Orthopaedic Nurse Test Orthopaedic Nurse Test Surgical Procedures & Perioperative Care 1 — Questions and Answers
Question 1: Prior to total hip arthroplasty, which positioning precaution is most critical for the nurse to reinforce with the patient?
- Avoid crossing legs at the ankles
- Avoid hip flexion beyond 90 degrees (Correct answer)
- Keep the operative leg elevated above the heart
- Apply ice to the hip every 2 hours
Correct answer: Avoid hip flexion beyond 90 degrees
After total hip arthroplasty, patients must avoid hip flexion greater than 90° to prevent prosthesis dislocation, especially in the early postoperative period.
Question 2: Which classification system is most commonly used to assess the severity of open fractures?
- Garden classification
- Gustilo-Anderson classification (Correct answer)
- Neer classification
- Weber classification
Correct answer: Gustilo-Anderson classification
The Gustilo-Anderson classification grades open fractures I–III based on wound size, contamination, and soft tissue damage to guide management.
Question 3: A patient returning from spinal fusion surgery develops sudden weakness and loss of bladder control. What is the priority nursing action?
- Administer prescribed analgesics
- Reposition the patient for comfort
- Notify the surgeon immediately (Correct answer)
- Encourage oral fluid intake
Correct answer: Notify the surgeon immediately
New-onset neurological deficits (weakness, bladder/bowel dysfunction) post-spinal surgery suggest epidural hematoma or cord compression — an emergency requiring immediate surgical notification.
Question 4: Which anticoagulation agent is most commonly used for DVT prophylaxis following total knee replacement in the US?
- Heparin infusion
- Warfarin or a direct oral anticoagulant (DOAC) (Correct answer)
- Aspirin 81mg only
- Clopidogrel
Correct answer: Warfarin or a direct oral anticoagulant (DOAC)
AAOS and ACCP guidelines recommend warfarin or DOACs (e.g., rivaroxaban, apixaban) as standard DVT prophylaxis after total knee arthroplasty.
Question 5: Compartment syndrome is best confirmed by which assessment finding?
- Skin pallor over the affected limb
- Pain out of proportion to injury with pain on passive stretch (Correct answer)
- Moderate swelling with intact distal pulses
- Patient report of numbness only
Correct answer: Pain out of proportion to injury with pain on passive stretch
The hallmark signs of acute compartment syndrome are pain disproportionate to the injury and pain elicited by passive stretch of muscles in the affected compartment.
Question 6: What is the immediate treatment for confirmed acute compartment syndrome?
- Elevation of the extremity above heart level
- Application of a compression dressing
- Emergency fasciotomy (Correct answer)
- IV corticosteroid administration
Correct answer: Emergency fasciotomy
Emergency fasciotomy, the surgical release of the fascia, is the definitive treatment for acute compartment syndrome to relieve pressure and restore perfusion.
Orthopaedic Nurse Test Orthopaedic Nurse Test Surgical Procedures & Perioperative Care 1
Prior to total hip arthroplasty, which positioning precaution is most critical for the nurse to reinforce with the patient?