Orthopaedic Nurse Test Case Studies & Practical Application 4 — Questions and Answers
Question 1: A patient's wound VAC dressing over a sternal-sparing hip wound has lost its seal and is no longer creating negative pressure. What should the nurse do first?
- Inspect the dressing edges, reinforce with tape or replace the drape, and verify suction resumes (Correct answer)
- Remove the wound VAC and apply a standard moist dressing until the wound care team arrives
- Increase the negative pressure setting to compensate for the air leak
- Document the event and continue monitoring the wound every 4 hours
Correct answer: Inspect the dressing edges, reinforce with tape or replace the drape, and verify suction resumes
A lost wound VAC seal stops therapeutic negative pressure; reinforcing or replacing the drape is the first step to restore function.
Question 2: A post-operative patient with a spinal fusion at L4-L5 is being assisted to sit at the edge of the bed for the first time. She reports severe dizziness. What is the priority nursing action?
- Return the patient to the supine position, assess vital signs, and have her sit up slowly after symptoms resolve (Correct answer)
- Lower the head of the bed and place the patient in Trendelenburg position immediately
- Administer prescribed antiemetic before attempting to re-dangle
- Encourage the patient to breathe deeply and push through the dizziness to prevent deconditioning
Correct answer: Return the patient to the supine position, assess vital signs, and have her sit up slowly after symptoms resolve
Orthostatic hypotension is common after spinal surgery; returning to supine and reassessing before re-attempting dangling prevents falls and injury.
Question 3: A nurse is caring for a patient in Buck's traction preoperatively for a hip fracture. Which finding requires immediate intervention?
- Weights are resting on the bed frame rather than hanging freely (Correct answer)
- The patient is reporting mild discomfort at the fracture site
- The foot of the bed is elevated for counter-traction
- The rope runs through the pulley in a straight line
Correct answer: Weights are resting on the bed frame rather than hanging freely
Traction weights must hang freely to provide the therapeutic pulling force; resting on the frame renders traction ineffective.
Question 4: A patient with rheumatoid arthritis is admitted for bilateral knee replacement. Pre-op assessment shows C-spine instability. How does this affect positioning during surgery, and what is the nurse's role?
- Communicate the finding to anesthesia and the surgeon; document to ensure proper neck support during intubation and positioning (Correct answer)
- Obtain a cervical collar and apply it routinely post-operatively to prevent injury
- Notify occupational therapy to assess cervical range of motion before surgery
- Delay surgery until the patient undergoes MRI to further evaluate the instability
Correct answer: Communicate the finding to anesthesia and the surgeon; document to ensure proper neck support during intubation and positioning
C-spine instability in RA patients carries risk of cord injury during intubation; clear communication to the anesthesia and surgical team is the nurse's critical pre-operative role.
Question 5: A 45-year-old male athlete reports acute knee pain, immediate swelling, and inability to bear weight after pivoting during basketball. Anterior drawer test is positive. What injury does this clinical picture most suggest?
- Anterior cruciate ligament (ACL) tear (Correct answer)
- Medial collateral ligament (MCL) sprain
- Patella dislocation
- Meniscal tear without ligament involvement
Correct answer: Anterior cruciate ligament (ACL) tear
A positive anterior drawer test, acute hemarthrosis, and a pivoting mechanism are classic signs of an ACL tear.
Question 6: A patient with a below-knee amputation is being fitted with a prosthesis for the first time. She says the residual limb feels very warm inside the socket after 30 minutes of use. What is the correct nursing guidance?
- Remove the prosthesis, inspect the residual limb for skin breakdown or pressure areas, and limit initial wear time (Correct answer)
- Tell the patient warmth is normal and she should gradually increase wearing time to 4 hours
- Apply a silicone liner over the residual limb before reapplying the prosthesis
- Advise the patient to elevate the limb for 10 minutes and then resume prosthesis wear
Correct answer: Remove the prosthesis, inspect the residual limb for skin breakdown or pressure areas, and limit initial wear time
Warmth after prosthesis wear can indicate friction or pressure injury; the limb must be inspected and wear time adjusted to prevent skin breakdown.
Question 7: A post-op patient with a total shoulder replacement has a Hemovac drain that has not produced output for 4 hours and is no longer compressed. What should the nurse assess first?
- Check whether the drain tubing is kinked or occluded and recompress the reservoir if patent (Correct answer)
- Remove the drain since output has stopped, indicating the wound is dry
- Increase the patient's IV fluids to promote drainage through the Hemovac
- Notify the surgeon immediately that the drain has malfunctioned
Correct answer: Check whether the drain tubing is kinked or occluded and recompress the reservoir if patent
Loss of Hemovac suction is often due to a kink or the reservoir needing to be recompressed; assess before escalating to the surgeon.
Orthopaedic Nurse Test Case Studies & Practical Application 4
A patient's wound VAC dressing over a sternal-sparing hip wound has lost its seal and is no longer creating negative pressure.
What should the nurse do first?