Deck 46: Amputations

Question 1

A patient with peripheral vascular disease (PVD)and diabetes asks what he can do to help prevent an amputation.What is the best response of the nurse?

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."

Answer 1

"Stopping smoking would help prevent vasoconstriction."

Question 2

What is the greatest danger in the early postoperative period after an amputation?

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

Answer 2

Hemorrhage

Question 3

Why is a closed amputation usually performed?

A) To create a weight-bearing residual limb
B) To alleviate the effects of trauma
C) To allow infection to heal and drain
D) To treat a limb with gangrene

Answer 3

To create a weight-bearing residual limb

Question 4

A patient who had a below-the-knee amputation 24 hours earlier is complaining of burning pain in his left foot.Which intervention is most appropriate for the nurse to implement?

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 5

What controls the movement with a myoelectrically controlled prosthesis?

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

Question 6

What are late signs of hemorrhage in the postoperative period after an amputation?

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

Question 7

A patient asks when he should expect to be up and walking after his below-the-knee amputation.When should the nurse assure him that most people with amputations can fully bear weight?

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

Question 8

A nurse is aware that a patient who is having his leg amputated is also having a prosthesis fitted during at the same time as the surgery.Which fact should the preoperative teaching plan include?

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 9

An 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.Which remark by the patient indicates an understanding of the procedure?

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."

Question 10

A nurse is conducting a safety seminar and reminds the audience that upper extremity amputations are most frequently caused by trauma.Which population has the highest incidence of this type of amputation?

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

Question 11

Where is the limb severed with an elbow disarticulation?

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

Question 12

A patient who has a below-the-elbow prosthesis shows the home health care nurse the residual limb, which is red, edematous, and warm to touch.What should the nurse instruct this patient to do?

A) Apply soothing lotion to the 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 13

What routine preoperative diagnostic tests are appropriate for a patient anticipating a below-the-knee amputation?

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

Question 14

A patient who amputated his thumb in a lawnmower accident hands the emergency department nurse his thumb in a glass jar.What is the best action for the nurse to implement?

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 15

A nurse is caring for a patient with a recent below-the-knee amputation.What should the nurse recommend to this patient to prevent the loss of calcium and protein?

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 16

What is an appropriate outcome for a patient with feelings of anxiety related to a perceived threat of disability?"

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 17

During the admission of a patient scheduled for an amputation, a patient relates that she is a practicing Orthodox Jew.What arrangements are appropriate for the nurse to make for this patient?

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

Question 18

A nurse is caring for a patient who has undergone replantation of a body part.What might the saliva of leeches be used to treat in this patient?

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

Question 19

A child comes to the school nurse with his index finger partially amputated and hanging by a shred of skin and muscle.What is the best action by the nurse?

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 20

What nursing action should be implemented in the postoperative care for a patient with replantation of the right thumb?

A) Decreasing the temperature of the room to 70 $\degree$ 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 21

Which major situational occurrences might lead to amputations? (Select all that apply.)

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

Question 22

How should a nurse modify a teaching plan for an older adult who has had an above-the-knee amputation? (Select all that apply.)

A) Offer smaller units of information at a time.
B) Increase time for learning.
C) Place less emphasis on chronic health problems.
D) Clarify the reality of phantom pain.
E) Include frequent repetition.

Question 23

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

Question 24

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

Question 25

A home health care nurse suspects a neuroma in a patient who had an above-the-knee amputation 1 month earlier.Which complaint by the patient led the nurse to suspect a neuroma?

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 26

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

Question 27

Which action should a nurse implement to diminish swelling of the residual limb in the postoperative period after an above-the-knee amputation?

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

Question 28

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

Question 29

What is a closed amputation designed to do? (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 30

Which postoperative observation must be reported to the physician immediately?

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 31

The verbalization of microvascular precautions is a criterion for measuring the achievement of which outcome?

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