Iggy 4, 14-16 (lifespan)
Which are interventions for the medical surgical nurse to use in preventing hypoxemia for the postoperative patient? (Select all that apply)
-Monitor the patient's oxygen saturation -Encourage the patient to cough and breathe deeply -Get the patient up ambulating as soon as possible
When assessing the older postoperative patient for hydration status, where must the nurse assess for tenting of the skin? (Select all that apply)
-On the forehead -On the sternum
Which clinical features are found in an MH crisis? (Select all that apply)
-Sinus tachycardia -Tightness and rigidity of the patient's jaw area -Lowering of the blood pressure -Skin mottling and cyanosis -Tachypnea
What techniques are essential to performing a proper surgical scrub of the hands by the surgeon, assistant, and scrub nurse? (Select all that apply)
-Use a broad-spectrum, surgical antimicrobial solution -Hold hands higher than the elbows during the scrub and rinse -Scrub for 3-5 minutes, followed by a rinse with water
The acute, life-threatening complication of MH results from the use of which agents?
Succinylcholine and inhalation agents
A 49-year-old patient is in the PACU following a frontal craniotomy for repair of a ruptured cerebral aneurysm. The nurse assesses that the patient's eyes open on verbal stimulation. Pupils are equal, reactive to light, and diameter is 3 mm. The patient's hand grasps are equal and strong. When the nurse asks the patient to state name, the patient states name correctly. The patient has had one episode of nausea and vomiting. Incision edges are dry and approximated with sutures. Lung sounds are slightly diminished per auscultation and the nurse observes the patient is using abdominal accessory muscles to breath. Which body systems has the nurse assessed? (Select all that apply)
-Gastrointestinal -Neurologic -Integumentary -Respiratory
In which situations is regional anesthesia used instead of general anesthesia? (Select all that apply)
-In patients who have had an adverse reaction to general anesthesia -In some cases when pain management after surgery is enhanced by regional anesthesia -In patients with serious medical problems -When the patient has a preference and a choice is possible
During surgery, what things do anesthesia personnel monitor, measure, and assess? (Select all that apply)
-Intake and output -Cardiopulmonary function -Level of anesthesia -Vital signs
What criteria guide the handoff report when a patient is transferred from the OR to the PACU? (Select all that apply)
-It is a two-way verbal interaction -The language is clear -Standardized reports help avoid omissions -Receiving nurse repeats information to verify what was said
To reduce the incidence of patients with a known history or risk of malignant hyperthermia (MH), what best practices are put in place in the operating room? (Select all that apply)
-List of medications available for emergency treatment of MH -Dedicated MH cart with treatment medications -Treatment before, during, and after surgery if the patient has a known history or risk -Additional nursing support on call if MH develops -Available MH hotline number
A patient with breast cancer is scheduled for a left mastectomy. The patient has informed the surgeon and nurse that she is a Jehovah's Witness and does not want any blood transfusions. In preparation for intraoperative care of this patient, what measures does the nurse take? (Select all that apply)
-Make provider aware of patient's request for no blood transfusions -Ensure auto transfusion device is in place intraoperatiely
Which disorders have a genetic pattern of inheritance? (Select all that apply)
-Malignant hyperthermia -Cystic fibrosis -Polycystic kidney disease -Sickle cell disease
Which factors may lead to an anesthetic overdose in a patient? (Select all that apply)
-Patient who is older -Slowed metabolism and drug elimination -Liver or kidney disease
Which signs/symptoms are considered postoperative complications? (Select all that apply)
-Pulmonary embolism -Hypothermia -Wound evisceration
A postoperative patient in the PACU has had an open reduction internal fixation of a left fractured femur. Vital signs are blood pressure 87/49 mmHg, heart rate 100/min sinus rhythm, respirations 22/min, temperature 98.3F. The Foley catheter has a total amount of 110 mL of clear, yellow urine in the last 4 hours. Which body systems have been assessed by the nurse? (Select all that apply)
-Respiratory -Cardiovascular -Renal/urinary
The PACU nurse is assessing an older adult postoperative patient for pain. Which nonverbal manifestations by the patient suggest pain to the nurse? (Select all that apply)
-Restlessness -Profuse sweating -Confusion -Increased blood pressure
The nurse on the medical-surgical unit is caring for a postoperative patient. Which assessment criteria indicate to the nurse that the patient is experiencing respiratory difficulty? (Select all that apply)
-The patient is using accessory muscles to breathe -The patient makes a high-pitched crowing sound when breathing
Which criteria are used to determine if inheritance is autosomal-dominant (AD)? (Select all that apply)
-The risk for the affected person to pass the trait to a child is 50% with each pregnancy. -Unaffected people do not have affected children -The trait is found equally in males and females
A patient who is 2 days postoperative for abdominal surgery states, "I coughed and heard something pop." The nurse's immediate assessment reveals an opened incision with a portion of large intestine protruding. Which statements apply to this clinical situation? (Select all that apply)
-This is an emergency situation -The wound must be kept moist with normal saline-soaked sterile dressings -Incision evisceration has occured
The health care team determines a patient's readiness for discharge from the PACU by noting a post anesthesia recovery score of at least 10. After determining that all criteria have been met, the patient is discharged to the hospital unit or home. Review the patient profiles after 1 hour in the PACU listed below. Which patient should the nurse expect to be discharged from the PACU first?
42-year-old woman, colonoscopy. IV conscious sedation. Awake and alert. Up to bathroom to void. IV discontinued. Resting quietly in chair. VS are within normal limits
For a patient with a genetic predisposition to develop type 2 diabetes mellitus, which factor increases the risk that the patient will be diagnosed with this disease?
Grandfather with type 1 diabetes
The nurse is assessing a postoperative patient's gastrointestinal system. What is the best indicator that peristaltic activity has resumed?
Passing of flatus or stool
Which nursing intervention is most appropriate for the patient in the operative setting?
Provide a climate of privacy, comfort, and confidentiality when caring for the patient
The morning after a patient's lower leg surgery, the nurse notes that the dressing is wet from drainage. The surgeon has not yet been in to see the patient on rounds. What does the nurse do about the dressing?
Reinforces the dressing by adding dry, sterile dressing material on top of the existing dressing
A patient cared for in the PACU has had a colostomy placed for treatment of Crohn's disease. The nurse assesses that an abdominal dressing is 25% saturated with serosanguineous drainage and nots that the incision is intact. An IV is infusing with D5 lactated Ringer's at 100 mL/hr through a 20-g peripheral IV access. Auscultation of abdomen reveals hypoactive bowel sounds in all four quadrants, abdomen soft, and no distention. Foley catheter is in place and draining yellow urine with sediment, 375 mL output in Foley bag. Which body systems have been assessed by the nurse?
Renal/Urinary Gastrointestinal Integumentary
A patient experiences MH immediately after induction of anesthesia. What is the nurse anesthetist's first priority action?
Stop all inhalation anesthetic agents and succinylcholine
A child has two identical alleles for pointed ears. Which term best describes the child's likelihood of developing pointed ears?
The child is homozygous and will develop pointed ears
A new born infant inherits a blood type A allele from his mother and a blood type B allele from his father. What type of blood will the infant have?
Type AB
The surgical team understands that time is crucial in recognizing and treating an MH crisis. Once recognized, what is the treatment of choice?
Dantrolene sodium (Dantrium)
A patient arrives in the PACU. Which action does the nurse perform first?
Assess for a patent airway and adequate gas exchange
To avoid electrical safety problems during surgery, what does the nurse do?
Ensures proper placement of the grounding pads
Which statement best reflects the correct actions of the health care professional who is providing genetic counseling?
"I'm here to provide information so that you can make an informed decision about genetic testing"
If a patient experiences a wound dehiscence, which description illustrates what is happening with the wound?
A partial or complete separation of outer layers is present at incision site
Which definition is appropriate for local anesthesia?
Injection of an anesthetic agent directly into the tissue around an incision, wound, or lesions
The patient is of Chinese heritage. Which heritage-based precaution is essential when the health care provider prescribes warfarin (Coumadin) for this patient?
Monitor the patient's INR (International Normalized Ratio) more frequently
The patient has the gene for Huntington disease (HD). What is her risk for developing this disease?
The HD gene has high penitence and the patient's risk is almost 100%
What are autosomes?
The chromosomes not involved in gender determination
The health care provider removed a patient's original surgical dressing 2 days after surgery and is discharging the patient home on daily dressing changes. Which actions does the nurse take for this patient's discharge teaching? (Select all that apply)
-Ask the patient's family or significant other to observe the dressing change -Instruct that the drainage will appear serosanguineous -Have the case manager arrange for a home health nurse to ensure that dressing changes are done and there are no complications of infection
Which patient would be a candidate for moderate sedation? (Select all that apply)
-Endoscopy -Closed fracture reduction -Cardiac catheterization -Cardioversion
What is the role of the medical-surgical nurse in genetic testing? (Select all that apply)
-Ensure that the patient's rights are respected -Refer the patient to a genetic counseling expert -Teach patients about the nature of genetic testing
A patient is requesting moderate sedation for repair of a torn meniscus and has no medical contraindications. How does the nurse respond to this patient's request?
"You can discuss your request for moderate sedation with your surgeon and anesthesiologist."
The patient is scheduled to have minimally invasive surgery (MIS) for a laparoscopic cholecystectomy. Part of this surgery is the injection of air (insufflation) into the abdomen to separate and better see the organs. What patient teaching must the nurse do about the insufflation?
"You may experience some abdominal discomfort from the air injected with the surgery."
The PACU nurse is assessing a patient transferred in from the OR. Which assessment findings apply to assessment of the cardiovascular system? (Select all that apply)
-Absent dorsalis pedis pulse left foot -Monitor shows normal sinus rhythm -Apical pulse 85 beats/minute
Which interventions must the operating room (OR) nurses provide for patient physiological integrity during the intraoperative period? (Select all that apply)
-Apply padding to the OR bed to protect skin integrity -Monitor patient's airway, vital signs, electrocardiogram (ECG), and oxygen saturation during and after sedation -Assess and document skin condition before transferring patient to the post anesthesia care unit (PACU)
A person's genetic sequencing for a specific protein has a variation or mutation. Which statements express what may happen to that person? (Select all that apply)
-Function of the protein may be reduced -Function of the protein may be eliminated -Function of the protein may be enhanced
When assessing for genetic risks, which factors indicate that a patient may have an increased genetic risk for a disease or disorder? (Select all that apply)
-A close family member has an identified genetic problem -A patient has been diagnosed with two different types of cancer -A patient's sister had breast cancer at age 24
In the PACU, the nurse assesses that a patient is bleeding profusely from an abdominal incision. What is the nurse's best first action?
Apply pressure to the wound dressing
The nurse transfers a patient to the PACU with an incision and drainage of an abscess in the right groin under general anesthesia. Blood pressure is 80/47 mmHg, heart rate 117/min in sinus tachycardia, respiratory rate 28/min, pulse oximetry reading 93% on oxygen at 3L nasal cannula, temp is 38.5C. The Jackson-Pratt drain has 70 mL of a cream-colored output. Normal saline is infusing at 150 mL/hr. The surgeon orders a bolus of 500 mL IV over 1 hour of normal saline, two sets of blood cultures, and culture drainage from the Jackson-Pratt drain. The patient's history includes vulvar cancer, hypertension treated with lisinopril (Zestril) 5 mg PO daily, and no known drug allergies. The patient is a full code. Using the SBAR (situation, background, assessment, recommendation) charting format, which information should be included in assessment?
Blood pressure 80/47 mmHg, heart rate 117/min, sinus tachycardia, respirations 28/min, pulse oximetry 93% on O2 at 3L nasal cannula, temp 38.5C, Jackson-Pratt drain with 70mL cream-colored output
The PACU nurse is caring for a postoperative patient. The patient's oxygen saturation drops from 98% to 88%. What is the nurse's priority action?
Call the Rapid Response Team
A patient develops respiratory distress after having a left total hip replacement. The patient develops labored breathing and a pulse oximetry reading is 83% on 2L oxygen via nasal cannula. Which intervention is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
Check the patient's vital signs
Which description illustrates the beginning of the postoperative period?
Completion of the surgical procedure and transfer of the patient to the post anesthesia care unit (PACU)
The patient desires genetic testing for the HD gene but does not want other members of his family to know the results. Which ethical issue would be violated if the patient's family was informed of these results?
Confidentiality
Which duties are within the scope of practice of the circulating nurse in the operative setting?
Coordinates, oversees, and participates in the patient's nursing care while the patient is in the operating room
Which medical condition increases a patient's risk for surgical wound infection?
Diabetes mellitus
Which characteristics are appropriate to the anesthetic agent ketamine HCl?
Dissociative emergence reations; can induce nausea and vomiting
Which statement about a sex-linked recessive pattern of inheritance is accurate?
Female carriers have a 50% risk with each pregnancy of passing the gene to their children
What is the smallest functional unit of deoxyribonucleic acid (DNA)?
Gene
A patient arrives at the PACU and the nurse notes a respiratory rate of 10 with sternal retractions. The report from anesthesia personnel indicates that the patient had received fentanyl during surgery. What is the nurse's best priority first action?
Maintain an open airway through positioning and suction if needed
A patient has an MH incident during surgery. To whom does the nurse report this incident?
North American Malignant Hyperthermia Registry
The patient in the OR holding area tells the nurse that his surgery is for the right foot. The patient's chart states that the surgery is for his left foot. What is the nurses's best action?
Notify the surgeon immediately before the patient goes into the OR about this discrepancy
What is the primary purpose of a PACU?
Ongoing critical evaluation and stabilization of the patient
Which nursing interventions will prevent the potential intraoperative complication of radial joint stiffness, pain, and inflammation?
Place pillow or foam padding under bony prominences; maintain good body alignment; slightly flex joints and support with pillows, trochanter rolls, and pads
The nurse is teaching incisional care to a patient who has been discharged after abdominal surgery. Which priority instruction must the nurse include?
Practice proper hand-washing.
Which nursing interventions are appropriate during stage 2 of anesthesia?
Shield patient from extra noise and physical stimuli. Protect the patient's extremities. Assist anesthesia personnel as needed. Stay with patient.
Which statement about autosomal-recessive patterns of inheritance is accurate?
The children of two affected parents will always be affected
Which feature is "key" when a genetic counselor is providing a patient with genetics counseling?
The counseling should be nondirective
The nurse is caring for a patient who has had abdominal surgery. After a hard sneeze, the patient reports pain in the surgical area, and the nurse immediately sees that the patient has a wound evisceration. What priority action must the nurse do first?
The nurse calls for help and stays with the patient
The medical-surgical nurse is caring for a postoperative patient whose lab values reveal an increase in band cells (immature neutrophils). What is the nurse's best interpretation of this value?
The patient is developing an infection
Which intervention for post surgical care of a patient is correct?
The patient should splint the surgical wound for support and comfort when getting out of bed
Which patient is most at risk for postoperative nausea and vomiting? (PONV)
The patient with a history of motion sickness
The patient received moderate sedation (conscious sedation) by IV prior to a bronchoscopy procedure. Before allowing the patient to have oral liquids what must the nurse assess in this patient?
The patient's gag reflex is working
A person's hair is curly. Which statement is true about this person's alleles for hair type?
The person may have one allele for curly hair and one allele for straight hair
