Chapter 45 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.

1 A patient's muscle movement and the prosthesis

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.

1 Create a weight-bearing residual limb

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.

1 Pulse volume recording and WBC

How should a nurse modify a teaching plan for an older adult who has had an above the knee amputation (select all that apply) 1. Offer smaller units of information at a time 2. Increase time for learning 3. Place less emphasis on chronic health problems 4. Clarify the reality of phantom pain 5. Include frequent repetition

1, 2, 4, 5

Which action should a nurse implement to diminish swelling of the residual limb in the postoperative period After an above the knee amputation? 1. Elevate the foot of the bed on blocks 2. Elevate the residual limb on pillows 3. Elevate the head of the bed 15° 4. Turn the patient on the affected side

1. Elevate the foot of the bed on blocks

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."

2 "Stopping Smoking would help prevent vasoconstriction"

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.

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

14. An appropriate outcome for a nursing diagnosis of "Anxiety related to perceived threat of disability" would be: 1. Comfort is increased verbalize pain is less 2. Anxiety is relieved the patient verbalizes concern related to disability 3. Grief is resolved; the patient expresses an acceptance of loss 4. Residue on the limb is clean; no exudate, redness, or Edema is observed

2 Anxiety is relieved the patient verbalizes concern related to disability

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.

2 Cyanosis and hypotension

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

2 Hemorrhage

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.

2 medicate patient with the ordered pain remedy

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.

2. elevating the hand but keeping it below the level of the heart

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.

3 Young men

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.

3 ambulate 30 minuets a day

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

3 patient knowledge of therapeutic measures

A home healthcare nurse suspects a neuroma in a patient who had an above the knee and the amputation one month earlier. Which complaint by the patient let the nurse to suspect a neuroma? 1. Area of swelling and bruising on distal portion of residual limb 2. Prickling sensation over residue all Limb 3. Sharp severe pain in the residual limb 4. Area of numbness and distal portion of residual limb

3 sharp severe pain in the residual limb

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.

3 the amputated part to be buried

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

3 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."

3. "If this heals well, how long until I get a prosthesis?"

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

4 Bright red bleeding

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

Staged or guillotine

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.

4 decreased blood flow.

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.

4 through the elbow joint

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.

4 wrap the hand securely and place on an ice water-filled baggie

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.

4 wrap the thumb in a cloth saturated with normal saline and place in a baggie

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.

4. 3 months after surgery.

A patient who has a below the knee prosthesis shows the home healthcare nurse the residue a limb, which is red, Edematous, and warm to touch. What should the nurse instruct this patient to do? 1. Apply soothing lotion to the residual limb before replacing the prosthesis 2.Dampen the prosthetic limb sock and hydrate the cool and residual limb 3. Pad the socket with lambs wool and replace the prosthesis 4. Leave the prosthesis off and notify physician

4. Leave the prosthesis off and notify physician

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

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

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 bed rest

ANS: 1, 2, 3, 4,

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

Disarticulation

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

Prone

Pre-operative exercises for a patient undergoing a lower extremity amputation include __________training

Upper body

13. To reduce the possibility of hip contractures in an above-knee amputee, the nurse periodically places the patient in a ____ position.

prone