Chapter 46: Amputations

Chapter 46: Amputations

Linton: Medical-Surgical Nursing, 7th Edition

MULTIPLE CHOICE

• 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?

• Inadequate arterial blood flow
• Venous insufficiency
• Venous congestion
• Increased arterial blood flow

ANS: C

Leeches are used to treat venous congestion:

DIF: Cognitive Level: Comprehension REF: p: 907 OBJ: 4 | 5 TOP: Replantation KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

• 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:

• Wrap the thumb in a cloth saturated with normal saline and place it in a baggie:

ANS: D

The amputated part should be wrapped in a towel soaked with normal saline solution,

placed in a baggie, and put in a cool bath:

DIF: Cognitive Level: Application REF: p: 906 OBJ: 4 TOP: Care of the Amputated Thumb KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

• 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:

• / 4

ANS: D

An inflamed residual limb suggests an infection: the prosthesis should be removed, the limb should be gently cleansed with soap and water, and the physician should be

notified:

DIF: Cognitive Level: Application REF: p: 903 OBJ: 5 TOP: Infection KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

• 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:

• 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:

• Wrap the hand and finger securely and place it on an ice water–filled plastic bag:

ANS: D

The nurse should leave the shred of skin and muscle intact, wrap the hand and finger

in a towel soaked in normal saline, and place it on a cool surface:

DIF: Cognitive Level: Application REF: p: 906 OBJ: 4 TOP: Partial Amputation KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

• What nursing action should be implemented in the postoperative care for a patient with

replantation of the right thumb?

• Decreasing the temperature of the room to 70 F
• Elevating the hand but keeping it below the level of the heart
• Offering coffee, tea, or cola to help increase fluid intake
• Placing an antiembolus sleeve on the right arm

ANS: B

Slight elevation of the hand will encourage drainage but not affect arterial perfusion: the room temperature should be 80 F: the patient should avoid all caffeine drinks and

tight clothing or dressings:

DIF: Cognitive Level: Application REF: p: 907 OBJ: 4 TOP: Nursing Care of Replantation KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

• 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: 2 / 4

d. Take vitamin supplements daily:

ANS: C

Even a small amount of ambulation will decrease the loss of calcium and protein: DIF: Cognitive Level: Application REF: p: 906 OBJ: 4 TOP: Postoperative Ambulation KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

• What are late signs of hemorrhage in the postoperative period after an amputation?
• Restlessness and increased respirations
• Cyanosis and hypotension
• Confusion and seizures
• Headache and hypertension

ANS: B

Cyanosis and hypotension are late signs of hemorrhage in the postoperative period

after an amputation:

DIF: Cognitive Level: Comprehension REF: p: 902 OBJ: 4 TOP: Complications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

• 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:

• A series of temporary prostheses will be put in place before the permanent one:
• Wiring the residual limb will be needed to ensure acceptance of the prosthesis:

ANS: B

A rigid dressing will be applied to the residual limb to accommodate the prosthesis

immediately after surgery:

DIF: Cognitive Level: Application REF: p: 900 OBJ: 3 TOP: Preoperative Teaching KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

• 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?

• 3 weeks
• 1 month
• 6 weeks 3 / 4

• 3 months

ANS: D

Most people with amputations can fully bear weight 3 months after surgery:

DIF: Cognitive Level: Comprehension REF: p: 900 OBJ: 5 TOP: Amputation Recovery KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

• The verbalization of microvascular precautions is a criterion for measuring the

achievement of which outcome?

• Adequate circulation in the replanted limb
• Pain relief
• Patient knowledge of therapeutic measures
• Adjustment to change in appearance and function

ANS: C

Verbalizing the information related to microvascular precautions is evidence of the

patient’s achievement of having acquired the necessary knowledge:

DIF: Cognitive Level: Knowledge REF: p: 907 OBJ: 5 TOP: Nursing Care Planning KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

• Which postoperative observation must be reported to the physician immediately?
• Brownish-red drainage on the dressing, which is damp
• Respirations of 20 breaths/min
• Pulse of 72 beats/min
• Bright-red bleeding

ANS: D

Bright-red bleeding is not expected and indicates hemorrhage: Direct pressure should be applied over the dressing and the physician or charge nurse should be notified: DIF: Cognitive Level: Comprehension REF: p: 902 OBJ: 4 TOP: Complications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

• 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?

• Area of swelling and bruising on distal portion of residual limb
• Prickling sensation over residual limb
• Sharp severe pain in the residual limb
• Area of numbness on distal portion of residual limb
• / 4