Chapter 45: Amputations
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. 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.
c.
A series of temporary prostheses will be put in place before the permanent one.
d.
Wiring the residual limb will be needed to ensure acceptance of the prosthesis.
2. 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?
a.
3 weeks
b.
1 month
c.
6 weeks
d.
3 months
3. A nurse is conducting a safety seminar and reminds the audience that upper extremity
amputations are most frequently caused by trauma. Which population has the highest
incidence of this type of amputation?
a.
School-aged girls
b.
School-aged boys
c.
Young men
d.
Young women
4. An 80-year-old man with diabetes has had vascular problems with his feet and lower legs for
10 years and is scheduled for a left below-the-knee amputation. Which remark by the patient
indicates an understanding of the procedure?
a.
“I am glad this amputation will end my diabetic problems.”
b.
“After they have hacked my leg, I won’t be able to drive.”
c.
“If this heals well, how long until I get a prosthesis?”
d.
“I hate that my left knee is going to be useless without a foot.”
5. What routine preoperative diagnostic tests are appropriate for a patient anticipating a
below-the-knee amputation?
a.
Pulse volume recording and white blood cell (WBC) count
b.
Cardiac catheterization and WBC count
c.
Pulse volume recording and radiographic images
d.
Thermography and cardiac catheterization
6. Where is the limb severed with an elbow disarticulation?
a.
Just above the elbow joint
b.
Just below the elbow joint
c.
Between the shoulder and elbow
d.
Through the elbow joint
7. What do thermographic findings of cool spots in a certain areas of the body indicate?
a.
Increased blood flow
b.
Decreased infection
c.
Increased infection
d.
Decreased blood flow
8. A patient with peripheral vascular disease (PVD) and diabetes asks what he can do to help
prevent an amputation. What is the best response of the nurse?
a.
“There is not really anything you can do to help.”
b.
“Stopping smoking would help prevent vasoconstriction.”
c.
“You will not need to check your blood glucose levels.”
d.
“It is important to eat big meals so your body can heal.”
9. Why is a closed amputation usually performed?
a.
To create a weight-bearing residual limb
b.
To alleviate the effects of trauma
c.
To allow infection to heal and drain
d.
To treat a limb with gangrene
10. What controls the movement with a myoelectrically controlled prosthesis?
a.
Patient’s muscle movement and the prosthesis
b.
Battery-operated muscles implanted in the prosthesis
c.
Motion-sensing mechanism that swings the prosthesis forward
d.
Internal computer chip in the prosthesis
11. A patient who had a below-the-knee amputation 24 hours earlier is complaining of burning
pain in his left foot. Which intervention is most appropriate for the nurse to implement?
a.
Remind the patient that it is only phantom pain.
b.
Medicate the patient with the prescribed pain remedy.
c.
Remind him that such sensations will go away in a few weeks.
d.
Distract the patient with conversation.
12. During the admission of a patient scheduled for an amputation, a patient relates that she is a
practicing Orthodox Jew. What arrangements are appropriate for the nurse to make for this
patient?
a.
A veil should cover the amputated part.
b.
A rabbi must be present for the surgery.
c.
The amputated part should be buried.
d.
A family member should be present to read the Torah.
13. What is an appropriate outcome for a nursing diagnosis, “Anxiety, related to perceived threat
of disability?”
a.
Comfort is increased; verbalized pain is less.
b.
Anxiety is relieved; the patient verbalizes concern related to disability.
c.
Grief is resolved; the patient expresses an acceptance of loss.
d.
Residual limb is cleaned; no exudate, redness, or edema is observed.
14. What is the greatest danger in the early postoperative period after an amputation?
a.
Infection
b.
Hemorrhage
c.
Pain
d.
Edema
15. A nurse is caring for a patient that has undergone replantation of a body part. What might the
saliva of leeches be used to treat in this patient?
a.
Inadequate arterial blood flow
b.
Venous insufficiency
c.
Venous congestion
d.
Increased arterial blood flow
16. 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.
d.
Wrap the thumb in a cloth saturated with normal saline and place it in a baggie.
17. 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 the 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.
18. 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.
b.
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.
d.
Wrap the hand and finger securely and place it on an ice water–filled plastic bag.
19. What nursing action should be implemented in the postoperative care for a patient with
replantation of the right thumb?
a.
Decreasing the temperature of the room to 70° F
b.
Elevating the hand but keeping it below the level of the heart
c.
Offering coffee, tea, or cola to help increase fluid intake
d.
Placing an antiembolus sleeve on the right arm
20. 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.
d.
Take vitamin supplements daily.
21. What are late signs of hemorrhage in the postoperative period after an amputation?
a.
Restlessness and increased respirations
b.
Cyanosis and hypotension
c.
Confusion and seizures
d.
Headache and hypertension
22. The verbalization of microvascular precautions is a criterion for measuring the achievement of
which outcome?
a.
Adequate circulation in the replanted limb
b.
Pain relief
c.
Patient knowledge of therapeutic measures
d.
Adjustment to change in appearance and function
23. Which postoperative observation must be reported to the physician immediately?
a.
Brownish-red drainage on the dressing, which is damp
b.
Respirations of 20 breaths/min
c.
Pulse of 72 beats/min
d.
Bright-red bleeding
24. 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?
a.
Area of swelling and bruising on distal portion of residual limb
b.
Prickling sensation over residual limb
c.
Sharp severe pain in the residual limb
d.
Area of numbness on distal portion of residual limb
25. Which action should a nurse implement to diminish swelling of the residual limb in the
postoperative period after an above-the-knee amputation?
a.
Elevate the foot of the bed on blocks.
b.
Elevate the residual limb on pillows.
c.
Elevate the head of the bed 15 degrees.
d.
Turn the patient on the affected side.
26. Which major situational occurrences might lead to amputations? (Select all that apply.)
a.
Trauma
b.
Disease
c.
Tumors
d.
Congenital defects
e.
Carelessness
27. What is a closed amputation designed to do? (Select all that apply.)
a.
Prepare a weight-bearing limb.
b.
Cover the stump with tissue and muscle.
c.
Place sutures immediately over the bone.
d.
Be staged to closure.
e.
Be immediately ready for a prosthesis.
28. What should a nurse consider when selecting possible nursing diagnoses for a 32-year-old
patient who is in anticipatory grieving for an upcoming bilateral above-the-knee amputation?
(Select all that apply.)
a.
Anxiety, related to knowledge deficit of procedure
b.
Disturbed body image, related to loss of body part
c.
Sexual dysfunction, related to perceived disfigurement
d.
Disturbed self-image, related to loss of independence
e.
Activity intolerance, related to bed rest
29. How should a nurse modify a teaching plan for an older adult who has had an above-the-knee
amputation? (Select all that apply.)
a.
Offer smaller units of information at a time.
b.
Increase time for learning.
c.
Place less emphasis on chronic health problems.
d.
Clarify the reality of phantom pain.
e.
Include frequent repetition.
COMPLETION
30. A nurse clarifies that the precise term for the patient’s amputation, which will be through the
knee joint, is called _____.
31. An amputation of a gangrenous limb that is left open for 10 days before closure is classified as
a(n) _____ amputation.
32. To reduce the possibility of hip contractures in a patient with an above-the-knee amputation, a
nurse periodically places the patient in a(n) _____ position.
33. Preoperative exercises for a patient undergoing a lower-extremity amputation include _____
training.