Preop Joint Surgery
A client scheduled for total hip arthroplasty asks why they must stop aspirin 7 days before surgery. What is the best response?
A. Prevents infection
B. Reduces bleeding risk
C. Improves anesthesia response
D. Prevents blood clots
Answer: B
Rationale: Aspirin inhibits platelet aggregation, increasing bleeding risk during surgery.
What is the priority nursing action immediately after hip surgery?
A. Encourage ambulation
B. Maintain abduction pillow
C. Remove Foley catheter
D. Provide high-fiber diet
Answer: B
Rationale: Prevents hip dislocation.
Which client finding should be reported before surgery?
A. Hemoglobin 13 g/dL
B. INR 3.0
C. BP 128/78
D. HR 72
Which lab value is most concerning pre-op?
A. WBC 8,000
B. Platelets 90,000
C. Sodium 140
D. Glucose 110
Answer: B
Rationale: Elevated INR indicates high bleeding risk and must be corrected before surgery.
The nurse is preparing to administer ketorolac IV to a client following a total knee arthroplasty (TKA). Which finding in the client's medical record would require the nurse to hold the medication and consult the surgeon?
A. Allergy to shellfish
B. Serum creatinine of 1.9 mg/dL
C. History of postoperative nausea
D. Client is currently taking a beta-blocker
Correct Answer: B
Rationale: Ketorolac is a potent NSAID. NSAIDs can cause nephrotoxicity and should be avoided in clients with renal impairment. A creatinine of 1.9 mg/dL is significantly elevated (normal range roughly 0.6–1.2 mg/dL).
Which client is highest risk for complications?
A. Age 45
B. BMI 22
C. Diabetes
D. Active lifestyle
Answer: C
Rationale: Diabetes increases infection risk and delays healing.
The nurse receives four clients in the orthopedic trauma unit. Which client should the nurse assess first?
A. A client with a closed transverse fracture of the humerus reporting pain level 4/10.
B. A client with a displaced comminuted fracture of the femur awaiting surgery.
C. A client with a Grade III open fracture of the tibia with a saturated dressing.
D. A client with an impacted fracture of the wrist who has a capillary refill of 2 seconds.
Correct Answer: C
Rationale: An Open Fracture (formerly called compound) involves a break in the skin. A Grade III as the most severe, with extensive soft tissue damage. This client is at the highest risk for osteomyelitis (bone infection) and hemorrhage.
Which finding indicates hip dislocation?
A. Shortened, internally rotated leg
B. Mild swelling
C. Pain at incision
D. Slight fever
Answer: A
Rationale: Classic sign of dislocation.
A client who underwent a total hip arthroplasty (THA) 12 hours ago is receiving enoxaparin subcutaneously. Which laboratory result should the nurse prioritize reporting to the healthcare provider?
A. Hemoglobin of 11.2 g/dL
B. Platelet count of 92,000/mm³
C. Prothrombin time (PT) of 12 seconds
D. International Normalized Ratio (INR) of 1.1
Answer: B
Rationale: Low platelets increase bleeding risk.
A client 24 hours post-total hip arthroplasty (THA) becomes suddenly agitated and confused. The nurse notes petechiae on the patient's chest and an SpO2 of 88% on room air. Which action should the nurse take first?
A. Administer the ordered PRN intravenous morphine for pain.
B. Increase the IV fluid rate to maintain blood pressure.
C. Apply oxygen via non-rebreather mask at 10-15 L/min.
D. Perform a neurovascular assessment of the affected extremity.
Correct Answer: C
Rationale: The triad of confusion, petechiae, and hypoxia after a long-bone or major joint surgery strongly suggests Fat Embolism Syndrome (FES). The most important treatment is supportive, starting with high-flow oxygen to prevent organ ischemia.
Which client is ready for discharge? Select all that apply
A. Vital signs are stable
B. Pain is at a tolerable level on oral medications
C. Functional status is at baseline
D. Able to "teach back" medications and signs of complications.
All of the above
Which instruction is most important preoperatively?
A. Avoid fiber
B. Use incentive spirometer
C. NPO after midnight
D. Limit fluids
Answer: C
Rationale: Prevents aspiration during anesthesia.
Which intervention prevents DVT?
A. Bed rest
B. Leg crossing
C. Compression devices
D. Low fluid intake
Answer: C
Rationale: Promotes venous return.
The nurse is reviewing the pre-operative laboratory results for a client scheduled for a total knee arthroplasty (TKA) in two hours. Which result requires the nurse to immediately notify the surgeon and anesthesiologist?
A. Potassium 3.4 mEq/L
B. White Blood Cell (WBC) count 14,500 mm³
C. Hemoglobin 12.1 g/dL
D. Glucose 118 mg/dL
Correct Answer: B
Rationale: Any sign of active infection is a contraindication for elective joint replacement due to the high risk of prosthetic joint infection (PJI). A WBC of 18,500 indicates leukocytosis. Surgery will likely be postponed until the source of infection is identified and treated.
A client recovering from joint surgery is being discharged on Warfarin for VTE prophylaxis. The nurse identifies that the client understands the teaching when they state they will avoid which over-the-counter herbal supplement?
A. Melatonin
B. Glucosamine
C. Vitamin C
D. Ginkgo biloba
Correct Answer: D
Several herbs (Ginkgo, Garlic, Ginseng, Ginger) have antiplatelet properties and can significantly increase the risk of bleeding when taken with anticoagulants like Warfarin.
The nurse is developing a plan of care for a client following a total hip arthroplasty (THA) via a posterior approach. Which interventions should the nurse include to prevent prosthesis dislocation? (Select all that apply.)
A. Place an abductor wedge between the legs while in bed.
B. Use a toilet seat riser for all bathroom voids.
C. Assist the client to flex the hip to 110 degrees for meals.
D. Instruct the client not to cross their legs at the knees or ankles.
E. Keep the client’s HOB at 90 degrees while resting.
Correct Answers: A, B, D
Rationale: For a posterior approach THA, the client must avoid hip flexion greater than 90 degrees, adduction (crossing legs), and internal rotation.
A nurse notes the client is anxious and repeatedly asks questions about the surgical procedure. What is the best action?
A. Provide sedation information
B. Notify surgeon about the client's questions
C. Clarify teaching about the procedure
D. Delay surgery until anxiety resolves
Answer: B. Notify surgeon
Rationale: scope of practice. Nurses do not provide surgical information about invasive procedures
Which finding requires immediate action?
A. Serosanguinous drainage on dressing
B. Sudden severe hip pain
C. Mild edema at the incision site
D. Temp 99°F orally
Answer: B
Rationale: May indicate dislocation.
A client has a severely displaced fracture of the femoral neck. The nurse knows that the primary reason for immediate surgical internal fixation is to prevent which complication?
A. Fat Embolism Syndrome
B. Avascular Necrosis
C. Compartment Syndrome
D. Malunion
Correct Answer: B
Rationale: In a displaced fracture, the bone ends are out of anatomical alignment. For the femoral neck, this displacement often tears the nutrient arteries. Without rapid restoration of alignment, the bone tissue may die due to lack of blood supply (Avascular Necrosis).
A 68-year-old client who underwent an above-the-knee amputation (AKA) two days ago tells the nurse, "I feel much more comfortable when I keep my limb propped up on two pillows." Which action should the nurse take first?
A. Document the client’s comfort level and continue to monitor.
B. Explain that the limb should not be elevated to prevent hip flexion contractures.
C. Encourage the patient to lie prone for 30 minutes three to four times a day.
D. Assess the surgical site for increased edema or signs of hemorrhage.
Answer: B
Rationale: The nurse must analyze the conflict between patient comfort and the physiological risk of contractures. While elevation of the residual limb on pillows is often done for the first 24 hours to reduce edema, prolonged elevation after that period is contraindicated in AKA patients because it leads to hip flexion contractures, which can make prosthetic fitting impossible.
The nurse is providing education to a client with a grade II calf strain. The client asks, "I understand I need to use ice, but why do I have to wrap it with an elastic bandage? Isn't that just for support?" Which response by the nurse is based on the physiological principles?
A. "The wrap provides stability to the joint to prevent a secondary sprain."
B. "The compression helps decrease the inflammatory vasodilation and fluid shift."
C. "The bandage keeps the muscle warm, which increases the rate of tissue repair."
D. "Compression redirects the blood flow from the muscle to the bone for faster healing."
Correct Answer: B
Rationale: In the RICE (Rest, Ice, Compression, Elevation) protocol. Compression is used to limit "development of edema" by decreasing the space available for fluid to leak into the interstitial tissue.
Which statement indicates effective pre-op teaching?
A. “I will cross my legs after surgery.”
B. “I will use a raised toilet seat.”
C. “I will bend forward to tie shoes.”
D. “I will sleep on my operative side.”
Answer: B
Rationale: Raised seats prevent excessive hip flexion.
Four hours after a total shoulder arthroplasty, the nurse notes that the client's operative arm is cool to the touch, and the capillary refill is 5 seconds. The client reports "pins and needles" in the fingers. What is the nurse's priority interpretation of these findings?
A. This is a normal expected effect of the regional nerve block.
B. The client is experiencing early signs of compartment syndrome.
C. The surgical dressing is likely too loose, causing heat loss.
D. Arterial circulation to the extremity is compromised.
Correct Answer: D
Rationale: While "pins and needles" (paresthesia) can be part of compartment syndrome, the combination of cool skin and prolonged capillary refill (normal is < 3 seconds) specifically indicates arterial insufficiency. This is a surgical emergency.
A client with a suspected femur fracture has a normal X-ray, but continues to have severe pain and inability to bear weight. What is the nurse’s best interpretation?
A. The client is exaggerating symptoms
B. The fracture has healed
C. Additional imaging like MRI may be needed
D. The client can be discharged
Answer: C
Rationale: Some fractures (e.g., stress or occult fractures) may not appear on initial X-rays. MRI or CT scan is more sensitive and may be required for diagnosis.
A client who had a below-the-knee amputation (BKA) yesterday morning reports sharp, stabbing pain in the foot that is no longer there. The client states, "I know the foot is gone, but it hurts so much. I feel like I'm losing my mind." How should the nurse interpret and respond to this finding?
A. Administer a sedative to help the client cope with the psychological distress of limb loss.
B. Reassure the client that these sensations are common and usually resolve within a week.
C. Medicate the client with the prescribed analgesic, as the pain is a real physiological phenomenon.
D. Remind the client that the limb has been removed and encourage them to focus on the healing incision.
Answer: C
Rationale: The nurse must distinguish between psychological distress and the neurological reality of phantom limb pain (PLP) to determine the correct intervention. Phantom limb pain is a real sensation caused by mirroring in the brain’s cortex. It should be treated like any other post-operative pain. Denying the pain or treating it as purely psychological (A or D) is non-therapeutic and ineffective.
A client is being discharged following a severe knee sprain. Which statement by the client indicates a need for further teaching regarding the recovery phase?
A. "I will apply ice for 20 minutes at a time, several times a day, for the next two days."
B. "I will keep my knee propped up on pillows above the level of my heart."
C. "Once the swelling goes down in 24 hours, I will start my usual weight-lifting routine to regain strength."
D. "I'll use an elastic wrap starting from the area farthest from my heart and wrapping upward."
Correct Answer: C
Rationale: After the acute inflammatory phase (24–48 hours), the focus shifts to protecting the healing tissue. Returning to a "usual weight-lifting routine" too early can turn an acute injury into a chronic one. Strength exercises must be introduced gradually.