ONC Degenerative Disease Practice Exam 50 Questions with Verified Answers
A patient with a history of osteoarthritis states she has been using exercise
... [Show More] as a means to delay progression of the disease. However, she now complains of increased pain in her knees. Given this complaint, which of the following forms of exercise should the nurse suspect the patient uses?
a. Swimming
b. Water aerobics
c. Running
d. Stationary bicycling - CORRECT ANSWER c. Running
Rationale: Activity modification in the treatment of OA may include switching from high-impact exercise such as running and competitive sports to low-impact exercise such as swimming and walking. Running could exacerbate joint symptoms.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 71
A patient recently underwent left hip arthroplasty. The nurse should do which of the following to decrease the patient's risk of venous thromboembolism (VTE)?
a. Elevate the foot of the patient's bed.
b. Place an abductor pillow between the patient's legs.
c. Encourage the patient to begin ambulation.
d. Ensure the patient has adequate pain management. - CORRECT ANSWER c. Encourage the patient to begin ambulation.
Rationale: Patients undergoing orthopaedic surgery are at increased risk for VTE. Prevention strategies are mechanical, physical, and pharmacological. Physically, the formation of clots can be prevented with early ambulation and bed exercises such as ankle pumps.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 201; An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 139
Following total shoulder arthroplasty, a patient is wearing a complicated sling that is unfamiliar to the nurse. What should be the nurse's best strategy when the patient asks for help in dressing?
a. Find instructions on the Internet about how to remove the sling.
b. Tell the patient to have a family member help with dressing.
c. Tell the nursing assistant the patient needs help with dressing.
d. Ask the occupational therapist to review removal and application of the sling. - CORRECT ANSWER d. Ask the occupational therapist to review removal and application of the sling.
Rationale: Patients who have shoulder surgery must adhere to postoperative precautions, especially when completing ADLs. If the patient must wear a sling, an occupational therapist will be an excellent resource in discussing removal and application of the device.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 175
The nurse is caring for a patient who underwent total knee arthroplasty. The nurse should identify which of the following as a primary risk factor for possible development of deep vein thrombosis (DVT)?
a. Poor nutritional status
b. Venous stasis
c. Low oxygen saturation
d. History of lung disease - CORRECT ANSWER b. Venous stasis
Key: b
Rationale: The pathophysiology of deep vein thrombosis is explained by Virchow's Triad of venous stasis, trauma, and hypercoagulability state. Venous stasis is caused by immobility and leads to blood pooling, which can contribute to clot formation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 200
In providing a staff inservice on pain management after total knee arthroplasty, the nurse should remind attendees that poor postoperative pain management can contribute to
a. increased patient satisfaction.
b. increased risk of infection.
c. decreased blood pressure and heart rate.
d. decreased effectiveness of rehabilitation. - CORRECT ANSWER d. decreased effectiveness of rehabilitation.
Rationale: Poor pain management can lead to decreased effectiveness of the rehabilitation program, with physiologic, economic, and psychological consequences.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 130
A new nurse receives orders to administer enoxaparin (Lovenox) to a patient following resurfacing hip arthroplasty. In reviewing a medication reference for information about enoxaparin, the nurse should learn
a. this medication is given intramuscularly.
b. this drug is interchangeable with heparin.
c. the injection site should not be massaged after drug administration.
d. the platelet count need not be monitored during use of this drug. - CORRECT ANSWER c. the injection site should not be massaged after drug administration.
Key: c
Rationale: It is recommended to alternate sites of administration; do not rub injection site after administration. Enoxaparin should not be given intramuscularly (IM) but should be administered by subcutaneous injection. As a low molecular weight heparin, enoxaparin can contribute to development of thrombocytopenia. The nurse should monitor results of complete blood counts and assess for signs of bleeding.
Reference: Hochadel, M. (2016). Mosby's drug reference for health professions (5th ed.). St. Louis, MO: Elsevier. pp. 557-559
A patient with chronic sepsis of the right knee is in the clinic to discuss surgical options. The nurse should expect which of the following procedures to be discussed?
a. Total knee arthroplasty
b. Arthrodesis
c. Synovectomy
d. Tibial osteotomy - CORRECT ANSWER b. Arthrodesis
Rationale: Arthrodesis, or knee fusion, is one of the last options to give the patient a stable, painless knee. Indications include chronic sepsis, failed TKA, and periarticular tumor. The other procedures would not be indicated for a septic joint.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 577
A perioperative nurse is preparing to receive a patient for total hip arthroplasty. The nurse should expect the patient to need antibiotic-impregnated cement based on which of the following in the patient's medical history?
a. Diabetes
b. Hypertension
c. Long-term use of NSAIDs
d. Chronic opioid use - CORRECT ANSWER a. Diabetes
Rationale: Antibiotic-impregnated cement may be used in patients with diabetes, those taking immunosuppressive medications, or patients undergoing revision surgery.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 575
A 62-year-old seeks evaluation for unrelenting pain and a progressive loss of shoulder function in the last year. The nurse should know which of the following is MOST LIKELY to be recommended for treatment?
a. Treatment with NSAIDs
b. Intra-articular steroid injection
c. Total shoulder arthroplasty
d. Physical therapy three times a week - CORRECT ANSWER c. Total shoulder arthroplasty
Rationale: TSA is indicated due to the progressive loss of function and unrelenting pain. NSAIDs and injections are temporary treatments that will not address the underlying problem. Physical therapy is a conservative treatment not indicated given the progressive loss of function.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 26
The nurse is preparing to discharge a patient following total knee arthroplasty. Which of the following should the nurse include in patient education?
a. Maintaining a desirable weight
b. Using opioids for long-term pain management
c. Getting used to a more sedentary lifestyle
d. Having a family member perform range of motion on the knee - CORRECT ANSWER a. Maintaining a desirable weight
Rationale: Maintaining a healthy weight will prolong the life of the new prosthesis by putting less stress on it. The other options are not appropriate for discharge care.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 349
The nurse is preparing to discharge a 36-year-old construction worker who underwent total hip arthroplasty. Which of the following should the nurse identify as a life-altering change expected for this patient?
a. The need for assistance during rehabilitation
b. Use of an assistive device such as walker or crutches
c. Having to seek a different job
d. Using antibiotics before dental work - CORRECT ANSWER c. Having to seek a different job
Rationale: Due to the heavy lifting typical to a construction worker, the patient should change jobs to prevent damage to the hip joint. The other options are temporary, not life-altering.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 553
Some weeks after undergoing total ankle arthroplasty for traumatic arthritis, a patient has an office visit. The patient's condition during an office visit is consistent with osteomyelitis. Which of the following should the nurse recognize as indicative of early osteomyelitis?
a. A pathologic fracture of the affected bone
b. Drainage from an abscess on the affected limb
c. X-ray changes showing areas of bony destruction
d. Acute pain and swelling accompanied by fever - CORRECT ANSWER d. Acute pain and swelling accompanied by fever
Rationale: Osteomyelitis starts as an acute infection with an inflammatory reaction within the infected bone. Early signs would be acute pain, swelling, and fever. Pathologic fracture and abscess formation are late signs of osteomyelitis. X-ray changes are not apparent until after the infection has been present long enough to cause bony destruction.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 220-221
A patient who has been recently diagnosed with osteoarthritis (OA) tells the nurse his mother had rheumatoid arthritis. He asks, "What is the difference?" The nurse's response should be based on knowledge that OA is characterized by which of the following?
a. Positive anti-CCP antibodies
b. Use of DMARD therapy
c. Asymmetrical joint involvement
d. Development of a swan neck deformity - CORRECT ANSWER c. Asymmetrical joint involvement
Rationale: OA is marked by asymmetric joint involvement; e.g., the right knee and the left hip could be affected. The other options are all characteristic of rheumatoid arthritis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 342
A patient complains of pain in his neck, and numbness and tingling in the upper extremities. The nurse should expect the diagnosis of cervical degenerative disc disease to be verified by
a. electromyogram (EMG).
b. computerized axial tomography (CT).
c. magnetic resonance imaging (MRI).
d. bone mineral density testing (BMD). - CORRECT ANSWER c. magnetic resonance imaging (MRI).
Rationale: Cervical degenerative disc disease is best evaluated by MRI.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 456, 462
Following surgery to stabilize the cervical spine, the patient has a halo brace placed. The nurse should understand proper adjustment of the pins ensures they do not
a. come loose.
b. pierce the skin.
c. create large holes.
d. puncture the skull. - CORRECT ANSWER d. puncture the skull.
Rationale: The pins are pushed through the skin and rest against the skull. Proper tightening of the pins ensures they do not puncture the skull.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 470
The nurse is presenting a class about osteoarthritis for older women at the community center. Which of the following should the nurse identify as the most often cited disability among older women with osteoarthritis?
a. Immobility
b. Swelling
c. Pain
d. Stiffness - CORRECT ANSWER c. Pain
Rationale: Disabling pain is the most often cited disability among older women, and the most common reason persons with OA seek medical care.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 347
A patient reviews modifiable risk factors for symptomatic knee osteoarthritis with the nurse. Which of the following, if identified by the patient, should indicate to the nurse the need for further education on this topic?
a. Obesity
b. Injury
c. Mechanical stress
d. Crepitus - CORRECT ANSWER d. Crepitus
Reference: Obesity, injury, and mechanical stress are modifiable risk factors for knee OA. Crepitus is a sign of OA, not a risk factor for the disease.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 347
The nurse is orienting a new graduate nurse to the orthopaedic unit. In caring for a patient who has undergone cervical discectomy and fusion, the nurse should explain to the new graduate that the incision for this procedure is made routinely on the front left of the neck to minimize the risk of injury to the
a. carotid artery.
b. axillary nerve.
c. internal Haversian system.
d. recurrent laryngeal nerve. - CORRECT ANSWER d. recurrent laryngeal nerve.
Rationale: The recurrent laryngeal nerve is protected anatomically on the left side of the neck.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 457, 459
The nurse is discussing possible surgical options for a patient with osteoarthritis of the knee. Which of the following, if identified by the patient, should indicate to the nurse the need for further education?
a. Proximal tibial osteotomy
b. Unicompartmental knee arthroplasty
c. Total knee arthroplasty
d. Patellectomy - CORRECT ANSWER d. Patellectomy
Rationale: Patellectomy is not an appropriate surgery for OA of the knee. The other procedures may be considered, depending on patient symptoms and surgeon recommendation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 349
A nurse is discussing the unpredictable course of osteoarthritis with a patient recently diagnosed with knee OA. The nurse should recognize which of the following statements by the patient as indicating a need for further education?
a. "I should try to maintain my ideal weight."
b. "I should avoid exercise to decrease stress on the joint."
c. "I should use proper body mechanics at work."
d. "I should take over-the-counter medications to decrease joint pain." - CORRECT ANSWER b. "I should avoid exercise to decrease stress on the joint."
Rationale: Exercise is important to maintain joint mobility and help in weight loss. It is not beneficial to be sedentary.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 350
A nurse identifies arthritic deformities on the distal interphalangeal joints of a patient with osteoarthritis. The nurse should recognize these as
a. Bouchard's nodes.
b. Pott's deformity.
c. Colles instability.
d. Heberden's nodes. - CORRECT ANSWER d. Heberden's nodes.
Rationale: Heberden's nodes indicate osteophyte formation and loss of joint space in the distal interphalangeal joints of persons with OA. Bouchard's nodes appear on the proximal interphalangeal joints.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 347-348
The nurse is discussing diagnosis of different forms of arthritis with a patient with suspected osteoarthritis. The nurse should identify which of the following as best able to differentiate between OA and rheumatoid arthritis?
a. Radiographs
b. Erythrocyte sedimentation rate (ESR)
c. Synovial fluid analysis
d. Serum uric acid - CORRECT ANSWER c. Synovial fluid analysis
Rationale: Synovial fluid analysis differentiates OA from inflammatory arthritis. Joint fluid is clear yellow in OA, with high viscosity due to normal amounts of hyaluronic acid. White blood cell count is low. Synovial fluid in rheumatoid arthritis, an inflammatory condition, is straw-colored and slightly cloudy, with flecks of fibrin and white blood cells.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 341, 348
A patient diagnosed with a spinal disorder is undergoing conservative treatment. Which of the following should the nurse recognize as one spinal condition that would require immediate surgical management?
a. Cauda equina syndrome
b. Idiopathic scoliosis
c. Postural kyphosis
d. Cervical herniation - CORRECT ANSWER a. Cauda equina syndrome
Rationale: Conservative treatment for spinal disorders is attempted before considering surgery, with the exception of cauda equina syndrome. This condition is marked by saddle anesthesia, acute paraplegia, and/or bowel or bladder incontinence; it is a surgical emergency.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 462, 464
The nurse is caring for a patient with a herniated intervertebral disc in the lumbar spine. The nurse should expect the patient to report the lumbar pain is usually aggravated by
a. axial loading.
b. rotation.
c. extension.
d. standing. - CORRECT ANSWER d. standing.
Reference: Pain from a herniated lumbar disc is usually aggravated by standing, walking, bending, and coughing or sneezing. Pain from cervical disc herniation may be aggravated by rotation, extension, lateral bending, and axial loading.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 462
A patient with a herniated intervertebral disc has been prescribed a corset for short-term use. The nurse providing instruction on the use of the corset should caution the patient that long-term use will
a. increase inflammation paradoxically.
b. weaken the muscles of the affected area.
c. cause permanent damage to the affected nerve root.
d. increase muscle spasms. - CORRECT ANSWER b. weaken the muscles of the affected area.
Rationale: A brace or corset may be used on a short-term basis, but long-term use is contraindicated because it will weaken the back and abdominal muscles of the affected area.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 457, 462
A patient with spinal stenosis asks the nurse about positions that may help with pain relief. The nurse should identify which of the following as MOST LIKELY to alleviate pain?
a. Forward flexed
b. Straight standing
c. Prone
d. Supine - CORRECT ANSWER a. Forward flexed
Rationale: A forward flexed posture, such as leaning on a grocery cart while shopping, opens the spinal canal slightly and may alleviate pressure on nerves for a person with spinal stenosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 462
The nurse should instruct the patient with spinal stenosis to avoid which of the following spinal positions during activity?
a. Flexion
b. Rotation
c. Extension
d. Circumduction - CORRECT ANSWER c. Extension
Rationale: Extension activities should be avoided because they cause further spinal compression for the patient with spinal stenosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 462
A patient has a history of failed back syndrome after multiple spinal surgeries. After providing information about appropriate activities for the patient, the nurse should recognize which of the following statements by the patient as indicating a need for further education?
a. "I will pace activities to provide rest intervals."
b. "I will use a brace as prescribed by my provider."
c. "I will participate in a supervised exercise program."
d. "I will limit spinal movement to decrease pain." - CORRECT ANSWER d. "I will limit spinal movement to decrease pain."
Rationale: A patient with failed back syndrome should be encouraged to participate in activities that promote mobilization and self-care. Minimizing spinal movement does not increase mobility, flexibility, and strength; the patient needs further education
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 466
During a preoperative joint arthroplasty program, the nurse is assessing a patient with hip osteoarthritis. The nurse should recognize which of the following as an abnormal gait that indicates progressive degeneration of the patient's hip?
a. Trendelenburg gait
b. Ataxic gait
c. Antalgic gait
d. Scissor gait - CORRECT ANSWER a. Trendelenburg gait
Rationale: Progressive degeneration of the hip commonly results in a Trendelenburg gait, caused by weakness of the hip abductor muscles. The pelvis droops on the unaffected side at the moment of heel strike on the affected side. Muscle atrophy results from disuse and decreased range of motion of the affected hip.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 55
During a preoperative patient education program on joint arthroplasty, the nurse discusses cemented vs. non-cemented prostheses. The nurse should identify which of the following as a benefit of the CEMENTED prosthesis?
a. Fewer problems with loosening
b. Decreased intraoperative blood loss
c. Early weight bearing
d. Increased joint range of motion - CORRECT ANSWER c. Early weight bearing
Rationale: The cemented prosthesis allows earlier weight bearing than the non-cemented prosthesis; this allows earlier mobility to patient tolerance and decreases the risk of mobility-related complications.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 554-555
After undergoing total hip arthroplasty via a posterolateral approach, the patient receives instructions on how to decrease the risk for dislocation. The nurse should include which of the following instructions?
a. "Avoid hyperextension of the hip."
b. "Do not internally rotate the hip."
c. "Maintain the hip in at least 90 degrees of flexion."
d. "Do not abduct the hip." - CORRECT ANSWER b. "Do not internally rotate the hip."
Rationale: The posterolateral approach results in less muscle damage but may be more prone to dislocation than other approaches. This patient must avoid internal rotation, adduction, and hip hyperflexion.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 556
Following a preoperative joint arthroplasty class, a patient tells the nurse, "My surgeon expects to use a porous coated prosthesis. What does that mean?" The nurse should identify this type of prosthetic as having
a. two metal articulating surfaces.
b. separate prosthetic elements for best fit.
c. polymethylmethacrylate cement in the femoral shaft.
d. a surface that allows for bony ingrowth. - CORRECT ANSWER d. a surface that allows for bony ingrowth.
Rationale: "Porous coated" refers to the surface of the components that allow for bony ingrowth of the prosthesis where it articulates with the bone. This is typical of non-cemented components.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 554
Following total knee arthroplasty, the patient is taught to perform ISOMETRIC exercises. The nurse should identify which of the following as an appropriate exercise for this patient?
a. Quadriceps setting
b. Straight leg raises
c. Standing calf raises
d. Leg extension - CORRECT ANSWER a. Quadriceps setting
Rationale: Isometric exercises include quadriceps setting, gluteal setting, and dorsiflexion/plantar flexion of the ankle (ankle pumps).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 578
A patient with knee osteoarthritis tells the nurse she has begun using glucosamine and chondroitin sulfate for treatment of this disorder but has had no response. The nurse should suggest the patient discontinue the supplements if a positive response has not been experienced in
a. 2 weeks.
b. 6 weeks.
c. 12 weeks.
d. 6 months. - CORRECT ANSWER b. 6 weeks.
Rationale: Studies show persons with mild-to-moderate OA who took these supplements experienced pain management similar to NSAIDs. However, if no symptom change has occurred after 6 weeks of usage, the patient should discontinue the supplements.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 349-350
Following total knee arthroplasty, a patient is started on a continuous passive motion (CPM) machine. In providing patient education, the nurse should identify decreased as a benefit of the CPM machine.
a. development of adhesions during healing
b. bleeding at the surgical site
c. analgesic requirements
d. wound dehiscence - CORRECT ANSWER a. development of adhesions during healing
Rationale: Passive motion has been shown to stimulate healing of articular cartilage and reduce the development of adhesions.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 249
A nurse is discussing shoulder osteoarthritis with a group of student nurses on the orthopaedic unit. Which statement by one of the students should the nurse identify as indicating the need for further instruction concerning causes of joint deformity in shoulder OA?
a. "Joint deformity occurs secondary to loss of articular cartilage."
b. "Collapse of subchondral bone can cause shoulder deformity."
c. "Atrophy of adjacent muscles can cause shoulder deformity."
d. "Joint deformity of the shoulder can result from prolonged immobility." - CORRECT ANSWER d. "Joint deformity of the shoulder can result from prolonged immobility."
Rationale: Joint immobility does not lead to shoulder deformity. However, loss of articular cartilage, collapse of subchondral bone, and atrophy of adjacent muscles can result in joint deformity in the osteoarthritic shoulder.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 482
Following shoulder surgery, an important goal of care for the patient is to reduce stress on the operative area. Which of the following positions should the nurse choose to accomplish this goal?
a. Place the operative arm on pillows.
b. Keep the head of the bed flat.
c. Remove the sling while the patient is in bed.
d. Place ice on the incision. - CORRECT ANSWER a. Place the operative arm on pillows.
Rationale: Positioning to reduce stress on the operative shoulder includes elevating the head of the bed, supporting the operative arm with pillows, and maintaining correct alignment of the shoulder while the patient is in bed.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 485-486
In educating a patient who has just been diagnosed with carpal tunnel syndrome, the nurse should identify which of the following as the affected nerve?
a. Ulnar
b. Radial
c. Median
d. Tibial - CORRECT ANSWER c. Median
Rationale: Carpal tunnel syndrome is a median nerve entrapment neuropathy. The median nerve is compressed under the transverse carpal ligament in the wrist.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 546
A patient returns from total knee arthroplasty with an epidural catheter in place for analgesic delivery. The nurse should perform a thorough assessment based on knowledge of which of the following as a potential complication of epidural analgesia?
a. Hypertension
b. Urinary incontinence
c. Coagulopathy
d. Neurologic impairment - CORRECT ANSWER d. Neurologic impairment
Rationale: Neurologic impairment can occur if the epidural catheter migrates to the cerebrospinal fluid. In addition, an epidural hematoma can develop and put pressure on the spinal nerves. The nurse should perform regular neurovascular assessments to quickly determine any deficits.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 173
patient is scheduled to undergo shoulder surgery. The nurse should expect which of the following as an appropriate nerve block for this patient?
a. Axillary
b. Interscalene
c. Supraclavicular
d. Mid-scapular - CORRECT ANSWER b. Interscalene
Rationale: An interscalene block is used for shoulder surgery and arthroscopic procedures of the upper extremity. Supraclavicular blocks can be used for lower arm contracture release or tendon repairs, but the increased risk for pneumothorax has led to their disuse. Axillary blocks have the same indication as supraclavicular blocks.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 175
The nurse is discussing risk factors for venous thromboembolism with a group of nursing students providing care to patients after joint arthroplasty. Which of the following statements by one of the students should indicate to the nurse a need for further education?
a. "A postmenopausal woman who takes estrogen replacement may be at greater risk for blood clots."
b. "A patient who is in surgery for more than 30 minutes is at increased risk for blood clots."
c. "Obesity is a significant risk factor for blood clots."
d. "Risk for blood clots is minimal until a patient reaches age 60." - CORRECT ANSWER d. "Risk for blood clots is minimal until a patient reaches age 60."
Rationale: Risk for clots increases after age 40, and becomes even greater after age 60. However, other risk factors identified in this question can affect a patient no matter what age.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 200
A nurse is caring for a patient who underwent total hip arthroplasty. The nurse should suspect the patient may have developed a pulmonary embolus based on which of the following assessment findings?
a. Confusion and dyspnea
b. Bradycardia and chest pain
c. Hypotension and bradypnea
d. Rubor and diaphoresis - CORRECT ANSWER a. Confusion and dyspnea
Rationale: Assessment of a patient with suspected PE may identify a feeling of apprehension, restlessness, confusion, anxiety, or lightheadedness. The patient may exhibit dyspnea, cough, hemoptysis, decreased/abnormal breath sounds, abnormal respiratory rate/pattern, tachypnea, hypoxia, or cyanosis. Cardiac signs may include tachycardia, palpitations, split S2, hypotension, syncope, and chest pain. The patient's skin may be cool or warm; the patient may be diaphoretic, with pallor, cyanosis, and sluggish capillary refill.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 201
A patient is scheduled to undergo total hip arthroplasty. The nurse should understand this patient is MOST LIKELY at risk for development of postoperative fat embolism syndrome due to which of the following?
a. Length of the procedure
b. Performance of intramedullary reaming
c. Excessive blood loss
d. Maintenance of intraoperative hypotension - CORRECT ANSWER b. Performance of intramedullary reaming
Rationale: Intramedullary reaming during joint arthroplasty is a risk factor for FES.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 203
Following total knee arthroplasty, a patient has progressed from a walker to a single cane. To ensure correct fit, the nurse should know the patient's elbow must be flexed to an angle of
a. 5-10 degrees.
b. 15-20 degrees.
c. 25-30 degrees.
d. 35-40 degrees. - CORRECT ANSWER c. 25-30 degrees.
Rationale: For correct fit of a cane, the patient's elbow must be flexed to a 25-30 degree angle.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 238
The nurse is teaching a patient how to go down the stairs with crutches as he prepares for discharge after total knee arthroplasty. Which of the following sequences should the nurse correctly use in instructing the patient?
a. Crutches, operative leg, unaffected leg
b. Crutches, unaffected leg, operative leg
c. Unaffected leg, crutches, operative leg
d. Operative leg, crutches, unaffected leg - CORRECT ANSWER a. Crutches, operative leg, unaffected leg
Rationale: The patient advances the crutches to the next step, followed by the operative leg. Then the stronger or unaffected leg is advanced.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 237
A patient has been diagnosed with mild early osteoarthritis of the hands. Assuming there are no contraindications for this patient, which of the follow should the nurse identify as a recommendation of the American College of Rheumatology for INITIAL treatment of osteoarthritic pain?
a. Ibuprofen (Motrin®) 400 mg four times daily
b. Acetaminophen (Tylenol®) 1000 mg four times daily
c. Celecoxib (Celebrex®) 100 mg twice daily
d. Tramadol (Ultram®) 25 mg twice daily - CORRECT ANSWER b. Acetaminophen (Tylenol®) 1000 mg four times daily
Rationale: Acetaminophen is recommended as the initial drug of choice for treating OA pain in doses up to 1000 mg four times daily if the patient has no liver disease.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 348
A patient had correction of a bunion deformity at the outpatient surgery center. Prior to discharge, she tells the nurse she will likely have surgery on the other foot in the future. The nurse should identify which of the following as a likely etiology for the patient's diagnosis of hallux valgus?
a. Elevated arch
b. Use of narrow-toed shoes
c. History of osteoarthritis
d. Plantar fasciitis - CORRECT ANSWER b. Use of narrow-toed shoes
Rationale: Use of narrow-toed or high-heeled shoes is a possible etiology for development of hallux valgus. Severe flatfoot deformity, rheumatoid arthritis, and chronic tightness of the Achilles tendon are additional risk factors.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 598
A patient has come to the clinic with complaints of foot pain. The nurse should identify a flexion deformity of the distal interphalangeal joint of the toe as a
a. hammer toe deformity.
b. claw toe deformity.
c. mallet toe deformity.
d. trigger toe deformity. - CORRECT ANSWER c. mallet toe deformity.
Rationale: A flexion deformity of the DIP joint of the toe is called mallet toe deformity. Hammer toe deformity is a plantar flexion deformity of the PIP. Claw toe deformity combines a hammer toe deformity and dorsiflexion (hyperextension) deformity of the MTP joint.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 601
The nurse is discussing minimally invasive hip arthroplasty with a patient who has osteoarthritis. Which of the following statements by the patient should indicate to the nurse a need for further teaching about this procedure?
a. "This surgery will cause less trauma to surrounding tissues."
b. "One of the risks of this procedure is tibial nerve palsy."
c. "I will be satisfied with the appearance of the smaller incision."
d. "I expect a shorter stay in the hospital." - CORRECT ANSWER b. "One of the risks of this procedure is tibial nerve palsy."
Rationale: One of the risks of minimally invasive hip surgery is sciatic or femoral nerve palsy. The other statements are true.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 555
A day after undergoing total hip arthroplasty, a patient falls on the way to the bathroom. Which of the following assessment findings should lead the nurse to suspect the patient had dislocated the hip?
a. Shortened extremity in external rotation
b. Shortened extremity in internal rotation
c. Abducted extremity
d. Adducted extremity - CORRECT ANSWER a. Shortened extremity in external rotation
Rationale: Signs of dislocation included acute groin pain in the operative hip, a shortened extremity in external rotation, and the patient's complaint of a "popping" sensation at the hip.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 564 [Show Less]