Perioperative Nursing MCQs

A gunshot wound would be classified under which category of surgery based on urgency? A. Emergent B. Elective C. Required D. Urgent

A

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching? A. Headache B. Seizures C. Itching D. Sore throat

A

As a nurse, which statement is incorrect regarding an informed consent signed by a patient? A. The nurse is responsible for obtaining the consent for surgery B. Patients under 18 years of age may need a parent or legal guardian to sign a consent form C. The nurse can witness the client signing the consent form D. It is the nurse's responsibility to ensure the patient has been educated by the physician about the procedure before informed consent is obtained

A All statements are correct except that it's the nurse's responsibility for obtaining the consent for surgery. It is the surgeon's responsibility.

What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound? A. Count the sponges. B. Label the tissue specimen. C. Prepare the necessary sutures. D. Hand equipment to the surgeon as needed.

A Standards call for the scrub nurse and the circulating nurse to count the sponges at the beginning of the surgery, when the surgical wound is being sutured, and when the skin is being sutured. Tissue specimens should be labeled when obtained. The sutures should be ready before the surgeon needs them. Although the scrub nurse does hand equipment to the surgeon, the sponge count is a higher priority action.

Which clinical manifestation is often the earliest sign of malignant hyperthermia? Tachycardia (heart rate >150 beats per minute) Hypotension Elevated temperature Oliguria

A Tachycardia is often the earliest sign of malignant hyperthermia. Hypotension is a later sign of malignant hyperthermia. The rise in temperature is actually a late sign that develops quickly. Scant urinary output is a later sign of malignant hyperthermia.

A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented? Circulating nurse Scrub nurse Surgeon Registered nurse first assistant

A The circulating nurse is responsible for ensuring that the second verification of the surgical procedure and site takes place and is documented. Each member of the surgical team verifies the patient's name, procedure, and surgical site using objective documentation and data before beginning the surgery.

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? The client is displaying early signs of shock. The client is showing signs of a medication reaction. The client is displaying late signs of shock. The client is showing signs of an anesthesia reaction.

A The early stage of shock manifests with feelings of apprehension and decreased cardiac output. Late signs of shock include worsening cardiac compromise and leads to death if not treated. Medication or anesthesia reactions may cause client symptoms similar to these; however, these causes are not as likely as early shock.

A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member? A. Surgeon B. Scrub nurse C. Circulating nurse D. Anesthetist

A The registered nurse first assistant practices under the direct supervision of the surgeon. The circulating nurse works in collaboration with other members of the health care team to plan the best course of action for each patient. The scrub nurse assists the surgeon during the procedure as well as setting up sterile tables and preparing equipment. The anesthetist administers the anesthetic medications.

After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements? A. "I'll be sleepy but able to respond to your questions." B. "I won't feel it, but I'll have a tube to help me breathe." C. "I'm so glad that I will be unconscious during the surgery." D. "Only the surgical area will be numb."

A With moderate sedation, the patient can maintain a patent airway (i.e., doesn't need a tube to help breathing), retain protective airway reflexes, and respond to verbal and physical stimuli. The patient is not unconscious with moderate sedation. Local anesthesia involves anesthetizing or numbing the area of the surgery.

A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? A. Lithotomy B. Dorsal recumbent C. Trendelenburg D. Sims

A The lithotomy position is used for nearly all perineal, rectal, and vaginal surgeries. The Trendelenburg position is usually used for surgery on the lower abdomen and pelvis. The Sims' or lateral position is used for renal surgery. The dorsal recumbent position is the usual position for surgical procedures.

Several of the clients at the clinic are preparing to have surgery within the next 2 weeks. They are completing preoperative paperwork today with their visit. What are some of the reasons that people might need to have surgery? Select all that apply. Cosmetic Palliative Diagnostic Causative Normative

A,B,C Reasons people have surgery include cosmetic reasons, diagnostic procedures, palliative surgeries, exploratory surgeries, and curative surgeries. Normative and causative are not reasons for surgery.

A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client? Urgent Elective Required Emergent

B Elective surgery means that the client should have the surgery even though failure to have the surgery is not catastrophic. Urgent surgery means that prompt attention is required within 24 to 30 hours. Required surgery means that the client needs to have surgery within a few weeks or months. Emergent surgery means that the client requires immediate attention for a life-threatening disorder without delay.

Informed consent from the surgical client is essential in all of the following categories of surgery except: A. Elective surgery B. Emergent surgery C. Required surgery D. Urgent surgery

B In an emergency, a physician may perform surgery without a client's informed consent in order to save the client's life.

In what phase of postanesthesia care (PACU) is the client prepared for self-care or care in the hospital or an extended care setting? Phase III PACU Phase II PACU Phase I PACU Phase IV PACU

B In some hospitals and ambulatory surgical centers, postanesthesia care is divided into three phases. In the phase I PACU, used during the immediate recovery phase, intensive nursing care is provided. In the phase II PACU, the patient is prepared for self-care or care in the hospital or an extended care setting. In phase III PACU, the patient is prepared for discharge. There is no phase IV PACU.

The nurse is preparing an older adult for a surgical procedure. Which action will the nurse take to protect the client from injury during the operative period? Apply a warm blanket after the procedure. Protect bony prominences with extra padding. Estimate amount of blood loss during the procedure. Provide antiembolic stockings to be applied postoperatively.

B Older adult clients are at higher risk for complications from anesthesia and surgery compared with younger adult clients due to several factors. One factor is age-related decline in physiological reserve that weakens the normal response to stressors, acute illness, anesthesia, and surgery. Nursing management for the older surgical client in the intraoperative period includes careful transferring and positioning in the OR bed by protecting pressure points and bony prominences with extra padding. Intraoperative warming techniques should be used to reduce unintentional hypothermia during the case. Blood loss is to be accurately measured and not estimated. Antiembolic stockings are to be used during the case to prevent the development of venous thromboemboli.

A postoperative client is being evaluated for discharge and currently has an Aldrete score of 8. Which of the following is the most likely outcome for this client? A. The client must remain in the PACU. B. The client can be discharged from the PACU. C. The client must be put on immediate life support. D. The client should be transferred to an intensive care area.

B The Aldrete score is a scoring system used to determine discharge from PACU- usually 8 to 10 before discharge from the PACU. Clients with a score of less than 7 must remain in the PACU until their condition improves or they are transferred to an intensive care area, depending on their preoperative baseline score.

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: Anesthesiologist Circulating nurse Scrub nurse Surgeon

B The circulating nurse is responsible for maintaining the safety of the client and the surgical environment.

The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock? A. Encouraging the client to breathe deeply B. Reinforcing dressings or applying pressure if bleeding is frank C. Rubbing the back D. Elevating the head of the bed

B The nurse should reinforce the dressing or apply pressure if bleeding is frank. The nurse should keep the head of the bed flat unless it is contraindicated. Encouraging the client to breathe deeply and rubbing the back will not help manage and minimize hemorrhage and shock.

The primary objective in the immediate postoperative period is A. controlling nausea and vomiting. B. maintaining pulmonary ventilation. C. relieving pain. D. monitoring for hypotension.

B The primary objective in the immediate postoperative period is to maintain pulmonary ventilation, which prevents hypoxemia. Controlling nausea and vomiting, relieving pain, and monitoring for hypotension are important, but they are not primary objectives in the immediate postoperative period.

As the nurse you are getting the patient ready for surgery. You are completing the preoperative checklist. Which of the following is not part of the preoperative checklist? A. Assess for allergies B. Conducting the Time Out C. Informed consent is signed D. Ensuring that the history and physical examination has been completed

B The time out is conducted by the OR nurse prior to surgery. All of the other options are conducted by the nurse getting the patient ready for surgery.

A patient is recovering from surgery. The patient is very restless, heart rate is 120 bpm and blood pressure is 70/53, skin is cool/clammy. As the nurse you would? A. Continue to monitor the patient B. Notify the MD C. Obtain an EKG D. Check the patient's blood glucose

B This is an emergency situation. The patient is more than likely experiencing a hemorrhage of some type. Notifying the MD would be the first line of action and then you could check the patient's blood glucose and obtain an EKG. This patient is probably going to need a surgical intervention.

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention? Assessing for hallucinations Frequently monitoring vital signs Administering oxygen Providing a quiet dark room for recovery

B Vital signs must be monitored frequently to assess for respiratory depression and to enable quick intervention. Oxygen may need to be administered if respiratory depression occurs; therefore, monitoring vital signs is a higher priority nursing intervention.

You are completing the history on a patient who is scheduled to have surgery. What health history increases the risk for surgery for the patient? A. Urinary Tract infections B. History of Premature Ventricle Beats C. Abuse of street drugs D. Hyperthyroidism

C If a patient has a history of street drug abuse this puts them at risk in surgery. This information is very important for the anesthesiologist due to the complications that can arise from the anestheisa. All of the other options are important to note but not a risk for surgery.

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign? A. An insertion of an intravenous catheter B. Irrigation of the external ear canal C. An open reduction of a fracture D. Urethral catheterization

C Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia; a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation.

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

C Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.

The nurse is caring for the postoperative client in the postanesthesia care unit. Which of the following is the priority nursing action? A. Monitor vital signs for early detection of shock. B. Assess the incisional dressing to detect hemorrhage. C. Position the client to maintain a patent airway. D. Administer antiemetics to prevent nausea and vomiting.

C Maintaining a patent airway is the immediate priority in the PACU.

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? A. hypothermia B. fluid volume excess C. malignant hyperthermia D. infection

C Malignant hyperthermia is an inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents. If the client's temperature begins to rise rapidly, anesthesia is discontinued, and the OR team implements measures to correct physiologic problems, such as fever or dysrhythmias. Hypothermia is a lower than expected body temperature. Signs of infection would not present during the procedure. Increased body temperature would not indicate fluid volume excess.

A patient who is currently undergoing surgery has vomited a small amount of emesis. How should the OR nurses best respond to this intraoperative event? Maintain the patient's current position and perform deep suctioning. Assist the anesthesiologist with extubating the patient. Turn the patient on his or her side and perform oral suctioning. Administer an antiemetic as ordered and closely monitor the patient for further vomiting.

C Nausea and vomiting, or regurgitation, may affect patients during the intraoperative period. If gagging occurs, the patient is turned to the side, the head of the table is lowered, and a basin is provided to collect the vomitus. Suction is used to remove saliva and vomited gastric contents. Gagging or vomiting does not necessitate extubating the patient, and deep suctioning is not indicated. Antiemetics may be required, but the priority is preventing aspiration.

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

C Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.

A nurse documents the presence of granulation tissue in a healing wound. Which of the following is the best description for the tissue? A. Necrotic and hard B. Pale yet able to blanch with digital pressure C. Pink to red and soft, noting that it bleeds easily D. White with long, thin areas of scar tissue

C Second-intention healing (granulation) occurs in infected wounds or in wounds in which the edges have not been approximated. Gradually, the necrotic material disintegrates and escapes, and the abscess cavity fills with a red, soft, sensitive tissue that bleeds easily. This tissue is composed of minute, thin-walled capillaries and buds that later form connective tissue. These buds, called granulations, enlarge until they fill the area left by the destroyed tissue. Healing is complete when skin cells grow over these granulations.

A client scheduled for surgery follows a vegan eating plan. For which potential postoperative complication will the nurse plan care for this client? A. Stasis pneumonia B. Blood clots C. Delayed wound healing D. Hypoactive bowel sounds

C The client following a vegan eating plan is at risk for a low protein intake. The reduced protein can lead to impaired or delayed wound healing and cause decreased skin and wound strength. A low protein intake does not cause blood clots, stasis pneumonia, or hypoactive bowel sounds.

A recently extubated postoperative client starts to gag and make vomiting sounds. What action should the nurse perform first? A. Obtain suction equipment. B. Administer an antiemetic. C. Turn the client onto their side. D. Provide an emesis basin.

C The nurse should turn the client on their side to avoid aspiration. The nurse may need to obtain suction equipment, provide an emesis basin, or administer an antiemetic, but the first priority is protecting the client's airway by preventing aspiration.

A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role? A. Anesthetist B. Registered nurse first assistant C. Scrub role D. Circulating nurse

C The scrub role includes performing a surgical hand scrub, setting up the sterile tables, and preparing sutures, ligatures, and special equipment. The circulating nurse manages the operating room and protects patient safety. The registered nurse first assistant functions under the direct supervision of the surgeon. Responsibilities may include handling tissue, providing exposure of the operative field, suturing, and maintaining hemostasis. The anesthetist administers the anesthetic medications.

A client is scheduled for an invasive procedure. What should the nurse document in the chart regarding the procedure? A. A signed consent form from the client's family B. A report from the dietician C. A detailed urinalysis report D. A signed consent form from the client

D A signed consent is required and is important for initiating invasive procedures. The nurse should therefore check for the signed consent form of the client. Checking a report from the dietitian or a signed consent form from the client's family is not necessary. A urinalysis report might be required if the physician requests it, but is not required before performing an invasive procedure.

A client asks why a drain is in place to pull fluid from the surgical wound. What is the best response by the nurse? A. "It will cut down on the number of dressing changes needed." B. "The drain will remove necrotic tissue." C. "Most surgeons use wound drains now." D. "It assists in preventing infection."

D A wound drain assists in preventing infection by removing the medium in which bacteria could grow. The purpose of the wound drain is not to remove necrotic tissue or to decrease the number of dressing changes. Stating that most surgeons use wound drains does not answer the client's question appropriately.

A nurse assesses a postoperative client as having abdominal organs protruding through the surgical incision. Which term best describes this assessment finding? A. Hernia B. Dehiscence C. Erythema D. Evisceration

D Evisceration is a surgical emergency. A hernia is a weakness in the abdominal wall. Dehiscence refers to the partial or complete separation of wound edges. Erythema refers to the redness of tissue.

A nurse is caring for a patient following surgery under a spinal anesthetic. What interventions can the nurse implement to prevent a spinal headache? A. Have the patient sit in a chair. B. Ambulate the patient. C. Limit fluids. D. Keep the patient lying flat.

D Measures that are helpful in relieving headache include maintaining a quiet environment, keeping the patient lying flat, and keeping the patient well hydrated. Sitting or standing the patient up and limiting fluids would not relieve a spinal headache.

What does the nurse recognize as one of the most common postoperative respiratory complications in elderly clients? A. Pulmonary edema B. Pleurisy C. Hypoxemia D. Pneumonia

D Older clients recover more slowly, have longer hospital stays, and are at greater risk for development of postoperative complications. Delirium, pneumonia, decline in functional ability, exacerbation of comorbid conditions, pressure ulcers, decreased oral intake, GI disturbance, and falls are all threats to recovery in the older adult.

A nurse is caring for a client with obesity and diabetes after abdominal surgery. What is the client at increased risk for? A. Hypotension B. Contractures C. Phlebitis D. Wound dehiscence

D Risk factors for wound dehiscence include advanced age over 65 years, chronic disease such as diabetes, hypertension, obesity, history of radiation or chemotherapy, malnutrition, particularly insufficient protein and vitamin C, and hypoalbuminemia. This client is not at increased risk for hypotension, contractures, or phlebitis.

A client is transferred from the postanesthesia care unit (PACU) to an inpatient care unit. What will the nurse assess first? Surgical site Pain level Level of consciousness Breathing

D The nurse will assess the client being transferred from the PACU to an inpatient care unit. The priority is to assess breathing and administer oxygen if prescribed because this provides a baseline and helps identify for the development of respiratory distress. Pain level is assessed after the surgical site and level of consciousness are assessed.

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? A. Passing instruments B. Assisting the surgeon C. Setting up the sterile tables D. Coordinating the surgical team

D The person in the scrub role, either a nurse or a surgical technician, provides sterile instruments and supplies to the surgeon during the procedure by anticipating the surgical needs as the surgical case progresses. The circulating nurse coordinates the care of the patient in the OR. Care provided by the circulating nurse includes planning for and assisting with patient positioning, preparing the patient's skin for surgery, managing surgical specimens, anticipating the needs of the surgical team, and documenting intraoperative events.

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 The scrub nurse is responsible for preparing the sterile instruments for the surgical procedure.