Diagnostics & Imaging
This scan estimates bone mass density and is the gold standard for osteoporosis
What is a DEXA scan?
What patient education prevents dislocation after hip arthroplasty?
Avoid hip flexion >90°, crossing legs, internal rotation, or turning on operative side.
What device promotes circulation and prevents scar tissue after knee replacement?
CPM (Continuous Passive Motion) machine.
Which patient is at greatest risk for delayed wound healing following joint replacement surgery?
A. 40-year-old with asthma
B. 55-year-old with hypothyroidism
C. 62-year-old with well-controlled type 2 diabetes
D. 72-year-old with poorly controlled diabetes and peripheral vascular disease
Answer: D
Rationale: Uncontrolled diabetes and PVD impair circulation and oxygen delivery to tissues, delaying wound healing and increasing infection risk. Hypothyroidism and asthma are not direct risks for delayed healing
What type of injury is the leading cause of traumatic amputations?
Motor vehicle crashes/industrial equipment accidents.
A patient is scheduled for a DEXA scan. Which statement by the patient indicates correct understanding?
A. “I should remove all metallic objects before the scan.”
B. “I will be NPO for at least 6 hours before the scan.”
C. “I should expect to receive IV contrast dye during the scan.”
D. “I should drink plenty of fluids afterward to flush the isotope.”
Answer: A
Rationale: DEXA scans require removal of metallic objects, but no fasting, contrast, or isotopes are involved. Fluid encouragement is for nuclear bone scans, not DEXA
The nurse is reinforcing pre-op teaching for a hip arthroplasty. Which statement by the client indicates correct understanding?
A. “I will scrub the surgical site with antiseptic soap before surgery.”
B. “I should stop taking all antihypertensives the morning of surgery.”
C. “I need to avoid blood testing before surgery to prevent infection.”
D. “I should remain NPO for 12 hours before surgery.”
Answer: A
Rationale: Patients should scrub the surgical site with antiseptic soap the night before and morning of surgery, wear clean clothes, and use clean linens. Some antihypertensives are taken with sips of water. Blood tests are required, and NPO is usually 6–8 hrs, not 12
What is the safest side to transfer a patient from bed after knee arthroplasty?
Unaffected side
What lifestyle habits should patients avoid pre- and post-arthroplasty to promote healing?
Smoking, poor glucose control, and sedentary lifestyle.
Which statement by a new amputee indicates a need for further teaching about preventing contractures?
A. “I will avoid sitting in a chair for long periods.”
B. “I will lie prone several times a day for 20–30 minutes.”
C. “I will keep my residual limb elevated on pillows for the first 2 weeks.”
D. “I will discourage myself from staying in one position too long.”
Answer: C
Rationale: Elevating the limb for more than 24 hours increases risk of hip/knee flexion contractures. Prone positioning, avoiding prolonged sitting, and frequent repositioning are correct
A patient scheduled for arthroscopy has a joint infection. Why is this a contraindication?
Because bacteria can spread into the surgical site and worsen infection.
What should a patient do the night before hip replacement surgery to reduce infection risk?
Scrub surgical site with antiseptic soap, wear clean clothes, use clean linens.
Why are older adults at higher risk of post-op complications?
Due to comorbidities like CAD, DM, HTN, COPD.
A patient 2 days post–hip arthroplasty develops redness, warmth, and purulent drainage at the incision site. Which is the nurse’s PRIORITY action?
A. Document the finding and recheck in 2 hours
B. Administer PRN acetaminophen
C. Notify the provider immediately
D. Encourage increased ambulation
Answer: C
Rationale: These findings suggest surgical site infection. Infection near a prosthesis is high risk because it may cause prosthesis failure. Documentation, acetaminophen, or ambulation do not address the urgent complication
What nursing intervention prevents hip contractures post-amputation?
Lie prone for 20–30 min several times daily.
Why are uncontrolled diabetes and hypertension contraindications for joint arthroplasty?
A. They increase anesthesia complications.
B. They impair healing and increase infection risk.
C. They reduce pain relief post-op.
D. They limit prosthetic range of motion.
Answer: B
Rationale: Both uncontrolled diabetes and hypertension impair wound healing and increase infection risk. They do not directly affect anesthesia, pain relief, or prosthetic function
Cemented vs. non-cemented prosthesis: which delays weight-bearing, and why?
Non-cemented, because bone must grow into the prosthesis for stabilization.
Which finding requires immediate action post-arthroplasty: low-grade fever, mild swelling, or sudden calf pain?
Sudden calf pain = DVT.
A patient post-knee arthroplasty reports sudden calf pain with redness and swelling. Which complication should the nurse suspect?
A. Pulmonary embolism
B. Deep vein thrombosis
C. Compartment syndrome
D. Neurovascular compromise
Answer: B
Rationale: Calf pain, redness, and swelling are hallmark signs of DVT. PE presents with chest pain/dyspnea. Compartment syndrome involves unrelieved pain/6 Ps. Neurovascular compromise shows diminished circulation or sensation
Why should residual limb not be elevated beyond 24 hours post-op?
It increases risk of flexion contractures.
A patient post-arthroplasty asks why they needed a chest x-ray and ECG before surgery. The nurse’s BEST explanation is:
A. “These tests are only for insurance clearance.”
B. “They identify pulmonary or cardiac contraindications to surgery.”
C. “They confirm you do not have osteoporosis before replacement.”
D. “They detect joint instability before the prosthetic is implanted.”
Answer: B
Rationale: Chest x-ray rules out pulmonary disease/tumors; ECG detects dysrhythmias or cardiac issues that may contraindicate anesthesia. Insurance clearance (A) and osteoporosis/joint instability (C/D) are not the purpose
A patient post-hip arthroplasty crosses their legs while sitting. What is the nurse’s priority response?
A. Reposition the legs and remind them not to cross legs.
B. Document the action and continue monitoring.
C. Encourage ambulation to relieve stiffness.
D. Apply ice packs to reduce discomfort.
Answer: A
Rationale: Crossing legs after hip replacement risks hip dislocation. The nurse must immediately reposition and reinforce education. Ice and ambulation do not prevent dislocation, and documentation alone is unsafe
A patient after hip replacement reports acute dyspnea and tachycardia. What is the likely complication?
Pulmonary embolism
An older adult is recovering from a total knee arthroplasty. Which factor MOST increases their risk for developing a venous thromboembolism (VTE)?
A. Advanced age combined with reduced mobility after surgery
B. Postoperative opioid use for pain control
C. History of seasonal allergies with antihistamine use
D. Mild dehydration related to poor appetite
Answer: A
Rationale: The greatest risk for VTE is immobility after major orthopedic surgery, especially in older adults who already have slower circulation and comorbidities. Opioid use and mild dehydration can complicate recovery, but they do not outweigh the risk of immobility. Allergies are irrelevant.
A patient with diabetes mellitus undergoes a below-the-knee amputation. Which nursing action is the HIGHEST priority for preventing delayed healing?
A. Monitor blood glucose and keep it within expected range
B. Encourage prone positioning to prevent hip contractures
C. Provide frequent dressing changes using aseptic technique
D. Encourage the patient to verbalize feelings about body image
Answer: A
Rationale: While aseptic dressing care (C), positioning (B), and psychosocial support (D) are all important, glucose control is the most critical factor in preventing delayed wound healing and infection in diabetic patients