Amputation (25 Questions)

1.1 Mr. Desjardin, a 68-year-old male patient, has just returned to the nursing unit after undergoing an above-knee amputation (AKA) of his right leg due to complications from peripheral artery disease. The surgery was completed without complications, and he is now in the recovery phase. As he arrives on the unit, he was transferred from the stretcher to his hospital bed.

Question:
You should place the patient in which position? *
1.2 He has been healing well and receiving daily care, including physical therapy and emotional support.

During your morning assessment, he tells you:
"My leg feels a bit swollen. I’d like to elevate my limb to help reduce the swelling. Is that okay?"

Question:
As the nurse, what is the most appropriate response? *
1.3 Later in the day, as part of the care plan, you encourage Mr. Desjardins to lie in a prone position (on his stomach) for short periods several times a day.
He looks puzzled and asks:

“Why do I need to lie on my stomach? It’s not comfortable for me.”

You explain, “Lying on your stomach can be very beneficial for your recovery.”

Question:
Which statement is your most appropriate response? *
1.4 His postoperative pain has been moderately well controlled, but today he reports a burning, stabbing pain in the missing limb, especially when trying to rest.

You review his medication record, which includes:
*Gabapentin (Neurontin) 300 mg PO tid
*Acetaminophen + Codeine (Atasol 30) 1–2 tabs PO q4h PRN

However, Mr. Desjardin tells you:
“I’ve been skipping the gabapentin. I don’t have epilepsy, so I don’t think I need it.”

Question:
What is the most appropriate response to help Mr. Desjardin understand the role of gabapentin in his care? *
1.5 During your shift, the physiotherapist suggests introducing mirror box therapy as part of his rehabilitation program.

Mr. Desjardin looks confused and asks:
"How is looking in a mirror supposed to help the pain in a leg I don't even have?"

Question:
What is the most appropriate explanation to give Mr. Desjardin about the purpose of the therapy? *
2. Mr. Dubois, 59 years old, is postoperative day 1 following a right below-knee amputation for critical limb ischemia. His history includes type 2 diabetes, chronic neuropathy, and hyperlipidemia.

Post-op orders include:
*morphine 2 mg IV q3h PRN, acetaminophen 1,000 mg q6h
*cefazolin IV q8h
*vital signs q2h

This morning he reports throbbing residual limb pain rated 8/10, stating the pain worsens when he tries to move. His stump dressing is dry and intact; the skin above the incision is warm but not red. He appears tense and is grimacing with movement. HR is 108 and RR 22. He says he is afraid “the phantom pain is starting already.” He refuses his first physiotherapy session because of the pain.

Question:
What is the priority action? *
3. Mme. Caron, 72 years old, is postoperative day 2 following a left above-knee amputation after a traumatic fall. Past history includes hypertension and peripheral vascular disease. She reports burning, shooting pain rated 7/10, saying it “feels like the leg is still there.” Her stump dressing shows minimal serosanguinous drainage. Surrounding skin is pink but not warm. Temperature is 37.2°C, HR 96, BP 134/70. Medical orders include:
*hydromorphone 1 mg IV q4h PRN
*ketorolac 15 mg IV q8h
*heparin prophylaxis, and daily dressing changes.

She appears anxious and repeatedly asks whether this amount of pain is normal.

Question:
What is the most appropriate nursing action? *
4. Mr. Fournier, 66 years old, underwent a right above-knee amputation due to non-healing diabetic ulcers. He is postoperative day 2 and has been lying in a flexed hip position for long periods. Physiotherapy notes concern about developing a hip flexion contracture.

His orders include:
*turn q2h
*keep residual limb flat
*sit at bedside BID, and begin ROM exercises

He reports mild stump discomfort (3/10) but refuses repositioning because he “just wants to stay comfortable.” His vital signs are stable. The nurse observes he is consistently keeping pillows under the stump despite instructions to avoid this.

Question:
What is the priority? *
5. Mme. Laramée, 63 years old, is postoperative day 1 after a left below-knee amputation for advanced vascular insufficiency. Her dressing was clean this morning but now shows rapidly increasing bright red drainage. She feels dizzy when sitting upright. Vital signs: HR 118, BP 92/58, RR 20.

Medical orders include:
*vital signs q1h
*CBC in the morning
*normal saline at 75 mL/hr
*notify surgeon for signs of bleeding.

She reports mild stump pain (4/10). The drain output has doubled in the last hour.

Question:
What should the nurse do first? *
6. Mr. Tremblay, 78 years old, is postoperative day 3 following a right above-knee amputation due to osteomyelitis. His orders include early mobilization with physiotherapy, morphine 2 mg PO q4h PRN, and daily dressing changes. He reports pain 6/10 during transfers and refuses to get out of bed. Vital signs are stable. The stump dressing is clean, with no signs of infection. He states he is afraid of falling because he “feels weak,” and he has barely eaten since surgery. His bed chart shows multiple missed physiotherapy visits.

Question:
What is the best nursing intervention? *
7. Mme. Roy, 70 years old, is postoperative day 2 following a left below-knee amputation for gangrene. Her temperature today is 38.1°C, up from 37.2°C. The stump dressing has moderate serosanguinous drainage with a mild odor. The surrounding skin is warm to the touch. Her orders include:
*cefazolin IV q8h
*acetaminophen 650 mg q4h PRN fever
*daily8 dressing changes

She reports dull aching pain (5/10). HR is 104, BP 110/64. She asks if the wound “is supposed to smell like that.”

Question:
What is the priority action? *
8. Mr. Picard, 51 years old, is postoperative day 4 after a right above-knee amputation following an industrial accident. He reports burning and cramping sensations in the missing limb and rates his pain 6/10.

His orders include:
*gabapentin 300 mg PO BID
*morphine 2 mg IV q4h PRN
*sleep hygiene interventions.

He appears restless, has difficulty sleeping, and becomes tearful, saying, “I can feel my leg even though it’s not there.” Vital signs are stable. His stump dressing is clean, dry, and intact. Physiotherapy notes he is struggling with participation due to fatigue.

Question:
What should the nurse do first? *
9. Mme. Nadeau, 64 years old, had a left above-knee amputation after a prolonged period of limb ischemia. She is postoperative day 2. Her urine is now dark brown, and she reports muscle soreness in the remaining leg. Vital signs: HR 110, BP 98/62.

Orders include:
*IV NS at 100 mL/hr
*electrolytes daily
*CBC
*notify provider for urine color changes

She reports mild stump pain (3/10). The nurse notes decreased urine output in the last 6 hours.

Question:
What is the priority intervention? *
10. Mr. Gendron, 75 years old, is postoperative day 1 following a right below-knee amputation due to severe atherosclerosis. He received morphine 4 mg IV one hour ago for pain 8/10. He now appears drowsy with shallow respirations at 10/min. Vital signs show HR 92, BP 130/76, SpO₂ 92% on room air.

His orders include:
*morphine 2–4 mg IV q3h PRN
*vitals q1h
*notify physician if RR < 12.

His stump dressing is intact.

Question:
What is the priority nursing action? *
11. Mme. Pelletier, 62 years old, is postoperative day 3 after a right above-knee amputation for cancer. She refuses to look at her stump and cries during dressing changes. She reports mild pain (4/10) but expresses strong feelings of loss and fear about prosthesis use. Her orders include: morphine 2 mg PO q4h PRN, acetaminophen scheduled, psychology consult, and early mobility with assistance. Vital signs are stable. She has eaten poorly since surgery and has declined physiotherapy twice today.

Question:
What is the priority nursing action? *
12. Mr. Bélanger, 61 years old, is postoperative day 1 following a left below-knee amputation due to severe peripheral arterial disease. His history includes long-term smoking and hypertension.

Medical orders include:
*hydromorphone 1 mg IV q3h PRN
*acetaminophen 1,000 mg q6h
*VS q2h
*early mobilization as tolerated

He reports pain 6/10 and appears visibly anxious, stating he is afraid to move because he thinks the incision will open. His stump dressing is dry and intact, with no bleeding. Vital signs are stable. He repeatedly presses the call bell asking if movement is dangerous.

Question:
What is the most appropriate nursing intervention? *
13. Mme. Lefrançois, 74 years old, is postoperative day 2 after a right above-knee amputation for vascular disease.

Her orders include:
*stump elevation for edema control
*no pillow under the hip
*VS q4h
*analgesia PRN

During rounds, the nurse finds the stump elevated high on three pillows, causing marked hip flexion. She reports mild pain (3/10) and significant stiffness. Vital signs are normal, and the incision is clean.

Question:
What is the priority action? *
14. Mr. Gauthier, 56 years old, is postoperative day 3 following a traumatic below-knee amputation after a workplace accident. He has no significant medical history. His orders include PRN morphine, physiotherapy daily, and psychosocial support PRN. He becomes withdrawn, avoids eye contact, and states, “My life is over.” Pain is 4/10, vital signs stable, and stump healing is appropriate. He refuses visitors and physiotherapy.

Question:
What is the priority nursing intervention? *
15. Mme. Paquette, 68 years old, is postoperative day 2 after a left below-knee amputation. Orders include morphine 2 mg IV q3h PRN, VS q2h, and monitor stump circulation. She suddenly reports sharp pain 9/10 in the stump. The stump appears swollen and tense compared to earlier, though the dressing is intact. Vital signs show HR 114, BP 140/86. She appears distressed.

Question:
What is the priority action? *
16. Mr. Renaud, 72 years old, is postoperative day 4 after an above-knee amputation. His history includes chronic alcoholism and malnutrition. Orders include high-protein diet, daily weights, and wound care. He eats less than 25% of meals and states he has no appetite. The stump incision is healing slowly but remains clean. Vital signs are stable.

Question:
What nursing intervention best supports wound healing? *
17. Mme. Bourque, 79 years old, is postoperative day 2 following a right below-knee amputation. Orders include mobilize with assistance, VS before and after activity, and IV fluids at 75 mL/hr. When sitting at the bedside, she becomes dizzy and pale. BP drops from 132/78 to 98/60, HR increases to 110. She denies pain.

Question:
What is the priority nursing action? *
18. Mr. Côté, 64 years old, is postoperative day 5 after a left below-knee amputation. Orders include gabapentin, PRN opioids, and education on phantom sensations. He reports tingling and a sensation that his toes are curled, but pain is only 2/10. He appears concerned that something is wrong. Vital signs and incision are normal.

Question:
What is the best nursing response? *
19. Mme. Leduc, 83 years old, is postoperative day 3 after a right above-knee amputation. She is mostly bedbound and has fragile skin. Orders include turn q2h, pressure-relief mattress, and daily skin assessment. The nurse notices redness on her sacrum that does not blanch. The stump incision is intact. Pain is minimal.

Question:
What is the priority nursing action? *
20. Mr. Morin, 70 years old, is postoperative day 1 after a left below-knee amputation. Orders include strict I&O, IV fluids at 100 mL/hr, and notify provider if UO <30 mL/hr. Over the last 4 hours, urine output has averaged 20 mL/hr. Vital signs show HR 112, BP 98/60. The stump dressing is dry.

Question:
What is the priority action? *
21. Mme. Thibault, 58 years old, is postoperative day 7 after a below-knee amputation. The incision is healing well with minimal edema. Orders include stump shaping with elastic bandage, physiotherapy, and education. She asks why the bandage must be applied snugly and consistently. Pain is minimal, and vital signs are stable.

Question:
What is the best explanation? *