Orthopaedic Nurse Test Risk Assessment & Management 5 — Questions and Answers
Question 1: Which tool is used to screen orthopaedic patients for fracture risk due to osteoporosis?
- Morse Fall Scale
- FRAX Tool (Correct answer)
- Braden Scale
- STOP-BANG questionnaire
Correct answer: FRAX Tool
The FRAX tool calculates 10-year probability of major osteoporotic fracture using clinical risk factors and optional bone density data.
Question 2: A patient develops HIT (heparin-induced thrombocytopenia) while receiving unfractionated heparin post-arthroplasty. What is the CORRECT management?
- Switch to a lower dose of unfractionated heparin
- Discontinue heparin and administer a direct thrombin inhibitor (Correct answer)
- Transfuse platelets to maintain count above 50,000
- Switch to low-molecular-weight heparin immediately
Correct answer: Discontinue heparin and administer a direct thrombin inhibitor
All heparin products must be stopped and replaced with a non-heparin anticoagulant such as argatroban or bivalirudin in HIT.
Question 3: An elderly patient with a hip fracture is admitted from a nursing home. Which additional risk assessment is ESSENTIAL to complete on admission?
- Cardiac stress test
- Nutritional assessment using the MNA or similar tool (Correct answer)
- Pulmonary function testing
- Bone density scan
Correct answer: Nutritional assessment using the MNA or similar tool
Malnutrition is prevalent in elderly hip fracture patients and independently predicts complications, delayed healing, and mortality.
Question 4: Which finding on a postoperative patient's assessment MOST warrants notification of the surgeon for possible wound complication?
- Serosanguineous drainage on postoperative day 1
- Mild incision site warmth on postoperative day 2
- Purulent drainage with erythema extending 2 cm from wound edges on day 5 (Correct answer)
- Ecchymosis surrounding the wound on day 3
Correct answer: Purulent drainage with erythema extending 2 cm from wound edges on day 5
Purulent drainage with spreading erythema is a classic sign of surgical site infection requiring prompt provider notification.
Question 5: A patient with a spinal cord injury at T6 develops sudden severe headache, diaphoresis above the level of injury, and bradycardia. The nurse should FIRST:
- Administer IV morphine for pain relief
- Place the patient supine to prevent fainting
- Sit the patient upright and identify the noxious stimulus (Correct answer)
- Prepare for emergency intubation
Correct answer: Sit the patient upright and identify the noxious stimulus
These are signs of autonomic dysreflexia; sitting the patient upright drops blood pressure and the trigger (e.g., full bladder) must be found and removed.
Question 6: Which intervention BEST reduces the risk of aspiration pneumonia in a post-operative orthopaedic patient who has difficulty swallowing after prolonged intubation?
- Keep the patient NPO until dysphagia resolves on its own
- Request a speech-language pathology swallowing evaluation before resuming oral intake (Correct answer)
- Start clear liquids and progress as tolerated without specialist input
- Administer proton pump inhibitors prophylactically
Correct answer: Request a speech-language pathology swallowing evaluation before resuming oral intake
A formal swallowing evaluation by a speech-language pathologist identifies aspiration risk and guides safe diet modifications.
Question 7: A patient has a femoral nerve block in place after total knee replacement. Which assessment finding requires IMMEDIATE action?
- Inability to perform a straight leg raise on the operative side
- Absence of sensation on the medial aspect of the lower leg
- Signs of local anesthetic systemic toxicity including perioral numbness and metallic taste (Correct answer)
- Mild quadriceps weakness with ambulation
Correct answer: Signs of local anesthetic systemic toxicity including perioral numbness and metallic taste
Perioral numbness and metallic taste are early signs of local anesthetic systemic toxicity (LAST), a life-threatening emergency requiring immediate intervention.
Orthopaedic Nurse Test Risk Assessment & Management 5
Which tool is used to screen orthopaedic patients for fracture risk due to osteoporosis?