Amputation (aka), (bka)

The client with an aka amputation is to use crutches while his prosthesis is being adjusted. In which of the following exercises should the nurse instruct the client to best prepare him for using crutches? A) Abdominal exercises B) Isometric shoulder exercises C) Quadriceps setting exercises D) Triceps stretching exercises

4) Triceps stretching exercises Rationale: Use of crutches requires significant strength from the triceps muscles. Therefore, efforts are focused on strengthening these muscles in anticipation of crutch walking. Bed and wheelchair push-ups are excellent exercises targeted at the triceps muscles. Abdominal exercises, range-of-motion and isometric exercises of the shoulders, and quadriceps and gluteal setting exercises are not helpful in preparing for crutch walking.

Smoking is contraindicated after replantation of a limb because nicotine causes: A) Vasoconstriction B) Vasodilation C) Hyperglycemia D) Shortness of breath

A) Vasoconstriction (No rationale given)

A client in the postanesthesia care unit with a left bka has pain in her left big toe. Which of the following should the nurse do first? A) Tell the client it is impossible to feel the pain B) Show the client that the toes are not there C) Explain to the client that her pain is real D) Give the client the prescribed opioid analgesic

D) Give the client the prescribed opioid analgesic Rationale: The nurse's first action should be to administer the prescribed opioid analgesic to the client, because this phenomenon is phantom sensation and interventions should be provided to relieve it. Pain relief is the priority. Phantom sensation is a real sensation. It is incorrect and inappropriate to tell a client that it is impossible to feel the pain. Although it does relieve the client's apprehensions to be told that phantom sensations are a real phenomenon, the client needs prompt treatment to relieve the pain sensation. Usually phantom sensation will go away. However, showing the client that the toes are not there does nothing to provide the client with relief.

The nurse is caring for a client who had an aka 2 days ago. The residual limb was wrapped in an elastic compression bandage, which has come off. Which immediate action should the nurse take? A) Apply ice to the site B) Call the healthcare provider C) Apply a dry sterile dressing and elevate it on one pillow D) Rewrap the residual limb with an elastic compression bandage

D) Rewrap the residual limb with an elastic compression bandage

When you examine a patient's replanted hand, it is slightly bluish, swollen, and warm. These findings indicate which of the following? A) Arterial occlusion B) Rejection of the replanted hand C) Venous congestion D) That the replantation was successful

C) Venous congestion (No rationale available)

The nurse conducting a safety seminar reminds the audience that upper extremity amputation is most frequently caused by trauma and that the highest incidence of this is: A) Elementary School-age girls B) Elementary School-age boys C) Young men D) Young women

C) Young men Rationale: Young men are at greater risk from work trauma, because traditionally they are the ones working with farm and heavy machinery.

The nurse is aware that the patient who is to have his leg amputate is also to have a prosthesis fitted in the OR at the same time. The preoperative teaching plan will include the fact that there will be: A) The need for extra preoperative medications B) A rigid dressing applied to accommodate the prosthesis C) A series of temporary prostheses before the permanent one is put in place D) The need to "wire" the residual limp for acceptance of the prosthesis.

B) A rigid dressing applied to accommodate the prosthesis Rationale: There will be a rigid dressing applied to the residual limb to accommodate the prosthesis immediately after surgery

The 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 bka amputation. the remark by the patient that indicates an understanding of the procedure is: A) "I'm 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."

C) If this heals well, how long until I get a prosthesis?" Rationale: Only this answer indicates that the patient realizes the extent of the surgery.

The nurse is developing a teaching plan for a client who must undergo an aka amputation of the left leg. After a leg amputation, exercise of the remaining limb: A) Isn't necessary B) Should begin immediately postoperatively C) Should begin the day after surgery D) Begins at the rehabilitation center

C) Should begin the day after surgery Rationale: Exercise should begin the day after surgery. Exercise is necessary to maintain the muscle tone of the remaining limb. Immediately after surgery, the client isn't alert enough to participate and may be in too much pain. Exercise needs to begin before discharge to a rehabilitation center.

A client who has had an aka develops a dime-sized bright red spot on the dressing after 45 minutes in the post anesthesia unit. The nurse should: A) Elevate the stump B) Reinforce the dressing C) Call the surgeon D) Draw a mark around the site

D) Draw a mark around the site Rationale: The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding. Once the area is marked, the nurse can determine whether the bleeding is increasing or decreasing by the size of the area marked. Because the spot is bright red, the bleeding is most likely arterial in origin. Once the rate and source of bleeding are identified, the surgeon should be notified. The stump is not elevated because adhesions may occur, interfering with the ability to fit a prosthesis. The dressing would be reinforced if the bleeding is determined to be of venous origin, characterized by slow oozing of darker blood that ceases with the application of a pressure dressing. Typically, operative dressings are not changed for 24 hours. Therefore, the dressing is reinforced to prevent organisms from penetrating through the blood-soaked areas of the initial postoperative dressing.

A client says, "I hate the idea of being an invalid after they cut off my leg." Which of the following would be the nurse's most therapeutic response? A) "At least you will still have one good leg to use." B) "Tell me more about how you're feeling." C) "Let's finish the preoperative teaching." D) "You're luck to have a wife to care for you."

B) "Tell me more about how you're feeling." Rationale: Encouraging the client who will be undergoing amputation to verbalize his feelings is the most therapeutic response. Asking the client to tell more about how he is feeling helps to elicit information, providing insight into his view of the situation and also providing the nurse with ideas to help him cope.

In the early post-op period, what is the greatest danger to the patient who has had an amputation? A) Paralysis B) Hemorrhage C) Thrombosis D) Sepsis

B) Hemorrhage (No rationale available)

A patient complains that her amputated foot itches and feels hot. This represents which of the following? A) Poor psychological adjustment B) Phantom limb sensation C) Early symptoms of infection D) Denial of the amputation

B) Phantom limb sensation (No rationale available)

A nurse is preparing to care for a client who had undergone an above-knee amputation (aka) of the right leg. The nurse plans to allow which position for the client in the first 24 hours? A) Supine with affected limb flat on the bed B) Supine with the affected limb supported with pillows C) Prone with the affected limb in a dependent position D) Trendelenburg's position

B) Supine with the affected limb supported with pillows Rationale: The amputated limb is usually supported with pillows on the first post-op day to promote venous return and reduce edema

The client asks the nurse, "Why can't the physician tell me exactly how much of my leg he's going to take off? Don't you think I should know that?" On which of the following should the nurse base the response? A) The need to remove as much of the leg is possible. B) The adequacy of the blood supply to the tissues. C) The ease with which a prosthesis can be fitted. D) The client's ability to walk with a prosthesis.

B) The adequacy of the blood supply to the tissues. Rationale: The level of amputation often cannot be accurately determined until during surgery, when the surgeon can directly assess the adequacy of the circulation of the residual limb. From a moral, ethical, and legal viewpoint, the surgeon attempts to remove as little of the leg as possible. Although a longer residual limb facilitates prosthesis fitting, unless the stump is receiving a good blood supply the prosthesis will not function properly because tissue necrosis will occur. Although the client's ability to walk with a prosthesis is important, it is not a determining factor in the decision about the level of amputation required. Blood supply to the tissue is the primary determinant.

Which of the following is the reason a compression dressing or a cast is applied after amputation? A) To reduce pain B) To shape the residual limb C) To prevent wound contamination D) To prevent stimulation of nerve endings

B) To shape the residual limb Rationale: Following amputation, compression dressings will be applied to reduce swelling and begin shaping the residual limb for prosthetic fitting.

Which of the following is the most common cause of Below the knee amputation? A) Trauma B) Vascular disease C) Tumors D) Congenital defects

B) Vascular Disease The leading cause of lower limb amputations is vascular disease, specifically diabetes and arteriosclerosis.

Measures to prevent contractures in a residual limb after lower extremity amputation include which of the following? SATA A) Keep the patient up in a chair as much as possible B) Guide the patient through active ROM exercises C) Have the patient lie supine for 30 minutes 3-4 times/day D) Prop the residual limb on a pillow when the patient is supine

B, C (No rationale given)

Patient teaching related to care of a residual limb and prosthesis should include which of the following statements? SATA A) Wash, rinse, and dry the prosthetic socket every day B) Apply lotion to the residual limb only if ordered C) Redness and irritation of the residual limb are normal D) Wash the residual limb with soap and water daily

B, C, D ** I have NO idea why you wouldn't want to wash, rinse & dry the prosthetic socket? I just wrote the answer that was given**

To preserve an amputated body part for possible replantation, it is best to do which of the following? SATA A) Cover the part with ice B) Wrap the part in a clean, moist cloth C) Wash the part carefully then dry and wrap in in plastic D) Seal the part in a plastic bag and put it in ice water

B, D B) Wrap the part in a clean, moist cloth D) Seal the part in a plastic bag and put it in ice water (No rationale available)

In which of the following situations would an open amputation be most likely? SATA A) A teenager with bone cancer B) A diabetic patient with gangrene C) A child with congenital deformity D) An accident victim with a traumatic injury

B, D Rationale: an open (or "guillotine") amputation is often required when infection or a great risk for infection is present and there is a need for free drainage from the operative sit. A second surgical procedure involving stump revision or closure is needed but will be performed only after the infection has been eliminated.

When the patient asks when he should expect to be up and walking after his below-knee amputation, the nurse assures him that most amputees are fully weight bearing within: A) 3 weeks B) 1 month C) 6 weeks D) 3 months

D) 3 months Rationale: Most amputees are fully weight-bearing within 3 months after surgery