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The nurse is caring for a patient who has just arrived on the orthopedic unit after a right above-the-knee amputation with an immediate prosthetic fitting. Which of the following actions should the nurse implement first?
- A. Place the patient in a prone position.
- B. Check the surgical site for hemorrhage.
- C. Remove the prosthesis and wrap the site.
- D. Keep the residual leg elevated on a pillow.
Correct Answer: B
Rationale: The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.
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The nurse is evaluating the crutch-walking technique of a patient who is to have no weight bearing on the right leg. Which of the following observations indicates that the patient can safely ambulate independently?
- A. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.
- B. The patient advances the right leg and both crutches together and then advances the left leg.
- C. The patient moves the left crutch with the left leg and then the right crutch with the right leg.
- D. The patient uses the bedside chair to assist in balance as needed when ambulating in the room.
Correct Answer: B
Rationale: When using crutches, patients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.
The nurse is caring for a patient in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?
- A. If dislocation, apply compression bandage.
- B. Realignment of the bone(s).
- C. Administer tetanus with an open fracture.
- D. Apply heat to the affected area.
Correct Answer: C
Rationale: An initial action in the emergency treatment of soft tissue injuries is to administer tetanus if there is evidence of an open fracture. If dislocation is suspected, a compression bandage is contraindicated. The nurse would apply ice, not heat, to the affected area. Realignment of the bone is not to be attempted.
The nurse is preparing a patient for discharge 4 days after insertion of a femoral head prosthesis using a posterior approach. Which of the following patient statements indicate a need for additional discharge instructions?
- A. I should not cross my legs while sitting.
- B. I will use a toilet elevator on the toilet seat.
- C. I will have someone else put on my shoes and socks.
- D. I can sleep in any position that is comfortable for me.
Correct Answer: D
Rationale: The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other patient statements indicate that the patient has understood the teaching.
The nurse is providing home care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm. Which of the following information should the nurse include in the teaching plan?
- A. Keep the hand immobile to prevent soft tissue swelling.
- B. Keep the right shoulder elevated on a pillow or cushion.
- C. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48 hours after the injury.
- D. Call the health care provider for increased swelling or numbness.
Correct Answer: D
Rationale: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and vessels. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder. The forearm should be elevated to reduce swelling. NSAIDs can be used to manage pain and swelling.
The nurse is caring for a patient who has a cast in place after fracturing the radius and the patient asks when the cast can be removed. Which of the following information related to the length of time that the cast will need to remain in place should the nurse tell the patient?
- A. Several months
- B. At least 3 weeks
- C. Until swelling of the wrist has resolved
- D. Until x-rays show complete bony union
Correct Answer: B
Rationale: Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healing.