Module 5 Practice Questions (MS Surgeries)

A nurse is caring for a client who is post op following knee arthroplasty and has a CPM machine.

Apply ice to the operative knee

A nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? (SATA) A. Skin reddened over the joint B. Pain when bearing weight C. Joint crepitus D. Swelling of the affected joint E. Limited joint motion

B C D E (skin that is reddened can indicate infection is not an expected finding)

A 91-year-old client is slated for orthopedic surgery and the nurse is integrated gerontologic considerations into the client's plan of care. What intervention is most justified in the care of this client? A. Total parenteral nutrition (TPN) B. Administration of prophylactic antibiotics C. Use of a pressure-relieving mattress D. Use of a Foley catheter until discharge

C Older adults have a heightened risk of skin breakdown; use of a pressure-reducing mattress addresses this risk. Older adults do not necessarily need TPN and the Foley catheter should be discontinued as soon as possible to prevent urinary tract infections. Prophylactic antibiotics are not a standard infection prevention measure.

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury? A. Hypertension B. Constipation C. Infection D. Hematuria

D The pelvis is very vascular and close to major organs. Injury to the pelvis can cause integral damage that may manifest as blood in the urine (hematuria) or stool. The nurse should also assess for signs of hemorrhage and hypovolemic shock, which include hypotension and tachycardia. Constipation and infection are not complications of a pelvic fracture.

A nurse is caring for a pt 8 hr post op following a total knee replacement

Encourage increased fluid intake

A nurse on a medical-surgical unit is caring for four clients who are 24-36 hr post op

High arthroplasty

A nurse is reviewing the prescriptions for a client who had a total hip arthroplasty.

Instructed the client to restrict flexion of the hip past 120

A nurse is planning care for a pt who is post op following a total hip arthroplasty

Prevent hip flexion of the affected extremity

A nurse is caring a pt following a right total hip arthroplasty.

Abduction

Mr. Johnston took his diuretic this morning, which may cause hypokalemia.

For Although it is not a nursing task to make the decision for or against the addition of potassium to the patient's medication orders, it is important to understand the rationales involved in order to watch for the presence of unwanted reactions.

A nurse is planning care for a client who is postoperative following an arthroscopy of the knee. Which of the following actions should the nurse take? (SATA) A. Assess the color and temperature of the extremity B. Apply warm compress to incision sites C. Place pillows under the extremity D. Administer analgesic medication E. Assess pulse and sensation in the foot

A C D E (Cold compress)

A nurse is reviewing the health record of a client who is to undergo TJA. The nurse should recognize which of the following findings as a contraindication to this procedure? A. Age 78 years B. Hx of cancer C. Previous joint replacement D. Bronchitis 2 weeks ago

Bronchitis 2 weeks ago (bronchitis/recent infection can experience failure of the prothesis if micro-organisms are still present in the body and migrate to surgical site)

A client who has a plaster leg splint reports a painful pressure sensation under the elastic wrap that is holding the splint in place. What is the nurse's best initial action? A. Remove the splint to reduce skin pressure. B. Perform a neurovascular assessment. C. Report the client's concern to the primary health care provider. D. Inspect the skin under the elastic bandage

Perform a neurovascular assessment

A nurse is caring for a pt who is scheduled for an arthroplasty

This procedure will replace my joint to improve function

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus. Which action should the nurse take next? A. Immobilize the left arm. B. Assess the clients distal pulse. C. Monitor for signs of infection. D. Administer prescribed steroids.

A A grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the nurse should immobilize the clients arm and tell the client not to move the arm. The grating sound does not indicate circulation impairment or infection. Steroids would not be indicated.

What is the safest initial management of a person with a suspected hip fracture? A. Call for ambulance assistance and do not attempt to move the person. B. Roll victim on to unaffected side and pull shoulders to move. C. Move victim by grabbing shoulders and legs and lifting as a unit. D. Put a pressure dressing over the bleeding area and splint legs together with tape.

A After assessment of the ABCs -- airway, breathing, and circulation (pulse) -- the victim should be left in the position in which he was found and covered with a blanket. 911should be called immediately. Moving this type of victim could cause more internal bleeding and increased damage to interior structures, especially nerves. The hip should be stabilized and supported by emergency personnel. With an open fracture, there is a risk for osteomyelitis, tetanus, and gas gangrene. The tetanus, and antibiotic prophylaxisbegun in the emergency department will help prevent these complications. Splinting thelegs together could put greater stress on the already fractured hip. More bleeding could result.

A nurse is planning the care of a client who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions? A. Improving the client's level of function B. Improving the client's adherence to treatment C. Administering medications safely D. Helping the client come to terms with limitations

A Improving function is the overarching goal after orthopedic surgery. Some clients may need to come to terms with limitations, but this is not true of every client. Safe medication administration is imperative, but this is not a goal that guides other aspects of care. Similarly, adherence to treatment is important, but this is motivated by the need to improve functional status.

Why is it important to auscultate Mr. Johnston's lung sounds frequently? A. He has a history of CHF. B. Because of the history of hypertension, he is at risk for a heart attack. C. Older hip fracture patients are at risk for osteoporosis. D. He may be at risk for infection.

A Mr. Johnston is receiving D5 NS with 20 mEq of KCl at 80 mL per hour. Although he had a low BP in the ED, he does have a history of CHF and hypertension. This situation may have caused cardiac enlargement; with the extra fluids, his left ventricle may fail and cause back-up of fluid and pressure into the lungs. Atrial fibrillation involves decreased atrial contraction ability because of quivering ineffective atrial muscle activity. Because Mr. Johnston has been NPO prior to surgery, he needs extra IV fluids to maintain circulation and prevent dehydration. Although Mr. Johnston may be at risk for infection and the lungs could eventually be involved, presently the greatest risk for infection lies in his wound. The history of hypertension may eventually put him at higher risk for a heart attack; however, if the BP is not controlled, he may be at greater risk for a stroke. Although distractor #3 is true, monitoring the lung sounds will not have an effect on the risk for osteoporosis.

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first? A. Administer oxygen via nasal cannula. B. Re-position to a high-Fowlers position. C. Increase the intravenous flow rate. D. Assess response to pain medications.

A The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Sitting the client in a high-Fowlers position will not decrease hypoxia related to a fat embolism. The IV rate is not related. Pain medication most likely would not cause the client to be restless.

A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge? A. Client is able to perform transfers safely. B. Client is able to demonstrate full ROM of the affected hip. C. Client is able to perform ADLs independently. D. Client is able to weight-bear equally on both legs.

A The client must be able to perform transfers and to use mobility aids safely. Each of the other listed goals is unrealistic for the client who has undergone recent hip replacement.

A nurse is caring for a client who is postoperative day 1 right hip replacement. How should the nurse position the client? A. Keep the client's hips in abduction at all times B. Elevate the head of the bed to high Fowler's C. Keep hips flexed at no less than 90 degrees D. Seat the client in a low chair as soon as possible

A The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The client's hips should be higher than the knees; as such, high seat chairs should be used.

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first? A. Assess the pedal pulses. B. Apply oxygen by nasal cannula. C. Increase the IV flow rate. D. Loosen the traction.

A These symptoms represent early warning signs of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible. Vital signs need to be obtained to determine if oxygen and intravenous fluids are necessary. Traction, if implemented, should never be loosened without a providers prescription.

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all that apply.) A. Administer additional opioids as prescribed. B. Elevate the extremity on pillows. C. Apply ice to the fracture site. D. Place a heating pad at the site of the injury.e. Keep the extremity in a dependent position.

A B C The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Administration of an additional opioid within the dosage guidelines may be ordered. Heat will increase edema and may increase pain. Dependent positioning will also increase edema.

Which of the following lab and testing parameters may indicate bleeding? A.Hemoglobin B. Hematocrit C. Platelets D. Pulse Oximetry E. Respiratory Rate. F. Skin color G. Diaphoresis H. SOB I. Urine output

A B C D E F G H I Before fluid administration, hemoglobin and hematocrit may actually be elevated, caused by hemo-concentration. After rehydration, they will decrease, indicating blood loss. If the platelets are low, less than 100,000 (when the norm is 150,000-400,000) there is additional risk for bleeding. This platelet situation is unlikely with Mr. Johnston unless he has some type of undetected cancer or bone marrow abnormality. A drop in the pulse oximetry reading to less than 91%, and an increase in respiratory rate accompanied by SOB, may also indicate an inability of the blood to adequately carry oxygen. Pallor and diaphoresis may be present as well. Pallor and cyanosis indicate less oxygen. Diaphoresis may indicate shock that may be caused by bleeding. Urine output and color should be checked frequently. Output of less than 30cc per hour may indicate fluid conservation by the kidneys to combat blood loss. Also, the presence of blood in the urine (hematuria) may indicate Foley insertion trauma or bladder injury from the fall.

Prior to surgery include monitoring for shock and bleeding. Which parameters should the nurse check? A. Blood pressure B. Thigh girth C. Respiratory rate D. Peripheral sensation E. Heart rate

A B C E It is necessary to check all of the parameters to prevent complications prior to surgery.However, heart rate, blood pressure, respiratory rate, and thigh girth are parameters that may indicate development of shock and bleeding. Since the patient had low blood pressure in the ER and needed extra IV fluids to increase it, the nurse should be alert to the possibility of shock related to continued bleeding within the fractured hip. Establishing a baseline of peripheral pulses and circulatory status is important. Measuring the thigh girths for comparison may reveal an enlargement on the left side related to continued bleeding. The nurse also needs to monitor the blood pressure and heart rate for signs of shock. A narrowing pulse pressure with decreased systolic pressure as in 100/86 could be indicative of blood loss into the leg tissue. Because the patient took digoxin and metoprolol this morning, the typical tachycardia associated with shock may be absent. They both decrease heart rate. Note: Femoral fractures can bleed significantly and lead to increased pressure in the thigh compartment increasing the sigh girth. The bleeding can either penetrate the muscle membrane and spread over a large area, or it can accumulate in the muscle.

A nurse is admitting a client to the orthopedic unit following a TKA. Which of the following actions by the nurse are appropriate? (SATA) A. Check continuous passive motion device settings B. Palpate dorsal pedal pulses C. Place a pillow behind the knee D. Elevate heels off bed E. Apply heat therapy to incision

A B D (place pillow under lower calf/foot and apply cold therapy)

A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.) A. Edema Increased capillary permeability B. Pallor Increased blood blow to the area C. Unequal pulses Increased production of lactic acid D. Cyanosis Anaerobic metabolism E. Tingling A release of histamine

A C D Clinical manifestations of compartment syndrome are caused by several physiologic changes. Edema is caused by increased capillary permeability, release of histamine, decreased tissue perfusion, and vasodilation. Unequal pulses are caused by an increased production of lactic acid. Cyanosis is caused by anaerobic metabolism. Pallor is caused by decreased oxygen to tissues, and tingling is caused by increased tissue pressure.

A nurse is planning discharge therapy for a client who had a total hip arthroplasty. Which of the following should the nurse include in teaching? (SATA) A. Clean incision daily with soap and water B. Turn the shoes inward when sitting or lying C. Sit in a straight-backed armchair D. Bend at the waist E. Use a raised toilet seat

A C E (rotate outward, no bending at waist)

A nurse is completing a preoperative teaching plan for a client who is scheduled to have a TKA. Which of the following should the nurse include in the teaching plan? (SATA) A. Encourage complete autologous blood donation B. Sit in a low reclining chair C. Instruct client to roll onto the operative hip D. Use abductor pillow when turning the client E. Perform isometric exercises

A D E

A nurse is providing discharge teaching to a client following hip arthroplasty.

A straight-back chair with an elevated seat

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? A. Keep the hip flexed by placing pillows under the client's knee B. Protect the affected leg from internal rotation C. Keep the affected leg in a position of adduction D. Have the client reposition himself independently

B Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. The client may not be capable of safe independent repositioning at this early stage of recovery.

Which of the following is a risk for an older patient who is taking Vicodin and plain Tylenol frequently? A. The codeine will cause diarrhea. B. It is recommended that Tylenol not exceed 4 grams in 24 hours or liver problems may occur. C. Pain medication such as Tylenol is more effective than Vicodin. D. The patient should not need so much pain medication.

B Although the Vicodin (5 mg hydrocodone and 500 mg Tylenol) contains codeine which may aggravate the patient's constipation problem, it is important to believe how the patient rates his pain. Even if the patient takes two Vicodin (a total of 1000 mg of Tylenol) every 6 hours, that will total 4000 mg or 4 grams. An older person or someone with liver problems should aim not to exceed 2 grams of Tylenol over a 24 hour period or perhaps not take Tylenol at all.

The patient asks what the Lovenox is for and why he needs it every day. What do you think the nurse should tell the patient? A. "Lovenox is given every day into your abdomen to prevent ulcer formation." B. "Lovenox is like synthetic heparin, which will prevent blood clots from developing in your legs." C. "Lovenox prevents red blood cell formation, which could cause clots in your veins." D. "This drug increases your platelets, which are important in helping your body fight infection."

B DVT (deep vein thrombosis) is the most common complication after hip fractures and hip repair.Lovenox is a synthetic, low-molecular-weight heparin that prevents leg clots in post-surgical patients. The patient will also be prescribed oral warfarin (Coumadin). The Lovenox is given in the abdomen to facilitate absorption. An air bubble in the syringes of 30 and 40 mg doses must not be expelled prior to injection. The bubble acts as an airlock to prevent the medication from leaking out. The nurse must also encourage oral fluids and remind the patient to do foot and ankle exercises. The nurse should check the patient's circulation every 4 hours for signs of DVT, such as swelling, pain, redness, and warmth. DVT increases the risk of pulmonary embolism, a lethal complication.

A client is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions? A. Use of a cardiopulmonary bypass machine B. Autologous blood donation C. Prophylactic blood transfusion D. Postoperative blood salvage

B Many clients donate their own blood during the weeks preceding their surgery. Autologous blood donations are cost-effective and eliminate many of the risks of transfusion therapy. Orthopedic surgery does not necessitate cardiopulmonary bypass and blood is not salvaged postoperatively. Transfusions are not given prophylactically.

A nurse cares for a client who had a long-leg cast applied last week. The client states, I cannot seem to catch my breath and I feel a bit light-headed. Which action should the nurse take next? A. Auscultate the clients lung fields anteriorly and posteriorly. B. Administer oxygen to keep saturations greater than 92%. C. Check the clients blood glucose level. D. Ask the client to take deep breaths.

B The clients symptoms are consistent with the development of pulmonary embolism caused by leg immobility in the long cast. The nurse should check the clients pulse oximetry reading and provide oxygen to keep saturations greater than 92%. Auscultating lung fields, checking blood glucose level, or deep breathing will not assist this client.

What is the rationale for the doctor's order for ferrous sulfate? A. The iron augments the effects of morphine. B. The medication provides iron, an essential component in the formation of hemoglobin. C. The iron that it contains will help to relieve constipation. D. Normally, digoxin depletes the body of iron; the patient should have been taking this medication before admission.

B Iron supplements are usually ordered after surgery with anticipated blood loss to help the body rebuild RBCs and oxygen-carrying capacity. It is best absorbed when given between meals with orange juice. Vitamin C seems to increase its absorption.Patient teaching also involves telling the patient that his stool may turn black while he is taking iron. In this patient with preexisting constipation, stool frequency must be assessed, as constipation is a common side effect after surgery and also with Vicodin, because of the codeine it contains. Since proton pump inhibitors may decrease absorption, it is important to separate the iron supplement from the Protonix when administering them. All the other options are false. In fact, iron may cause constipation.

A nurse is completing preoperative teaching for a. client who is to undergo an arthroscopy to repair a shoulder injury. Which of the following statements should the nurse include? (SATA) A. "Avoid damage or moisture to the cast on your arm" B. "Inspect your incision daily for indications of infection" C. "Apply ice packs to the area for the first 24 hours" D. "Keep your arm in a dependent position" E. "Perform isometric exercises"

B C E No cast for arthroscopy Elevate extremity for 12 to 24 hours

Why is it important for Mr. Johnston to cough and use his incentive spirometer? A. To prevent venous thromboembolism B. To prevent pneumonia C. To prevent pneumothorax D. To prevent atelectasis

B D Atelectasis and pneumonia are risks for older patients after surgery. The risk is amplified if they do not take deep breaths and cough adequately to reinflate their lungs. Nosocomial pneumonia has ahigh mortality rate.

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement? A. "Our goal will actually be to have you walking normally within 5 days of your surgery." B. "For the first 2 weeks after the surgery, you can use a wheelchair to meet your mobility needs." C. "The physical therapist will likely help you get up using a walker the day after your surgery." D. "Actually, clients are only on bed rest for 2 to 3 days before they begin walking with assistance."

C Clients post-THA begin ambulation with the assistance of a walker or crutches within a day after surgery. Wheelchairs are not normally utilized. Baseline levels of mobility are not normally achieved until several weeks after surgery, however.

A client with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, the client reports a new onset of pain at the surgical site. What is the nurse's best action? A. Administer pain medication as prescribed B. Assess the client for signs and symptoms of systemic infection C. Assess the surgical site and the affected extremity D. Reassure the client that pain is a direct result of increased activity

C Worsening pain after a total hip replacement may indicate dislocation of the prosthesis. Assessment of pain should include evaluation of the wound and the affected extremity. Assuming he's anxious about discharge and administering pain medication do not address the cause of the pain. Sudden severe pain is not considered normal after hip replacement. Sudden pain is rarely indicative of a systemic infection.

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? A. The presence of leg shortening B. The client's complaints of pain C. The presence of internal or external rotation D. Signs of neurovascular compromise

D Because impaired circulation can cause permanent damage, neurovascular assessment of the affected leg is always a priority assessment. Leg shortening and internal or external rotation are common findings with a fractured hip. Pain, especially on movement, is also common after a hip fracture.

A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest risk for developing deep vein thrombosis? A. An 18-year-old male athlete with a fractured clavicle B. A 36-year old female with type 2 diabetes and fractured ribs C. A 55-year-old woman prescribed aspirin for rheumatoid arthritis D. A 74-year-old man who smokes and has a fractured pelvis

D Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other clients do not have risk factors for DVT.

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture? A. Sedentary lifestyle B. A 30pack-year smoking history C. Prescribed oral contraceptives D. Pagets disease

D Pagets disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing but may cause other health risks.

A phone triage nurse speaks with a client who has an arm cast. The client states, My arm feels really tight and puffy. How should the nurse respond? A. Elevate your arm on two pillows and get ice to apply to the cast. B. Continue to take ibuprofen (Motrin) until the swelling subsides. C. This is normal. A new cast will often feel a little tight for the first few days. D. Please come to the clinic today to have your arm checked by the provider.

D Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome. The client should come to the clinic that day to be evaluated by the provider because delay of treatment can cause permanent damage to the extremity. Ice and ibuprofen are acceptable actions, but checking the cast is the priority because it ensures client safety. The nurse should not reassure the client that this is normal.

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? A. Risk for Infection B. Unilateral Neglect Related to Hematoma C. Disturbed Kinesthetic Sensory Perception D. Risk for Ineffective Peripheral Tissue Perfusion

D The hematoma may cause an interruption of tissue perfusion. There is also an associated risk for infection because of the hematoma, but impaired perfusion is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than tissue perfusion.

Mr. Johnston received extra fluids in the ED, which may increase urine output and potassium loss.

For Although it is not a nursing task to make the decision for or against the addition of potassium to the patient's medication orders, it is important to understand the rationales involved in order to watch for the presence of unwanted reactions.

Mr. Johnston takes digoxin. Hypokalemia may promote digoxin toxicity.

For Although it is not a nursing task to make the decision for or against the addition of potassium to the patient's medication orders, it is important to understand the rationales involved in order to watch for the presence of unwanted reactions.

A nurse is teaching a pt who had a total knee arthroplasty about self-administering morphine via a PCA infusion device.

I should tell the nurse if I can't control my pain with this device

A nurse is caring for a client who is 1-day postoperative following total hip arthroplasty. It is 0830 and the client is scheduled for PT at 0900. Which of the following interventions should the nurse take?

Identify the client's pain level and medicated if needed

A nurse is caring for a pt who is post op following a total hip arthroplasty.

Place a wedge pillow between the legs

A nurse is reviewing the diagnostic test results of an older adult female pt who is pre op for a knee arthroplasty, what's alarming?

WBC count 20,000/mm3