Surgical Scenario 1: Marilyn Hughes
Pre-quiz – Simulation – SBAR FEEDBACK – Post-quiz (All in this document)
1 The nurse understands that neurovascular assessments should be performed how
frequently during the first 24 hours following application of an immobilization device to a
fractured extremity?
Every hour
2 Which of the following are appropriate initial nursing interventions to control
discomfort in a fractured extremity stabilized with a splint or cast? (Select all that apply.)
Elevation of extremity , Analgesic medication , Intermittent cold packs
3 The nurse understands that assessing neurovascular function in a client with a brace,
splint, or cast is vitally important. This assessment should include which of the following
components? (Select all that apply.)
Numbness of the extremity , Movement of the extremity , Skin color of the extremity
4 What assessment findings observed by the nurse would demonstrate poor vascular
perfusion to a splinted lower extremity? (Select all that apply.)
Decreased pedal pulses , Pale foot
5 When monitoring for potential complications after surgery, what finding would cause
the nurse to suspect that Ms. Hughes is experiencing postoperative bleeding?
Decrease in hemoglobin
6 The nurse understands that surgical fixation of fractures carries a risk of infection. The
nurse monitors for which of the following signs and symptoms of infection? (Select all
that apply.)
Pain , Swelling , Elevated white blood cell count , Redness
7 Which of the following can reduce the incidence of fat embolism and shock as
complications from a bone fracture?
Early surgical fixation
8 When monitoring for potential complications in the client with a cast, splint, or brace,
the nurse recognizes that which of the following is an early hallmark sign of
compartment syndrome?
Acute pain with passive range of motion
9 When monitoring Ms. Hughes for possible complications following the surgical repair
of a fracture, it is important for the nurse to be alert for development of which of the
following conditions? (Select all that apply.)
Pulmonary embolism , Compartment syndrome , Deep vein thrombosis
Simulation
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Wash hands
ID patient
Verify consent
Assess allergy
Sit the patient up
Assess Vitals (all)
Assess patient dressing
Loosen dressing
Assess pain (all the relevant options)
Examine patient’s legs
Lower the patient’s leg (remove orthopedic pillow)
Ask to rate patient’s pain
Provide patient education
Ask if she could feel her toes
Ask if she can move her toes
Assess IV
Check carotid pulse
Check pedal pulse
Phone the provider
Handoff patient
Surgical Scenario 1: Marilyn Hughes
SBAR Feedback
Situation
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She is admitted after surgery on her left leg
She has signs of possible compartment syndrome
She showed signs of poor perfusion in her left foot
Background
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Mrs. Hughes has no prior medical complaints
She suffered a left tibia-fibula fracture
Her left foot was elevated with an orthopedic pillow
Assessment
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The Ace dressing seemed really tight
I lowered her left leg to improve circulation
The Ace dressing needed to be loosened
Her left foot appeared cold and cyanotic
Mrs. Hughes could not feel or move her left toes
She has O2 saturations at 98% room air
I called the provider to inform about my findings and concerns
She is alert and oriented times 4
Recommendation
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Continue to monitor vital signs every hour
Contact the provider if they are not here in the next hour
Pain assessment is needed
Surgical Scenario 1: Marilyn Hughes
post-quiz
1. The nurse is aware that Choose Answer.. is/are of immediate concern and could indicate Choose Answer..
as a potential complication.
Pain 8 out of 10, compartment syndrome
2. The nurse knows that which follow-up assessment finding with ORIF would need immediate intervention?
(Select all that apply.)
No palpable pulses in the affected extremity, Capillary refill greater than 3 seconds in the affected extremity,
Edema noted to affected extremity distal to the surgery, Numbness and pain noted in the affected extremity
3. The nurse is aware Choose Answer.. is a high priority complication and suspects the client may be
experiencing Choose Answer.., which requires Choose Answer.. as a priority intervention.
No palpable pulse, compartment syndrome, immediate provider notification
4. The nurse is aware that postoperative management of clients with ORIF should include which of the following
interventions? (Select all that apply.)
Assess extremity for sensation and movement., Maintain limb alignment as prescribed., Administer pain
medication as required., Assess vital signs frequently for infection.
5. The nurse is aware that when Choose Answer.. intervention does not relieve pain and restore tissue perfusion
to the affected extremity, the nurse should anticipate Choose Answer.. from the provider.
Loosening the bandage, emergency fasciotomy
6. The nurse is aware that expected outcomes from appropriate interventions following an ORIF procedure
should include which of the following assessments? (Select all that apply.)
Sensation and movement of associated muscles in the extremity, Skin warm and dry with capillary refill less than 3
seconds, dressing to the affected extremity is clean and without any drainage, Vital signs assessed reflect client's
baseline, and client remains afebrile, Client reports ability to sense touch and denies numbness to extremity