Deck 43: Amputations

Question 1

The 80-year-old man with diabetes has had vascular problems with his feet and lower legs for 10 years and is scheduled for a left below-the-knee amputation.The remark by the patient that indicates an understanding of the procedure is:

A) "I am glad this amputation will end my diabetic problems."
B) "After they have hacked my leg, I won't be able to drive."
C) "If this heals well, how long until I get a prosthesis?"
D) "I hate that my left knee is going to be useless without a foot."

Answer 1

"If this heals well, how long until I get a prosthesis?"

Question 2

The nurse excitedly tells the patient about the myoelectrically controlled prosthesis,the movement of which is controlled by:

A) Patient's muscle movement and the prosthesis
B) Battery-operated muscles implanted in the prosthesis
C) Motion-sensing mechanism that swings the prosthesis forward
D) Internal computer chip in the prosthesis

Answer 2

Patient's muscle movement and the prosthesis

Question 3

The nurse explains that the routine preoperative diagnostic tests for a patient anticipating a below-the-knee amputation are:

A) Pulse volume recording and white blood cell (WBC) count.
B) Cardiac catheterization and WBC count.
C) Pulse volume recording and x-ray images.
D) Thermography and cardiac catheterization.

Answer 3

Pulse volume recording and white blood cell (WBC) count.

Question 4

The nurse conducting the safety seminar reminds the audience that upper extremity amputations are most frequently caused by trauma.The highest incidence of this type of amputation is in:

A) School-aged girls
B) School-aged boys
C) Young men
D) Young women

Question 5

The child comes to the school nurse with his index finger partially amputated and hanging by a shred of skin and muscle.The nurse should:

A) Flush the hand with warm water, and wrap it in a towel.
B) Carefully cut the skin holding the finger, and wrap the finger and hand in a clean towel.
C) Pinch the finger to stop the bleeding, and take the child to the hospital.
D) Wrap the hand and finger securely, and place it on an ice water-filled plastic bag.

Question 6

A patient who amputated his thumb in a lawnmower accident hands the emergency department nurse his thumb in a glass jar.The nurse should:

A) Place the thumb in a baggie with iced lactated Ringer solution.
B) Wrap the thumb in plastic wrap, and place it on ice.
C) Leave the thumb in the jar, and place it in the refrigerator.
D) Wrap the thumb in a cloth saturated with normal saline, and place it in a baggie.

Question 7

Preoperative exercises for a patient undergoing a lower-extremity amputation include ____________________ training.

A) Upper body
B) Lower body
C) Upper thigh
D) Head and neck

Question 8

During the admission of a patient scheduled for an amputation,the patient relates that she is a practicing Orthodox Jew.The nurse should make arrangements for:

A) A veil to cover the amputated part.
B) A rabbi present for the surgery.
C) The amputated part to be buried.
D) A family member present to read the Torah.

Question 9

The patient with peripheral vascular disease (PVD)and diabetes asks what he can do to help prevent an amputation.The nurse is quick to respond:

A) "There is not really anything you can do to help."
B) "Stopping smoking would help prevent vasoconstriction."
C) "You will not need to check your blood glucose levels."
D) "It is important to eat big meals so your body can heal."

Question 10

The patient who had a below-the-knee amputation 24 hours earlier is complaining of burning pain in his left foot.The most helpful intervention is to:

A) Remind the patient that it is only phantom pain.
B) Medicate the patient with the prescribed pain remedy.
C) Remind him that such sensations will go away in a few weeks.
D) Distract the patient with conversation.

Question 11

To reduce the possibility of hip contractures in a patient with an above-the-knee amputation,the nurse periodically places the patient in a _________________ position.

A) High Fowler
B) Side-lying
C) Flat supine
D) Completely prone

Question 12

The greatest danger in the early postoperative period after an amputation is:

A) Infection
B) Hemorrhage
C) Pain
D) Edema

Question 13

The nurse is aware that a thermographic finding of cool spots in a certain area indicates:

A) Increased blood flow
B) Decreased infection
C) Increased infection
D) Decreased blood flow

Question 14

The nurse explains that for an elbow disarticulation,the limb will be severed:

A) Just above the elbow joint
B) Just below the elbow joint
C) Between the shoulder and elbow
D) Through the elbow joint

Question 15

Because of the anticoagulant in the saliva of leeches,they are used to treat which one of the following in the patient who has undergone replantation of a body part?

A) Inadequate arterial blood flow
B) Venous insufficiency
C) Venous congestion
D) Increased arterial blood flow

Question 16

The nurse is aware that the patient who is having his leg amputated is also having a prosthesis fitted during the surgery at the same time.The preoperative teaching plan will include the fact that:

A) Extra preoperative medications will be needed.
B) A rigid dressing will be applied to accommodate the prosthesis.
C) A series of temporary prostheses will be put in place before the permanent one.
D) Wiring the residual limb will be needed to ensure acceptance of the prosthesis.

Question 17

A closed amputation is usually performed to:

A) Create a weight-bearing residual limb.
B) Alleviate the effects of trauma.
C) Allow infection to heal and drain.
D) Treat a limb with gangrene.

Question 18

The patient who has a below-the-elbow prosthesis shows the home health care nurse the residual limb,which is red,edematous,and warm to the touch.The nurse instructs the patient to:

A) Apply soothing lotion to residual limb before replacing the prosthesis.
B) Dampen the prosthetic limb sock to hydrate and cool the residual limb.
C) Pad the socket with lamb's wool, and replace the prosthesis.
D) Leave the prosthesis off, and notify physician.

Question 19

When the patient asks when he should expect to be up and walking after his below-the-knee amputation,the nurse assures him that most amputees can fully bear weight in:

A) 3 weeks
B) 1 month
C) 6 weeks
D) 3 months

Question 20

An appropriate outcome for a nursing diagnosis,"Anxiety,related to perceived threat of disability," would be:

A) Comfort is increased; verbalized pain is less.
B) Anxiety is relieved; the patient verbalizes concern related to disability.
C) Grief is resolved; the patient expresses an acceptance of loss.
D) Residual limb is cleaned; no exudate, redness, or edema is observed.

Question 21

The nurse points out the major situational occurrences that lead to amputations are: (Select all that apply.)

A) Trauma
B) Disease
C) Tumors
D) Congenital defects
E) Carelessness

Question 22

The nurse discriminates between an open and a closed amputation by saying that a closed amputation is designed to: (Select all that apply.)

A) Prepare a weight-bearing limb.
B) Cover the stump with tissue and muscle.
C) Place sutures immediately over the bone.
D) Be staged to closure.
E) Be immediately ready for a prosthesis.

Question 23

The home health care nurse suspects a neuroma in a patient who had an above-the-knee amputation 1 month earlier when the patient complains of:

A) Area of swelling and bruising on distal portion of residual limb
B) Prickling sensation over residual limb
C) Sharp severe pain in the residual limb
D) Area of numbness on distal portion of residual limb

Question 24

Patient verbalization of microvascular precautions is a criterion for measuring the achievement the outcome of:

A) Adequate circulation in the replanted limb
B) Pain relief
C) Patient knowledge of therapeutic measures
D) Adjustment to change in appearance and function

Question 25

The postoperative observation that must be reported to the physician immediately is:

A) Brownish-red drainage on the dressing, which is damp
B) Respirations of 20 breaths/min
C) Pulse of 72 beats/min
D) Bright-red bleeding

Question 26

The nurse modifies a teaching plan for an older adult who has had an above-the-knee amputation by: (Select all that apply.)

A) Offering smaller units of information at a time.
B) Increasing time for learning.
C) Placing less emphasis on chronic health problems.
D) Clarifying the reality of phantom pain.
E) Including frequent repetition.

Question 27

To diminish swelling of the residual limb in the postoperative period after an above-the-knee amputation,the nurse should:

A) Elevate the foot of the bed on blocks.
B) Elevate the residual limb on pillows.
C) Elevate the head of bed 15 degrees.
D) Turn the patient on the affected side.

Question 28

To prevent the loss of calcium and protein,the nurse reminds the patient with a recent below-the-knee amputation that he should:

A) Drink 1 to 2 L of fluid daily.
B) Ingest at least four milk products each day.
C) Ambulate 30 minutes a day.
D) Take vitamin supplements daily.

Question 29

An amputation of a gangrenous limb that is left open for 10 days before closure is classified as a ________________ amputation.

Question 30

The nurse clarifies that the precise term for the patient's amputation,which will be through the knee joint,is called ____________________.

Question 31

Late signs of hemorrhage in the postoperative period after an amputation include:

A) Restlessness and increased respirations
B) Cyanosis and hypotension
C) Confusion and seizures
D) Headache and hypertension

Question 32

The nurse includes in postoperative care for a patient with replantation of the right thumb the implementations of:

A) Decreasing the temperature of the room to 70° F.
B) Elevating the hand, but keeping it below the level of the heart.
C) Offering coffee, tea, or cola to help increase fluid intake.
D) Placing an antiembolus sleeve on the right arm.

Question 33

The nurse,when selecting possible nursing diagnoses for the 32-year-old patient who is in anticipatory grieving for an upcoming bilateral above-the-knee amputation,would consider: (Select all that apply.)

A) Anxiety, related to knowledge deficit of procedure
B) Disturbed body image, related to loss of body part
C) Sexual dysfunction, related to perceived disfigurement
D) Disturbed self-image, related to loss of independence
E) Activity intolerance, related to pain
F) None of above