ORTHOPEDIC WARD

A patient with an open reduction and internal fixation for a fractured hip is to being ambulation. The hip was
repaired using a compression plate and screws. The patient will most likely begin ambulation with:
A. Full weight bearing on the affected leg
B. Nonweight bearing on the affected leg
C. Toe touch weight bearing on the affected leg
D. Weight bearing as tolerated on the affected leg
Answer C is correct. The patient with ORIF of a fractured hip will begin ambulation with toe touch weight bearing
on the affected leg. Answer A is incorrect because it places to much weight on the newly repaired hip. Answer B is
incorrect because the patient allowed to bear minimal weight on the affected leg. Answer D is incorrect because it
can place too much or too little pressure on the newly repaired hip.

The nurse is performing a post-op assessment of an elderly patient with a total hip repair. Although he has not
requested medication for pain, the nurse suspects that the patient's discomfort is severe and prepares to
administer pain medication. Which of the following signs would not support the nurse's assessment of acute post-
op pain?
A. Increased blood pressure
B. Inability to concentrate
C. Dilated pupils
D. Decreased heart rate
Rationale: Answer D is correct. The patient in acute pain experiences physiological arousal similar to the fight or
flight response- for example, an increased (not decreased) heart rate, an increased BP, and dilated pupils. Answers
A,B, and C are wrong because increased BP, inability to concentrate, and dilated pupils are reactions to pain. The
question asks which does not support as assessment of post-op pain, so answer D is correct.

To prevent dislocation of a hip prosthesis following a total hip replacement, the nurse should:
A. Maintain the patient's affected leg in an adducted position
B. Maintain the patient's affected hip in a flexed position
C. Tell the patient to remain in supine position
D. Place an abduction pillow between the patient's leg
Rationale: Answer D is correct. The patient's leg should be maintained in an abducted position to prevent
dislocation of the prosthesis. This is accomplished by the use of an abduction pillow. Answers A and B will increase
the likelihood of dislocation of the prosthesis; therefore, they are incorrect. Answer C is unnecessary; therefore, it
is incorrect.

The nurse at an orthopedic joint clinic is preparing pre-operative teaching for a patient scheduled for total hip
replacement surgery. Which would be included in the teaching plan?
A. Avoid sitting in a chair
B. Make sure that commode seats are at low levels
C. Avoid crossing the legs when sitting
D. Physical Therapy will assist with adduction exercises
Rationale: Answer C is correct. The patient with joint hip replacement should avoid adduction of the legs and
flexion of the hips greater than 90 degrees to ensure continued placement of the prosthetic joint. It is
recommended for these patients to use recliners for seating instead of straight chairs., therefore A is incorrect.
Commode seats will have to be raised and abduction of the legs is required, making B and D incorrect choices.

The nurse is preparing a teaching plan for a patient who is being discharged following a total hip replacement. The
nurse would include which part of the following content as a part of the teaching plan? Select all that apply
A. Avoid low, cushioned chairs
B. Use a device that raises toilet seat
C. Avoid bending greater than 90 degrees
D. Turn at the waist to reach objects
E. Do not cross the legs
 ORTHOPEDIC WARD

Rationale: A,B,C,E are correct. Following a total hip replacement, the patient must be instructed to avoid activities
such as sitting in low, cushioned chairs; crossing legs; and using a standard- height toilet. These activities cause
adduction of the less or greater than 90 degrees' flexion at the hip, leading to possible dislocation. Turning at the
waist violates principles of general body mechanics.

The primary purpose for using a continuous passive movement (CPM) apparatus for a patient with a total knee
repair is to help:
A. Prevent contractures
B. Promote flexion of the artificial joint
C. Decrease the pain associated with early ambulation
D. Alleviate lactic acid production in the leg muscles
Answer B is correct. The primary purpose of the continuous passive motion machine is to promote flexion of the
artificial joint. Answers A,C, and D do not describe the purpose of the CPM machine; therefore, they are incorrect.

A patient with a total knee replacement returns from surgery. Which findings require immediate nursing
intervention?
A. The is 30ml bloody drainage from the surgical drain
B. The continuous passive motion machine is set on 90-degree flexion
C. The patient is unable to ambulate to the bathroom
D. The patient is complaining of muscle spasm
Answer B is correct. The CPM machine should not be set at 90-degree flexion until the fifth postoperative day.
Answers A, C, and D are expected findings and do not require immediate nursing intervention, so they are
incorrect

An elderly patient with a fractured hip is placed in Buck's traction. The primary purpose for Buck's traction for the
patient is:
A. To decrease muscle spasm
B. To prevent the need for surgery
C. To alleviate the pain associated with the fracture
D. To prevent bleeding associated with the hip fractures
Rationale: Answer A is correct. Buck's traction is a skin traction used to decrease muscle spasms. Buck's traction
will not prevent the need for surgery, making answer B wrong. It also will not alleviate the pain associated with the
fracture or prevent bleeding, so answers C and D are wrong.

The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of
the weights completely defeats their purpose and may result in injury to the patient.

A patient complains of tingling and numbness in his right leg following application of a long leg cast. The patient's
discomfort is most likely the result of:
A. Reduced venous return
B. Bone healing
C. Arterial insufficiency
D. Nerve compression
Rationale: Answer D is correct. Numbness and tingling in a n extremity immobilized by a cast are most likely the
result of nerve compression. Answer A is incorrect because reduced venous return results in swelling in the
extremity. Answer B is incorrect because numbness and tingling are not associated with bone healing. Answer C is
incorrect because arterial insufficiency results in diminished or absent pulses in the extremity.

Which activity is most appropriate for a three- year old with a cast?
A. Barbie doll and accessories
B. Toy telephone
C. Coloring book and crayons
D. Puzzles
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Rationale: Answer B is correct. The toy telephone is large enough that it cannot be placed beneath the cast, and it
promotes social and language development. Answers A,C, and D contain small pieces that can be placed beneath
the cast, so they are incorrect.