ONCB Tests Your Orthopaedic IQ - Summer 2018 Potpourri
ONCB presents quarterly mini-quizzes to give all orthopaedic nurses a quick review opportunity. Already an orthopaedic-certified nurse? Test your knowledge just for fun! Planning to test? Get a taste of the types of questions you may encounter on the exam! Answer the questions, get the rationale, and find the reference. This quarter's questions will assess your knowledge on a variety of exam content areas.
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The nurse is assigned to care for a patient who experienced a traumatic amputation of several toes when using a lawn mower. Which of the following should the nurse identify as a potential long-term result of this injury?
Decreased ability to walk rapidly
Decreased ability to bear weight
Question 1 Explanation:
Amputation of toes may not change a normal walking gait, but it can decrease the patient’s ability to walk rapidly. Weight bearing is not a long-term concern. An ataxic gait is an unsteady, uncoordinated walk with variable leg placement; it often is related to cerebellar injury. Trendelenburg gait results from hip abductor weakness. Reference: Intro to Orthopaedic Nursing, 4th ed., p. 95
The nurse is caring for a patient with multiple fractures following a motor vehicle accident. The nurse is reviewing the risk for delirium following hip fracture with a student on the orthopaedic unit. Which of the following strategies should the nurse identify to minimize a patient’s risk for delirium?
Limit the patient’s activity.
Limit the patient’s use of opioid analgesics.
Maintain an organized environment.
Maintain consistent lighting in the room.
Question 2 Explanation:
Maintaining an organized environment will minimize the patient’s risk for delirium; for example, the patient should be oriented to the room and familiar items should be kept within the patient’s view. The patient’s independence should be maximized, and active participation encouraged in the day’s routine. Prophylactic analgesics should be used as needed, as unmanaged pain can contribute to delirium. Lighting should be appropriate to the time of day. Reference: Intro to Orthopaedic Nursing, 4th ed., p. 133
The nurse is caring for a patient in a halo vest for treatment of nondisplaced cervical fractures. Which of the following should the nurse recognize as a standard of care for this patient?
Apply creams or lotions to avoid development of dry skin under the vest.
Use a hair dryer after shampoo to remove moisture from the pins.
Cleanse the skin under the vest daily with light soap and water.
Perform pin care every other day with isopropyl alcohol.
Question 3 Explanation:
The skin under the vest should be cleansed at least daily with light soap and water, then dried thoroughly. Creams or lotions should be avoided under the vest, in part because they hold bacteria and can contribute to infection. Hairdryers must be avoided because the halo pins can loosen as a result of heating. A typical pin care regimen involves cleansing once or twice a day, often with a solution of equal parts of hydrogen peroxide and saline. Reference: Intro to Orthopaedic Nursing, 4th ed., p. 37
A patient is assessed with sensory and motor deficits following upper extremity surgery. Which of the following should the nurse recognize as suggesting the patient may have radial nerve involvement?
Inability to abduct the fingers
Decreased sensation at the tip of the index finger
Inability to oppose the thumb and little finger
Decreased sensation in the web space of the thumb
Question 4 Explanation:
Decreased sensation in the web space between the thumb and index finger suggests radial nerve involvement. Abduction of the fingers is a function of the ulnar nerve. Inability to oppose the thumb and little finger also suggests a deficit of the ulnar nerve. Decreased sensation at the tip of the index finger suggests medial nerve involvement. Reference: Intro to Orthopaedic Nursing, 4th ed., p. 9
A patient is admitted to the orthopaedic unit following total knee arthroplasty. The nurse assesses the patient’s sensation at the top of the foot on the operative side; the nurse also asks the patient to dorsiflex the ankle and extend the great toe. The nurse should understand that deficits in these areas would suggest development of
tibial nerve compression.
peroneal nerve palsy.
sural nerve damage.
obturator nerve entrapment.
Question 5 Explanation:
Peroneal nerve palsy is the most common nerve injury after TKA; the nurse’s assessment will verify intact peroneal nerve function. The sural nerve runs down the back of the leg and lateral ankle to the 4th and 5th toes; stretching injury to the nerve, as often occurs in an ankle sprain, can cause problems with sensation in those areas of the lower extremity. The tibial nerve provides sensation to portions of the sole of the foot and allows a patient to perform plantarflexion. The obturator nerve provides sensation to the medial thigh, and motor function to the hip and knee joints. Reference: Intro to Orthopaedic Nursing, 4th ed., pp. 62-63
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