Fundies Exam 3 Surgery
A client undergoing preoperative assessment informs the nurse that he takes medication for high blood pressure and for asthma. What is the nurse's best action? A Notify the surgeon and the anesthesiologist. B Tell the client not to take the medication on the day of surgery. C Document the information in the client's record. D Tell the client to take medications preoperatively with a sip of water.
A
A client voluntarily signed the operative consent form. What is the nurse's next action? A Sign under the client's name as a witness. B Call for the physician to sign the form. C Teach the client about the surgery. D Have family members witness the signature.
A
A client will be undergoing palliative surgery. The client's daughter asks what this means. What is the nurse's best response? A "The surgery will relieve the symptoms but will not cure your father." B "There are fewer risks with this type of surgery." C "There is no guarantee of the outcome of the surgery." D "The surgery must be performed immediately to save your father's life.
A
A colostomy is scheduled to be done on a patient who has severe Crohn's disease. What is the correct classification for this surgery? A Palliative B Curative C Minor D Restorative
A
A patient who can barely ambulate with a walker at home is having a left total knee replacement. What is the most appropriate category for this surgery? A Restorative B Simple C Palliative D Urgent
A
A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse recognizes that this type of surgery is categorized as which of the following? a. constructive surgery b. transplantation surgery c. palliative surgery d. reconstructive surgery
A
After a surgical patient has been given preoperative sedatives, which safety precaution should a nurse take? A. Reinforce to the patient to remain in bed or on the stretcher B. Raise the side rails and keep the bed or stretcher in the high position C. Determine if the patient has any allergies to latex D. Obtain informed consent immediately after sedative administration
A
A 76-year old patient is having surgery to remove kidney stones. What is the correct classification for this surgery? A Palliative B Restorative C Emergent D Urgent
D
A nurse is working in an ambulatory care setting and is ready to discharge a patient who is wheelchair dependent. The patient underwent dilation of an esophageal stricture. Her postanesthesia recovery score for ambulatory patients (PARSAP) score is 16. Her family is ready to go and eager to make the long road trip home. In determining if it is safe for the patient to be discharged at this time, the nurse should decide the following: A. The PARSAP score must be 18 or higher before being discharged. B. The patient's family is capable to care for her, and she understands her discharge instructions; thus the nurse proceeds with discharge. C. Since the patient hasn't been drinking much, the nurse is not concerned that she is unable to void and proceeds with discharge. D. Since the patient was admitted to the surgical center in a wheelchair, she can be discharged with a lower PARSAP score.
D
Because an older adult is at increased risk for respiratory complications after surgery, the nurse should: A. Withhold pain medications and ambulate the patient every 2 hours. B. Monitor fluid and electrolyte status every shift and vital signs with temperature every 4 hours. C. Orient the patient to the surrounding environment frequently and ambulate the patient every 2 hours. D. Encourage the patient to turn, deep breathe, and cough frequently and ensure adequate pain control.
D
In the postanesthesia care unit (PACU) the nurse notes that the patient is having difficulty breathing and suspects an upper airway obstruction. The nurse would first: A. Suction the pharynx and bronchial tree. B. Give oxygen through a mask at 4 L/min. C. Ask the patient to use an incentive spirometer. D. Position the patient on one side with the face down and the neck slightly extended so the tongue falls forward.
D
The nurse applies antiembolism stockings to a client preoperatively. When the client says that they are uncomfortably tight, what is the nurse's best action? A Measure the client's calf to ensure that they are the correct size. B Remove the stockings for an hour to relieve the pressure. C Pull the stockings down so that they are not constricting. D Teach the client the purpose of wearing the stockings.
D
Upon admission for an appendectomy, the pt provides the nurse with a document that specifies instructions his healthcare team should follow in the event he is unable to communicate these wishes post op. What is the document best known as? a. informed consent b. pt's bill of rights c. insurance card d. advance directive
D
What data are essential for the nurse to assess on a client who is scheduled for surgery? (Select all that apply.) a. Use of tobacco b. Current medications c. Use of herbal or over-the-counter therapy d. Mental status examination e. Power of attorney f. Allergies g. Date of last tetanus shot A A, B, C B B, C, D C A, B, C, D, F, G D A, B, C, D, F E C, D, F
D
When examining an adult client's preoperative laboratory results, the nurse notes that the potassium level is 2.9 mEq/mL. What is the nurse's priority action? A Increase the IV flow rate. B Document the finding C Alter the client's diet to include fruit. D Notify the surgeon.
D
When the nurse brings a client's preoperative medications, the client responds, "I don't need that. I had a good night's sleep last night." What is the nurse's best response? A "I will make a note that you refused to take the medication." B "I will ask your surgeon if you have to take the medication." C "The doctor ordered this medication so you should take it." D "Let me teach you about your medications for surgery."
D
Which of the following nursing interventions is most likely to prevent respiratory complications such as pneumonia and atelectasis in a post surgical patient? a. control of anxiety and agitation b. adequate nutrition and fluids c. adequate pain control d. use of incentive spirometry
D
A post-operative day 1 patient is found to have hypoactive bowel tones. The nurse knows this to be an expected (though abnormal) finding because of which of the following reasons? Select all that apply: a. The patient was NPO prior to surgery b. The patient is diabetic c. The patient received general anesthetic and opioid pain medications d. The patient has decreased physical mobility.
a, c, d. Decreased or hypoactive bowel tones following surgery are related to decreased oral intake and physical activity as well as the general anesthetic and opioid pain medications received. Diabetes does not result in gastroparesis or decreased peristalsis (bowel activity) specifically following surgery.
A patient is returning to the floor after orthopedic surgery is complaining of nausea. the nurse is aware that an appropriate intervention is to do which of the following? a. avoid strong smelling foods b. hold all meds c. provide clear liquids with a straw d. avoid oral hygiene until nausea subsides
a. avoid strong smelling foods
A 54 year old female pt has been scheduled for a bunionectomy which will be conducted on an ambulatory basis. Which of the following characteristics applies to this type of surgery? a. the pt will be admitted the day of surgery and return home the same day b. the surgery is classified as urgent rather than elective c. the surgery will be conducted using moderate sedation rather than general anesthesia d. the pt must be previously healthy with low surgical risks
A
A client tells the nurse that he has an advance directive with durable power of attorney for health care. The client asks how the advance directive will affect the surgery. What is the nurse's best response? A "If you are unable to make a decision, your designee will be asked." B "The surgical staff will resuscitate only if your heart stops during the operation." C "There will be no effect on your surgery." D "You will not be intubated during general anesthesia for the surgery."
A
The nurse has just completed preoperative teaching with a client who will be having surgery the following day. Which statement by the client indicates that additional teaching is needed? A "I will go to the bathroom as soon as I receive all my preoperative medications." B "I will remember to wear my glasses tomorrow instead of my contact lenses." C "I won't have to worry about putting my makeup on tomorrow morning." D "When I brush my teeth before surgery, I will be sure to spit out the water."
A
The nurse is caring for a client who will be undergoing emergency surgery as soon as possible. Which information is most important for the nurse to teach the client at this time? A What to expect in the operating and recovery rooms B How the surgery will be performed C Importance of early ambulation after surgery D Complications that may occur after surgery
A
The nurse is caring for an older adult client with a history of chronic lung disease who will be undergoing surgery the following day. When postoperative care is planned, which potential problem is the highest priority for this client? A Maintaining oxygenation B Hypovolemia C Tolerating activity D Anxiety and fear
A
The nurse is conducting preoperative assessments. Which client does the nurse teach about the possibility of developing a venous thromboembolism (VTE)? A Client undergoing hip replacement surgery B Client with body mass index (BMI) of 19 C Client with an international normalized ratio (INR) of 2.2 D Client with a latex allergy
A
The nurse is preparing a pt for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is are that which type of anesthesia is commonly used for this procedure? a. conscious sedation b. spinal anesthesia c. epidural anesthesia d. nerve block
A
The nurse is preparing to send a patient to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the pt. What is the nurses best action to the request? a. Inform the physician that it is his or her responsibility to obtain the signature b. inform the physician that the nurse manager will need to obtain the signature c. call the house officer to obtain the signature d. obtain the signature and ask another nurse to cosign the signature
A
The nurse is providing teaching to a patient regarding pain control after surgery. What time does the nurse inform the patient is the best time to request pain medication? a. before the pain becomes severe b. after the pain becomes severe and relaxation techniques have failed c. when the patient experiences pain rating of "10" on a 1-10 pain scale d. when there is no pain, but it is time for the medication to be administered
A
The primary reason that family members should be included when the nurse teaches the patient preoperative exercises is so they can: A. Coach and encourage the patient after surgery. B. Demonstrate to the patient at home. C. Relieve the nurse by getting the patient to do the exercises every 2 hours. D. Practice with the patient while he or she is waiting to be taken to the operating room.
A
Upon assessment, a pt reports that he drinks 5-6 beers every evening after work. Based upon this information, the nurse is aware that the pt may require which of the following? a. larger doses of anethetic agents and larger doses of post op analgesics b. lower does of anesthetic agents and lower does of post op analgesics c. larger does of anesthetic agents and lower does of post op analgesics d. lower doses of anesthetic agents and larger doses of post op analgesics
A
Which action is most appropriate during a preoperative chart review? A Ensure that the consent form is signed, dated, and witnessed. B Make sure the client understands the procedure. C Call the surgeon if the client has any food allergies. D Make sure all marks are washed off the surgical site.
A
Which of the following patients most likely requires special preoperative assessment and treatment as a result of his or her existing medication regimen? a. a woman who take daily anticoagulants to treat atrial fib. b. a woman who takes a daily thyroid supplement to treat her longstanding hypothyroidism. c. a man who regularly treats his rehumatoid arthritis with OTC NSAIDs. d. a man who takes an angiotensin converting enzyme inhibitor because he has hypertension
A
A patient, scheduled for open-heart surgery, tells the nurse he does not want to be "saved" if he dies during surgery. What should the nurse do next? A) Discuss with surgeon and document the wishes of the patient and family B) Administer the ordered oral and intravenous preoperative medications to aleviate anxiety C) Notify the physician after completion of the surgical procedure D) Verbally report the patient's wishes to the operating room supervisor
A) Discuss with surgeon and document the wishes of the patient and family
A 51 year old woman with a dx of breast cancer has been scheduled for a unilateral mastectomy. Which of the following categorizations of surgical procedures are represented in this case? a. diagnostic b. constructive c. reconstructive d. palliative e. ablative
A, E
Hand-off communications that occur between the postanesthesia care unit (PACU) nurse and the nurse on the postoperative nursing unit should be done when a patient returns to the nursing unit. Select appropriate components of a safe and effective hand-off. (Select all that apply.) A. Vital signs, the type of anesthesia provided, blood loss, and level of consciousness B. Uninterrupted time to review the recent pertinent events and ask questions C. Verification of the patient using one identifier and the type of surgery performed D. Review of pertinent events occurring in the operating room E. (OR) while at the nurses' station
A,B
The operating room (OR) and postanesthesia care unit (PACU) are high-risk environments for patients with a latex allergy. Which safety measures to prevent a latex reaction should the nurse implement? (Select all that apply.) A. Screening patients about food allergies known to have a cross-reactivity to latex such as kiwis and bananas B. Having a latex allergy cart available at all times C. Communicating with the operating room (OR) team as soon as 24 to 48 hours in advance of the surgery when a latex-sensitive patient is identified D. Scheduling the latex-sensitive patient for the last operative case of the day
A,B,C
You are caring for a patient after surgery who underwent a liver resection. His prothrombin time (PT) or an activated partial thromboplastin time (APTT) is greater than normal. He has low blood pressure; tachycardia; thready pulse; and cool, clammy, pale skin, and he is restless. You assess his surgical wound, and the dressing is saturated with blood. Which immediate interventions should you perform? (Select all that apply.) A. Notify the surgeon. B. Maintain intravenous (IV) fluid infusion and prepare to give volume replacement. C. Monitor the patient's vital signs every 15 minutes or more frequently until his condition stabilizes. D. Wean oxygen therapy. E. Provide comfort through bathing.
A,B,C
A patient is admitted through the emergency department for multisystem trauma following a motorcycle crash with multiple orthopedic injuries. He goes to surgery for repair of fractures. He is postoperative day 3 from an open reduction internal fixation of bilateral femur fractures and external fixator to his unstable pelvic fracture. Interventions that are necessary for prevention of venous thromboembolism in this high-risk postsurgical patient include: (Select all that apply.) A. Intermittent pneumatic compression stockings. B. Vitamin K therapy. C. Subcutaneous heparin or enoxaparin (Lovenox). D. Continuous heparin drip with a goal of an international normalized ratio (INR) 5 times higher than baseline
A,C
When assessing a client with wrist restraints, the nurse observes that the fingers on the right hand are blue. What action should the nurse implement first? A. Loosen the right wrist restraint. B. Apply a pulse oximeter to the right hand. C. Compare hand color bilaterally. D. Palpate the right radial pulse.
A. The priority nursing action is to restore circulation by loosening the restraint (A), because blue fingers (cyanosis) indicates decreased circulation. (C and D) are also important nursing interventions, but do not have the priority of (A). Pulse oximetry (B) measures the saturation of hemoglobin with oxygen and is not indicated in situations where the cyanosis is related to mechanical compression (the restraints).
8. All of the members of the surgical team must perform a "surgical scrub" except which of the following? A. Anesthetist/anesthesiologist B. Surgical technologist C. Scrub nurse D. Surgeon
ANS: A The anesthetist or anesthesiologist does not enter the sterile field. Caps, masks, scrub clothing, and scrub jackets are worn to prevent shedding of microorganisms, but sterile gloves and surgical scrubbing are not needed.
2. The client tells the nurse during the preoperative history that he is a three-pack a day cigarette smoker. This information alerts the nurse to which potential complication during the intraoperative and postoperative periods? A. A decreased tolerance to pain B. A decreased clotting ability C. An increased risk for atelectasis and hypoxia D. An increased risk for excessive scar tissue formation
ANS: C Smoking increases the level of circulating carboxyhemoglobin, which decreases oxygen delivery to the tissues. In addition, cigarette smoking damages the cilia of mucous membranes, decreasing transport of secretions and increasing the risk of pulmonary infection and atelectasis.
What is the priority nursing diagnosis for the client under general anesthesia during surgery? A. Acute Pain related to surgical procedure B. Risk for Infection related to surgical wound C. Risk for Impaired Skin Integrity related to prolonged static position D. Disturbed Body Image related to presence of surgical wound or scar
ANS: C The problem that nursing is most responsible for with this client is ensuring maintenance of skin integrity.
16. Two hours after abdominal surgery, the nurse auscultates the client's abdomen. No bowel sounds are present. What is the nurse's best first action? A. Position the client on the right side with the bed flat. B. Check the dressing and apply an abdominal binder. C. Palpate the bladder and measure abdominal girth. D. Document the finding as the only action.
ANS: D Absence of bowel sounds 2 hours after abdominal surgery is an expected finding that should be documented. No intervention specific to this finding is needed at this time.
15. Which client is at greatest risk for respiratory complications after surgery under general anesthesia? A. 65-year-old woman taking a calcium channel blocker for hypertension B. 55-year-old man with chronic allergic rhinitis C. 45-year-old woman with diabetes mellitus type 1 D. 35-year-old man who smokes two packs of cigarettes daily
ANS: D Cigarette smoking greatly increases the risk for pulmonary problems following general anesthesia because the cilia of the mucous membranes may be absent or hypoactive, the lining of the airways may be hypertrophied, and the alveoli may be less compliant. Age and gender are not significant in this case.
10. The anesthetized client with an open abdomen suddenly develops malignant hyperthermia. What intervention should the nurse be prepared to initiate or assist with? A. Discontinue mechanical ventilation. B. Administer intravenous potassium chloride. C. Administer intravenous calcium chloride. D. Administer intravenous dantrolene (Dantrium).
ANS: D Dantrolene is a skeletal muscle relaxant and can help lower body temperature by reducing metabolic heat production by the muscles. Clients become hyperkalemic and hypercalcemic; therefore, neither of these electrolytes should be administered. The client's gas exchange is severely compromised. If the client is not already receiving mechanical ventilation, it is initiated.
9. In the operating room, the client tells the circulating nurse that he is going to have the cataract in his left eye removed. The nurse notes that the consent form indicates that surgery is to be performed on the right eye. What is the nurse's best first action? A. Assume that the client is a little confused because he is older and has received midazolam intramuscularly. B. Check to see if the client has received any preoperative medications. C. Notify the surgeon and anesthesiologist. D. Ask the client his name.
ANS: D Ensuring proper identification of the client is a responsibility of all members of the surgical team. Especially in a specialty surgical setting, where many people undergo the same type of surgery each day, such as cataract removal, it is possible that the client and the record do not match. The nurse identifies the client and the client's consent form before the physicians are notified.
Who is responsible for accompanying the surgical client to the postanesthesia recovery area after surgery and for giving a report of the client's intraoperative experience to the PACU nurse? A. The surgeon and scrub nurse B. The surgeon and circulating nurse C. The anesthesiologist and scrub nurse D. The anesthesiologist and circulating nurse
ANS: D The anesthesiologist (or certified registered nurse anesthetist) and the circulating nurse are responsible for accompanying the client to the postoperative recovery area and giving a report of the client's intraoperative experience.
14. The client is admitted to the postanesthesia care unit (PACU) after surgery that took place with the client in the lithotomy position. Which change in assessment findings alerts the nurse to a possible complication of this surgical position? A. The electrocardiogram (ECG) shows tall, peaked T waves and wide QRS complexes. B. The client only arouses in response to light shaking. C. The pulse pressure has increased from 28 to 40 mm Hg. D. The dorsalis pedis pulses are not palpable bilaterally.
ANS: D The lithotomy position can compromise the client's peripheral circulation in the lower extremities.
The client is postoperative from surgery performed to determine whether a growth in her colon is cancerous. She asks the nurse what the pathology report shows. The pathology report indicates that the growth is benign. What is the nurse's best response? A. "Congratulations! The growth was not cancerous." B. "You will have to wait for your doctor to tell you the results." C. "You shouldn't worry. Most tumors of this sort are benign." D. "I will call your doctor to let her know you are awake and are concerned about the results."
ANS: D Unless there are specific orders to tell the client the pathology results, the surgeon is the person to explain them to the client.
6. Twenty minutes after the client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. What is the nurse's best first action? A. Document the findings as the only action. B. Check the client's pulse and blood pressure. C. Prepare to administer epinephrine and diphenhydramine (Benadryl). D. Explain to the client that these symptoms are normal responses to the medication.
B
A nurse has been asked to obtain informed consent for a surgical procedure. What is the role of the nurse? A) Securing informed consent from the patient B) Act as a patient advocate in ensuring patient questions are answered C) Ensuring the patient does not refuse treatment D) Refusing to participate based on legal guidelines due to conflict of interest
B) Act as a patient advocate in ensuring patient questions are answered
A nurse is working in the preoperative holding area and is assigned to care for a patient who is having a prosthetic aortic valve placed. The nurse inserts an intravenous (IV) line and obtains vital signs. The patient has a temperature of 39°C (102°F), heart rate of 120, blood pressure (BP) of 84/50, and an elevated white blood cell (WBC) count. The nurse immediately notifies the surgeon of the patient's vital signs because: A. They need to get the patient into the operating room (OR) quickly to start the surgery because of the low blood pressure. B. The surgery may need to be delayed to check the patient's WBC count and investigate the source of fever before surgery. C. The nurse anticipates the need for a fluid bolus to increase the patient's BP. D. The nurse anticipates an order for a sedative to help calm the patient and decrease the heart rate.
B
A patient with abdominal aortic aneurysm is having surgical repair. What is the correct classification for this surgery? A Urgent B Emergent C Restorative D Minor
B
An appendectomy is being performed on a patient with appendicitis. what is the correct classification for this surgery? A Diagnostic B Curative C Radical D Urgent
B
The nurse is conducting preoperative teaching with a client who will be undergoing pelvic surgery. What teaching is essential for this client? (Select all that apply.) a. "Wearing elastic stockings and using pneumatic compression devices are essential after surgery." b. "Extended bedrest will help you heal after this type of surgery." c. "Coughing and deep breathing will help to decrease postoperative complications." d. "Turning and moving your legs after surgery will help prevent clots from forming." e. "You will need to have your abdomen shaved before surgery." f. "You cannot wear your hearing aid into the surgical suite." A A, B, D B A, C, D C C, D D C, B, D E A, D
B
The nurse is preparing to transfer a client to the operating room for surgery. Put the interventions in order for the nurse to perform. (List in order of priority.) a. Take a full set of vital signs. b. Have the client go to the bathroom to void. c. Ask the client to state his or her name and check the ID band. d. Administer ordered preoperative sedation. A d, a, b, c B c, b, a, d C a, b, c, d D a, c, b, d E c, a, b, d
B
The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebtitis. When should the nurse teach the correct technique for leg exercises to a patient? a. upon transfer from post anesthetic care unit to the post surgical unit b. prior to surgery c. when early signs of venous stasis are evident d. in post anesthetic recovery
B
The nurse reviews a client's laboratory results before surgery and notes a fasting blood glucose of 120 mg/dL, a prothrombin time (PT) of 25 seconds, and potassium (K+) of 3.8 mEq/L. Which action by the nurse is best? A Increase the IV infusion of D5W to 100 mL/hr. B Ask the surgeon for additional laboratory studies. C Record laboratory results on the preoperative assessment. D Administer a potassium supplement of 20 mEq.
B
The telemetry unit nurse is reviewing lab results for an operative procedure later in the day. The nurse notes on the lab report that the pt has a serum potassium level of 6.5 mEq/L. The nurse informs the physician of this lab result because the nurse recognizes this increases the pts risk for which of the following? a. infection b. cardiac problems c. bleeding and anemia d. fluid imbalances
B
Twenty minutes after a client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. What is the nurse's priority action? A Explain to the client that these symptoms are expected. B Assess the client's pulse and blood pressure. C Administer diphenhydramine (Benadryl). D Document the findings.
B
What recently learned information about a client who is scheduled to have surgery within the next 2 hours is the nurse certain to communicate to the surgical team? A Taking 2000 mg of vitamin C each day B Hearing problem C An allergy to cats D Consumption of a glass of wine 12 hours ago
B
You are caring for a 65-year-old patient 2 days after surgery and helping him walk down the hallway. The surgeon has ordered exercise as tolerated. Your assessment indicates that the patient's heart rate at baseline is 88. After walking approximately 30 yards down the hallway, the heart rate is 110. What should be your next action? A. Stop exercise immediately and have him sit in a nearby chair. B. Ask him how he feels; determine if there is any discomfort or shortness of breath; and, if not, continue exercise. C. Tell him that he needs to walk further to reach a heart rate of 120. D. Have him walk slower; he has reached his maximum.
B
You have been given the following postoperative patients to care for on your shift. Based on the information provided, which patient should you see first? A. A 75-year-old following hip replacement surgery who is complaining of moderate pain in the surgical site, with a heart rate of 92 B. A 57-year-old following hip replacement 6 hours earlier who is receiving intravenous patient-controlled analgesia (PCA) with a history of OSA. The pulse oximeter has been alarming and reading 85% C. A 36-year-old following bladder neck suspension who is 30 minutes late to receive her postoperative dose of antibiotic D. A 48-year-old following total knee replacement who needs help repositioning in bed
B
A nurse is providing ongoing postoperative care to a patient who has had knee surgery. He assesses the dressing and finds it saturated with blood. The patient is restless and has a rapid pulse. What should the nurse do next? A) Document the data and apply a new dressing B) Apply a pressure dressing and report findings C) Reassure the family that this a common problem D) Make assessments every 15 minutes for 4 hours
B) Apply a pressure dressing and report findings
Your patient is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified: A) Urgent B) Elective C) Emergency D) Futile
B) Elective
Obesity places patients at an increased surgical risk because of which of the following factors? (Select all that apply.) A. Risk for bleeding is increased. B. Ventilatory capacity is reduced. C. Fatty tissue has a poor blood supply. D. Metabolic demands are increased.
B, C
4. When the nurse brings the preoperative medication to the client about to have abdominal surgery, she tells the nurse that she does not need the injection because she had a good night's sleep last night. What is the nurse's best first action? A. Tell the client that her surgeon has ordered the medication; therefore, she should go ahead and take the medication because the surgeon knows what is best. B. Tell the client that the preoperative medication is ordered to reduce the risk of some problems during surgery rather than to ensure adequate rest. C. Appropriately discard the preoperative medication and notify the surgeon. D. Document the client's statement and notify the charge nurse.
B.
What is the most important reason for starting intravenous infusions in the upper extremities rather than the lower extremities of adults? A. It is more difficult to find a superficial vein in the feet and ankles. B. A decreased flow rate could result in the formation of a thrombosis. C. A cannulated extremity is more difficult to move when the leg or foot is used. D. Veins are located deep in the feet and ankles, resulting in a more painful procedure.
B. Venous return is usually better in the upper extremities. Cannulation of the veins in the lower extremities increases the risk of thrombus formation (B) which, if dislodged, could be life-threatening. Superficial veins are often very easy (A) to find in the feet and legs. Handling a leg or foot with an IV (C) is probably not any more difficult than handling an arm or hand. Even if the nurse did believe moving a cannulated leg was more difficult, this is not the most important reason for using the upper extremities. Pain (D) is not a consideration.
A nurse is reviewing results of preoperative screening test and notes the patient's PT (prothrombin time) is very elevated. What should the nurse do next? A. Nothing; an elevated PT is not going to affect the surgical outcome. B. Document the data and notify the physician who will do the surgery C. Review the patient's medications and note he is on coumadin, so it is ok to proceed. D. Document the data and report it to the intraoperative nurse.
B. Document the data and notify the physician who will do the surgery
A PACU nurse has received a semiconscious patient form the operating room and reviews the chart for orders related to positioning of the patient. There are no specific orders on the chart related to specific orders for the patient's position. in this situation, in what position will the nurse place the patient? a. supine b. prone c. side-lying d. trendelenburg
C
A client is brought to the emergency department (ED) after a motorcycle accident. The client has suffered a ruptured spleen. What is the immediate priority? A Aggressive pain control B Calling the family members C Emergent surgery to control bleeding D Assessment of neurologic status
C
Which medications does the nurse correctly administer preoperatively? (Select all that apply.) a. Hydroxyzine (Atarax, Vistaril) for sedation b. Lorazepam (Ativan) for anxiety c. Hydromorphone (Dilaudid) to decrease postoperative secretions d. Metoclopramide (Reglan) to increase stomach emptying e. Aspirin to decrease blood clotting postoperatively f. Cimetidine (Tagamet) to prevent infection A C, D, E B B, D C A, B, D D A, B E C, E, F
C
A client is brought to the hospital unconscious and needs emergency surgery. The client's only family member cannot come to the hospital before the surgery. Which is the best option for obtaining informed consent for the client's emergent surgery? A Proceed with surgery and have the family member sign the consent as soon as possible. B Obtain written consultation with two surgeons that the surgery is needed. C Contact the family member by phone and obtain verbal consent with two witnesses. D Have the hospital administrator appoint a temporary legal guardian.
C
A client receiving preoperative medication tells the nurse that she took all the following vitamins and herbs last night before going to bed. Which one does the nurse report to the surgical team as a priority? A St. John's wort B Valerian root C Garlic D Chamomile
C
A female patient is having a biopsy of a nodule found in the right breast. Which classification identifies this surgery? A Urgent B Minor C Diagnostic D Cosmetic
C
A male patient has a facial scar on his forehead from a third-degree burn. What is the correct classification for this surgery? A Curative B Restorative C Cosmetic D Major
C
A nurse is recovering a patient who received conscious sedation for cosmetic surgery. Which of the following is an advantage that conscious sedation has over general anesthesia? A. Loss of sensation at the surgical site B. Reduction of fear and anxiety and need for assistance with airway patency and ventilation C. Amnesia and relief of pain D. Monitoring in phase I recovery
C
A pt has presented to a clinic for a presurgical consult, during which the pt has expressed concern about having to fast before surgery. Current recommendations for preop fasting include which of the following? a. pts generally must eat or drink nothing after midnight the night before surgery b. new recommendations allow eating and drinking until just prior to anesthetic being administered c. pts can usually eat or drink up to 2 hours prior to surgery d. preop fasting is still often recommended, even though it is medically unnecessary
C
During the preoperative assessment, the client tells the nurse that he smokes three packs of cigarettes daily. Which action by the nurse is best? A Call the surgeon to cancel the surgery B Give a nebulizer treatment. C Perform a respiratory assessment. D Have baseline laboratory studies drawn
C
Four clients are scheduled for surgery. Which client does the nurse determine is at highest risk for postsurgical complications? A 19-year-old requiring a laparoscopy B 40-year-old requiring gallbladder surgery C 89-year-old scheduled for a knee replacement D 10-year-old admitted for a tonsillectomy
C
The nurse is assessing a client before surgery. Which assessments contraindicate the client having surgery as scheduled? (Select all that apply.) a. Potassium level of 2.8 mEq/L b. International normalized ratio (INR) of 4 c. Prothrombin time (PTT) of 30 seconds d. Calcium level of 8.8 mEq/dL e. Positive pregnancy test f. Platelet count of 150,000 A C, D, F B A, B C A, B, E D A, B, F E B, D, E
C
The nurse is completing preoperative teaching for a client, and it becomes apparent that the client does not understand the surgery that will be performed. What is the priority action for the nurse? A Revise the teaching plan for the client. B Obtain informed consent from the client. C Notify the surgeon and document the finding. D Continue teaching the client about the surgery.
C
The nurse is performing preoperative teaching with an older adult client who will be having colon resection surgery the following day. The surgeon has ordered bowel preparation the night before. Which action is a priority? A Teach the client to eat only low-fat foods the night before surgery. B Administer antibiotics with a sip of water. C Tell the client not to get up and go to the bathroom alone. D Encourage the client to drink plenty of juice.
C
The operating room is aware that which of the following patients are at a greater risk related to a surgical procedure? a. an 8 year old boy b. a 48 year old man c. an 83 year old woman d. a 34 year old woman
C
Which state best describe the preoperative period? (Select all that apply.) a) it begins when the patient makes the appointment with the surgeon to discuss the need for surgery. b) It ends a the time of transfer to the surgical suite. c) It a time during which the patient's need for surgery is established. d) It begins when the patient is scheduled for surgery. e) It is a time during which the patient receives testing and education related to impending surgery. A a,d,e B a,b,c C b,d,e D d,e
C
An operating room nurse is preparing for a surgical procedure for an infant. His perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults? A )Increased vascular rigidity B) Diminished chest expansion C) Lower blood volume D) Decreased peripheral circulation
C) Lower blood volume
A 40 year old female is having a right mastectomy. She is currently taking 1 baby Aspirin a day for prophylactic reasons and is allergic to latex; otherwise she is healthy. You observe her fidgeting with her admission papers and is expressing anxiety regarding the surgery. In planning her care which intervention should be used A) Avoid using medication from glass ampules. B) Avoid using IV tubing that is made of polyvinyl chloride. C) Make all OR personnel aware of latex allergy and check all package labels for latex D) Place a rubber urinary catheter
C) Make all OR personnel aware of latex allergy and check all package labels for latex
5. The client who is scheduled to have surgery cannot read or write. The surgeon obtaining the consent wants to have the client's spouse sign the consent instead. What is the nurse's best action? A. Nothing; a signed informed consent statement does not need to be obtained from this client. B. Locate the spouse, because the informed consent statement must be signed by the client's closest relative. C. Inform the surgeon that the client may sign the informed consent statement with an X in front of two witnesses. D. Notify the administration because the court must appoint a legal guardian to represent the client's best interests and give consent for all surgical procedures.
C.
Which of the following interventions is of major importance during preoperative teaching? A. Ensure the patient has adequate breakfast the morning of surgery B. Encouraging the patient to identify and verbalize fears C. Discussing the site and extent of the surgical incision D. Telling the patient not to worry or be afraid of surgery
C. Discussing the site and extent of the surgical incision
You are a nurse in the postanesthesia care unit (PACU), and you note that your patient has a heart rate of 130 beats/min and a respiratory rate of 32 breaths/min; you also assess jaw muscle rigidity and rigidity of limbs, abdomen, and chest. What do you suspect, and which intervention is indicated? A. Infection: Notify surgeon and anticipate administration of antibiotics. B. Pneumonia: Listen to breath sounds, notify surgeon, and anticipate order for chest radiography. C. Hypertension: Check blood pressure, notify surgeon, and anticipate administration of antihypertensives. D. Malignant hyperthermia: Notify surgeon/anesthesia provider immediately, prepare to administer dantrolene sodium (Dantrium), and monitor vital signs frequently.
D
An elderly client with a fractured left hip is on strict bedrest. Which nursing measure is essential to the client's nursing care? A. Massage any reddened areas for at least five minutes. B. Encourage active range of motion exercises on extremities. C. Position the client laterally, prone, and dorsally in sequence. D. Gently lift the client when moving into a desired position.
D To avoid shearing forces when repositioning, the client should be lifted gently across a surface (D). Reddened areas should not be massaged (A) since this may increase the damage to already traumatized skin. To control pain and muscle spasms, active range of motion (B) may be limited on the affected leg. The position described in (C) is contraindicated for a client with a fractured left hip.
A nurse is teaching a surgical patient about postoperative p.r.n. pain control. Which of the following should be included? A) "We will bring you pain medication, you do not need to ask" B) "Even if you have pain, you may get addicted to the drugs" C) "You won't have much pain so just tough it out" D) "You need to ask for the medication before the pain becomes severe"
D) "You need to ask for the medication before the pain becomes severe"
After conducting a preoperative health assessment, the nurse documents that the patient has physical assessment supporting the medical diagnosis of COPD. Based on this finding, what postoperative interventions would be included on the plan of care? A) Perform sterile dressing changes each morning B) Administer pain medication as needed C) Conduct a head-to-toe-assessment Q 2 hours D) Thorough respiratory assessment, incentive spirometry q1 hour while awake
D) Thorough respiratory assessment, incentive spirometry q1 hour while awake
1. How does palliative surgery differ from any other type of surgery? A. The main purpose is cosmetic in nature rather than functional repair or comfort. B. There are fewer risks associated with palliative surgery than with any other type of surgery. C. The outcomes of palliative surgery cannot be ensured to produce the desired effect or restoration of functional ability. D. Palliative surgery is performed to provide temporary relief of distressing symptoms rather than to cure a problem or condition.
D.
A nurse is receiving a patient from surgery to the post-anesthesia care unit (PACU). She is most interested in which of the following assessment data? Select all that apply: a. Bowel function b. Pain c. Urinary output d. Pupillary response
b, c, d. Pain management, renal function, and neurologic function are priorities in the postanesthesia care unit period (as are respiratory function, cardiac function, and conditions of incisional dressings). These systems indicate physical response to analgesia, sedation, and fluid loss (usually related to bleeding). Bowel function is less of a concern immediately following surgery because the patient is not alert enough to take in food and is not a nursing priority in relation to the risk factors stated above.
A patient was admitted with nausea, vomiting, and abdominal pain. The patient is scheduled for an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure. What type of surgery would this describe? a. Explorative b. Diagnostic c. Curative d. Palliative
b. ERCP is an example of a diagnostic procedure to confirm a suspected diagnosis. Explorative surgery (e.g., lapa- rotomy, joint exploration) confirms the type and extent of a disease process. Curative surgery (e.g., appendectomy, kidney transplant) removes diseased or damaged body organs or structures, which may be replaced with donated or artificial organs. Palliative surgery (e.g., tumor debulking or feeding tube placement) alleviates pain or other disease symptoms but does not cure the underlying disease.
Which of the following is the final step before making the first surgical incision? a. Pre-operative teaching b. Anesthesia induction c. Procedural pause d. Skin preparation for infection control
c. Procedural pause is a final oral verification involving all team members in the operating room. The team reviews that the correct client is in the room and positioned correctly and that the site/procedure is agreed upon before the incision is made. Preoperative teaching should occur prior to induction with anesthesia. The patient is then given anesthesia and skin prep to prevent infection at the incision site.
A surgeon phones the nursing unit and asks the nurse to send the patient to surgery and sign the informed consent. Which of the following is most appropriate? a. Review surgical complications and procedure with the patient and RN signs consent as a witness. b. Explain procedure and risks/benefits and ask the patient to sign. c. Ask the patient to sign consent if they are comfortable, the RN signs as a witness. d. Include unsigned consent in the chart and send the patient to the pre-operative induction area.
c. The nurse's role in informed consent is to witness the patient's signature on the consent document and is part of the client's medical record before the procedure begins. If the patient is unsure or indicates lack of understanding, the surgeon should be notified so that more information can be provided. Statements A and B describe tasks that are out of scope for the RN (reviewing or explaining complications and procedural specifics). Statement D does not fulfill the nurse's duties around informed consent and puts the patient at risk for a procedure of which they are not fully educated.
A post-operative shoulder repair patient (post-op day 3) reports left calf pain. The nurse finds redness and swelling on assessment. What complication best explains these findings? a. Positioning during surgery b. Wound infection c. Atelectasis d. Deep vein thrombosis
d. Deep vein thrombosis (DVT) or venous thromboembolus (VTE) are complications resulting from immobility and venous stasis that lead to blood clots forming in the lower extremities. These are usually first suspected based on patient's report of pain, redness, and swelling. Positioning during surgery would not produce these findings 3 days later. Wound infection would be localized at the surgical site (shoulder). Atelectasis is collapse of the alveoli in the lungs impairing gas exchange and would not result in lower extremity pain or swelling.
A nurse is caring for a patient following a whipple procedure (removal of the head of the pancreas, duodenum, part of the stomach, and common bile duct). The patient has nausea and vomiting and absent bowel tones. The nurse inserts a nasogastric tube per physician order to treat which surgical complication? a. Pain b. Constipation c. Fluid volume deficit d. Paralytic ileus
d. Paralytic ileus is a condition in which the bowel becomes distended and partially paralyzed, resulting in significantly decreased bowel function. This condition is possibly a result of bowel manipulation during surgery and is commonly associated with gastrointestinal surgery. Pain, constipation, and fluid volume deficit are all effects of surgical procedures but are not necessarily complications.
