Orthopaedic Nurse Test Ultimate Orthopaedic Nurse 3 — Questions and Answers
Question 1: A patient undergoes an open reduction and internal fixation (ORIF) of the femur. On postoperative day 2, the nurse notes a sudden drop in hemoglobin from 10.2 to 7.1 g/dL with tachycardia. The priority nursing action is:
- Encourage oral iron supplementation
- Increase IV fluid infusion rate and notify the surgeon (Correct answer)
- Recheck the hemoglobin in 4 hours
- Elevate both legs to promote venous return
Correct answer: Increase IV fluid infusion rate and notify the surgeon
A significant acute hemoglobin drop with tachycardia suggests active hemorrhage requiring immediate fluid resuscitation and surgical assessment.
Question 2: Which assessment is MOST important when a patient with a cervical spine injury is admitted?
- Skin integrity assessment
- Respiratory rate and pattern (Correct answer)
- Pain level using a numeric scale
- Peripheral pulses in the upper extremities
Correct answer: Respiratory rate and pattern
High cervical injuries (C3–C5) can paralyze the diaphragm, making respiratory assessment the immediate priority.
Question 3: A patient who had a spinal fusion is being log-rolled by nursing staff. The PRIMARY rationale for this technique is:
- Reducing patient pain during repositioning
- Maintaining spinal alignment and preventing cord injury (Correct answer)
- Decreasing the risk of skin breakdown
- Improving nursing ergonomics during repositioning
Correct answer: Maintaining spinal alignment and preventing cord injury
Log-rolling keeps the spine in neutral alignment to protect the surgical site and prevent spinal cord injury during repositioning.
Question 4: Which finding in a patient with a total knee replacement MOST warrants immediate action for potential pulmonary embolism?
- Mild swelling of the operative knee
- Sudden onset of dyspnea and pleuritic chest pain (Correct answer)
- Low-grade fever of 38.1°C on postoperative day 2
- Complaints of incisional pain rated 6/10
Correct answer: Sudden onset of dyspnea and pleuritic chest pain
Sudden dyspnea and pleuritic chest pain are classic symptoms of pulmonary embolism, a life-threatening complication after joint replacement.
Question 5: A patient with Dupuytren's contracture asks what the condition involves. The nurse's BEST response is:
- Inflammation of the bursa in the shoulder joint
- Abnormal thickening of the palmar fascia causing finger contracture (Correct answer)
- Nerve entrapment at the carpal tunnel
- Degenerative changes in the metacarpophalangeal joints
Correct answer: Abnormal thickening of the palmar fascia causing finger contracture
Dupuytren's contracture involves fibrosis and contracture of the palmar fascia, causing the fingers to curl toward the palm.
Question 6: A patient with rheumatoid arthritis is prescribed methotrexate. The nurse should instruct the patient to report which side effect IMMEDIATELY?
- Mild nausea after taking the medication
- Mouth sores appearing within 48 hours of the dose
- Shortness of breath or dry cough (Correct answer)
- Fatigue on the day after the weekly dose
Correct answer: Shortness of breath or dry cough
Methotrexate can cause pulmonary toxicity including pneumonitis, which presents as dyspnea or cough and is a serious adverse effect.
Question 7: When assessing neurovascular status distal to a fracture, the nurse checks capillary refill. A normal finding is refill in:
- Less than 2 seconds (Correct answer)
- 2 to 3 seconds
- 3 to 4 seconds
- Greater than 4 seconds
Correct answer: Less than 2 seconds
Capillary refill of less than 2 seconds indicates adequate peripheral perfusion; a longer refill time suggests compromised circulation.
Orthopaedic Nurse Test Ultimate Orthopaedic Nurse 3
A patient undergoes an open reduction and internal fixation (ORIF) of the femur.
On postoperative day 2, the nurse notes a sudden drop in hemoglobin from 10.2 to 7.1 g/dL with tachycardia.
The priority nursing action is: