PERIOPERATIVE NURSE

7. A client who has undergone preadmission testing has had blood drawn for serum laboratory studies including a complete blood count, coagulation studies, and electrolytes and creatinine levels. Which of the following laboratory results should be reported to the surgeon's office by the nurse, knowing that it could cause surgery to be postponed? * A. Sodium 141 mEq/L B. Hemoglobin 8 g/dL C. Platelets 210,000/mm3 D. Serum creatinine 0.8mg/dL

B. Hemoglobin 8 g/dL

74. 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

D. The anesthesiologist and circulating nurse

80. In checking the neurologic status of the client just admitted to the PACU, the nurse notes that the right eye pupil is dilated more than the left pupil. What is the nurse's best first action? * A. Check the client's chart to compare these findings to the client's baseline neurologic assessment. B. Raise the head of the bed up to a 30-degree angle and administer oxygen. C. Test te client's deep tendon reflexes on all four extremities. D. Notify the physician and document the finding.

A. Check the client's chart to compare these findings to the client's baseline neurologic assessment.

99. On the 2nd day post op following an inguinal herniorrhaphy, the nurse assessing a client's wound would expect to find: * A. A small amount of serous drainage, edges approximated, and a pink color. B. A large amount of sanguineous drainage and edges pink in color. C. No drainage, the edges brown and coming apart. D. A penrose drain putting out large amounts of serosanguinous drainage.

A. A small amount of serous drainage, edges

36. The distance that an unsterile person should maintain away from the sterile field is: * A. At least 1 foot B. At least 1 meter C. At least 18 inches D. At least 2 steps

A. At least 1 foot

42. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover? * A. Circulating nurse B. Anesthesiologist C. Surgeon D. Nursing Aide

A. Circulating nurse

45. When everything is ready, who comes to the holding area for the client? * A. Circulator B. Anesthesia provider C. Scrub person D. Surgeon

A. Circulator

81. An adult who has had general anesthesia for major surgery is in the PACU. One of the signs that may indicate that his artificial airway should be removed is: * A. Gagging B. Restlessness C. An increase in pain D. Clear lungs on auscultation

A. Gagging

94. After an abdominal cholecystectomy, the nurse should assess for signs of respiratory complications because the: * A. Incision is in close proximity to the diaphragm B. Length of time require for surgery is prolonged C. Client's resistance in lowered because of bile in the blood D. Bloodstream is invaded by microorganisms from the biliary tract

A. Incision is in close proximity to the diaphragm

68. During surgery while the surgeon is dissecting the tissue, the scrub person should be ready to serve which of the following instruments? * A. Kelly B. Suture scissors C. Bobcock D. Army navy

A. Kelly

69. The surgeon will perform AV fistula creation. He tells the nurse to prepare for a stab knife. The nurse knows that this surgical blade will only fit: * A. Knife handle no.3 B. Knife handle no.4 C. Knife handle no.7 D. all of the above

A. Knife handle no.3

52. Surgeries like incision and drainage and debridement are relatively short procedures but considered "dirty cases". When are these procedures best scheduled? * A. Last case B. In between cases C. According to availability of anesthesiologist D. According to surgeon's preference

A. Last case

29. Which of the following items comes into contact with non-intact skin and mucous membrane? * A. Respiratory therapy equipment B. Eating utensils C. Surgical instruments D. Needles

A. Respiratory therapy equipment

26. What OR attires are worn in the semi-restricted area? * A. Scrub suit, OR shoes, head cap B. Head cap, scrub suit, mask, OR shoes C. Mask, OR shoes, scrub suit D. Cap, mask, gloves, shoes

A. Scrub suit, OR shoes, head cap

40. "Sterile" is the condition of almost all items, devices or supplies used in the OR for any surgical procedure. Shelf life of a packaged sterile item is event related and depends on the following, EXCEPT: * A. Type of sterilizer used to sterilized items B. Amount of handling C. The quality of packaging material used D. Storage conditions

A. Type of sterilizer used to sterilized items

97. A 58-year old smoker underwent major abdominal surgery two days ago. During the respiratory assessment, the nurse notes he is taking shallow breaths and breath sounds are decreased in the bases. The best interpretation of these findings is that the patient is experiencing post op: * A. Pneumonia B. Atelectasis C. Hemorrhage D. Thromboembolism

B. Atelectasis

71. Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has a low threshold of pain, what needle would you prepare? * A. Round needle B. Atraumatic needle C. Reverse cutting needle D. Tapered needle

B. Atraumatic needle

67. Using the WHO Surgical Checklist, Sign In is performed: * A. Before preop medication B. Before anesthesia induction C. Before incision D. Before the patient leaves the OR

B. Before anesthesia induction

72. When is the first closing count reported? * A. Before closing the subcutaneous layer B. Before peritoneum is closed C. Before closing the skin D. Before fascia is sutured

B. Before peritoneum is closed

76. One hour after admission to the PACU, the postoperative client has become very restless. What is the nurse's best first action? * A. Ask the client if he or she is having pain. B. Check the client's oxygen saturation level. C. Document the finding as the only action. D. Explain to the client that he or she is in the "recovery room" after surgery.

B. Check the client's oxygen saturation level.

4. A risk in obtaining informed consent before surgery is: * A. Completing the informed consent papers before all preoperative test results are in the patient's chart B. Completing informed consent papers 1 hour after the preoperative medication is given C. Completing informed consent papers evening before the surgery Completing informed consent papers with a family member present

B. Completing informed consent papers 1 hour after the preoperative medication is given

92. Which of the following interventions is inappropriate for the treatment of postoperative wound evisceration? * A. Give prophylactic antibiotics as ordered. B. Have the client drink as much fluids as possible. C. Explain to the client what happening and give support. D. Cover the protruding internal organs with sterile gauze moistened with sterile saline.

B. Have the client drink as much fluids as possible.

96. The nurse assesses a postoperative client who has a rapid weak pulse; urine output less than 30 ml/hr; and decreased blood pressure. The client's skin is cool and clammy. What complication should the nurse suspect? * A. Thrombophlebitis B. Hypovolemic shock C. Aspiration pneumonia D. Wound dehiscence

B. Hypovolemic shock

16. The nurse in an outpatient department is interviewing an adult one week prior to her scheduled elective surgery. In planning for the surgery, which of the following should the nurse include in her teaching? * A. The client will be able to return home alone following surgery. B. Limitation of oral intake the day of the procedure. C. The laboratory studies ordered do not need to be done until after the surgery. D. The client should not take any of her routine medications the morning of the surgery.

B. Limitation of oral intake the day of the procedure.

34. If required to place a sterile item on a sterile field, the nurse should: * A. Hand the sterile package to a sterile nurse and have her place it on the sterile field B. Open the sterile package and drop the item on the sterile field C. Open the sterile package and place the item on the sterile field D. Open the sterile package and take the item out with a clean gloved hand

B. Open the sterile package and drop the item on the sterile field

87. Which assessment finding in a postoperative client indicates to the nurse that the interventions to prevent hypovolemia need to be re-evaluated? * A. The blood pressure changes from 136/80 to 122/80 mm Hg. B. The urine output decreases from 40 to 10 mL/hour. C. The client cannot count backward from 100 by threes. D. The client's temperature has changed from 37.1° to 37.5° C.

B. The urine output decreases from 40 to 10 mL/hour.

85. Which of the following interventions is performed first when changing a dressing or giving wound care? * A. Put on gloves. B. Wash hands thoroughly. C. Slow remove the soiled dressing D. Observe the dressing for the amount, type and odor of drainage.

B. Wash hands thoroughly

1. A preoperative client expresses anxiety to a nurse about upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse? * A. "If it's any help, everyone is nervous before surgery." B. "I will be happy to explain the entire surgical procedure to you." C. "Can you share with me what you've been told about your surgery?" D. "Let me tell you about the care you'll receive after surgery and the amount of pain you can anticipate."

C. "Can you share with me what you've been told about your surgery?"

84. The client is most likely to require the greatest amount of analgesia for pain during which of the following time periods? * A. Immediately after surgery B. 4 hours after surgery C. 12 to 36 hours after surgery D. 48 to 60 hours after surgery.

C. 12 to 36 hours after surgery

8. 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

C. An increased risk for atelectasis and hypoxia

100. Most surgical patients are encouraged to be out of bed: * A. Within 6 to 8 hours after surgery B. Between 10 and 12 hours after surgery C. As soon as it is indicated D. On the second postoperative day

C. As soon as it is indicated

11. In which situation is the nurse performing the role of client advocate during the preoperative period? * A. Serving as a witness to the informed consent procedure B. Teaching the client how to perform coughing and deep breathing exercises C. Assuring the client whose religion does not permit blood transfusions that his or her wishes will be followed D. Ensuring that the client's impaired hearing problem is clearly communicated to the entire surgical team

C. Assuring the client whose religion does not permit blood transfusions that his or her wishes will be followed

93. Which maneuver or technique should the nurse avoid to prevent pulmonary emboli in a postoperative client? * A. Application of elastic wraps to the lower extremities B. Measuring calf circumference every shift C. Calf muscle massage D. Early ambulation

C. Calf muscle massage

2. When obtaining consent for surgery, the nurse should initially: * A. Explain the risks involved in the surgery. B. Explain that obtaining the signature is routine for any surgery. C. Evaluate whether the client's knowledge level is sufficient to give consent. D. Witness the signature because this is what the nurse's signature documents.

C. Evaluate whether the client's knowledge level is sufficient to give consent.

75. A 56 year old man is in the postanesthesia care unit (PACU) following a hemicolectomy. While in the PACU, the nurse will monitor his vital signs: * A. Continuously B. Every 5 minutes C. Every 15 minutes D. On a PRN basis

C. Every 15 minutes

60. Which change in the anesthetized client alerts the nurse to the possibility of malignant hyperthermia? * A. Widened pulse pressure B. Increased output of dilute urine C. Increased end tidal carbon dioxide level D. Ascending flaccid paralysis of skeletal muscles

C. Increased end tidal carbon dioxide level

64. An OR nurse is positioning a client on the operating room table to prevent the client's extremities from dangling over the sides of the table. A nursing student who is observing for the day asks the nurse why this is important. The nurse responds that this is done primarily to prevent: * A. An increase in pulse rate B. A drop in blood pressure C. Nerve and muscle damage D. Muscle fatigue in the extremities

C. Nerve and muscle damage

48. When testing the efficiency of the instruments like scissors, needle holders and clamps as they are needed, are one of the duties and responsibility of the: * A. Surgeon B. Assistant Surgeon C. Scrub Nurse D. Circulating Nurse

C. Scrub Nurse

10. When asked about allergies, the preoperative client tells the nurse she has allergies to all of the following substances. Which allergy alerts the nurse to potential problems in relation to the scheduled surgery? * A. Pollens B. Bee stings C. Shellfish D. Peanuts

C. Shellfish

98. The client's postop orders state "diet as tolerated". The client has been NPO. The nurse will advance the client's diet to clear liquid based on which of the following assessment? * A. No complaints of nausea and vomiting B. Pain level is maintained at a rating of 2-3 / 10 C. States passing flatus D. Ambulates minimal assistance

C. States passing flatus

55. There are four stages to general anesthesia. An unconscious patient with normal pulse and respirations is considered to be in the stage known as: * A. Beginning anesthesia B. Excitement C. Surgical anesthesia D. Medullary depression

C. Surgical anesthesia

13. Which of the following outcomes would demonstrate the effectiveness of preoperative teaching? * A. The client sleeps well at night before surgery B. The client has a balanced intake and output C. The client demonstrates deep breathing, coughing, splinting, and leg exercises D. The client remains free of infection, as manifested by normal temperature

C. The client demonstrates deep breathing, coughing, splinting, and leg exercises

33. The nurse has a sterile field in front of her and needs to reach something on the other side of the sterile field. To maintain sterile technique, the nurse should: * A. Move the sterile field away from her and reach the object B. Reach across the sterile field

C. Walk around the sterile field, keeping herself facing the sterile field

43. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. While the surgeon performs the surgical procedure, who monitors the status of the client like urine output and blood loss? * A. scrub nurse B. surgeon C. anesthesiologist D. circulating nurse

C. anesthesiologist

38. Which of the following is NOT used for chemical sterilization? * A. Ethylene oxide gas B. Formaldehyde gas C. steam D. hydrogen peroxide

C. steam

24. 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.

D. Ask the client his name.

57. Which statement regarding conscious sedation is true? * A. Only an anesthesiologist or certified registered nurse anesthetist may administer agents for conscious sedation. B. The basis for pain relief and amnesia during conscious sedation is hypnosis. C. The client remains alert and awake during the process. D. Defensive reflexes remain intact during the procedure.

D. Defensive reflexes remain intact during the procedure.

89. 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.

D. Document the finding as the only action.

30. You have a critical heat labile instrument to sterilize and are considering to use a high level disinfectant. What should you do? * A. Cover the soaking vessel to contain the vapor B. Double the amount of high level disinfectant C. Test the potency of the high level disinfectant D. Prolong the exposure time according to manufacturer's direction

D. Prolong the exposure time according to manufacturer's direction

62. Surgical pain might be minimized by which nursing action in the O.R. * A. Skill of surgical team and lesser manipulation B. Appropriate preparation for the scheduled procedure C. Use of modern technology in closing the wound D. Proper positioning and draping of clients

D. Proper positioning and draping of clients

41. Which is the best technique to use when rinsing hands and forearms after a surgical scrub? * A. Rinsing is not performed after a surgical scrub because it will reduce the antimicrobial activity of the cleansing solution. B. Rinsing should start at the hand, with water running up the forearm. C. Rinsing should start at the elbow, with water running down to the hand. D. Rinsing should start with the hand positioned so that water runs off the extremity rather than up or down.

D. Rinsing should start with the hand positioned so that water runs off the extremity rather than up or down.

63. The circulating nurse's primary goal when positioning the patient on the OR table is to achieve: * A. a comfortable position for the client B. a position that is acceptable to the surgeon C. a position that prevents exposure and promotes privacy D. a position that avoids circulatory impairment and protects nerve function

D. a position that avoids circulatory impairment and protects nerve function

44. Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. For orthopedic cases, what department is usually informed to be present in the OR? * A. rehabilitation department B. laboratory department C. maintenance department D. radiology department

D. radiology department

31. Before you use a disinfected instrument, it is essential that you: * A. Rinse with tap water followed by alcohol B. Wrap the instrument with sterile towel C. Dry the instrument thoroughly D. Rinse with sterile water

D. Rinse with sterile water

32. Which of the following techniques will maintain surgical asepsis? * A. Change the sterile field after sterile water is spilled on it. B. Put on sterile gloves; then open a container of sterile saline. C. Place a sterile dressing 1/2" (1.3cm) from the edge of the sterile field. 2inches D. Clean the wound with circular motion, moving from outer circles toward the center. Center to outward

A. Change the sterile field after sterile water is spilled on it.

21. The nurse enters the client's room to administer 10 mg Valium PO, the ordered preop medication for her hysterectomy. During the conversation, the client tells the nurse that she and her husband are planning to have another child in the coming year. The best action for the nurse to take is which of the following? * A. Do not administer the preop medication, notify the nursing supervisor and the physician. B. Go ahead administer the medication as ordered. C. Check to see if the patient has signed a surgical consent. D. Send the patient to the operating room (OR) without medication.

A. Do not administer the preop medication, notify the nursing supervisor and the physician.

3. In relation to obtaining an informed consent from a 17-year old adolescent, the nurse should remember that the adolescent: * A. Does not have the legal capacity to give consent. B. Is not able to make an acceptable or intelligent choice. C. Is able to give voluntary consent when parents are not available. D. Will most likely be unable to choose between alternatives when asked to consent.

A. Does not have the legal capacity to give consent.

17. A nurse is developing a plan of care for a client scheduled for surgery. The nurse should include which activity in the nursing care plan for the client on the day of surgery? * A. Have the client void immediately before surgery. B. Avoid oral hygiene and rinsing with mouthwash. C. Verify the client has not eaten for the last 24 hours. D. Report immediately any slight increase in blood pressure or pulse.

A. Have the client void immediately before surgery.

88. As part of the report, the nurse of the medical surgical unit was told that the client's Foley catheter had been empty prior to leaving the PACU/recovery room. Two hours later, the nurse notes that the client's output is 30 mL. What is the nurse's best first action? * A. Measure and compare total output with total intake. B. Document the finding as the only action. C. Increase the rate of IV fluids by 50 mL/hour. D. Notify the surgeon immediately.

A. Measure and compare total output with total intake.

47. Which of the following role would be the responsibility of the circulator? * A. Monitors traffic in the operating room B. Determines when the client may be moved to recovery room after the operation has been completed. C. Must be certain that all team members are aware of what is needed during the procedure and that all necessary equipment and instruments are available D. Should be familiar with the characteristics of each surgeon's technique

A. Monitors traffic in the operating room

83. The client who is 24 hours postoperative from abdominal surgery has light brown fluid with small particles that look like coffee grounds in the NG tube drainage. What is the nurse's best action? * A. Notify the physician. B. Irrigate the tube with normal saline. C. Clamp the tube and advance it 1 to 2 inches. D. Document the finding as the only action.

A. Notify the physician

50. Who usually acts as an important part of the OR personnel by getting the wheelchair or stretcher and pushing/pulling them toward the operating room? * A. Orderly/clerk B. Nurse supervisor C. Circulator D. Anesthesia provider

A. Orderly/clerk

19. Neomycin is ordered preoperatively for a client with a diagnosis of cancer of the colon. The client asks why neomycin is being given. The best response by the nurse should be: * A. "It will decrease you kidney function and lessen urine production during surgery." B. "It will kill the bacteria in your bowel and decrease the risk for infection after surgery." C. "It is used to alter the body flora, which reduces the spread of the tumor to adjacent organs." D. "It is used to prevent you from getting an infection, particularly a bladder infection, before surgery."

B. "It will kill the bacteria in your bowel and decrease the risk for infection after surgery."

77. The postoperative client's arterial blood gas values are pH 7.22, HCO3- 21 mEq/L, PCO2 65 mm Hg, and PO2 58 mm Hg. What is the nurse's best first action? * A. Notify the physician. B. Assess the client's airway. C. Increase the oxygen flow rate. D. Document the finding as the only action.

B. Assess the client's airway.

20. 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. Check the client's pulse and blood pressure.

86. The nurse empties 80 mL of sanguineous drainage from the Jackson-Pratt drain in the client's hip after hip surgery. What other actions regarding the drain should the nurse take * A. Flush the tubing with urokinase to ensure patency. B. Compress and close the drain to ensure suction. C. Advance the tubing ½ inch from the insertion site. D. Clamp the drain for 2 hours and release the clamp for 2 hours.

B. Compress and close the drain to ensure suction.

91. An adult client's wound has eviscerated. The nurse assesses his respiratory status because: * A. Dehiscence elevates the diaphragm B. Coughing increases the risk of evisceration C. Respiratory arrest commonly accompanies wound dehiscence D. Splinting the wound will compromise respiratory status

B. Coughing increases the risk of evisceration

37. Gloves are good barrier to prevent harboring and transfer of microorganism both to patient and the nurse. If accidental contamination of worn gloves happened, what is the best way to do? * A. Remove the torn gloves and wear a new one B. Do not remove the torn gloves but rather wear over it new gloves C. Remove both gloves and wear another pair of new gloves D. Inform the surgeon that you accidentally punctured your gloves

B. Do not remove the torn gloves but rather wear over it new gloves

6. The nurse administers 10 mg IM morphine as a preop medication, and then discovers that there is no signed operative permit. The best action for the nurse to take is to: * A. Sent the patient to surgery as scheduled. B. Notify the nursing supervisor, the OR, and the physician as the effects of the drug must be allowed to wear off before the consent can be obtained. C. Cancel the surgery. D. Obtain the needed consent.

B. Notify the nursing supervisor, the OR, and the physician as the effects of the drug must be allowed to wear off before the consent can be obtained.

49. When testing the electrosurgical unit (ESU), tourniquet laser and or equipment before the patient enters the room is one of the duties and responsibility of the: * A. Orderly B. OR Technician C. Circulating Nurse D. Scrub Nurse

B. OR Technician

58. Which nursing intervention by the circulating nurse is most important for clients having surgery under regional anesthesia? * A. Monitoring respiratory rate and depth B. Positioning for safety and comfort C. Minimizing external noise and stimuli D. Planning for nonpharmacologic pain interventions

B. Positioning for safety and comfort

95. The nurse in the postanesthesia care unit notices that after an abdominal cholecystectomy, a client has serosanguinous fluid on the abdominal dressing. The nurse should: * A. Change the dressing B. Reinforce the dressing C. Apply an abdominal binder D. Remove the tape and apply Montgomery straps

B. Reinforce the dressing

59. A 26-year old client has acute leukemia and is scheduled for a IJ catheter insertion under local anesthesia. A major advantage of regional anesthesia is that the client: * A. Retains reflexes B. Remains conscious C. Has retroactive amnesia D. Is in the OR for a short period of time.

B. Remains conscious

28. Spaulding categorized instruments according to use. Where do you classify endoscopic instruments? * A. Critical items B. Semi-critical items C. Noncritical items D. Sterile instruments

B. Semi-critical items

46. Which task or function during a surgical procedure is designated as being within the scope of practice for the scrub nurse? * A. Closing the surgical wound B. Setting up the sterile field C. Administering blood products D. Monitoring the client's cardiopulmonary function

B. Setting up the sterile field

79. The nurse should position a client recovering from general anesthesia in a: * A. Supine position B. Side-lying position C. High-Fowler's position D. Trendelenburg position

B. Side-lying position

51. Like any nursing interventions, counts should be documented. To whom does the scrub nurse report any discrepancy of counts so that immediate and appropriate action is instituted? * A. Anesthesiologist B. Surgeon C. OR nurse supervisor D. Circulating nurse

B. Surgeon

39. Chemical indicators communicate that: * A. The items are sterile-being an indicator of sterility. B. That the items had undergone sterilization process but not necessarily sterile C. The items are disinfected D. That the items had undergone disinfection process but not necessarily disinfected

B. That the items had undergone sterilization process but not necessarily sterile

5. A client is brought to the emergency room by emergency medical services (EMS) after being hit by a car. The name of the client is not known and the client has sustained a severe head injury and multiple fractures, and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which of the following is the best action? * A. Obtain a court order for the surgical procedure. B. Transport the victim to the operating room for surgery. C. Call the police to identify the client and locate the family. D. Ask the EMS team to sign the informed consent.

B. Transport the victim to the operating room for surgery.

14. The nurse demonstrates leg exercises to a preoperative client. Which statement made by the client indicates a need for further teaching? * A. "These exercises help prevent blood clots." B. "Once I am up and walking around, I won't need to do these as often." C. "Keeping my knees bent will prevent my arthritis from making me so stiff." D. "If I feel pain in my calf when I bend my ankles up and down, I should tell my nurse."

C. "Keeping my knees bent will prevent my arthritis from making me so stiff."

66. Hair removal can injure skin. Breaks in the skin surface afford an opportunity for entry of microorganisms and are potential source of infection. Hair removal is best carried out per surgeon's order during: * A. Just a few minutes after the surgery was performed. B. An hour or 30 minutes prior to the scheduled time for the surgical procedure. C. As close as possible to the time of incision creation D. Eight hours prior to the scheduled surgical procedure.

C. As close as possible to the time of incision creation

9. The client receiving preoperative medication tells the nurse that all of the following medications (drugs or herbs) were ingested yesterday. Which one should the nurse report to the surgical team? * A. Acetaminophen (Tylenol) B. Vitamin C C. Aspirin D. Diphenhydramine (Benadryl)

C. Aspirin

56. Why would epidural anesthesia be a good choice for an older adult client who is having total knee replacement surgery? * A. The risk for anaphylaxis is completely eliminated. B. The client will be able to ambulate sooner after surgery. C. Cardiopulmonary complications are reduced with this type of anesthesia. D. This type of anesthesia reduces the potential for blood loss during and after surgery.

C. Cardiopulmonary complications are reduced with this type of anesthesia.

23. Which of the following method is the best for correctly identifying the client prior to surgery? * A. Ask the client his or her date of birth and confirm it with the chart. B. Ask the client his or her name and social security number. C. Check the client's armband and ask his or her name. D. Check the client's medical record number and surgical consent form.

C. Check the client's armband and ask his or her name

18. The client refuses to remove his plain gold wedding band before going to surgery. What is the best action for the nurse to take? * A. Firmly insist that it must be removed or surgery cannot be performed B. Ask his wife to assist you in discussing this with her husband C. Cover the wedding band with adhesive tape and tape it to his finger D. Pre-medicate him and remove the wedding band after he falls to sleep

C. Cover the wedding band with adhesive tape and tape it to his finger

22. A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid (Aspirin). The nurse determines that the client needs additional teaching if the client states: * A. "Aspirin can cause bleeding after surgery." B. "Aspirin can cause my ability to clot blood to be abnormal." C. "I need to discontinue the aspirin 48 hours before the scheduled surgery." D. "I need to continue to take aspirin until the day of the surgery."

D. "I need to continue to take aspirin until the day of the surgery."

90. The client is 4 days postoperative from a bowel resection and has a large abdominal incision. When the nurse enters the client's room, he tells her that he felt the incision "pop" when he coughed just a moment ago. What is the nurse's best response? * A. "It is good that you are coughing and deep breathing to prevent lung complications." B. "That is a normal feeling in the incision whenever you are moving." C. "Be sure to splint the incision with a pillow or your hands when you cough." D. "Lie down flat on the bed and let me examine your incision."

D. "Lie down flat on the bed and let me examine your incision."

12. Which of the following statements by the client indicates that the preoperative teaching regarding gallbladder surgery has been effective? * A. "I cannot eat or drink anything after midnight." B. "I'm not going to cough after surgery because it might open my incision." C. "I might have a stroke if I stop taking my anticoagulant." D. "The nurse showed me how to contract and relax my calf muscles."

D. "The nurse showed me how to contract and relax my calf muscles."

53. 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

D. 35-year-old man who smokes two packs of cigarettes daily

61. 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).

D. Administer intravenous dantrolene (Dantrium).

70. Which of the following OR instruments are classified as grasping or holding instrument? * A. Metzembaum B. Kelly C. Army navy D. Allis forceps

D. Allis forceps

65. In essence, patient positioning is a shared responsibility among all team members. Who has the final say or word in positioning the patient when physiologic status and monitoring are in question? * A. Surgeon if surgical site B. Scrub Nurse C. Circulating Nurse D. Anesthesiologist

D. Anesthesiologist

25. The nurse is developing a plan of care for a preoperative client who has a latex allergy. Which intervention should be included in the plan? * A. Avoid using medications from glass ampules. B. Avoid using IV tubing that is made of polyvinyl chloride. C. Use medications that are from ampules with rubber stoppers. D. Apply a cloth barrier to the client's arm under a blood pressure cuff when taking the blood pressure.

D. Apply a cloth barrier to the client's arm under a blood pressure cuff when taking the blood pressure.

54. The client is to undergo a gynecologic surgical procedure that requires the client to be in the lithotomy position. At what point should the circulating nurse place the client in the lithotomy position? * A. Before anesthesia is administered to allow the client to move her legs herself and tell the nurse if any discomfort is being felt B. During stage 1 of general anesthesia to take advantage of the client's relaxed state C. During stage 2 of general anesthesia to ensure that the client will not be embarrassed by the position D. During stage 3 of general anesthesia to avoid overstimulating the client or disrupting the attainment of a patent airway

D. During stage 3 of general anesthesia to avoid overstimulating the client or disrupting the attainment of a patent airway

82. A semi-conscious client in the PACU is experiencing dyspnea. Which of the following immediate actions should the nurse perform first? * A. Place a pillow under the client's head. B. Remove the oropharyngeal airway. C. Apply oxygen by mask. D. Reposition the client to keep the tongue forward.

D. Reposition the client to keep the tongue forward.

73. Mr. T. received droperidol and fentanyl [Innovar] during surgery. In planning his care, the nurse will need to monitor for which of the following during the immediate post-op period? * A. Restlessness and anxiety B. Delirium C. Dysrhythmias D. Respiratory depression

D. Respiratory depression

27. Drape barrier placed between the client's head and the operative area is one of the preventive measures of which of the following sources of contamination in the OR? * A. Hair B. Skin C. Circulating air D. Respiratory tract

D. Respiratory tract

15. A nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse should include which piece of information in discussions with the client? * A. Inhale as rapidly as possible. B. Keep a loose seal between the lips and the mouthpiece. C. After maximum inspiration, hold the breath for 15 seconds and exhale. 3 to 4 lang D. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees

D. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees

78. 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.

D. The dorsalis pedis pulses are not palpable bilaterally.

35. After sterile gloves are put on, it's important to keep one's hands: * A. Down and below the waist B. Folded and above the waist C. folded and below the waist D. in sight and above the waist

D. in sight and above the wais