Chapter 43 Amputations

10. The nurse excitedly tells the patient about the myoelectrically controlled prosthesis, the movement of which is controlled by: 1. the patient's muscle movement and the prosthesis. 2. battery-operated muscles implanted in the prosthesis. 3. motion-sensing mechanism that swings the prosthesis forward. 4. internal computer chip in the prosthesis.

ANS: 1 A patient's muscle movement and the prosthesis control movement with a myoelectrically controlled prosthesis.

19. Risk for injury related to unsteady gait is an appropriate nursing diagnosis for the above-knee amputee who is going home. The statement by the patient that indicates understanding of the risk is: 1. "I will have my daughter get rid of my scatter rugs." 2. "I like to keep my newspapers on the floor in front of my chair." 3. "I don't need to practice using stairs because I will only go up and down a couple of times each day." 4. "Why would I need arm exercises? They operated on my leg."

ANS: 1 Planning safety provisions indicates that the patient is aware of potential sources of injury.

5. The nurse explains that the routine preoperative diagnostic tests for a patient anticipating a below-knee amputation are: 1. pulse volume recording and WBC (white blood count). 2. cardiac catheterization and WBC. 3. pulse volume recording and x-rays. 4. thermography and cardiac catheterization.

ANS: 1 Pulse volume recording and WBC are two diagnostic tests for patients anticipating a below-knee amputation.

9. A closed amputation is usually performed to: 1. create a weight-bearing residual limb. 2. alleviate the effects of the trauma. 3. allow infection to heal and drain. 4. treat a limb with gangrene.

ANS: 1 This is the definition of a closed amputation as given in the text.

15. Preoperative exercises for a patient undergoing a lower extremity amputation include: 1. upper body training. 2. lower body training. 3. upper thigh training. 4. head and neck training.

ANS: 1 Upper body training will strengthen the arms to aid in movement after the loss of a lower extremity.

2. The nurse discriminates between an open and closed amputation by saying that a closed amputation is designed to (select all that apply): 1. prepare a weight-bearing limb. 2. cover the stump with tissue and muscle. 3. place sutures immediately over the bone. 4. be staged to closure. 5. be immediately ready for a prosthesis.

ANS: 1, 2 Closed amputations are meant to prepare the limb for weight-bearing 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 as are open amputations, and may or may not be prepared for an immediate prosthesis.

MULTIPLE RESPONSE 1. The nurse points out the major situational occurrences that lead to amputations are (select all that apply): 1. trauma. 2. disease. 3. tumors. 4. congenital defects. 5. carelessness.

ANS: 1, 2, 3, 4 Carelessness usually leads to trauma.

3. The nurse, when selecting possible nursing diagnoses for the 32-year-old patient who is in anticipatory grieving for an upcoming bilateral above-knee amputation, would consider (select all that apply): 1. anxiety related to knowledge deficit of procedure. 2. disturbed body image related to loss of body part. 3. sexual dysfunction related to perceived disfigurement. 4. disturbed self-image related to loss of independence. 5. activity intolerance related to pain.

ANS: 1, 2, 3, 4, 5 All concerns mentioned would need to be addressed.

23. Late signs of hemorrhage in the postoperative period following an amputation include: 1. restlessness and increasing respirations. 2. cyanosis and hypotension. 3. confusion and seizures. 4. headache and hypertension.

ANS: 2 Cyanosis and hypotension are late signs of hemorrhage in the postoperative period following an amputation.

16. The greatest danger in the early postoperative period after an amputation is: 1. infection. 2. hemorrhage. 3. pain. 4. edema.

ANS: 2 Hemorrhage is the greatest danger in the early postoperative period after an amputation.

14. An appropriate goal for a nursing diagnosis of "Anxiety related to perceived threat of disability" would be: 1. the patient will state that pain is relieved. 2. the patient will verbalize concerns about injury. 3. the patient will demonstrate realistic goal setting. 4. the patient will report that the limb did not become infected.

ANS: 2 Only option 2 is specific to the diagnosis. Others are possible goals but do not pertain to this diagnosis.

21. The nurse includes in postoperative care for a patient with reimplantation of the right thumb the implementations of: 1. decreasing the temperature of the room to 70ºF. 2. elevating the hand, but keeping it below the level of the heart. 3. offering coffee, tea, or cola to help increase fluid intake. 4. placing an antiembolus sleeve on the right arm.

ANS: 2 Slight elevation of the hand will encourage drainage, but not embarrass arterial perfusion. The room temperature should be 80º F. The patient should avoid all caffeine drinks and tight clothing or dressings.

8. The patient with peripheral vascular disease and diabetes asks what he can do to help prevent an amputation. The nurse is quick to respond: 1. "There is really not anything you can do to help." 2. "Stopping smoking would help prevent vasoconstriction." 3. "You will not need to check your blood glucose levels." 4. "It is important to eat big meals so your body can heal."

ANS: 2 Smoking cessation is a huge step in maintaining healthy tissue.

11. The patient who had a below-knee amputation 3 days ago is complaining of burning pain in his left foot. The nurse should: 1. remind the patient that it is only phantom pain. 2. medicate patient with the ordered pain remedy. 3. remind him that such sensations will go away in a few weeks. 4. distract the patient with conversation.

ANS: 2 The nurse should medicate a patient who is complaining. Phantom pain is real.

1. The nurse is aware that the patient who is to have his leg amputated 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: 1. the need for extra preoperative medications. 2. a rigid dressing applied to accommodate the prosthesis. 3. a series of temporary prostheses before the permanent one is put in place. 4. the need to "wire" the residual limb for acceptance of the prosthesis.

ANS: 2 There will be a rigid dressing applied to the residual limb to accommodate the prosthesis immediately after surgery.

22. The nurse reminds the patient with a below-knee amputation that to prevent the loss of calcium and protein, the patient should: 1. drink 1 to 2 liters of fluid daily. 2. ingest at least four milk products each day. 3. ambulate 30 minutes a day. 4. take vitamin supplements daily.

ANS: 3 Even a small amount of ambulation will decrease the loss of calcium and protein.

17. Because of the anticoagulant in the saliva of leeches, they are used to treat which of the following in the replantation patient? 1. inadequate arterial blood flow 2. venous insufficiency 3. venous congestion 4. increased arterial blood flow

ANS: 3 Leeches are used for venous congestion.

4. 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 below-knee amputation. The remark by the patient that indicates an understanding of the procedure is: 1. "I am glad this amputation will end my diabetic problems." 2. "After they have hacked my leg, I won't be able to drive." 3. "If this heals well, how long until I get a prosthesis?" 4. "I hate that my left knee is going to be useless without a foot."

ANS: 3 Only this answer indicates that the patient realizes the extent of the surgery.

24. Patient verbalization of microvascular precautions is a criterion for measuring the achievement of which nursing goal? 1. Adequate circulation in the replanted limb 2. Pain relief 3. Patient knowledge of therapeutic measures 4. Adjustment to change in appearance and function

ANS: 3 Option 3 is the best answer, because it addresses patient knowledge. The others do not.

12. During the admission of a patient scheduled for amputation, the patient relates that she is a practicing Orthodox Jew. The nurse should make arrangements for: 1. a veil to cover the amputated part. 2. a rabbi present for the surgery. 3. the amputated part to be buried. 4. a family member present to read the Torah.

ANS: 3 Orthodox Jews bury all body parts.

3. The nurse conducting the safety seminar reminds the audience that upper extremity amputation is most frequently caused by trauma and that the highest incidence of this is: 1. school-age girls. 2. school-age boys. 3. young men. 4. young women.

ANS: 3 Young men are at greater risk from work trauma, because traditionally they are the ones working with farm and heavy machinery.

25. Which of the following postoperative observations must be reported to the physician immediately? 1. Brownish red drainage on the dressing, which is damp 2. Respirations of 20/min 3. Pulse of 72 4. Bright red bleeding

ANS: 4 Bright red bleeding is not expected and indicates hemorrhage.

6. The nurse explains that for an elbow disarticulation, the limb will be severed: 1. just above the elbow joint. 2. just below the elbow joint. 3. between the shoulder and elbow. 4. through the elbow joint.

ANS: 4 Disarticulations sever limbs through the joints.

20. The child comes to the school nurse with his index finger partially amputated and hanging by a shred of skin. The nurse should: 1. flush the hand with warm water and wrap in a towel. 2. carefully cut the skin holding the finger and wrap the finger and hand in clean towel. 3. pinch the finger to stop bleeding and take the child to the hospital 4. wrap the hand securely and place on an ice water-filled baggie.

ANS: 4 Leave the shred of skin intact, wrap the hand and finger in a normal saline-soaked towel, and place on a cool surface.

2. 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: 1. 3 weeks. 2. 1 month. 3. 6 weeks. 4. 3 months.

ANS: 4 Most amputees are fully weight-bearing within 3 months after surgery.

18. A patient who amputated his thumb in a lawnmower accident hands the ER nurse his thumb in a glass jar. The nurse should: 1. place the thumb in a baggie with iced Ringer's lactate. 2. wrap the thumb in plastic wrap and place on ice. 3. leave the thumb in the jar and put it in the refrigerator. 4. wrap the thumb in a cloth saturated with normal saline and place in a baggie.

ANS: 4 The amputated part should be wrapped in a normal saline solution-soaked towel, placed in a baggie, and put in a cool bath.

7. The nurse is aware that a thermography finding of cool spots in a certain area indicates: 1. increased blood flow. 2. decreased infection. 3. increased infection. 4. decreased blood flow.

ANS: 4 The area is cool because there is less blood flow.

13. To reduce the possibility of hip contractures in an above-knee amputee, the nurse periodically places the patient in a ____ position. 1. high Fowler's 2. side-lying 3. flat supine 4. completely prone

ANS: 4 The prone position will cause the muscles of the thigh to stretch and prevent contracture.

COMPLETION 1. The nurse clarifies that the precise term for the patient's amputation, which will be through the knee joint, is called ____________________.

ANS: Disarticulation