Chapter 45: Amputations

30. A nurse clarifies that the precise term for the patient's amputation, which will be through the knee joint, is called _____.

ANS: disarticulation Disarticulation is the appropriate term for an amputation through the knee joint. DIF: Cognitive Level: Knowledge REF: p. 990 OBJ: 2 TOP: Disarticulation KEY: Nursing Process Step: Implementation

32. To reduce the possibility of hip contractures in a patient with an above-the-knee amputation, a nurse periodically places the patient in a(n) _____ position.

ANS: prone The prone position will cause the muscles of the thigh to stretch and prevent contracture. DIF: Cognitive Level: Application REF: p. 999 OBJ: 4 TOP: Nursing Care to Prevent Contractures KEY: Nursing Process Step: Implementation

31. An amputation of a gangrenous limb that is left open for 10 days before closure is classified as a(n) _____ amputation.

ANS: staged guillotine A staged or guillotine amputation is one in which the wound is left open until the area is free of infection or evidence of gangrene. DIF: Cognitive Level: Knowledge REF: p. 993 OBJ: 1 TOP: Staged Amputation KEY: Nursing Process Step: N/A

33. Preoperative exercises for a patient undergoing a lower-extremity amputation include _____ training.

ANS: upper body Upper body training will strengthen the arms to aid in movement after the loss of a lower extremity. DIF: Cognitive Level: Knowledge REF: p. 999 OBJ: 4 TOP: Upper Body Training KEY: Nursing Process Step: N/A

9. Why is a closed amputation usually performed? a. To create a weight-bearing residual limb b. To alleviate the effects of trauma c. To allow infection to heal and drain d. To treat a limb with gangrene

ANS: A A closed amputation is performed to create a weight-bearing limb. DIF: Cognitive Level: Comprehension REF: p. 992 OBJ: 3 TOP: Surgical Treatment KEY: Nursing Process Step: N/A

10. What controls the movement with a myoelectrically controlled prosthesis? a. Patient's muscle movement and the prosthesis b. Battery-operated muscles implanted in the prosthesis c. Motion-sensing mechanism that swings the prosthesis forward d. Internal computer chip in the prosthesis

ANS: A A patient's muscle movement and the prosthesis control movement with a myoelectrically controlled prosthesis. DIF: Cognitive Level: Knowledge REF: p. 993 OBJ: 3 TOP: Prostheses KEY: Nursing Process Step: Implementation

25. Which action should a nurse implement to diminish swelling of the residual limb in the postoperative period after an above-the-knee amputation? a. Elevate the foot of the bed on blocks. b. Elevate the residual limb on pillows. c. Elevate the head of the bed 15 degrees. d. Turn the patient on the affected side.

ANS: A Elevating the foot of the bed on blocks will help diminish edema and will not cause hip contracture deformity. DIF: Cognitive Level: Application REF: p. 999 OBJ: 4 TOP: Prevention of Postoperative Edema KEY: Nursing Process Step: Implementation

5. What routine preoperative diagnostic tests are appropriate for a patient anticipating a below-the-knee amputation? a. Pulse volume recording and white blood cell (WBC) count b. Cardiac catheterization and WBC count c. Pulse volume recording and radiographic images d. Thermography and cardiac catheterization

ANS: A Pulse volume recording and WBC count are two diagnostic tests for patients anticipating a below-the-knee amputation. DIF: Cognitive Level: Comprehension REF: p. 991 OBJ: 4 TOP: Diagnostic Tests and Procedures KEY: Nursing Process Step: Implementation

27. What is a closed amputation designed to do? (Select all that apply.) a. Prepare a weight-bearing limb. b. Cover the stump with tissue and muscle. c. Place sutures immediately over the bone. d. Be staged to closure. e. Be immediately ready for a prosthesis.

ANS: A, B Closed amputations are meant to prepare the limb for weight-bearing activities with tissue and muscle applied to the residual limb. Sutures are not placed over the bone for future comfort and better healing. Closed amputations are not staged because are open amputations, and they may or may not be prepared for an immediate prosthesis. DIF: Cognitive Level: Comprehension REF: p. 992 OBJ: 2 TOP: Closed Amputation KEY: Nursing Process Step: Implementation

28. What should a nurse consider when selecting possible nursing diagnoses for a 32-year-old patient who is in anticipatory grieving for an upcoming bilateral above-the-knee amputation? (Select all that apply.) a. Anxiety, related to knowledge deficit of procedure b. Disturbed body image, related to loss of body part c. Sexual dysfunction, related to perceived disfigurement d. Disturbed self-image, related to loss of independence e. Activity intolerance, related to bed rest

ANS: A, B, C, D All concerns mentioned except the bed rest would need to be addressed. DIF: Cognitive Level: Application REF: p. 997 OBJ: 5 TOP: Preoperative Nursing Diagnosis KEY: Nursing Process Step: Planning

26. Which major situational occurrences might lead to amputations? (Select all that apply.) a. Trauma b. Disease c. Tumors d. Congenital defects e. Carelessness

ANS: A, B, C, D The categories of occurrences that lead to amputation are trauma, disease, tumors, and congenital defects. Carelessness frequently leads to trauma. DIF: Cognitive Level: Knowledge REF: p. 990 OBJ: 1 TOP: Causes for Amputation KEY: Nursing Process Step: Implementation

29. How should a nurse modify a teaching plan for an older adult who has had an above-the-knee amputation? (Select all that apply.) a. Offer smaller units of information at a time. b. Increase time for learning. c. Place less emphasis on chronic health problems. d. Clarify the reality of phantom pain. e. Include frequent repetition.

ANS: A, B, D, E Older adults are quite capable of learning, but the amount of information offered at one time should be lessened, the time for learning should be increased, the probability of phantom pain should be clarified, and repetition should be frequently used. DIF: Cognitive Level: Application REF: p. 1000-1001 OBJ: 4 TOP: Teaching the Older Adult KEY: Nursing Process Step: Planning

1. A nurse is aware that a patient who is having his leg amputated is also having a prosthesis fitted during at the same time as the surgery. Which fact should the preoperative teaching plan include? a. Extra preoperative medications will be needed. b. A rigid dressing will be applied to accommodate the prosthesis. c. A series of temporary prostheses will be put in place before the permanent one. d. Wiring the residual limb will be needed to ensure acceptance of the prosthesis.

ANS: B A rigid dressing will be applied to the residual limb to accommodate the prosthesis immediately after surgery. DIF: Cognitive Level: Application REF: p. 993 OBJ: 3 TOP: Preoperative Teaching KEY: Nursing Process Step: Planning

21. What are late signs of hemorrhage in the postoperative period after an amputation? a. Restlessness and increased respirations b. Cyanosis and hypotension c. Confusion and seizures d. Headache and hypertension

ANS: B Cyanosis and hypotension are late signs of hemorrhage in the postoperative period after an amputation. DIF: Cognitive Level: Comprehension REF: p. 997 OBJ: 4 TOP: Complications KEY: Nursing Process Step: Assessment

14. What is the greatest danger in the early postoperative period after an amputation? a. Infection b. Hemorrhage c. Pain d. Edema

ANS: B Hemorrhage is the greatest danger in the early postoperative period after an amputation. DIF: Cognitive Level: Comprehension REF: p. 997 OBJ: 4 TOP: Complications KEY: Nursing Process Step: Assessment

19. What nursing action should be implemented in the postoperative care for a patient with replantation of the right thumb? a. Decreasing the temperature of the room to 70° F b. Elevating the hand but keeping it below the level of the heart c. Offering coffee, tea, or cola to help increase fluid intake d. Placing an antiembolus sleeve on the right arm

ANS: B Slight elevation of the hand will encourage drainage but not affect arterial perfusion. The room temperature should be 80° F. The patient should avoid all caffeine drinks and tight clothing or dressings. DIF: Cognitive Level: Application REF: p. 1002 OBJ: 4 TOP: Nursing Care of Replantation KEY: Nursing Process Step: Assessment

8. A patient with peripheral vascular disease (PVD) and diabetes asks what he can do to help prevent an amputation. What is the best response of the nurse? a. "There is not really anything you can do to help." b. "Stopping smoking would help prevent vasoconstriction." c. "You will not need to check your blood glucose levels." d. "It is important to eat big meals so your body can heal."

ANS: B Smoking causes vasoconstriction, which aggravates PVD. DIF: Cognitive Level: Comprehension REF: p. 992 OBJ: 3 TOP: Prevention of Disease KEY: Nursing Process Step: Implementation

11. A patient who had a below-the-knee amputation 24 hours earlier is complaining of burning pain in his left foot. Which intervention is most appropriate for the nurse to implement? a. Remind the patient that it is only phantom pain. b. Medicate the patient with the prescribed pain remedy. c. Remind him that such sensations will go away in a few weeks. d. Distract the patient with conversation.

ANS: B The nurse should medicate a patient for pain. Phantom pain is real. Although distraction is a possible intervention, it is not the most effective. DIF: Cognitive Level: Application REF: p. 999 OBJ: 4 TOP: Phantom Pain KEY: Nursing Process Step: Implementation

13. What is an appropriate outcome for a nursing diagnosis, "Anxiety, related to perceived threat of disability?" a. Comfort is increased; verbalized pain is less. b. Anxiety is relieved; the patient verbalizes concern related to disability. c. Grief is resolved; the patient expresses an acceptance of loss. d. Residual limb is cleaned; no exudate, redness, or edema is observed.

ANS: B The relief of anxiety speaks directly to the nursing diagnosis. Other options are possible outcome goals but do not pertain to this diagnosis. DIF: Cognitive Level: Application REF: p. 997 OBJ: 4 | 5 TOP: Nursing Care KEY: Nursing Process Step: Planning

24. A home health care nurse suspects a neuroma in a patient who had an above-the-knee amputation 1 month earlier. Which complaint by the patient led the nurse to suspect a neuroma? a. Area of swelling and bruising on distal portion of residual limb b. Prickling sensation over residual limb c. Sharp severe pain in the residual limb d. Area of numbness on distal portion of residual limb

ANS: C A neuroma causes sharp severe pain in the residual limb. A neuroma occurs when severed nerve endings attempt to regenerate. The neuroma requires excision by the surgeon. DIF: Cognitive Level: Comprehension REF: p. 996 OBJ: 4 TOP: Neuroma KEY: Nursing Process Step: Assessment

20. A nurse is caring for a patient with a recent below-the-knee amputation. What should the nurse recommend to this patient to prevent the loss of calcium and protein? a. Drink 1 to 2 L of fluid daily. b. Ingest at least four milk products each day. c. Ambulate 30 minutes a day. d. Take vitamin supplements daily.

ANS: C Even a small amount of ambulation will decrease the loss of calcium and protein. DIF: Cognitive Level: Application REF: p. 1000 OBJ: 4 TOP: Postoperative Ambulation KEY: Nursing Process Step: Implementation

15. A nurse is caring for a patient that has undergone replantation of a body part. What might the saliva of leeches be used to treat in this patient? a. Inadequate arterial blood flow b. Venous insufficiency c. Venous congestion d. Increased arterial blood flow

ANS: C Leeches are used to treat venous congestion. DIF: Cognitive Level: Comprehension REF: p. 1003 OBJ: 4 | 5 TOP: Replantation KEY: Nursing Process Step: N/A

4. An 80-year-old man with diabetes has had vascular problems with his feet and lower legs for 10 years and is scheduled for a left below-the-knee amputation. Which remark by the patient indicates an understanding of the procedure? a. "I am glad this amputation will end my diabetic problems." b. "After they have hacked my leg, I won't be able to drive." c. "If this heals well, how long until I get a prosthesis?" d. "I hate that my left knee is going to be useless without a foot."

ANS: C Only this option indicates that the patient realizes the extent of the surgery. DIF: Cognitive Level: Comprehension REF: p. 993 OBJ: 4 TOP: Amputation KEY: Nursing Process Step: Evaluation

12. During the admission of a patient scheduled for an amputation, a patient relates that she is a practicing Orthodox Jew. What arrangements are appropriate for the nurse to make for this patient? a. A veil should cover the amputated part. b. A rabbi must be present for the surgery. c. The amputated part should be buried. d. A family member should be present to read the Torah.

ANS: C Orthodox Jews bury all body parts. DIF: Cognitive Level: Application REF: p. 1000 OBJ: 4 TOP: Nursing Care for the Orthodox Jew KEY: Nursing Process Step: Implementation

22. The verbalization of microvascular precautions is a criterion for measuring the achievement of which outcome? a. Adequate circulation in the replanted limb b. Pain relief c. Patient knowledge of therapeutic measures d. Adjustment to change in appearance and function

ANS: C Verbalizing the information related to microvascular precautions is evidence of the patient's achievement of having acquired the necessary knowledge. DIF: Cognitive Level: Knowledge REF: p. 1002 OBJ: 5 TOP: Nursing Care Planning KEY: Nursing Process Step: Evaluation

3. A nurse is conducting a safety seminar and reminds the audience that upper extremity amputations are most frequently caused by trauma. Which population has the highest incidence of this type of amputation? a. School-aged girls b. School-aged boys c. Young men d. Young women

ANS: C Young men are at greater risk from work trauma because they are traditionally the ones working with farm and heavy machinery. DIF: Cognitive Level: Comprehension REF: p. 990 OBJ: 1 TOP: Incidence KEY: Nursing Process Step: Implementation

17. A patient who has a below-the-elbow prosthesis shows the home health care nurse the residual limb, which is red, edematous, and warm to the touch. What should the nurse instruct this patient to do? a. Apply soothing lotion to the residual limb before replacing the prosthesis. b. Dampen the prosthetic limb sock to hydrate and cool the residual limb. c. Pad the socket with lamb's wool and replace the prosthesis. d. Leave the prosthesis off and notify physician.

ANS: D An inflamed residual limb suggests an infection. The prosthesis should be removed, the limb should be gently cleansed with soap and water, and the physician should be notified. DIF: Cognitive Level: Application REF: p. 1000 OBJ: 5 TOP: Infection KEY: Nursing Process Step: Implementation

23. Which postoperative observation must be reported to the physician immediately? a. Brownish-red drainage on the dressing, which is damp b. Respirations of 20 breaths/min c. Pulse of 72 beats/min d. Bright-red bleeding

ANS: D Bright-red bleeding is not expected and indicates hemorrhage. Direct pressure should be applied over the dressing and the physician or charge nurse should be notified. DIF: Cognitive Level: Comprehension REF: p. 997 OBJ: 4 TOP: Complications KEY: Nursing Process Step: Assessment

6. Where is the limb severed with an elbow disarticulation? a. Just above the elbow joint b. Just below the elbow joint c. Between the shoulder and elbow d. Through the elbow joint

ANS: D Disarticulations sever the limbs through the joints. DIF: Cognitive Level: Knowledge REF: p. 990 OBJ: 2 TOP: Type of Amputation KEY: Nursing Process Step: Implementation

2. A patient asks when he should expect to be up and walking after his below-the-knee amputation. When should the nurse assure him that most people with amputations can fully bear weight? a. 3 weeks b. 1 month c. 6 weeks d. 3 months

ANS: D Most people with amputations can fully bear weight 3 months after surgery. DIF: Cognitive Level: Comprehension REF: p. 993 OBJ: 5 TOP: Amputation Recovery KEY: Nursing Process Step: Implementation

16. A patient who amputated his thumb in a lawnmower accident hands the emergency department nurse his thumb in a glass jar. What is the best action for the nurse to implement? a. Place the thumb in a baggie with iced lactated Ringer solution. b. Wrap the thumb in plastic wrap and place it on ice. c. Leave the thumb in the jar and place it in the refrigerator. d. Wrap the thumb in a cloth saturated with normal saline and place it in a baggie.

ANS: D The amputated part should be wrapped in a towel soaked with normal saline solution, placed in a baggie, and put in a cool bath. DIF: Cognitive Level: Application REF: p. 1001 OBJ: 4 TOP: Care of the Amputated Thumb KEY: Nursing Process Step: Implementation

7. What do thermographic findings of cool spots in a certain areas of the body indicate? a. Increased blood flow b. Decreased infection c. Increased infection d. Decreased blood flow

ANS: D The area is cool because blood flow is decreased. DIF: Cognitive Level: Comprehension REF: p. 992 OBJ: 3 TOP: Diagnostic Tests KEY: Nursing Process Step: Assessment

18. A child comes to the school nurse with his index finger partially amputated and hanging by a shred of skin and muscle. What is the best action by the nurse? a. Flush the hand with warm water and wrap it in a towel. b. Carefully cut the skin holding the finger and wrap the finger and hand in a clean towel. c. Pinch the finger to stop the bleeding and take the child to the hospital. d. Wrap the hand and finger securely and place it on an ice water-filled plastic bag.

ANS: D The nurse should leave the shred of skin and muscle intact, wrap the hand and finger in a towel soaked in normal saline, and place it on a cool surface. DIF: Cognitive Level: Application REF: p. 1001 OBJ: 4 TOP: Partial Amputation KEY: Nursing Process Step: Implementation