repair of a fractured femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurse's BEST INITIAL response?
"I can't because the weights are needed to keep the bone aligned."
A patient who underwent a right above-the-knee amputation 4 days ago also has a diagnosis of depression. Which order would you clarify with the health care provider? A. Give fluoxetine 40 mg once a day B. Administer acetaminophen with codeine 1 to 2 tablets every 4 hours PRN C. Assist the patient to the bedside chair every shift D. Reinforce the dressing to the right residual limb as needed
A. Give fluoxetine 40 mg once a day
A patient with a right above the knee amputation asks you why he has phantom limb pain. What is your best response? A. Phantom limb pain is not explained or predicted by any one theory B. Phantom limb pain occurs because your body thinks your leg is still present C. Phantom limb pain will not interfere with your activities of daily living D. Phantom limb pain is not real pain but is remembered pain
A. Phantom limb pain is not explained or predicted by any one theory
Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess for which important characteristics of the pedal pulses?
Amplitude and symmetry.
48. Which patients with fractures have factors that put them at risk for developing venous thromboembolism ? Select all that apply A. Has type 2 diabetes mellitus B. Had hip surgery that took several hours. C. Is obeses and smokes 2 packs per day D. Take oral contraceptive E. Takes steroid medications F. Was bedridden prior to sustaining fracture
B. Had hip surgery that took several hours. C. Is obeses and smokes 2 packs per day D. Take oral contraceptive F. Was bedridden prior to sustaining fracture
The charge nurse is assigning the nursing care of a patient who had a left below the knee amputation 1 day ago to an experienced LPN, who will function under your supervision. What will you tell the LPN is the major focus for the patient's care today? A. To attain pain control over phantom pain B. To monitor for signs of sufficient tissue perfusion C. To assist the patient to ambulate as soon as possible D. To elevate the residual dumb when the patient is supine
B. To monitor for signs of sufficient tissue perfusion
When should the nurse begin the process of rehabilitation when a client is scheduled for an amputation?
Before the surgery.
52. An older patient is discharged to home following an orthopedic injury. Which mobilization device is usually preferred for older patients who need additional support for balance? a. Crutches b. Cane c. Walker d. Wheelchair
C. Walker
A nurse provides discharge teaching for a client who had a total hip replacement. Which activities to avoid identified by the client indicate an understanding of the teach?
Crossing the legs. Sitting in a low chair.
During morning care, a patient twit below-the-knee amputation asks the UAP about prostheses. How will you instruct the UAP to respond? A. You should get a prosthesis so that you can walk again B. Wait and ask your doctor that question the next time he comes in C. It's too soon to be worrying about getting a prosthesis D. I'll ask the nurse to come in and discuss this with you
D. I'll ask the nurse to come in and discuss this with you
A client had an above the knee amputation of the left leg because of trauma from a motor vehicle collision. The health care provider orders ambulation with crutches until the residual limb is healed and the client can be fitted with a prosthesis. What should be the nurse's FIRST intervention?
Determine if the client has ever used crutches before.
A nurse is caring for a client in the evening after the client has had a below the knee amputation. What action should be implemented by the nurse?
Elevate the foot of the bed.
A nurse is caring for a client who had a total hip replacement. What nursing action should be incorporated into the plan of care to prevent thrombus formation?
Encouraging the client to perform ankle exercises.
A nurse is caring for a client who had a total hip replacement. What is the priority assessment when monitoring the client for hemorrhage?
Examining the bedding under the client
What should be included in the nurse's instructions to help a client prepare for walking with crutches?
Exercises with or without weights to strengthen the muscles of the upper extremities.
A nurse receives a change of shift report for a client who had a total hip replacement 24 hours ago. After reviewing the client's clinical record and completing a physical assessment, which complication should the nurse conclude that the client is experiencing?
Fat embolism
On the first postoperative day after a total hip replacement, a client asks for assistance onto the bedpan. What should the nurse instruct the client to do?
Flex the knee on the unoperated leg and pull on the trapeze to lift the pelvis.
The care plan for a client with a fractured hip includes nursing actions to prevent which type of contracture?
Flexion of the hip.
Which crutch gait should the nurse teach the client wearing a prosthesis after a single leg amputation?
Four point.
A client has a total knee replacement, and a continuous passive motion device is being used. The nurse concludes that the teaching was effective when the client states, "The goal of this therapy to--"
Improve joint flexion."
A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity?
Internal rotation with extension of the knee and hip.
A client has an amputation of a lower limb. What instructions should the nurse give the client to prevent a hip flexion contracture?
Lie on the abdomen 30 minutes four times daily.
A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse understands that aseptic necrosis is associated with which factor?
Loss of blood supply to the head of the femur.
After an above the knee amputation of a leg, a client reports pain in the foot that is no longer there. What should the nurse include about phantom limb pain in a discussion with the client?
Nerve endings in the limb are still intact and react to stimuli.
A client has surgery to repair a fractured right hip. Where should the nurse stand when assisting the client to ambulate?
On the client's left side.
Which position should a nurse avoid placing a client who had surgery for a total hip replacement?
Orthopneic
A nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. On which part of the body should the nurse instruct the client to place weight?
Palms of the hands
Which is an example of the principles of body mechanics that the nurse uses when caring for immobilized clients?
Placing the feet apart to increase the stability of the body.
A nurse is caring for a client with a below the knee amputation. What should the nurse encourage the client to do to prepare the residual limb for a prosthesis?
Press the end of the residual limb against a pillow periodically.
A nurse is caring for a client with a fracture of the head of the femur. The health care provider places the client in a buck extension. What explanation does the nurse give the client for why the traction is being used?
Reduces muscle spasms.
A client with a fractured hip is placed in traction until surgery can be performed. What should the nurse explain is the purpose of the traction?
Relieve muscle spasm and pain.
What should the nurse do to control edema of the residual limb 1 week after a client has an above the knee amputation?
Rewrap the elastic bandage as necessary.
Which clinical indicator should the nurse expect to identify when assessing a client with a fracture of the neck of the femur?
Shortening of the affected extremity with external rotation.
After an open reduction and internal fixation of a fractured hip. What assessments of the client's affected leg should the nurse make?
Skin temperature. Sensation in the toes. Presence of pedal pulse.
A nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. The client has an order for ambulation with slight weight bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. What assistive devise does the nurse expect the health care provider to order for this client?
Standard walker
When a client is in the right side lying position after the insertion of a left hip prosthesis, the nurse ensures that the client has a pillow placed between the thighs and that the entire length of the upper leg is supported. What does this pillow prevent?
Strain on the operative site.
A client experiences a traumatic amputation of a leg in a motor vehicle accident. What nursing intervention initially should receive the lowest pirority?
Teaching residual limb care.
Which principle should the nurse consider when assisting a client with crutches to learn the four point gait?
The client must be able to bear weight on both legs.
A client is ready to walk with crutches after knee surgery. Which crutch walking technique will the nurse most likely have to reinforce after the client returns from physical therapy?
Three-point
A nurse is caring for a client who has had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery?
Toes for mobility.
What should the nurse do to promote early and efficient ambulation after a client has a midthigh amputation?
Turn the client to the prone position routinely.
A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postoperative thrombus formation has been ineffective?
Unilateral chest pain. Sudden onset of shortness of breath.
A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?
Use a pillow to keep the legs abducted.
To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is ordered. How does the nurse increase the countertraction?
Use a slight Trendelenburg position.
53. The nurse is interviewing an older adult with a history of osteoporosis who reports falling and catching her weight on her outstretched dominant hand. This patient is most likely to have sustained what type of fracture? a. Carpal scaphoid bone b. Phalanges fracture c. Humeral fracture d. Colles' wrist fracture
d. Colles' wrist fracture
A client with a fractured hip is helped from the bed to a chair after surgery. The nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. What should the nurse explain is the benefit of bearing most of the weight on the unaffected?
Will help maintain the strength of the unaffected limb
22. The patient has returned from the postanesthesia care unit (PACU) after TJR. Which interventions will the nurse use to prevent venous thromboembolism? (Select all that apply.) a. Apply sequential compression devices (SCDs) b. Administer subcutaneous enoxaparin (Lovenox) as ordered. c. Keep the patient on bedrest for the first and second days postoperatively. d. Teach the patient to perform leg exercises such flexion and dorsiflexion. e. Instruct the patient to have blood drawn for INR every month
a. Apply sequential compression devices (SCDs) b. Administer subcutaneous enoxaparin (Lovenox) as ordered. d. Teach the patient to perform leg exercises such flexion and dorsiflexion.
73. A patient who has sustained a traumatic amputation of the left leg expresses concern about working and taking care of his family after his injury. What resources does the nurse recommend to help the patient adjust to his lost limb? (Select all that apply.) a. Chaplain b. Medical social worker c. Physical therapist d. Physician e. National Amputation Foundation
a. Chaplain b. Medical social worker e. National Amputation Foundation
35. Which interventions does the nurse implement to improve mobility for a patient who has undergone a THR? (Select all that apply.) a. Encourage use of assistive devices such as a walker when ambulating. b. Recommended to quickly decrease rest periods between activities. c. Instruct to flex the hips 90 degrees or greater. d. Instruct to sit on a soft chair with a raised back. e. Instruct in the use of a raised toilet seat.
a. Encourage use of assistive devices such as a walker when ambulating. e. Instruct in the use of a raised toilet seat.
25. A patient is receiving low-molecular-weight heparin (LMWH) therapy to prevent postoperative deep vein thrombosis (DVT). Which routine assessments are most important for this patient during anticoagulation therapy? (Select all that apply.) a. Ensure that antiembolic stockings or sequential compression devices are in use. b. Monitor complete blood count (CBC) and platelet counts. c. Monitor activated partial thromboplastin time (aPTT) levels. d. Check stools for occult blood. e. Monitor the surgical site for bleeding.
a. Ensure that antiembolic stockings or sequential compression devices are in use. b. Monitor complete blood count (CBC) and platelet counts. d. Check stools for occult blood. e. Monitor the surgical site for bleeding.
45. Which nursing intervention is best to prevent increased pain in a patient experiencing phantom limb pain? a. Handle the residual limb carefully when assessing the site or changing the dressing. b. Advise the patient that the sensation is temporary and will diminish over time. c. Remind the patient that the part is not really there, so the pain is not real. d. Encourage the patient to mourn the loss of the body part and express grief.
a. Handle the residual limb carefully when assessing the site or changing the dressing.
20. The nurse is preparing an educational program for student nurses on the orthopedic unit. Which three signs of hip dislocation would be included in this offering? (Select all that apply.) a. Increased pain b. Hip flexing of 45 degrees c. Shortening of affected leg d. Leg ratation e. Skin breakdown near the incision
a. Increased pain c. Shortening of affected leg d. Leg ratation
18. Which are contraindications for TJA? (Select all that apply.) a. Infection b. Severe pain c. Advanced osteoporosis d. Severe inflammation e. Open wound
a. Infection c. Advanced osteoporosis d. Severe inflammation
55. An older adult patient has skin traction in place for a hip fracture. What is the main purpose of this type of traction? a. It decreases painful muscle spasms. b. It helps heal the fracture. c. It prevents extension of the fracture. d. It prevents compression syndrome.
a. It decreases painful muscle spasms.
30. For patients who have TJA, the risk of DVT is high. Which statements are true? (Select all that apply.) a. Older adults are at high risk for DVT and compromised circulation. b. Thinner patients are more at risk than obese patients c. Patients with a history of DVT are at high risk for recurrence. d. Leg exercises must be started in the immediate postoperative period. e. Use of an abduction splint will decrease the risk of DVT.
a. Older adults are at high risk for DVT and compromised circulation. c. Patients with a history of DVT are at high risk for recurrence. d. Leg exercises must be started in the immediate postoperative period.
28. Adlea is a refined capsaicin product. What is the advantage of infusing this drug directly into the surgical joint during knee surgery? a. Patients experience less acute postoperative pain. b. Capsaicin shuts down C fiber receptors. c. It depletes calcium stores in nerve cells and blocks pain transmission. d. It works as a local anesthetic, numbing nerves in the operative region.
a. Patients experience less acute postoperative pain.
17. For preoperative care of a patient scheduled for TJA, what does the nurse plan to do? (Select all that apply.) a. Provide written or videotaped information about the procedure. b. Assess the patient's understanding of the procedure. c. Assess and include the patient's support people or family. d. Include interdisciplinary providers, if possible. e. Assist in scheduling needed dental procedures after the surgery.
a. Provide written or videotaped information about the procedure. b. Assess the patient's understanding of the procedure. c. Assess and include the patient's support people or family. d. Include interdisciplinary providers, if possible.
21. Which interventions can the nurse use to prevent or manage infections in patients who have undergone total joint replacement (TJR)? (Select all that apply.) a. Use aseptic technique for wound care and emptying of drains. b. Wash hands thoroughly when caring for patients. c. Culture drainage fluid if a change is observed. d. Encourage early ambulation along with leg exercises. e. Report excessive inflammation or drainage to the provider.
a. Use aseptic technique for wound care and emptying of drains. b. Wash hands thoroughly when caring for patients. c. Culture drainage fluid if a change is observed. e. Report excessive inflammation or drainage to the provider.
19. The nurse is preparing an educational session for a patient who is scheduled to undergo hip replacement. Which potential complications does the nurse make the patient aware of? (Select all that apply.) a. Venous thromboembolism b. Hip dislocation c. Overgrowth of bone d. Neurovascular compromise e. Infection
a. Venous thromboembolism b. Hip dislocation d. Neurovascular compromise e. Infection
24. A patient is reluctant to consider hip surgery because of a fear of blood transfusion reaction. What is the nurse's best response? a. "No one will force you to receive blood if you don't want it." b. "You could donate your own blood for several weeks before the surgery." c. "Why do you think you are going to have a blood transfusion reaction?" d. "Blood products are very safe these days and there are numerous safety protocols."
b. "You could donate your own blood for several weeks before the surgery."
29. Postoperative total hip replacement (THR) patients can develop numerous complications. Which interventions are most important in preventing complications? (Select all that apply.) a. Bedrest with pillow between legs b. Adequate diet and fluid intake c. Getting out of bed on the first postoperative day d. Sitting on the side of the bed e. Frequent assessment of the patient's pain
b. Adequate diet and fluid intake c. Getting out of bed on the first postoperative day e. Frequent assessment of the patient's pain
43. The nurse's neighbor comes running over because her husband "cut his finger off with a power saw." After calling for help, what is the first priority action when the nurse gets to the neighbor's house? a. Examine the amputation site. b. Assess for airway or breathing problems. c. Elevate the hand above the heart. d. Assess the severed finger.
b. Assess for airway or breathing problems.
37. Al though arthritis is not curable, many "cures" are marketed to patients with the disease. What does the nurse encourage the patient to do? a. Take advantage of clinical trials or experimental therapy. b. Check with the Arthritis Foundation for appropriate modalities. c. Buy special liniments and creams d. Take herbal and vitamins.
b. Check with the Arthritis Foundation for appropriate modalities.
33. Postoperative care for total knee replacement (TKR) may include which techniques? (Select all that apply.) a. Hot compresses to the incisional area b. Continuous passive motion (CPM) used immediately or several days postoperatively c. Ice packs or cold packs to the incisional area d. The use of a CPM machine in the daytime and an immobilizer at night e. Maintaining abduction
b. Continuous passive motion (CPM) used immediately or several days postoperatively c. Ice packs or cold packs to the incisional area d. The use of a CPM machine in the daytime and an immobilizer at night
47. The patient is a middle-aged man with a history of uncontrolled diabetes. His right foot is a dark brownish-purple color and there is no palpable dorsalis pedis or posterior tibial pulse. The nurse prepares the patient for which diagnostic test? a. X-ray of the foot and ankle b. Doppler ultrasound c. Electromyelogram d. Arthrogram
b. Doppler ultrasound
27. How does a continuous peripheral nerve blockage (CPNB) device work? a. Infuses intravenous opioids. b. Infuses a local anesthetic into the surgical site. c. Circulates cold liquids within a wrap around the incision site. d. Stimulates vibration-sensitive receptors in the incision area to "close the gate" on pain.
b. Infuses a local anesthetic into the surgical site.
34. Postoperative care following finger and wrist replacements includes which techniques? (Select all that apply.) a. Traction b. Joint wrapped in a bulky dressing c. Splint, brace, or cast d. Abduction pillow e. Elevation of the arm to prevent edema f. CPM machine
b. Joint wrapped in a bulky dressing c. Splint, brace, or cast e. Elevation of the arm to prevent edema f. CPM machine
50. The nurse is caring for a patient with an abovethe-knee amputation (AKA). In order to prevent hip flexion contractures, how does the nurse position the patient? a. Supine position with the residual limb elevated on a pillow b. Prone position every 3 to 4 hours for 20- to 30-minute periods c. Supine position with an abduction pillow placed between the legs d. Head of the bed elevated 30 degrees with assurance that the bandage is wrapped around the limb
b. Prone position every 3 to 4 hours for 20- to 30-minute periods
42. According to the patient's chart, there is a family history of osteoporosis. In order to plan interventions related to this finding, what action does the nurse take? a. Ask the patient's age and assess for weight loss. b. Review the patient's dietary intake of calcium. c. Assess the patient for kyphoscoliosis or other deformities. d. Assess the patient for occult fractures of the long bones.
b. Review the patient's dietary intake of calcium.
23. Which preoperative tests are performed for a patient shceduled to undergo a total hip arthroplasty (THA)? (Select all that apply.) a. X-ray of nonoperative hip b. X-ray of operative hip c. Computed tomography (CT) of operative hip d. Biopsy of operative hip e. Magnetic resonance imaging (MRI) of operative hip
b. X-ray of operative hip c. Computed tomography (CT) of operative hip e. Magnetic resonance imaging (MRI) of operative hip
46. A young patient had a great toe amputated because of severe injury. The patient is depressed and withdrawn after the physician tells him that the amputation will affect balance and gait. What is the nurse's best response? a. "The physical therapy department can help you with exercises for balance and gait." b. "Let me get your parents and we can talk about rehabilitation programs." c. "When the doctor was explaining things to you, what were you thinking about?" d. "How have you usually handled stressful situations in the past?"
c. "When the doctor was explaining things to you, what were you thinking about?"
56. The nurse is caring for a patient who had hemiarthroplasty and is at risk for hip dislocation. The nurse ensures that the hip is maintained in which position? a. Adduction b. Anatomically Neutral c. Abduction d. Extended
c. Abduction
26. The nurse is poroviding care for a patient scheduled for a THA. Which medications should the patient receive before surgery? a. Enoxaparin by subcutaneous injection b. Bisacodyl (Dulcolax) tablet orally c. Antihypertensive tablet orally d. Aspirin 2 tablets for headache orally
c. Antihypertensive tablet orally
16. When educating a patient about total joint arthroplasty (TJA), what does the nurse do first? a. Asks whether the patient has insurance b. Reviews instructions and asks the patient to repeat them back c. Assesses the patient's knowledge about TJA d. Asks if the provider has explained the procedure
c. Assesses the patient's knowledge about TJA
32. It is important to monitor which laboratory test for patients on anticoagulant therapy with LMWH after TJA? (Select all that apply.) a. Prothrombin time and INR b. Oxygen saturation c. CBC d. Activated partial thromboplastin time e. Platelet count
c. CBC e. Platelet count
57. A patient reports dramatic changes in color and temperature of the skin over the left foot with intense burning pain, sensitive skin, excessive sweating, and edema. The physician makes a preliminary medical diagnosis of complex regional pain syndrome. What is the priority for nursing care? a. Patient education b. Care of the skin to prevent skin breakdown c. Management of pain d. Assessment of circulation
c. Management of pain
54. Which factor carries the greatest risk for hip fracture? a. Decreased visual acuity b. Joint stiffness c. Osteoporosis d. Cardiac drug regimen
c. Osteoporosis
44. An excited group of teenagers brings a friend to the ED who severed a finger while playing sports. The bleeding from the site is wellcontrolled and the patient is alert and stable. What does the nurse do with the severed finger? a. Place it directly into a bag of ice and then put the bag into a refrigerator. b. Wrap it in moist sterile gauze and ensure that it stays with the patient. c. Wrap it in dry gauze, place it in a waterproof bag, and put the bag in ice water. d. Carefully clean it with sterile saline, and then place it in a sterile container.
c. Wrap it in dry gauze, place it in a waterproof bag, and put the bag in ice water.
49. A patient injured a lower extremity and has been placed in a running traction. What instructions does the nurse give to the UAP? a. Support the weights when turning the patient every 2 hours. b. Apply countertraction before moving the patient. c. Defer hygienic care and moving the patient until traction is removed. d. Moving the patient or the bed during care can alter the countertraction.
d. Moving the patient or the bed during care can alter the countertraction.
31. To prevent a DVT, several types of anticoagulant medications can be ordered. Which is the most commonly used drug during hospitalization? a. Oral or parenteral aspirin b. Warfarin c. Intravenous tPA d. Subcutaneous LMWH
d. Subcutaneous LMWH
51. The nurse applies bandages to a patient's residual limb in order to help shape and shrink the limb for a prosthesis. What is the proper technique for the nurse to use? a. Reapply the bandages every 8 hours or more often if they become loose. b. Use a proximal-to-distal direction when wrapping. c. Use soft, flexible bandage material and pad the area with gauze. d. Use a figure-eight wrapping method to prevent restriction of blood flow.
d. Use a figure-eight wrapping method to prevent restriction of blood flow.
