Periopertive NCLEX Practice
The nurse at an outpatient surgical clinic witnesses client signatures. When obtaining signatures, which clients are able to sign their own consent for a procedure/surgery?
-62 year old with macular degeneration who is ordered a routine colonoscopy -married 17 year old who requires a cholecystectomy for relief of nausea and pain
A 75 year old patient is being prepared for surgery. What assessment data should be included?
-Fluid balance history -Current mobility problems -Current cognitive function
The patient had surgery at an ambulatory surgery center. Which criteria support that this patient is ready for discharge.
-Vital signs baseline or stable -minimal nausea and vomiting -responsible adult taking patient home
A postoperative patient is transferred from the postanesthesia unit to the medical-surgical nursing floor. The nurse notes that the patient has an order for D5½ NS to infuse at 125 ml/hr. Until an IV pump is available, the nurse regulates the IV flow rate at which of the following drops (gtts)/min, noting that the tubing has a drop factor of 10 drops/ml?
21 gtts/min
The nurse is preparing to administer cefazolin (Ancef) 2 gm in 100 ml of normal saline to a postoperative patient. Which of the following IV rates will infuse this medication over 20 minutes?
300 ml/hr
Which of the following events in the surgical suite represents a violation of aseptic technique?
A drape contacts the leg of the table that supports the sterile field.
Which of the following preoperative patients likely faces the greatest risk of bleeding as a result of their medication?
A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent
In planning postoperative interventions to promote ambulation, coughing, deep breathing, and turning, the nurse recognizes that which of the following actions will best enable the patient to achieve the desired outcomes?
Administering adequate analgesics to promote relief or control of pain
An alert male patient needs a tracheostomy because he has been intubated for 7 days with an endotracheal tube and cannot be weaned from the ventilator. The patient does not want the the tracheostomy, but his family insists that the surgery be performed. What is the best action for the nurse to take?
Advocate for the patient's right
A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. as the patient is preparing in the operating room, what should the nurse implement to maintain patient safety during surgery that is directly related to the type of anesthesia being used.
Assess peripheral pulses and skin color.
When assessing a patient's surgical dressing on the first postoperative day, the nurse notes new, bright-red drainage about 5 cm in diameter. In response to this finding, the nurse should do which of the following?
Assess the patient's blood pressure and heart rate.
The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia unit. Which of the following should be the nurse's initial action upon the patient's arrival?
Assess the patient's vital signs.
In caring for the postoperative patient on the clinical unit after transfer from the PACU, which care can be delegated to the unlicensed assistive personnel (UAP)?
Assist the patient to take deep breaths and cough.
Bronchial obstruction by retained secretions has contributed to a postoperative patient's recent pulse oximetry reading of 87%. Which of the following health problems is the patient experiencing?
Atelectasis
When reviewing the preoperative forms, the nurse notices that the informed consent from is not present or signed. What is the best action for the nurse to take?
Call the surgeon to obtain consent for surgery.
An older patient who had surgery is displaying manifestations of delirium. What should the nurse do first to provide the best care for this new patient?
Check his preoperative assessment for previous delirium and dementia
The patient donated a kidney, and early ambulation is included in her plan of care. But the patient refuses to get up and walk. What rationale should the nurse explain to the patient for early ambulation?
Early walking is the best way to prevent postoperative complications
As the nurse is preparing a patient for outpatient surgery, the patient wants to give his hearing aid to his wife so it will not be lost during surgery. Which action by the nurse should be taken in this situation.
Encourage the patient to wear it for the surgery.
The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus, weighs 146 kg, and is 5 feet 8 inches ta.. Which patient assessment is a priority related to anesthesia?
Has BMI 48.4 kg/m2
The nurse is admitting a patient to the same-day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which of the following nursing actions would be most appropriate?
Inform the anesthesiologist of the patient's recent use of kava.
A 70-year-old woman has been admitted prior to a bilateral mastectomy and breast reconstruction. Which of the following elements should the nurse include in the patient's preoperative teaching (select all that apply)?
Information about where in the hospital she will be taken postoperatively Information about performing postoperative deep breathing and coughing exercises
The perioperative nurse would recognize the need to monitor the patient for hallucinations and agitation when which of the following anesthetic agents is administered?
Ketamine (Ketalar)
Unless contraindicated by the surgical procedure, which of the following positions is preferred for the unconscious patient immediately postoperative?
Lateral
A patient is having elective cosmetic surgery performed on her face. The surgeon will keep her at the surgery center for 24 hours after surgery. What is the nurse's postoperative priority for this patient?
Manage oxygenation status
The patient is going to have a colonoscopy. Which type of anesthesia should the nurse expect to be used?
Monitored anesthesia care (MAC)
A surgical patient's premedication regimen includes midazolam (Versed). The most likely desired effects of this medication are
Monitored anesthesia care and amnesia
The nurse would be alerted to the occurrence of malignant hyperthermia when the patient demonstrates
Muscle rigidity.
Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. Which of the following is the most appropriate action for the nurse to take?
Offer the patient to use the urinal/bedpan after explaining the need to maintain safety.
A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just experienced intraoperative vomiting. The nurse should consequently anticipate the use of which of the following drugs?
Ondansetron (Zofran)
Which of the following intraoperative nursing responsibilities would be performed by the scrub nurse (select all that apply)?
Passing instruments and supplies to the surgeon by anticipating his or her needs Performing the count of sponges, needles, and instruments used during the surgical procedure Keeping track of irrigation solutions for monitoring of blood loss
Which National Patient Safety Goal (NPSG) requirement is enacted immediately before surgery with a surgical time-out?
Patient surgical procedure and site are checked
While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that
She can drink clear liquids up to 2 hours before surgery.
Before admitting a patient to the operating room, the nurse recognizes that which of the following must be in the chart of all patients (select all that apply)?
Signed consent form A physical examination report
A 78 year old patient is having surgery. What risk areas will the nurse need to be especially aware of for this patient during surgery?
Skin Integrity
Which of the following is the primary reason for accurately recording the patient's current medications during a preoperative assessment?
Some medications may interact with anesthetics, altering the potency and effect of the drugs.
As the nurse is preparing a patient for surgery, the patient refuses to remove a wedding ring. What should the nurse do?
Tape the ring securely to the finger and document this on the preoperative checklist.
The new nursing student is confused about where the patient's family (ho are wearing street clothes) can be with the patient in the surgical suite. Which explanation should the perioperative nurse give to the student nurse?
The family can be with the patient in the preoperative holding area.
In which surgical area will the patient's skin be prepped for surgery, and what clothing will the person doing the prepping be wearing?
operating room wearing surgical attire and masks
The patient had abdominal surgery. The estimated blood loss was 400 ml. The patient received 300 mL of 0.9% saline during surgery. Postoperatively, the patient is hypotensive. What should the nurse anticipate for this patient?
restoring circulating volume
It is 6:00 am the anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 7:30am cefazolin (Ancef) IV to be infused 30 minutes before surgery, midazolam (Versed) before surgery and scopolamine patch (Transderm Scop) behind the ear. Which medication should the nurse administer first?
scopolamine patch (Transderm Scop)