Free Orthopaedic Nurse Questions and Answers — Questions and Answers
Question 1: The patient's arm is in a sling and a long-arm posterior splint with the elbow in 90-degree flexion following a right total elbow arthroplasty. Which sleeping position is most likely to be cozy for the patient, who needs to keep their right arm raised?
- Supine with the head partially elevated (Correct answer)
- Supine with the head flat
- Side-lying to the right
- Side-lying to the left
Correct answer: Supine with the head partially elevated
Following a total elbow arthroplasty, keeping the affected arm elevated is crucial to reduce swelling and promote healing. Sleeping supine (on the back) with the head partially elevated allows for the arm to be comfortably supported and elevated, often with pillows, without putting direct pressure on the surgical site. Side-lying positions would likely put pressure on the splinted arm or make elevation difficult, increasing discomfort and potential complications.
Question 2: A 16-year-old kid was identified as having spinal muscular atrophy, type III, after experiencing weakness in his lower extremities and trouble walking. Which of the following complications should the nurse advise the parents to prepare for?
- Swallowing difficulties and impaired respirations
- Death within 2 years of the onset of symptoms
- Increased susceptibility to respiratory infections (Correct answer)
- Unstable and floppy limbs and trunk
Correct answer: Increased susceptibility to respiratory infections
Spinal Muscular Atrophy (SMA) type III, while generally less severe than types I and II, still involves muscle weakness, particularly in the limbs and trunk. This weakness can affect the respiratory muscles over time, leading to impaired cough reflex and reduced lung capacity. Consequently, individuals with SMA are at an increased risk for respiratory infections, making respiratory care and monitoring a critical aspect of their management.
Question 3: A distal femoral osteosarcoma patient will undergo limb-salvage surgery. How long will the patient need to go through physical therapy to learn to walk on the saved limb?
- 6 months
- 12 months (Correct answer)
- 6 weeks
- 3 months
Correct answer: 12 months
Limb-salvage surgery for osteosarcoma is a complex procedure involving significant bone and tissue reconstruction. The rehabilitation process is extensive, requiring patients to regain strength, range of motion, and learn to bear weight on the reconstructed limb. A full year of dedicated physical therapy is often necessary to achieve optimal functional recovery and independence in walking.
Question 4: Contraindications to ultrasound therapy include
- a muscle sprain
- a suspected fracture (Correct answer)
- a sprain
- bursitis
Correct answer: a suspected fracture
Ultrasound therapy generates heat and mechanical vibrations that can potentially disrupt the healing process of a fracture or worsen an undiagnosed one. Applying ultrasound to a suspected fracture site could delay proper diagnosis, cause further injury, or interfere with bone alignment and healing. Therefore, it is a contraindication to prevent complications and ensure patient safety.
Question 5: Which kind of metastasis should be carefully watched for in a patient with osteosarcoma of the proximal end of the humerus?
- Liver
- Lung (Correct answer)
- Kidney
- Brain
Correct answer: Lung
Osteosarcoma is a highly aggressive bone cancer with a strong tendency to metastasize hematogenously (via the bloodstream). The lungs are the most common site for distant metastasis, occurring in a significant percentage of patients. Therefore, careful monitoring for lung metastases is crucial for staging, treatment planning, and determining the prognosis in individuals with osteosarcoma.
Question 6: A kid with achondroplasia experiences numbness, sleep apnea, widespread weakness, urine and fecal incontinence, and rapid reflexes. Which of the following complications needs to be evaluated at the beginning for the child?
- Cervicomedullary compression (Correct answer)
- Chronic otitis media
- Hydrocephalus
- Spinal cord myelopathy
Correct answer: Cervicomedullary compression
Achondroplasia often leads to a narrowed foramen magnum, the opening at the base of the skull. This narrowing can cause compression of the cervicomedullary junction, where the brainstem meets the spinal cord. The described symptoms (numbness, sleep apnea, weakness, incontinence, rapid reflexes) are classic signs of neurological compression at this critical area, requiring urgent evaluation to prevent severe neurological damage.
Question 7: How can a nurse tell if a cervical collar is tight enough when it is being fitted?
- Ask the patient to attempt to turn the head from side to side
- Ask the patient to flex the chin forward (Correct answer)
- Compare the collar and neck measurements
- Ask the patient if the collar is comfortable
Correct answer: Ask the patient to flex the chin forward
A properly fitted cervical collar is designed to restrict neck movement, especially flexion. If the patient can easily flex their chin forward into the collar, it indicates that the collar is too loose and not providing adequate immobilization. Asking the patient to attempt this movement helps the nurse assess the collar's effectiveness in limiting cervical spine motion and ensuring proper fit.
