Orthopaedic Nurse Test Case Studies & Practical Application 5 — Questions and Answers
Question 1: A 70-year-old patient with a hip replacement develops unilateral leg swelling, warmth, and calf tenderness on post-op day 3. Doppler ultrasound confirms DVT. Which intervention is the priority?
- Initiate anticoagulation therapy as ordered and avoid vigorous massage of the affected limb (Correct answer)
- Apply compression stockings to both legs and elevate the affected limb
- Encourage ambulation immediately to prevent clot propagation
- Place the patient on strict bed rest until the clot is completely resolved
Correct answer: Initiate anticoagulation therapy as ordered and avoid vigorous massage of the affected limb
Anticoagulation is the definitive treatment for DVT; massaging the leg is contraindicated due to risk of embolization.
Question 2: A patient with a pelvic fracture is noted to have gross hematuria and a distended abdomen. Blood pressure is 88/54 mmHg. What is the nurse's priority action?
- Activate the trauma response, initiate large-bore IV access, and prepare for fluid resuscitation (Correct answer)
- Insert a urinary catheter to monitor urine output and assess for ongoing bleeding
- Apply a pelvic binder and transfer to CT immediately
- Administer prescribed analgesics and recheck vital signs in 15 minutes
Correct answer: Activate the trauma response, initiate large-bore IV access, and prepare for fluid resuscitation
Hemodynamic instability with internal bleeding signs requires immediate trauma team activation and resuscitation before other interventions.
Question 3: An elderly patient with osteoporosis is prescribed bisphosphonate therapy after a wrist fracture. She states she takes the pill with orange juice right after breakfast. What teaching point does the nurse prioritize?
- Bisphosphonates must be taken with a full glass of plain water on an empty stomach, and the patient must remain upright for 30 minutes after (Correct answer)
- Orange juice is preferable to plain water because the acidic environment improves absorption
- The pill should be taken with food to minimize gastrointestinal side effects
- She should take the medication at bedtime to avoid esophageal irritation from lying down
Correct answer: Bisphosphonates must be taken with a full glass of plain water on an empty stomach, and the patient must remain upright for 30 minutes after
Bisphosphonates require plain water, fasting, and remaining upright to ensure absorption and prevent esophageal erosion.
Question 4: A patient with a tibial plateau fracture managed non-operatively is in a long leg cast. The nurse notes an area of the cast that feels warm and has a foul odor. What is the most likely cause and priority action?
- Suspect wound infection or pressure injury underneath; notify the provider for cast windowing or removal (Correct answer)
- Reassure the patient that heat is generated as the cast cures and odor from normal sweat is expected
- Apply powder inside the cast to reduce moisture and odor
- Elevate the extremity and increase the frequency of neurovascular checks
Correct answer: Suspect wound infection or pressure injury underneath; notify the provider for cast windowing or removal
Localized warmth and foul odor under a cast suggest skin breakdown or infection requiring provider evaluation and possible cast removal.
Question 5: A nurse is discharging a patient who had an ORIF for a distal radius fracture. The patient asks when he can return to his manual labor job. Which response is most appropriate?
- Return-to-work timing depends on healing confirmed by imaging and the surgeon's assessment, typically 8–12 weeks for heavy labor (Correct answer)
- He can return when pain is gone, usually within 2 weeks for desk work and 4 weeks for manual labor
- Once the cast is off at 6 weeks, he can resume all activities including heavy lifting
- There is no standard timeline; tell him to return to work when he feels ready
Correct answer: Return-to-work timing depends on healing confirmed by imaging and the surgeon's assessment, typically 8–12 weeks for heavy labor
Return to manual labor after ORIF depends on radiographic healing and surgeon clearance, typically 8–12 weeks, not symptom resolution alone.
Question 6: A patient with a cervical spine injury is admitted in a halo vest. During morning care, the nurse notices that one of the halo pins is loose. What is the correct action?
- Notify the neurosurgeon immediately; do not attempt to retighten the pin without a provider order (Correct answer)
- Retighten the pin using the torque screwdriver kept at the bedside per protocol
- Apply additional padding around the loose pin to stabilize it temporarily
- Replace the halo vest entirely until the surgeon can assess the pin site
Correct answer: Notify the neurosurgeon immediately; do not attempt to retighten the pin without a provider order
Halo pin retightening requires a physician order and proper technique; unauthorized tightening can cause skull penetration or infection.
Question 7: A patient with a recent Achilles tendon repair is eager to begin weight-bearing. The nurse reviews the surgeon's order, which specifies NWB for 6 weeks. The patient says his friend had the same surgery and walked in 2 weeks. What is the best nursing response?
- Explain that weight-bearing protocols are individualized and this surgeon's order must be followed to protect the repair (Correct answer)
- Allow the patient to begin toe-touch weight-bearing as a compromise between NWB and his request
- Contact the surgeon to request an updated order reflecting the patient's motivation to progress
- Document the patient's preference and defer to physical therapy to make the weight-bearing decision
Correct answer: Explain that weight-bearing protocols are individualized and this surgeon's order must be followed to protect the repair
Weight-bearing restrictions after Achilles repair are individualized; the nurse must reinforce the surgeon's specific orders, not anecdotal comparisons from others.
Orthopaedic Nurse Test Case Studies & Practical Application 5
A 70-year-old patient with a hip replacement develops unilateral leg swelling, warmth, and calf tenderness on post-op day 3.
Doppler ultrasound confirms DVT.
Which intervention is the priority?