NUR 362 Exam 1 Practice Qs

The nurse is aware that the amino acid, arginine, A)Stimulates T-cell response B)Is essential for antibody formation C)Is involved in capillary formation D)Is important for normal blood clotting

A

Which findings would be indicative of a nursing diagnosis of decreased cardiac output? A)urinary output > 60 ml; BP 90/60; tachypnea B)bradycardia; urinary output < 30 ml; confusion C)tachycardia; hemoglobin 10.9 gm/dL; BP 88/56 confusion; D)tachypnea; hemoglobin 14.2 gm/dL

C

Which of the following clinical manifestations increase the risk for evisceration in the postoperative client? A)Hypovolemia B)Edema C)Valsalva maneuver D)Hypoxia

C

Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply. A)Discussing and reviewing the advanced directive document B)Establishing an intravenous line C)Ensuring that the sponge, needle, and instrument counts are correct D)Administering medications, fluid, and blood component therapy, if prescribed E)Beginning discharge planning

C, D

Adequate hourly urine output for a client with an indwelling urinary catheter is A)0.5 mL/kg/h. B)1.0 mL/kg/h. C)1.5 mL/kg/h. D)2.0 mL/kg/h.

D

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? A)Pituitary B)Adrenal C)Thyroid D)Parathyroid

adrenal

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? A)Splint the incision site using a pillow during deep breathing and coughing exercises. B)Pain medication should be taken before completing deep breathing and coughing exercises. C)Deep breathing and coughing exercises should be completed every 8 hours. D)Deep breathing and coughing exercises may be used as relaxation techniques.

A

A client sustained severe burns over both lower extremities 1 week ago. The client informs the nurse that he had to wait for 30 minutes last night to receive pain medication, which caused the pain not to be relieved after administration. What suggestions could the nurse make to the physician to provide adequate relief of pain? A)Provide the client with a patient-controlled analgesia (PCA) pump. B)If the nurse is going to be late with administration, have an extra dose of medication available. C)Increase the frequency of the medication so that the client will have less time to wait. D)Increase the dosage of the medication so the client will stay medicated longer.

A

A nurse is caring for a client who is three hours post op from open abdominal surgery. During routine assessment, the nurse notes the previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the client's change in condition? A)The client is displaying early signs of shock. B)The client is showing signs of a medication reaction. C)The client is displaying late signs of shock. D)The client is showing signs of an anesthesia reaction.

A

A nurse who works in the operating room is required to assess the client continuously and protect the client from potential complications. Which symptoms would the nurse watch for as indicative of malignant hyperthermia? Select all that apply. A)Cyanosis B)Cardiac arrest C)Increased urine output D)Mottled skin

A

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? A)A blood urea nitrogen level of 42 mg/dL B)A creatine kinase level of 120 U/L C)A serum creatinine level of 0.9 mg/dL D)A urine creatinine level of 1.2 mg/dL

A

During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse? A)Notify the surgical team to remove all latex-based items. B)Notify the dietary department. C)Notify the physician regarding postoperative pain medications.

A

A postoperative client is experiencing a flash pulmonary edema. What finding in the client's sputum is consistent with this problem? A)Pink color B)Copious red blood in the sputum C)Foul smell D)Pieces of vomitus

A Flash pulmonary edema that occurs when protein and fluid accumulate in the alveoli unrelated to elevated pulmonary artery occlusive pressure. Signs and symptoms include agitation, tachypnea, tachycardia, decreased pulse oximetry readings, frothy, pink sputum, and crackles on auscultation.

A patient who underwent abdominal surgery 3 hours ago has started to hemorrhage. The nurse would classify this type of hemorrhage has which of the following? A)Intermediary B)Primary C)Secondary D)Tertiary

A Explanation: Intermediary hemorrhage occurs during the first few hours after surgery when the rise of blood pressure to its normal level dislodges insecure clots formed in untied vessels. Primary hemorrhage occurs at the time of surgery. Secondary hemorrhage may occur some time after surgery if a suture slips because a blood vessel was not securely tied, became infected, or was eroded by a drainage tube.

What action during a surgical procedure requires immediate intervention by the circulating nurse? A)The scrub nurse calling the blood bank to obtain blood products B)The surgeon reaching within the sterile field to obtain equipment C)The anesthesiologist monitoring blood gas levels D)The registered nurse's first assistant suturing the surgical wound

A - breaks sterility of scrub nurse

Why should the nurse be vigilant with assessment of perioperative risks on the older adult client? Select all that apply. A)Ciliary action decreases, reducing the cough reflex. B)Fatty tissue increases, prolonging the effects of anesthesia. C)Liver size decreases, reducing the metabolism of anesthetics. Peristalsis increases. D)The elasticity of skin increases and decreases the risk of shearing.

ABC

A client is at postoperative day 1 after abdominal surgery. The client is receiving 0.9% normal saline at 75 mL/h, has a nasogastric tube to low wall suction with 200 mL every 8 hours of light yellow fluid, and a wound drain with 50 mL of dark red drainage every 8 hours. The 24-hour urine output total is 2430 mL. What action by the nurse is most appropriate? A)Document the findings and reassess in 24 hours. B)Assess for signs and symptoms of fluid volume deficit. C)Assess for edema. D)Discontinue the nasogastric tube suctioning.

Assess for signs and symptoms of fluid volume deficit. Explanation: The client's 24-hour intake is 1800 mL (75 x 24). The client's 24-hour output is 3180 mL [(200 × 3) + (50 × 3) + 2430]. Because the output is significantly higher than the intake, the client is at risk for fluid volume deficit. The nurse should not discontinue the nasogastric suctioning without a physician's order. The findings should be documented and reassessed, but the nurse needs to take more action to prevent complication. Edema is usually associated with fluid volume excess.

A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit? A)Dizziness and a feeling of detachment B)Pupillary dilation and rapid pulse C)Unconsciousness and regular respirations D)Weak, thready pulse and cyanosis

B

Corticosteroids have which effect on wound healing? A)Reduce blood supply B)Mask the presence of infection C)Cause hemorrhage D)May cause protein-calorie depletion

B

The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response? A)"The anesthetic may last for 1 hour." B)"The anesthetic may last for 3 hours." C)"The anesthetic may last for 5 hours." D)"The anesthetic may last for 7 hours."

B

The nurse is caring for a client in the postanesthesia care unit (PACU). The client has the following vital signs: pulse 115, respirations 20, oral temperature 97.2°F, blood pressure 84/50. What should the nurse do first? A)Notify the physician. B)Assess for bleeding. C)Increase rate of IV fluids.

B The client is tachycardic with low blood pressure; thus assessing for hemorrhage is the priority action. While the physician may need to be notified, the nurse needs to be able to communicate a complete picture of the client, which would include bleeding, when calling the physician. The rate of IV fluid administration should be adjusted according to a physician order. The nurse should review prior vital signs but only after the immediate threat of hemorrhage is assessed.

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? A)Make inhalation longer than exhalation. B)Exhale through an open mouth. C)Use diaphragmatic breathing. D)Use chest breathing.

C

A nurse on the surgical team has been assigned the role of scrub nurse. What action by the scrub nurse is appropriate? A)Leading the surgical team in a debriefing session B)Keeping all records and adjusting lights C)Handing instruments to the surgeon and assistants D)Coordinating activities of other personnel

C

Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out? A)Ensure that sufficient surgical supplies are available. B)Check that all surgical personnel are properly attired. C)Review the scheduled procedure, site, and client. D)Confirm that informed consent has been obtained.

C

The nurse documents the presence of granulation tissue in a healing wound. How should the nurse describe the tissue? A)Necrotic and hard B)Pale yet able to blanch with digital pressure C)Pink to red and soft, bleeding easily D)White with long, thin areas of scar tissue

C

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? A)"Who is here with you?" B)"Did you bring a copy of your health care power of attorney?" C)"When is the last time you ate or drank?" D)"Did you bring any valuables with you?"

C

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? A)Pregnancy B)Diabetes C)Urinary tract infection D)Osteoporosis

D

A patient has a wound that has hemorrhaged. What does the nurse understand is the cause of the patient's increased risk of infection? A)Reduced amounts of oxygen and nutrients are available B)The tissue becomes less resilient C)Retrograde bacterial contamination may occur D)Dead space and dead cells provide a culture medium

D

A patient who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be most appropriate? A)Notify the anesthesiologist immediately. B)Position the patient on the side. C)Turn on the television for distraction. D)Encourage increased fluid intake.

D

Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dl and has vertigo when getting out of bed. The nurse suspects abnormal orthostatic changes. The vital sign values that most support the nurse's analysis are: A)blood pressure of 150/100 mm Hg and pulse of 130 beats/minute. B)blood pressure of 150/100 mm Hg and pulse of 50 beats/minute. C)blood pressure of 80/40 mm Hg and pulse of 50 beats/minute. D)blood pressure of 80/40 mm Hg and pulse of 130 beats/minute.

D

The nurse is assisting with positioning the patient on the operating table. The nurse understands that the most commonly used position is which of the following? A)Lithotomy B)Sims C)Trendelenburg D)Dorsal recumbent

D

The scrub nurse is responsible for: A)Calling the "time-out" to verify the surgical site and procedure B)Monitoring the administration of the anesthesia C)Monitoring the operating-room personnel for breaks in sterile technique D)Preparing the sterile instruments for the surgical procedure

D

Unless contraindicated, how should the nurse position an unconscious patient? A)Flat on the back, without elevation of the head, to facilitate frequent turning and minimize pulmonary complications B)In semi-Fowler's position, to promote respiratory function and reduce the incidence of orthostatic hypotension when the patient can eventually stand C)In Fowler's position, which most closely simulates a sitting position, thus facilitating respiratory as well as gastrointestinal functioning D)On the side with a pillow at the patient's back and the chin extended, to minimize the dangers of aspiration

D

What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block? A)"Avoid drinking liquids until the gag reflex returns." B)"Avoid eating milk products for 24 hours." C)"Notify a nurse if you experience blood in your urine." D)"Remain supine for the time specified by the physician."

D

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate? A)Considering the gown sterile from mid-thigh to neck B)Positioning the sterile drape on a table from back to front C)Allowing circulating nurses to contact sterile equipment D)Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

D

Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery? A)Trendelenburg position B)Lithotomy position C)Supine position D)Sims position

D

The nurse is responsible for monitoring cardiovascular function in a postoperative patient. What method can the nurse use to measure cardiovascular function? A)Complete blood count B)Central venous pressure C)Upper endoscopy D)Chest x-ray

B

The nurse recognizes that the client most at risk for mortality associated with surgery is the: A)Client who is obese B)Client with chronic alcoholism C)Client with controlled diabetes D)Client with controlled hypertension

B

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? 1, 3, 5 or 7

7

The nurse is teaching the client about patient-controlled analgesia. Which of the following would be appropriate for the nurse to include in the teaching plan? A)The client can self-administer oral pain medication as needed with patient-controlled analgesia. B)Family members can be involved in the administration of pain medications with patient-controlled analgesia. C)Therapeutic drug levels can be maintained more evenly with patient-controlled analgesia. D)There are no advantages of patient-controlled analgesia over a PRN dosing schedule.

CAdvantages of patient-controlled analgesia include participation of the client in care, elimination of delayed administration of analgesics, and maintenance of therapeutic drug levels.

Which would be included as a responsibility of the scrub nurse? A)Obtaining and opening wrapped sterile equipment B)Keeping all records and adjusting lights C)Handing instruments to the surgeon and assistants D)Coordinating activities of other personnel

Handing instruments to the surgeon and assistants Explanation: The responsibilities of a scrub nurse are to assist the surgical team by handing instruments to the surgeon and assistants, preparing sutures, receiving specimens for laboratory examination, and counting sponges and needles. Responsibilities of a circulating nurse include obtaining and opening wrapped sterile equipment and supplies before and during surgery, keeping records, adjusting lights, and coordinating activities of other personnel.

When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal? A)Within the first 12 hours B)About 24 hours postoperatively C)On the second or third day D)4 days after a surgical procedure

c

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care: A)Is used as an adjunct to spinal anesthesia. b)may result in the administration of general anesthesia. C)is a type of regional anesthesia. D)requires the introduction of an anesthetic agent into the epidural space.

may result in the administration of general anesthesia. Explanation: Monitored anesthesia care may require the anesthsiologist to convert to general anesthesia.

A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication? A)tolerance B)addiction C)drug allergy D)poor quality control by the drug manufacturer

tolerance

The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician? A)When the patient's blood ammonia concentration reaches 180 mg/dL B)When a lactate dehydrogenase concentration is 300 units C)When a serum albumin concentration is 5.0 g/dL D)When a serum globulin concentration reaches 2.8 g/dL

A

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? A)80 to 110 mg/dL B)150 to 240 mg/dL C)250 to 300 mg/dL D)300 to 350 mg/dL

A

Which conduction block anesthetizes the nerves supplying the chest, abdominal wall, and extremities? A)Paravertebral anesthesia B)Brachial plexus block C)Transsacral block D)Lumbar puncture

A

A nurse is caring for a client who is scheduled to have a thoracotomy. When planning care for this client, what mobility teaching will the nurse include in the plan of care? A)Lower back and rib range of motion exercises B)Use of a cane on the unaffected side C)Use of a cane on the affected side D)Shoulder and upper arm range-of-motion exercises

D

A client asks the nurse about possible ill effects from general anesthesia. What is the best response by the nurse? A)"Some possible negative effects include difficulty waking up and slow heart rate." B)"Few negative effects occur with general anesthesia." C)"Amnesia and analgesia are some of the negative effects of anesthesia." D)"Clients can experience pain and loss of consciousness."

A

A client develops a hemorrhage one hour post surgery. The nurse knows this is most likely an intermediary hemorrhage from a vein because it occurred: A)within the first few hours, and has darkly colored blood that bubbles out slowly. B)during surgery, and has bright red blood that flows freely. C)at a suture site, and the blood appears intermittently in spurts. D)a few hours after surgery, and the bright red blood appears with each heartbeat.

A

The nurse expects informed consent to be obtained for insertion of: A)An indwelling urinary catheter B)An intravenous catheter C)A gastrostomy tube D)A nasogastric tube

C

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next? A)Make the client NPO and order a stat hemoglobin and hematocrit. B)Remove the dressing, assess the wound, and apply a new sterile dressing. C)Outline the drainage with a pen and record the date and time next to the drainage. D)Take the client's vital signs and call the surgeon.

C

The nurse recognizes that written informed consent is required for insertion of a(n): A)Nasogastric tube. B)Urinary catheter. C)Peripherally-inserted central catheter. D)Oral airway.

C

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? A)Immediately upon admission B)Upon awakening in the postanesthesia care unit C)Up to 72 hours after alcohol withdrawal D)Up to 24 hours after alcohol withdrawal

C