3/21/25, 7:47 NU371 HESI Case Study: PVD with Amputation Flashcards |
AM
NU371 HESI CASE STUDY: PVD WITH AMPUTATION EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Terms in this set (63)
A disheveled man who appears to be between 50 and 60 years old is found
Meet the Client unconscious under a bridge with a necrotic right foot that is gangrenous. He is
brought to the emergency department by the paramedics and police department.
The client has no identification on his body. The police are unable to locate anyone
who knows his full name. Upon the client's admission to the emergency department
(ED) it is determined that he needs immediate surgery to amputate his right leg
Legal Issues above the knee.
The nurse caring for the client has no way to contact family to obtain informed
consent for the surgery, and the client has not regained consciousness.
Which action will the nurse implement first d) Prepare the client for surgery and document that no family member is available.
since informed consent cannot be -
obtained?
When surgery is emergent, the surgeon may operate without informed consent.
a)Call the operating room (OR) Therefore, the nurse should first prepare the client for immediate surgery.
department and inform them that the
surgery cannot be done at this time.
b) Request that the police department
find some of the client's family
members
immediately.
c) Contact the legal department of the
hospital to appoint a legal guardian for the
client.
d) Prepare the client for surgery
and document that no family
member is available.
Perioperative Care The client is wearing an old Timex watch and has a ring on his left index finger.
What must the nurse do with the client's c) Assign two nurses to place the items in a bag and place them in the hospital safe.
personal items?
1/16
,3/21/25, 7:47 NU371 HESI Case Study: PVD with Amputation Flashcards |
AM
a) Place the items in a bag with his name -
on it and put the bag under the
Document the items, document on the outside of the valuables bag, and place the
stretcher.
bag in the hospital safe according to hospital policy since there is no family
b) Request that the police remove
member to take responsibility for the items.
the items and take responsibility for
them.
c) Assign two nurses to place the items in
a bag and place them in the hospital
safe.
d) Place a piece of tape over the items and
allow the client to wear them to
surgery.
The client's right leg is marked in the ER -
to ensure that the correct site is operated
on. Because he is unconscious, he is not
able to participate in this activity. When
the
client arrives in the OR, he is positioned on
the operating table, intubated, and given
general anesthesia. A "time out" is called
by the circulating nurse.
d) So all members of the OR team participate in the positive identification of the
What is the purpose of the "time out?" client, identify the correct site, and identify the planned procedure.
-
a)To allow the operating team time
to scrub and gown. Surgical procedures that are site specific, such as left, right, or bilateral, require
b) So the anesthesiologist can wake up the patient identification before surgery. As required by The Joint Commission's NPSGs,
client up to ensure the correct procedure is to ensure that the correct site is selected and the wrong site is avoided, the site is
being done on the correct person. marked by a licensed independent practitioner and, whenever possible, involves
c) As a signal for the scrub nurse or the patient. The surgeon is accountable and should be present during the
procedure.
certified scrub technician to perform an
The nurse is an important part of this SAFETY measure. Before starting the operative
instrument and sponge count.
procedure, facilities use a "time-out" procedure to verify the correct site, patient,
d) So all members of the OR team
and procedure. The perioperative nurse is in a position of ensuring that these
participate in the positive identification of
SAFETY
the client, identify the correct site, and
measures are implemented immediately before the procedure is started (AORN,
identify the planned procedure.
2015). The "time-out" involves the participation of all members of the procedure
team, including the surgeon, anesthesia provider, circulating nurse, scrub person,
and any other active participants.
2/16
, 3/21/25, 7:47 NU371 HESI Case Study: PVD with Amputation Flashcards |
AM
The operating room nurse asks the -
surgeon, "What does the client want done
with the amputated extremity?" The
surgeon informs the operating room nurse
that the client was unconscious upon
admission and has no family members.
What will the operating room nurse do with c) Ensure that the limb is sent to the incinerator so that it can be burned.
the amputated limb? -
a) Place the amputated limb in a
Amputated limbs are disposed of in this manner. If the client makes special
biohazard bag and place it in the trash.
requests due to cultural needs, this must be discussed and arranged prior to the
b) Keep the limb in the morgue until the
surgery.
client can tell the staff what to do with the However, the client was unconscious upon admission and no family members were
limb. present, therefore, standard hospital protocol applies.
c) Ensure that the limb is sent to
The client is admitted to the Intensive Care Unit with a right, above the knee
the incinerator so that it can be
Intensive Care Unit amputation, a soft dressing to the residual limb, an IV of Lactated Ringer's at 125
mL/hr, and a Foley catheter.
The nurse hangs a new bag of IV fluids and 15 drops/mL X 125 mL/hr x 1 hr/60 minutes= 31.25 = 31 drops/min
checks the rate. The IV tubing delivers 15
drops/mL. How many drops/minute will the
IV set deliver? (Enter the numerical
value
only. If rounding is required, round to the
whole number.)
The client opens his eyes when spoken -
to and is able to answer simple questions.
He is pointing to his right leg and saying
"hurts real bad." The nurse assesses the
client's
vital signs, which are stable, and observes
that the right residual limb dressing is dry
and intact.
3/16
AM
NU371 HESI CASE STUDY: PVD WITH AMPUTATION EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Terms in this set (63)
A disheveled man who appears to be between 50 and 60 years old is found
Meet the Client unconscious under a bridge with a necrotic right foot that is gangrenous. He is
brought to the emergency department by the paramedics and police department.
The client has no identification on his body. The police are unable to locate anyone
who knows his full name. Upon the client's admission to the emergency department
(ED) it is determined that he needs immediate surgery to amputate his right leg
Legal Issues above the knee.
The nurse caring for the client has no way to contact family to obtain informed
consent for the surgery, and the client has not regained consciousness.
Which action will the nurse implement first d) Prepare the client for surgery and document that no family member is available.
since informed consent cannot be -
obtained?
When surgery is emergent, the surgeon may operate without informed consent.
a)Call the operating room (OR) Therefore, the nurse should first prepare the client for immediate surgery.
department and inform them that the
surgery cannot be done at this time.
b) Request that the police department
find some of the client's family
members
immediately.
c) Contact the legal department of the
hospital to appoint a legal guardian for the
client.
d) Prepare the client for surgery
and document that no family
member is available.
Perioperative Care The client is wearing an old Timex watch and has a ring on his left index finger.
What must the nurse do with the client's c) Assign two nurses to place the items in a bag and place them in the hospital safe.
personal items?
1/16
,3/21/25, 7:47 NU371 HESI Case Study: PVD with Amputation Flashcards |
AM
a) Place the items in a bag with his name -
on it and put the bag under the
Document the items, document on the outside of the valuables bag, and place the
stretcher.
bag in the hospital safe according to hospital policy since there is no family
b) Request that the police remove
member to take responsibility for the items.
the items and take responsibility for
them.
c) Assign two nurses to place the items in
a bag and place them in the hospital
safe.
d) Place a piece of tape over the items and
allow the client to wear them to
surgery.
The client's right leg is marked in the ER -
to ensure that the correct site is operated
on. Because he is unconscious, he is not
able to participate in this activity. When
the
client arrives in the OR, he is positioned on
the operating table, intubated, and given
general anesthesia. A "time out" is called
by the circulating nurse.
d) So all members of the OR team participate in the positive identification of the
What is the purpose of the "time out?" client, identify the correct site, and identify the planned procedure.
-
a)To allow the operating team time
to scrub and gown. Surgical procedures that are site specific, such as left, right, or bilateral, require
b) So the anesthesiologist can wake up the patient identification before surgery. As required by The Joint Commission's NPSGs,
client up to ensure the correct procedure is to ensure that the correct site is selected and the wrong site is avoided, the site is
being done on the correct person. marked by a licensed independent practitioner and, whenever possible, involves
c) As a signal for the scrub nurse or the patient. The surgeon is accountable and should be present during the
procedure.
certified scrub technician to perform an
The nurse is an important part of this SAFETY measure. Before starting the operative
instrument and sponge count.
procedure, facilities use a "time-out" procedure to verify the correct site, patient,
d) So all members of the OR team
and procedure. The perioperative nurse is in a position of ensuring that these
participate in the positive identification of
SAFETY
the client, identify the correct site, and
measures are implemented immediately before the procedure is started (AORN,
identify the planned procedure.
2015). The "time-out" involves the participation of all members of the procedure
team, including the surgeon, anesthesia provider, circulating nurse, scrub person,
and any other active participants.
2/16
, 3/21/25, 7:47 NU371 HESI Case Study: PVD with Amputation Flashcards |
AM
The operating room nurse asks the -
surgeon, "What does the client want done
with the amputated extremity?" The
surgeon informs the operating room nurse
that the client was unconscious upon
admission and has no family members.
What will the operating room nurse do with c) Ensure that the limb is sent to the incinerator so that it can be burned.
the amputated limb? -
a) Place the amputated limb in a
Amputated limbs are disposed of in this manner. If the client makes special
biohazard bag and place it in the trash.
requests due to cultural needs, this must be discussed and arranged prior to the
b) Keep the limb in the morgue until the
surgery.
client can tell the staff what to do with the However, the client was unconscious upon admission and no family members were
limb. present, therefore, standard hospital protocol applies.
c) Ensure that the limb is sent to
The client is admitted to the Intensive Care Unit with a right, above the knee
the incinerator so that it can be
Intensive Care Unit amputation, a soft dressing to the residual limb, an IV of Lactated Ringer's at 125
mL/hr, and a Foley catheter.
The nurse hangs a new bag of IV fluids and 15 drops/mL X 125 mL/hr x 1 hr/60 minutes= 31.25 = 31 drops/min
checks the rate. The IV tubing delivers 15
drops/mL. How many drops/minute will the
IV set deliver? (Enter the numerical
value
only. If rounding is required, round to the
whole number.)
The client opens his eyes when spoken -
to and is able to answer simple questions.
He is pointing to his right leg and saying
"hurts real bad." The nurse assesses the
client's
vital signs, which are stable, and observes
that the right residual limb dressing is dry
and intact.
3/16
