Orthopaedic Nurse Test Risk Assessment & Management 4 — Questions and Answers
Question 1: A patient on warfarin for atrial fibrillation requires emergency hip surgery. Which intervention MOST rapidly reverses warfarin's anticoagulant effect?
- Administer vitamin K only
- Hold warfarin and recheck INR in 24 hours
- Administer 4-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
- Transfuse fresh frozen plasma and recheck INR in 6 hours
Correct answer: Administer 4-factor prothrombin complex concentrate (4F-PCC)
4F-PCC provides rapid reversal of warfarin by replenishing factors II, VII, IX, and X within minutes.
Question 2: Which patient characteristic is the STRONGEST independent risk factor for postoperative delirium in orthopaedic patients?
- Female sex
- Preexisting cognitive impairment (Correct answer)
- Body mass index above 30
- History of depression
Correct answer: Preexisting cognitive impairment
Preexisting cognitive impairment is the strongest predictor of postoperative delirium in older surgical patients.
Question 3: An orthopaedic nurse is performing the 5 Ps assessment on a patient with a lower leg cast. What does each 'P' assess?
- Pain, Pallor, Paresthesia, Paralysis, Pulses (Correct answer)
- Pressure, Perfusion, Pulse, Position, Pain
- Petechiae, Pallor, Pressure, Paralysis, Pulse
- Pain, Pressure, Pulse, Perfusion, Posture
Correct answer: Pain, Pallor, Paresthesia, Paralysis, Pulses
The 5 Ps (Pain, Pallor, Paresthesia, Paralysis, Pulses) are used to assess neurovascular status and detect compartment syndrome.
Question 4: Which measure is MOST effective in preventing surgical site infections (SSI) in patients undergoing total joint replacement?
- Routine post-operative antibiotics for 7 days
- Pre-operative skin antiseptic shower and timely perioperative antibiotic prophylaxis (Correct answer)
- Wearing two pairs of sterile gloves intraoperatively
- Changing wound dressings every 6 hours post-operatively
Correct answer: Pre-operative skin antiseptic shower and timely perioperative antibiotic prophylaxis
Chlorhexidine showers before surgery combined with perioperative antibiotic prophylaxis within 60 minutes of incision are the most evidence-based SSI prevention measures.
Question 5: A patient recovering from a tibial plateau fracture reports that their pain has increased significantly and is no longer relieved by opioid analgesics. What should the nurse suspect?
- Opioid tolerance has developed
- Acute compartment syndrome (Correct answer)
- Wound infection
- Psychological drug-seeking behavior
Correct answer: Acute compartment syndrome
Pain out of proportion to injury that is unresponsive to opioids is the hallmark warning sign of acute compartment syndrome.
Question 6: Which electrolyte abnormality commonly seen after major orthopaedic surgery can increase the risk of cardiac arrhythmias?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hypokalemia
Hypokalemia decreases cardiac membrane stability and can precipitate ventricular arrhythmias, especially in patients receiving digoxin.
Question 7: A nurse is caring for a patient post-total hip replacement who is at high risk for hip dislocation. Which position is CONTRAINDICATED?
- Legs abducted with a pillow between the knees
- Head of bed elevated to 45 degrees
- Hip flexion greater than 90 degrees (Correct answer)
- Lateral repositioning with a pillow between legs
Correct answer: Hip flexion greater than 90 degrees
Hip flexion beyond 90 degrees after posterior approach total hip replacement places the prosthesis at high risk for posterior dislocation.
Orthopaedic Nurse Test Risk Assessment & Management 4
A patient on warfarin for atrial fibrillation requires emergency hip surgery.
Which intervention MOST rapidly reverses warfarin's anticoagulant effect?