Chapter 5: PrepU - Perioperative Nursing

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? 1- Circulating nurse 2- Scrub nurse 3- Surgeon 4- Registered nurse first assistant

1

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: 1- verapamil (Isoptin) 2- dantrolene sodium (Dantrium) 3- potassium chloride 4- an acetaminophen suppository

2

A 79-year-old man is scheduled for surgical repair of an inguinal hernia. In light of this patient's age, the nurse will prioritize nursing interventions aimed at preventing: 1- Overstimulation 2- Skin breakdown 3- Hyperglycemia or hypoglycemia 4- Early ambulation

2

The potential effects of prior medication therapy must be evaluated before surgery. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia? 1- Corticosteroids 2- Diuretics 3- Insulin 4- Anticoagulants

2

Which stage of surgical anesthesia is also known as excitement? 1- I 2- II 3- III 4- IV

2

The nurse recognizes that written informed consent is required for insertion of a(n): 1- Nasogastric tube. 2- Urinary catheter. 3- Peripherally-inserted central catheter. 4- Oral airway.

3

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? 1- Verify consent. 2- Document the start of surgery. 3- Acquire ordered blood products. 4- Count sponges and syringes.

1

The nurse expects informed consent to be obtained for insertion of: 1- An indwelling urinary catheter 2- An intravenous catheter 3- A gastrostomy tube 4- A nasogastric tube

3

A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that: 1- inserting a Foley catheter can decrease fluid retention. 2- administering I.V. antibiotics can prevent pneumonia. 3- this client may need intubation. 4- it may be necessary to raise the head of this client's bed.

4

The nurse recognizes the client has reached stage III of general anesthesia when the client: 1- Exhibits no change in behavior 2- Exhibits shallow respirations and a weak, thready pulse 3- Complains of ringing or buzzing in the ears 4- Has small pupils that react to light

4

When does the postoperative phase begin? 1- Admission of the patient to the OR 2- Admission of the patient to the PACU and ending when the patient is discharged to the unit or home 3- Admission of the patient to the PACU and ending with follow-up evaluation in the clinical setting or home 4- Admission to the PACU

2

As a circulating nurse, what task are you solely responsible for? 1- Keeping records. 2- Estimating the client's blood loss. 3- Handing instruments to the surgeon. 4- Counting sponges and needles.

1

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? 1- Discuss the risk for infection caused by wearing the ring. 2- Allow the client to wear the ring and cover it with tape. 3- Notify the surgeon to cancel surgery. 4- Remove the ring once the client is sedated.

2

A client with nausea and vomiting is to receive an antiemetic that inhibits the vomiting center in the brain. Which of the following would the nurse expect the physician to order most likely? 1- Odansetron (Zofran) 2- Hydroxyzine (Vistaril) 3- Prochlorperazine (Compazine) 4- Promethazine (Phenergan)

3

The nurse positions the client in the lithotomy position in preparation for 1- Renal surgery 2- Pelvic surgery 3- Perineal surgery 4- Abdominal surgery

3

The nurse's assessment of a postop client reveals a temperature of 103.2°F, tachycardia, and client complaints of increased incisional pain. What does the nurse recognize that this client is experiencing? 1- Hyperthermia 2- Atelectasis 3- Wound infection 4- Uncontrolled pain

3

Which of the following clinical manifestations increase the risk for evisceration in the postoperative client? 1- Hypovolemia 2- Edema 3- Valsalva maneuver 4- Hypoxia

3

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: 1- blood pressure of 150/100 mm Hg and pulse of 130 beats/minute. 2- blood pressure of 150/100 mm Hg and pulse of 50 beats/minute. 3- blood pressure of 80/40 mm Hg and pulse of 50 beats/minute. 4- blood pressure of 80/40 mm Hg and pulse of 130 beats/minute.

4

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? 1- Pulse rate of 110 beats/min 2- Respiratory rate of 18 breaths/min 3- Blood pressure of 104/62 mm Hg 4- Temperature of 102.5°F (39°C)

4

A nurse prepares to suction a client's tracheostomy tube. Place the procedure steps in correct order. 1 Apply intermittent suction while withdrawing the catheter. 2 Don sterile gloves. 3 Insert suction catheter into the lumen of the tube. 4 Lubricate the sterile suction catheter. 5 Position in the Fowlers position

5, 2, 4, 3, 1

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: 1- continuously monitors the sedated client. 2- performs a complete assessment of the client. 3- obtains a surgical consent from the client's mother. 4- assesses how well the client is recovering from anesthesia.

1

A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first? 1- Notify the surgical team. 2- Document the assessment findings. 3- Administer dantrolene sodium. 4- Obtain cooling blankets.

1

A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action? 1- Notify the surgeon. 2- Document what foods the client ate. 3- Give the client plenty of water to aid digestion. 4- Cancel the surgery.

1

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? 1- Splint the incision site using a pillow during deep breathing and coughing exercises. 2- Pain medication should be taken before completing deep breathing and coughing exercises. 3- Deep breathing and coughing exercises should be completed every 8 hours. 4- Deep breathing and coughing exercises may be used as relaxation techniques.

1

A nurse is caring for a client in the PACU after surgery requiring general anesthesia. The client tells the nurse, "I think I'm going to be sick." What is the primary action taken by the nurse? 1- Position the client in the side-lying position. 2- Administer an anti-emetic. 3- Obtain an emesis basin. 4- Ask the client for more clarification.

1

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? 1- The client is displaying early signs of shock. 2- The client is showing signs of a medication reaction. 3- The client is displaying late signs of shock. 4- The client is showing signs of an anesthesia reaction.

1

A nurse is caring for a client who underwent a skin biopsy and has three stitches in place. This wound is healing by: 1- first intention. 2- second intention. 3- third intention. 4- fourth intention.

1

A nurse is caring for a postoperative patient on POD 2. The patient had a large upper abdominal incision. While assessing the patient at the beginning of the shift, the nurse noted decreased breath sounds, crackles, and a mild cough. What is the patient most likely experiencing? 1- Atelectasis 2- Pneumonia 3- Acute bronchitis 4- Hypoxemia

1

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? 1- A blood urea nitrogen level of 42 mg/dL 2- A creatine kinase level of 120 U/L 3- A serum creatinine level of 0.9 mg/dL 4- A urine creatinine level of 1.2 mg/dL

1

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic? 1- Halothane 2- Fentanyl 3- Succinylcholine 4- Propofol

1

The client asks the nurse about possible ill effects from general anesthesia. Which of the following is the best response by the nurse? 1- "Some possible negative effects include oversedation and bradycardia." 2- "Few negative effects occur with general anesthesia." 3- "Amnesia and analgesia are some of the negative effects of anesthesia." 4- "Clients can experience pain and loss of consciousness."

1

The nurse has just admitted a 12-year-old client who is going to have an above-the-knee amputation of their left leg due to osteosarcoma. The nurse knows that adequate preoperative teaching and learning is important for what reason? 1- Client will have a shorter recovery period. 2- Client will understand after surgery they will not have a left leg. 3- Client will understand they have cancer. 4- Client's family will understand their child will lose their leg in the surgery.

1

The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse? 1- Notify the surgeon to possibly delay the surgery. 2- Notify the primary physician about the assessment findings. 3- Document the findings and continue moving the client through the preoperative phase. 4- Wait 1 hour and complete the assessment again.

1

The nurse recognizes that the older adult is at risk for surgical complications due to: 1- decreased renal function 2- Increased cardiac output 3- increased skeletal mass 4- decreased adipose tissue

1

What complication is the nurse aware of that is associated with deep venous thrombosis? 1- Pulmonary embolism 2- Immobility because of calf pain 3- Marked tenderness over the anteromedial surface of the thigh 4- Swelling of the entire leg owing to edema

1

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 1- 80 to 110 mg/dL 2- 150 to 240 mg/dL 3- 250 to 300 mg/dL 4- 300 to 350 mg/dL

1

What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound? 1- Count the sponges. 2- Label the tissue specimen. 3- Prepare the necessary sutures. 4- Hand equipment to the surgeon as needed.

1

What measurement should the nurse report to the physician in the immediate postoperative period? 1- A systolic blood pressure lower than 90 mm Hg 2- A temperature reading between 97°F and 98°F 3- Respirations between 20 and 25 breaths/min 4- A hemoglobin of 13.6

1

What medication should the nurse prepare to administer in the event the client has malignant hyperthermia? 1- Dantrolene sodium 2- Fentanyl citrate 3- Naloxone 4- Thiopental sodium

1

When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include? 1- "You shouldn't experience a headache after this type of anesthesia." 2- "Normally, the blood pressure drops fairly low initially." 3- "The anesthetic is introduced directly into the spinal cord." 4- "You won't be able to move, but you'll be able to feel sensations."

1

When is the ideal time to discuss preoperative teaching 1- Preadmission visit 2- Day of surgery 3- Prior to entering the pre-op area 4- When the patient is comfortable and sedated

1

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. 1- nutritional status 2- age 3- physical condition 4- gender 5- health status 6- Ethnicity

1,2,3,5

Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply. 1- Discussing and reviewing the advanced directive document 2- Establishing an intravenous line 3- Ensuring that the sponge, needle, and instrument counts are correct 4- Administering medications, fluid, and blood component therapy, if prescribed 5- Beginning discharge planning

1,2,5

The client asks the nurse about ways to control pain other than taking pain medication. Which strategy should the nurse include when responding to the client? Select all that apply. 1- Listening to music 2- An On-Q pump 3- Watching television 4- An epidural infusion 5- Changing position

1,3,5

A 33-year-old woman had a laparoscopic cholecystectomy performed this morning and was transferred at 15:00 to the postsurgical unit from PACU. It is now 16:30. At this point in the patient's recovery, what are the nursing priorities? 1- Health education about the dietary and lifestyle changes necessitated by her gall bladder surgery 2- Monitoring and treating the patient's pain, nausea, and vomiting 3- Encouraging the patient to ambulate, and teaching the patient about the benefits of early ambulation 4- Performing a sterile dressing change and assessing the integrity of the patient's surgical incision

2

A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient? 1- Risk for injury related to effects of anesthetic agents 2- Risk for perioperative positioning injury related to operative position 3- Anxiety related to the surgical experience 4- Disturbed sensory perception related to sedation

2

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? 1- Document the findings and reassess in 24 hours. 2- Assess for signs and symptoms of fluid volume deficit. 3- Assess for edema. 4- Discontinue the nasogastric tube suctioning.

2

A new scrub technician is being oriented to the operating room. The scrub technician states to the nurse, "You can skip the fire safety information because I have worked in hospitals for the past 10 years." What is the best response by the nurse? 1- "I know this information is not exciting but I'm required to cover it with you." 2- "The operating room has some unique circumstances that increases the chances of fire." 3- "OK, but you will be required to review the hospital's policy on fire safety on your own." 4- "This is a requirement of your job; just tough through it."

2

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? 1- Pituitary 2- Adrenal 3- Thyroid 4- Parathyroid

2

Corticosteroids have which effect on wound healing? 1- Reduce blood supply 2- Mask the presence of infection 3- Cause hemorrhage 4- May cause protein-calorie depletion

2

Fentanyl is categorized as which type of intravenous anesthetic agent? 1- Tranquilizer 2- Opioid 3- Dissociative agent 4- Neuroleptanalgesic

2

Surgical wound healing occurs in: 1- Two phases: inflammatory and maturation 2- Three phases: inflammatory, proliferative, and maturation 3- First-, second-, and third-intention wound healing 4- First and proliferative phase

2

The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room? 1- Medication 2- Elimination 3- Activity 4- Support system

2

There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements. 1- Stage I: beginning anesthesia 2- Stage II: excitement 3- Stage III: surgical anesthesia 4- Stage IV: medullary depression

2

To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes: 1- Assisting with incentive spirometry every 6 hours 2- Ambulating the client as soon as possible 3- Positioning the client in a supine position 4- Assessing breath sounds at least every 2 hours

2

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear? 1- Anxiety and fear increases the need for anesthesia and postoperative medications. 2- Anxious clients have a poor response to surgery and are prone to complications. 3- Anxious clients need psychological counseling after surgery. 4- Anxiety and fear can affect a client positively during and after surgery.

2

You are doing a preoperative assessment on a patient going to surgery. The patient informs you that he drinks six to eight beers each day and has for the last 15 years. What postoperative difficulties can the nurse anticipate for this patient? 1- Delirium tremens immediately following surgery 2- Delirium tremens within 72 hours after his last alcohol drink 3- Delirium tremens upon administration of general anesthesia 4- Delirium tremens 1 week after his last alcohol drink

2

A 30-year-old man is currently in the preoperative holding area on call for his tympanoplasty (eardrum reconstruction) that will be performed this morning. The nurse has administered the preanesthetic as ordered. What action should the nurse prioritize at this point in the patient's care? 1- Teaching the patient about pain management and the appropriate use of oral analgesics postoperatively 2- Teaching the patient the correct technique for performing deep-breathing and coughing exercises 3- Ensuring the patient's safety by keeping him in bed and discouraging him from ambulating 4- Performing a thorough respiratory assessment including breath sounds, respiratory rate, and oxygen saturation levels

3

A nurse who has provided care in perioperative settings for many years has seen first-hand the trend toward increasing numbers of surgical procedures being performed in ambulatory surgical centers and on an outpatient basis. What factors have contributed most significantly to this trend? 1- The emergence of managed care and the large number of Americans who lack health insurance 2- The nursing shortage and decreasing numbers of health care providers who are choosing surgical specialties 3- Advances in anesthesia and in the technology surrounding surgical techniques 4- Pressure from health care consumers to avoid hospital stays and the decreasing incidence of acute illnesses

3

A physician calls the nurse for an update on his client who underwent abdominal surgery 5 hours ago. The physician asks the nurse for the total amount of drainage collected in the Hemovac since surgery. The nurse reports that according to documentation, no drainage has been recorded. When the nurse finishes on the telephone, she goes to assess the client. Which assessment finding explains the absence of drainage? 1- The client has been lying on his side for 2 hours with the drain positioned upward. 2- The client has a nasogastric (NG) tube in place that drained 400 ml. 3- The Hemovac drain isn't compressed; instead it's fully expanded. 4- There is a moderate amount of dry drainage on the outside of the dressing.

3

A post op client reports severe abdominal pain. The nurse cannot auscultate bowel sounds and notes the client's abdomen is rigid. What is the nurse's priority action? 1- Re-attempt to auscultate bowel sounds. 2- Prepare to insert a nasogastric tube. 3- Call the health care provider. 4- Prepare to administer a stool softener.

3

How should a nurse teach a patient to perform deep breathing and coughing to use postoperatively? 1- The patient should take three deep breaths and cough hard three times. 2- The patient should take three deep breaths and exhale forcefully, take a quick short breath and cough from deep in the lungs. 3- The patient should take a deep breath in through the mouth and exhale all the air out through the mouth, take a short breath, and cough from deep in the lungs. 4- The patient should rapidly inhale, hold for 30 seconds, and exhale slowly.

3

Hypothermia may occur as a result of 1- the infusion of warm fluids. 2- increased muscle activity. 3- open body wounds. 4- being young.

3

Many medications are available to control nausea and vomiting without oversedating the patient. At what point should a nurse normally administer antiemetics to a surgical patient? 1- Upon admission from PACU 2- When the patient reports that he or she will soon vomit 3- At the patient's first report of nausea 4- When nonpharmacologic interventions are unsuccessful

3

Nursing assessment findings reveal urinary output < 30 ml/hr, tachycardia, tachypnea, decreased hemoglobin, and acute confusion. The findings are indicative of which nursing diagnosis? 1- Acute pain 2- Ineffective airway clearance 3- Decreased cardiac output 4- Urinary retention

3

The nurse is concerned that a postoperative patient may have a paralytic ileus. What assessment data may indicate that the patient does have a paralytic ileus? 1- Abdominal tightness 2- Abdominal distention 3- Absence of peristalsis 4- Increased abdominal girth

3

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? 1- The client can self-administer oral pain medication as needed with patient-controlled analgesia. 2- Family members can be involved in the administration of pain medications with patient-controlled analgesia. 3- Therapeutic drug levels can be maintained more evenly with patient-controlled analgesia. 4- There are no advantages of patient-controlled analgesia over a PRN dosing schedule.

3

The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury? 1- Absence of itching 2- Pulse oximetry 98% 3- Peripheral pulses palpable 4- Vital signs within normal limits for client

3

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? 1- Immediately upon admission 2- Upon awakening in the postanesthesia care unit 3- Up to 72 hours after alcohol withdrawal 4- Up to 24 hours after alcohol withdrawal

3

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? 1- "You will be just fine; the operating room nurses will take good care of you." 2- "It is best to take deep breaths and relax before the procedure." 3- "Let me explain to you what will happen next." 4- "We will keep your family informed of your progress."

3

A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate? 1- Temporarily set the OR temperature to 30°C. 2- Place warm damp drapes on the client, replacing them every 5 minutes. 3- Administer IV fluids warmed to room temperature. 4- Apply a warm air blanket, gradually increasing body temperature.

4

A patient has reported to the preadmission clinic in anticipation of her scheduled hysterectomy and oophorectomy. The patient states that her health care provider has explained the parameters for fasting prior to her surgery but tells the nurse that she does not entirely understand why she cannot eat or drink before surgery. What explanation should the nurse provide to this patient? 1- "It's important to rest your stomach and bowels during and after surgery so that blood flow is concentrated to your vital organs." 2- "Your surgeon and anesthetist need your stomach empty during surgery in case there is a need to insert a tube into your throat or stomach." 3- "You need to fast before surgery so that the surgical team has a 'clean slate' for managing your fluid balance and nutritional status." 4- "You're asked to refrain from eating and drinking so there's less of a chance that you'll inhale food or fluids into your lungs."

4

A postoperative client is moving from the bed to a chair when blood drips from the dressing. The nurse assesses the incision and notes evisceration. What does the nurse do first? 1- Place a dry, sterile dressing over the protruding organs. 2- Place a pressure dressing over the opening and secure. 3- Have the client lay quietly on back and call the physician. 4- Moisten sterile gauze with normal saline and place on the protruding organ.

4

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? 1- "I'm so glad that I will be unconscious during the surgery." 2- "I won't feel it, but I'll have a tube to help me breathe." 3- "Only the surgical area will be numb." 4- "I'll be sleepy but able to respond to your questions."

4

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern? 1- Anesthesiologist 2- Circulating nurse 3- Registered nurse first assistant 4- Surgeon

4

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is: 1- To have the client sign the consent immediately 2- To have the client's next of kin sign the consent 3- For the nurse to sign the consent with verbal permission of the client 4- To notify the surgeon

4

The nurse is completing a preoperative assessment. The nurse notices the client is tearful and constantly wringing their hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" What is the nurse's best response? 1- "You have nothing to worry about; you have the best surgical team." 2- "No one has ever died from the procedure you are having." 3- "What family support do you have after the surgery?" 4- "What are your concerns?"

4

The nurse is preparing to discharge a patient from the PACU using a PACU room scoring guide. With what score can the patient be transferred out of the recovery room? 1- 5 2- 6 3- 7 4- 8

4

Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery? 1 -Trendelenburg position 2- Lithotomy position 3- Supine position 4- Sims position

4

An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. 1- Associated with more nausea 2- Long duration of action 4- More pleasant onset of anesthesia 5- Ease of administration 6- Need for little equipment

4,5,6

The nurse recognizes older adults require lower doses of anesthetic agents due to: 1- decreased lean tissue mass. 2- increased tissue elasticity. 3- increased liver mass. 4- decreased bone mass.

1

An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia? 1- Beginning anesthesia 2- Excitement 3- Surgical anesthesia 4- Medullary depression

3

The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate? 1- Monitor for faulty electrical equipment. 2- Alert personnel who break sterile technique. 3- Allow unnecessary personnel to enter the OR environment. 4- Maintain the positive pressure OR environment.

3

The nurse caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia would assess for the most common early sign of: 1- Hypertension (BP >130/90). 2- Tachypnea (>35 breaths/min). 3- Oliguria (urinary output <400 mL/day). 4- Tachycardia (HR >150 bpm).

4

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? 1- "Avoid drinking liquids until the gag reflex returns." 2- "Avoid eating milk products for 24 hours." 3- "Notify a nurse if you experience blood in your urine." 4- "Remain supine for the time specified by the physician."

4

Which of the following is the appropriate response to the statement, "I'm so nervous about my surgery"? 1- "Relax. Your recovery period will be shorter if you're less nervous." 2- "Stop worrying. It only makes you more nervous." 3- "You needn't worry. Your doctor has done this surgery many times before." 4- "You seem nervous about your surgery."

4

When planning care for a client in the postoperative period, prioritize nursing diagnoses in the sequence from highest to lowest priority?

Impaired Gas Exchange Fluid Volume Deficit Altered Comfort Anxiety Risk for Infection

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? 1- 2 weeks 2- 4 weeks 3- 7 to 10 days 4- 2 to 3 days

3