Author Question: A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient ... (Read 120 times)

nevelica · **on:** Jun 25, 2018

A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient should the nurse assess first?

a. Patient who reports foot pain after hammertoe surgery
b. Patient with low back pain and a positive straight-leg-raise test
c. Patient who has not voided 10 hours after having a laminectomy
d. Patient with osteomyelitis who has a temperature of 100.5 F (38.1 C)

Question 2

Following laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action that the nurse should take is to

a. report the patient's complaint to the surgeon.
b. check the chart for preoperative assessment data.
c. check the vital signs for indications of hemorrhage.
d. turn the patient to the side to relieve pressure on the right leg.

parshano · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: C
Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and reported to the surgeon immediately. The information about the other patients is consistent with their diagnoses. The nurse will need to assess them as quickly as possible, but the information about them does not indicate a need for immediate intervention.

Answer to Question 2

ANS: B
The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness.