Med Surg - Exam 1
A break in sterile technique occurs during surgery when the scrub nurse touches A. the mask with sterile gloved hands B. sterile gloved hands to the gown at chest level C. the drape at the incision site with sterile gloved hands D. the lower arm to the instruments on the instrument tray
A
A patient comes to the clinic with a complaint of a dull pain in the anterior and posterior neck. On examination, the nurse notes that the patient has full range of motion of the neck and no throat redness or enlarged head or neck lymph nodes. What will be the nurse's next appropriate assessment indicated by these findings? A. palpation of the liver B. auscultation of bowel sounds C. inspection of the patient's ears D. palpation for the presence of hip pain
A
A patient in the PACU has emergence delirium manifested by agitation and thrashing. What should the nurse assess the patient for first? A. hypoxemia B. neurologic injury C. distended bladder D. cardiac dysrhythmias
A
A patient is scheduled for a hemorrhoidectomy at an ambulatory surgery center. As advantage of performing surgery at an ambulatory center is a decreased need for A. diagnostic studies and perioperative medications B. preoperative and postoperative teaching by the nurse C. psychologic support to alleviate fears of pain and discomfort D. preoperative nursing assessment related to possible risks and complications
A
A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of surgery. What response does the nurse expect when the ACP is notified? A. surgery will be done as scheduled B. surgery will be rescheduled for the following day C. surgery will be postponed for 8 hours after the fluid intake D. a nasogastric tube will be inserted to remove the fluids from the stomach
A
A patient who has been taking ibuprofen and imipramine for control of cancer pain is having increased pain. What would the nurse recommend to the HCP as an appropriate change in the medication plan? A. add PO oxycodone to the other medications B. substitute PO ketorolac, an NSAID, for imipramine C. add transdermal fentanyl to the use of the other medications D. substitue PO hydrocodone with acetaminophen for the other medications
A
A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying, "I just want this over." What should the nurse do to promote a positive surgical outcome for the patient? A. ask the patient what her specific concerns are about the surgery B. redirect the patient's attention to the necessary preoperative preparations C. reassure the patient that the surgery will be over soon and she will be fine D. tell the patient she should not be so anxious because she is having a common, safe surgery
A
A patient with advanced colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications? A. on an around-the-clock schedule B. as often as necessary to keep the pain controlled C. by alternating two different types of drugs to prevent tolerance D. when the pain cannot be controlled with distraction or relaxation
A
A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain? A. includes treatment with adjuvant analgesics B. will be chronic and require long-term treatment C. responds to small to moderate around-the-clock doses of oral opioids D. can be well controlled with salicylates or nonsteroidal antiinflammatory drugs (NSAIDs)
A
A patient with multiple injuries resulting from an automobile accident tells the nurse that he has "bad" pain but that he can "tough it out" and does not require pain medication. To gain the patient's participation in pain management, what is most important for the nurse to explain to the patient? A. patients have a responsibilty to keep the nurse informed about their pain B. unrelieved pain has many harmful effects on the body that can impair recovery C. using pain medications rarely leads to addiction when they are used for actual pain D. non pharmacological therapies can be used to relieve his pain if he is afraid to use pain medications
B
A preoperative patient reveals that an uncle died during surgery because of a fever and cardiac arrest. Knowing the patient is at risk for malignant hyperthermia, the perioperative nurse alerts the surgical team. What is likely to happen next? A. the surgery will have to be canceled B. specific precautions can be taken to safely anesthetize the patient C. dantrolene (Dantrium) must be given to prevent hyperthermia during surgery D. the patient should be placed on a cooling blanket during the surgical procedure
B
After the family members of a postoperative patient leave, the patient tells the nurse that his family gave him a headache by fussing over him so much. What is an appropriate intervention by the nurse? A. administer the PRN analgesic prescribed for his postoperative pain B. ask the patient's permission to use acupressure to ease his headache C. reassure the patient that his headache will subside now that his family is gone D. teach the patient biofeedback methods to relieve his headaches by controlling cerebral blood flow
B
Because of the rapid elimination of volatile liquids used for general anesthesia, what should the nurse anticipate the patient will need early in the anesthesia recovery period? A. warm blankets B. analgesic medications C. observation for respiratory depression D. airway protection in anticipation of vomiting
B
The student nurse is depressed. He is trying to study for an important exam but cannot focus. Yesterday he received news that his mother was diagnosed with metastatic breast cancer. What effect could the stress on the student's mind and spirit most likely have on the student's body? A. the student's stress will cause failure on the exam. B. the student's stress will contribute to physical illness. C. the student's worry will affect is driving to see his mother. D. the student's emotional stress will cause bad feelings about the exam.
B
What condition should the nurse anticipate that may occur during epidural and spinal anesthesia? A. spinal headache B. hypotension and bradycardia C. loss of consciousness and seizures D. downward extension of nerve block
B
When transporting an inpatient to the surgical department, a nurse from another area of the hospital is able to access which area? A. sterile core B. holding area C. corridors or surgical suite D. unprepared operating room
B
Which measures of drugs may be effective in controlling pain in the physiological pain process stage of transduction? (select all that apply) A. distraction B. corticosteroids C. epidural opioids D. local anesthetics E. antiseizure medications F. nonsteroidal anti-inflammatory drugs (NSAIDs)
B, D, E, F
For which nursing diagnoses or collaborative problems common in postoperative patients has ambulation been found to be an appropriate intervention? (select all that apply) A. impaired skin integrity related to incision B. impaired mobility related to decreased muscle strength C. risk for aspiration related to decreased LOC D. ineffective airway clearance related to decreased respiratory excursion E. constipation related to decreased physical activity and impaired gastrointestinal (GI) motility F. venous thromboembolism related to dehydration, immobility, vascular manipulation, or injury
B, D, E, F,
A common reason that a nurse may need extra time when preparing older adults for surgery is their A. ineffective coping B. limited adaptation to stress C. diminished vision and hearing D. need to include caregivers in activities
C
Amitriptyline is prescribed for a patient with chronic pain from fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse's best response to the patient? A. antidepressants will improve the patient's attitude and prevent a negative emotional response to the pain. B. chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring. C. some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain. D. certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain.
C
During surgery, a patient has a nursing diagnosis of rick for preoperative positioning injury. What is a common rick factor for this nursing diagnosis? A. skin lesions B. break in sterile technique C. musculoskeletal deformities D. electrical or mechanical equipment failure
C
How is the initial information given to the PACU nurses about the surgical patient? A. a copy of written operative report B. a verbal report from the circulating nurse C. a verbal report from the anesthesia care provider (ACP) d. an explanation of the surgical procedure from the surgeon
C
In addition to ambulation, which nursing intervention could be implemented to prevent or treat the postoperative complication of syncope? A. monitor vital signs after ambulation B. do not allow the patient to eat before ambulation C. slowly progress to ambulation with slow changes in position D. have the patient deep breathe and cough before getting out of bed
C
On the first postoperative day following a bowel resection, the patient complains of abdominal and incisional pain rated 9 on a scale of 0 to 10. Postoperative orders include morphine (4 mg IV q4hr) for pain and may repeat morphine (4 mg IV) for breakthrough pain. The nurse determines that it has been only 1 3/4 hours since the last does or morphine and wants to wait a little longer. What effect does the nurse's actions have on the patient? A. protects the patient from addiction and toxic effects of the drug. B. prevents hastening or causing the patient's death from respiratory dysfunction. C. contributes to unnecessary suffering and physical and psychosocial dysfunction. D. indicates that the nurse understands the adage of "start low and go slow" in administering analgesics
C
Pain has been defined as "whatever the person experiencing the pain says it is, existing whenever the patient days it does." This definition is problematic for the nurse when caring for which type of patient? A. a patient placed on a ventilator B. a patient with a history of opioid addiction C. a patient with decreased cognitive function D. a patient with pain resulting from severe trauma
C
While assessing a patient in the PACU, the nurse finds that the patient's blood pressure is below the preoperative baseline. The nurse determines that the patient has residual vasodilating effects of anesthesia when what is assessed? A. a urinary output >30mL/hr B. an oxygen saturation of 88% C. a normal pulse with warm, dry, pink skin D. a narrowing pulse pressure with normal pulse
C
Which tubes drain gastric contents? (select all that apply) A. t-tube B. penrose C. nasogastric tube D. indwelling catheter E. gastrointestinal tube
C, E
At the end of the surgical procedure, the perioperiative nurse evaluates the patient's response to the nursing care delivered during the perioperiative period. What reflects a positive outcome related to the patient's physical status? A. the patient's right to privacy is maintained throughout the procedure B. the patient's care is consistent with the preplanned perioperiatve plan of care C. the patient receives consistent and comparable care regardless of the surgical setting D. the patient's respiratory function is consistent with or improved from baseline levels established preoperatively.
D
Which procedures are done for curative purposes? (select all that apply) A. gastroscopy B. rhinoplasty C. tracheotomy D. hysterectomy E. herniorrhaphy
D, E
-ectomy
excision or removal of
Identify four key personal characteristics that promote adaptation to stressors.
Resilience, Hardiness, Attitude, Optimism
-ostomy
creation of opening into
-lysis
destruction of
What is the primary advantage of the use of midazolam as an adjunct to general anesthesia? A. amnestic effect B. analgesic effect C. prolonged action D. antiemetic effect
A
-otomy
cutting into or incision of
After receiving the assigned patients for the day, the nurse determines that stress-relieving interventions are a priority for which patient? A. the man with peptic ulcer disease B. the newly admitted woman with cholecystitis C. the man with a bacterial exacerbation of chronic bronchitis D. the woman who is 1 day post-op for knee replacement.
A
During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem? A. obesity B. dehydration C. enlarged liver D. decreased peripheral pulses
A
The PACU nurse applies warm blankets to a postoperative patient who is shivering and has a body temperature of 96 degrees F. What treatment may also be used to treat the patient? A. oxygen therapy B. vasodilating drugs C. antidysrhythmic drugs D. analgesics of sedatives
A
The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing? A. witnessing the patient's signature B. obtaining informed consent from the patient for the surgery C. verifying that the consent for surgery is truly voluntary and informed D. ensuring that the patient is mentally competent to sign the consent form
A
The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient? A. fentanyl B. hydrocodone C. intranasal butorphanol D. morphine sustained-release
A
What does progression of patients through various phases of care in post-anesthesia care unity (PACU) primarily depend on? A. condition of patient B. type of anesthesia used C. preference of surgeon D. type of surgical procedure
A
What is the primary goal of the circulating nurse during preparation of the operating room, transferring and positioning the patient, and assisting the anesthesia team? A. avoiding any type of injury to the patient B. maintaining a clean environment for the patient C. providing for patient comfort and sense of well-being D. preventing breaks in aseptic technique b the sterile members of the team
A
With what are the postoperative respiratory complications of atelectasis and aspiration of gastric contents associated? A. hypoxemia B. hypercapnia C. hyperventilation D. airway obstruction
A
The nurse is preparing a patient for transport to the operating room. The patient is scheduled for a right knew arthroscopy. What actions should the nurse take at this time? (select all that apply) A. ensure that the patient has voided B. verify that the informed consent is signed C. complete preoperative nursing documentation D. verify that the right knee is marked with indelible marker E. ensure that the H&P, diagnostic reports, and vitals signs are on the chart
A, B, C, D, E
A patient is receiving a continuous infusion of morphine via an epidural catheter following major abdominal surgery. Which actions should the nurse include in the plan of care? (select all that apply) A. label the catheter as an epidural access B. assess the patient's pain relief frequently C. use sterile technique when caring for the catheter D. monitor the patient's level of consciousness (LOC) E. monitor patient vital signs (BP, HR, respirations) F. assess the motor and sensory function or the patient's lower extremities
A, B, C, D, E, F
Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient? (select all that apply) A. garlic B. fish oil C. valerian D. vitamin E E. astragalus F. ginkgo biloba
A, B, D, F
What type of procedural information should be given to a patient in preparation for ambulatory surgery? (select all that apply) A. how pain will be controlled B. any fluid and food restrictions C. characteristics of monitoring equipment D. what odors and sensations may be experienced E. technique and practice of coughing and deep breathing, is appropriate
A, B, E
A 32-year-old man is admitted to the hospital with an acute exacerbation of Crohn's disease. Coping strategies that may be suggested by the nurse during his hospitalization include? (select all that apply) A. humor B. exercise C. journaling D. a cleansing diet E. relaxation therapy
A, C, E
Which nursing actions are completed by the scrub nurse? (select all that apply) A. prepares instrument table B. documents intraoperative care C. remains in the sterile area of the OR D. checks mechanical and electrical equipment E. passes instruments to surgeon and assistants F. monitors blood and other fluid loss and urine output
A, C, E
A patient has recently had a myocardial infarction. What emotion-focused coping strategies should the nurse encourage him to use to adapt to the physical and emotional stress of his illness? (select all that apply) A. use meditation B. plan dietary changes C. start an exercise program D. do favorite escape activities (ex: playing cards) E. share feelings with spouse of other family members
A, D, E
To prevent agitation during the patient's recovery from anesthesia, when should the nurse begin orientation explanations? A. when the patient is awake B. when the patient first arrives in the PACU C. when the patient becomes agitated or frightened D. when the patient can be aroused and recognizes where he or she is
B
What is included in the routine assessment of the patient's cardiovascular function on admission to the PACU? A. monitoring arterial blood gases B. electrocardiographic (ECG) monitoring C. determining fluid and electrolyte status D. direct arterial blood pressure monitoring
B
What is the physical environment of a surgery suite primarily designed to promote? A. electrical safety B. medical and surgical asepsis C. comfort and privacy of the patient D. communication among the surgical team
B
What is the rationale for using preoperative checklists on the day of surgery? A. the patient is correctly identified and preoperative medications administered B. all preoperative orders and procedures have been carried out and documented C. voiding is the last procedure before the patient is transported to the operating room D. patients' families have been informed as o where they can accompany and wait for patients
B
When a patient at the clinic is informed that testing indicates the presence of gonorrhea, the patient signs and says, "That, I can handle." What does the nurse understand about the patient in this situation? A. the patient is in denial about the possible complications of gonorrhea. B. the patient does not perceive the gonorrhea infection as a threatening stressor. C. the patient does not have other current stressors that require adaptation or coping mechanisms. D. the patient knows how to cope with gonorrhea from dealing with previous gonorrhea infections.
B
Which patient is ready for discharge from Phase 1 PACU care the the clinical unit? A. arouses easily, pulse is 112 bpm, respiratory rate is 24, dressing is saturated, SpO2 is 88% B. awake, vital signs stable, dressing is dry and intact, no respiratory depression, SpO2 is 92% C. difficult to arouse, pulse is 52, respiratory rate is 22, dressing is dry and intact, SpO2 is 91% D. arouses, blood pressure higher than preoperative and respiratory rate is 10, no excess bleeding, SpO2 is 90%
B
While caring for a female patient with Alzheimer's disease and her caregiver husband, the nurse finds that the patient's husband is experiencing increased asthma problems. What is a possible explanation for this finding? A. progressive worsening of asthma occurs in people as they age. B. chronic and intense stress can cause exacerbation of immune-based diseases. C. the husband is probably smoking more to help him cope with needing to care continually for his wife. D. the husband inadequately copes with his wife's condition by unconsciously forgetting to take his medications.
B
While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient's heel. During care of the ulcer, what is the nurse's understanding of the patient's perception of pain? A. the patient will have a behavioral response if pain is perceived. B. the area should be treated as a painful lesion, using gentle cleansing and dressing. C. the area can be thoroughly scrubbed because the patient is not able to perceive pain. D. all nociceptive stimuli that are transmitted to the brain result in the perception of pain.
B
While teaching relaxation therapy to a patient with fibromyalgia, what does the nurse recognize as being most important to incorporate? A. exercise B. relaxation breathing C. soft background music D. progressive muscle relaxation
B
A patient who had major surgery is experiencing emotional stress as well as physiological stress from the effects of surgery. What can this stress cause? A. diuresis B. hyperkalemia C. fluid retention D. impaired blood coagulation
C
A patient with chronic cancer-related pain has starting using MS Contin for pain control and has developed common side effects of the drug. The nurse reassures the patient that tolerance will develop to most of these side effects but that continued treatment with most likely be required for what? A. pruritus B. dizziness C. constipation D. N/V
C
Once generated, what may block the transmission of an action potential along a peripheral nerve fiber to the dorsal root of the spinal cord? A. nothing can stop the action potential along an intact nerve until it reaches the spinal cord. B. the action potential must cross several synapses, points at which the impulse may be blocked by drugs. C. the transmission may be interrupted by drugs (ex: local anesthetics) that act on peripheral sodium channels. D. the nerve fiber produces neurotransmitters that may activate nearby nerve fibers to transmit pain impulses.
C
To promote effective coughing, deep breathing, and ambulation in the postoperative patient, what is most important for the nurse to do? A. teach the patient controlled breathing B. explain the rationale for these activities C. provide adequate and regular pain medication D. use an incentive spirometer to motivate the patient
C
Upon admission of a patient to the PACU, the nurse's priority assessment is A. vital signs B. surgical site C. respiratory adequacy D. level of consciousness
C
What should be included in the instructions given to the postoperative patient before discharge? A. need for follow-up care with home care nurses B. directions for maintaining routine postoperative diet C. written information about self-care during recuperation D. need to restrict all activity until surgical healing is complete
C
When the nurse asks a preoperative patient about allergies, the patient reports a history of seasonal environmental allergies and allergies to a variety of fruits. What should the nurse do next? A. note this information in the patient's record as hay fever and food allergies B. place an allergy alert wristband that identifies the specific allergies on the patient C. ask the patient to describe the nature and severity of any allergic responses experienced from these agents D. notify the anesthesia care provider (ACP) because the patient may have an increased rick for allergies to anesthetics
C
A postoperative 68-yr-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well? A. opioid overdose B. nausea and itching C. lack of pain control D. adverse respiratory outcomes
D
During the preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic studies? A. ECG and chest x-ray B. serum glucose and CBC C. ABGs and coagulation tests D. BUN, serum creatinine, and electrolytes
D
Goals for patient safety in the OR include the Universal Protocol. What is included in the protocol? A. all surgical centers of any type must submit reports on patient safety infractions to the accreditation agencies B. members of the surgical team stop whatever they are doing to check that all sterile items have been prepared properly C. members of the surgical team pause right before surgery to mediate for 1 minute to decrease stress and possible errors D. a surgical timeout is preformed just before the procedure is started to verify patient identity, surgical procedure, and surgical site.
D
Monitored anesthesia care (MAC) is being considered for a patient undergoing a cervical dilation and endometrial biopsy in the health care clinic. The patient asks the nurse, "What is this MAC?" The nurse's response is based on the knowledge that MAC A. can be administered only by anesthesiologists or nurse anesthetists B. should never be used outside of the OR because of the risk of serious complications C. is so safe that it can be administered by nurses with direction from health care providers D. provides maximum flexibility to match the sedation level with the patient and procedure needs
D
The health care provider has ordered IV morphine q2-4hr PRN for a patient following major abdominal surgery. When should the nurse plan to administer the morphine? A. before all planned painful activities B. every 2 to 4 hours during the first 48 hours C. every 4 hours as the patient requests the medication D. after assessing the nature and intensity of the patient's pain
D
The nurse if reviewing the laboratory results for a preoperative patient. Which study result should be brought to the attention of the surgeon immediately? A. serum K+ of 3.8mEq/L B. hemoglobin of 15g/dL C. blood glucose of 100mg/dL D. white blood cell (WBC) count of 18,000/uL
D
The patient will be placed under moderate sedation to allow realignment of a fracture in the emergency department. When the family asks about this anesthesia, what should the nurse tell them? A. includes inhalation agents B. includes high levels of sedation C. frequently used from traumatic injuries D. patients will remain responsive and breath without assistance
D
Thirty-six hours postoperatively, a patient has a temperature of 100 degrees F. What is most likely cause of this temperature elevation? A. dehydration B. wound infection C. lung congestion and atelectasis D. normal surgical stress response
D
To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious, what will the nurse do? A. encourage deep breathing B. elevate head of bed C. administer oxygen per mask D. position the patient in a side-lying position
D
Which drainage is drained with a Hemovac? A. bile B. urine C. gastric contents D. wound drainage
D
Which short-acting barbiturate is most commonly used for induction of general anesthesia? A. nitrous oxide B. propofol (diprivan) C. isoflurane (forane) D. methohexital (brevital)
D
-oscopy
look into
-plasty
repair of reconstruction of
-orrhaphy
repair or suture of
