Orthopaedic Nurse Test Case Studies & Practical Application 3 — Questions and Answers
Question 1: A 65-year-old patient with a hip fracture is scheduled for surgery. Pre-operative assessment reveals a serum potassium of 2.9 mEq/L. What is the nurse's priority action?
- Notify the surgeon and anesthesia team of the electrolyte imbalance before proceeding (Correct answer)
- Administer a potassium supplement per protocol and proceed with surgery prep
- Document the value and continue pre-operative preparation
- Delay surgery notification until the morning lab panel is repeated
Correct answer: Notify the surgeon and anesthesia team of the electrolyte imbalance before proceeding
Hypokalemia (K+ <3.0 mEq/L) increases the risk of intraoperative arrhythmias; the surgical and anesthesia teams must be notified before proceeding.
Question 2: A patient with a cast on the right forearm complains that the cast feels very tight and rates pain 9/10 despite analgesics. The fingers are pale and cold. What is the correct action?
- Notify the provider immediately for bivalving or removal of the cast (Correct answer)
- Elevate the arm above heart level and reassess in 30 minutes
- Administer additional analgesics and apply ice over the cast
- Loosen the cast padding from the proximal end to relieve pressure
Correct answer: Notify the provider immediately for bivalving or removal of the cast
Pallor, coldness, and uncontrolled pain under a cast indicate vascular compromise requiring immediate cast removal or bivalving by the provider.
Question 3: A post-operative patient has a continuous passive motion (CPM) machine applied after total knee replacement. The patient asks to have it turned off because of discomfort. What is the best nursing response?
- Assess pain, medicate as ordered, adjust the range of motion if within protocol limits, and contact the provider if the patient refuses (Correct answer)
- Turn off the machine to respect patient autonomy and document the refusal
- Increase the speed of the CPM to finish the cycle faster and reduce total discomfort time
- Apply heat to the knee and restart the CPM at the same setting once pain subsides
Correct answer: Assess pain, medicate as ordered, adjust the range of motion if within protocol limits, and contact the provider if the patient refuses
Addressing pain and adjusting CPM settings within protocol balances patient comfort and therapeutic goals before escalating to the provider.
Question 4: A nurse is educating a patient about crutch walking with a non-weight-bearing (NWB) restriction after ankle surgery. Which patient statement indicates a need for further teaching?
- 'I can put a little weight on my heel if I need to steady myself.' (Correct answer)
- 'I will keep my elbows slightly bent when using the crutches.'
- 'I will not bear weight on my surgical leg.'
- 'I will lift my surgical leg off the floor when walking.'
Correct answer: 'I can put a little weight on my heel if I need to steady myself.'
Non-weight-bearing means no weight at all on the operative limb; placing even heel weight violates the restriction and risks re-injury.
Question 5: An 80-year-old patient with dementia is post-op day 1 after hip pinning. She is trying to climb out of bed repeatedly. What is the safest initial intervention?
- Reorient the patient, ensure pain is managed, and use a bed exit alarm (Correct answer)
- Apply bilateral soft wrist restraints to prevent falls
- Administer a PRN sedative to keep the patient calm in bed
- Place the patient in a recliner chair with a lap tray as a reminder to stay seated
Correct answer: Reorient the patient, ensure pain is managed, and use a bed exit alarm
Non-restraint strategies such as reorientation, pain management, and bed alarms are the least restrictive and safest first interventions for an agitated post-operative dementia patient.
Question 6: A patient reports a sudden 'popping' sensation in the hip 2 days after total hip arthroplasty and cannot bear weight. X-ray confirms dislocation. What pre-reduction nursing priority applies?
- Keep the patient NPO and prepare for conscious sedation or surgical reduction (Correct answer)
- Apply manual traction to the limb to reduce the dislocation at bedside
- Position the patient with the hip flexed at 90 degrees while awaiting the surgeon
- Administer IV opioids and attempt gentle passive range of motion
Correct answer: Keep the patient NPO and prepare for conscious sedation or surgical reduction
Hip dislocation requires closed or open reduction under sedation or anesthesia; keeping the patient NPO prepares for the procedure safely.
Question 7: A patient with a long arm cast for a humerus fracture is being discharged. Which instruction is most important to include?
- Return immediately if fingers become numb, blue, or you cannot move them (Correct answer)
- Keep the arm dependent to reduce swelling around the fracture site
- Remove the cast weekly for hygiene and reapply it snugly
- Avoid elevating the arm above shoulder height for 6 weeks
Correct answer: Return immediately if fingers become numb, blue, or you cannot move them
Numbness, color change, or inability to move digits are signs of neurovascular compromise requiring immediate evaluation.
Orthopaedic Nurse Test Case Studies & Practical Application 3
A 65-year-old patient with a hip fracture is scheduled for surgery.
Pre-operative assessment reveals a serum potassium of 2.9 mEq/L.
What is the nurse's priority action?