Orthopaedic Nurse Test Case Studies & Practical Application 2 — Questions and Answers
Question 1: A 72-year-old patient with a total hip replacement is found sitting with the operative leg crossed over the non-operative leg. What is the priority nursing action?
- Instruct the patient to uncross the legs immediately and reinforce hip precautions (Correct answer)
- Document the position and notify the surgeon at the next scheduled round
- Apply a hip abduction pillow and continue monitoring
- Place the patient in Trendelenburg position to reduce joint stress
Correct answer: Instruct the patient to uncross the legs immediately and reinforce hip precautions
Crossing the legs after total hip replacement violates hip precautions and can cause dislocation; immediate correction and reinforcement of precautions is the priority.
Question 2: A patient 3 days post-ORIF of a femur fracture reports sudden onset of chest pain and dyspnea. Oxygen saturation drops to 88%. What should the nurse do first?
- Administer supplemental oxygen and call a rapid response (Correct answer)
- Reposition the patient to the side-lying position
- Increase IV fluid rate to maintain perfusion
- Administer prescribed analgesic to rule out musculoskeletal cause
Correct answer: Administer supplemental oxygen and call a rapid response
These signs in a post-operative orthopaedic patient suggest pulmonary embolism; immediate oxygen and rapid response activation are the priority actions.
Question 3: A nurse is caring for a patient in skeletal traction for a femur fracture. The patient reports numbness and tingling in the foot. What is the most appropriate first action?
- Assess neurovascular status of the affected extremity and notify the provider (Correct answer)
- Increase traction weight to reduce muscle spasm causing compression
- Reassure the patient this is a normal sensation after fracture
- Elevate the foot of the bed to improve circulation
Correct answer: Assess neurovascular status of the affected extremity and notify the provider
Numbness and tingling are signs of neurovascular compromise; immediate assessment and provider notification prevent permanent nerve damage.
Question 4: A 58-year-old patient with a total knee replacement has a surgical wound with serous drainage, mild erythema extending 2 cm from the incision, and a temperature of 38.4°C on post-op day 4. What is the priority intervention?
- Notify the surgeon and obtain wound culture as ordered (Correct answer)
- Change the dressing using sterile technique and document findings
- Apply warm compresses to promote circulation
- Reassess in 2 hours as low-grade fever is expected post-operatively
Correct answer: Notify the surgeon and obtain wound culture as ordered
Erythema, drainage, and fever on day 4 suggest surgical site infection; notifying the surgeon and culturing the wound allows timely treatment.
Question 5: During compartment syndrome assessment after a tibial fracture repair, the nurse notes the 5 Ps. Which finding is the EARLIEST and most reliable indicator?
- Pain out of proportion to the injury, especially with passive stretch (Correct answer)
- Pulselessness in the distal extremity
- Paralysis of the affected limb
- Pallor of the skin distal to the injury
Correct answer: Pain out of proportion to the injury, especially with passive stretch
Pain out of proportion to injury and worsening with passive stretch is the earliest and most sensitive indicator of compartment syndrome.
Question 6: A patient with osteoporosis is admitted after a vertebral compression fracture at T12. She rates pain 8/10 and has difficulty ambulating. Which non-pharmacological intervention is the priority?
- Implement a fall prevention protocol and assist with log-roll positioning (Correct answer)
- Apply heat to the thoracic spine to reduce muscle spasm
- Begin range-of-motion exercises to maintain spinal flexibility
- Encourage the patient to ambulate independently to prevent deconditioning
Correct answer: Implement a fall prevention protocol and assist with log-roll positioning
Patients with vertebral fractures are at high fall risk, and log-roll technique protects spinal alignment during positioning.
Question 7: A patient who underwent shoulder arthroplasty is discharged with a sling. He states he will remove the sling at night 'so it doesn't bother him.' How should the nurse respond?
- Explain that the sling must be worn continuously as prescribed, including during sleep, to protect the joint (Correct answer)
- Allow the patient to remove it at night as comfort is a priority during healing
- Tell the patient to use a pillow under the arm instead of the sling at night
- Document patient preference and notify the surgeon during the next appointment
Correct answer: Explain that the sling must be worn continuously as prescribed, including during sleep, to protect the joint
After shoulder arthroplasty, continuous sling use is essential to prevent dislocation and protect the repair, including during sleep.
Orthopaedic Nurse Test Case Studies & Practical Application 2
A 72-year-old patient with a total hip replacement is found sitting with the operative leg crossed over the non-operative leg.
What is the priority nursing action?