212 - Perioperative practice questions
A nurse is providing teaching for a client who is in the immediate postoperative period and has a PCA pump. Which of the following statements should the nurse include in the teaching?
"Do not allow your family to push the PCA button if you are sleeping." The nurse should instruct the client that they should be awake when receiving a dose of the medication and that they are the only authorized user of the PCA pump. Allowing visitors to push the button is a safety risk for the client.
The nurse is educating a client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction?
"Pain medication will take away my pain." Pain medication will reduce pain, but will not take it away completely.
A client who is preparing to undergo a vaginal hysterectomy is concerned about being exposed. How does the nurse ensure that this client's privacy will be maintained?
Ensure that drapes will minimize perianal exposure. Using drapes is the best action to take to ensure the client's privacy.
A nurse is caring for a client who has bradycardia following a surgical procedure using spinal anesthesia. The nurse should plan to administer which of the following medications to the client?
Epinephrine The nurse should plan to administer epinephrine, a vasopressor, to increase the client's heart rate and prevent cardiac arrest.
The RN has just received reports about all of these clients on the inpatient surgical unit. Which client does the nurse care for first?
A 43-year-old who had a bowel resection 7 days ago and has new serosanguineous drainage on the dressing. The nurse would first care for the 7-day postoperative client who has new serosanguineous drainage. New drainage on the seventh postoperative day is unusual and suggests a complication that would require further assessment and possible immediate action.
Which client is at greatest risk for slow wound healing?
A 47-year-old obese man with diabetes Obesity and diabetes would significantly put a client at greatest risk for slow wound healing.
A nurse is receiving evening shift report on four clients who returned from the PACU that morning. The nurse should assess which of the following clients first?
A client who is postoperative following a thoracotomy and has a chest tube with 150mL of bright-red blood in the collection chamber from the past 1 hr When using the airway, breathing, circulation approach to client care, the nurse should first assess the client who has 150 mL of blood in the collection chamber because this finding is above the expected reference range and can be an indication of hemorrhage.
A nurse is monitoring a client who received succinylcholine during a surgical procedure. Which of the following actions should the nurse take if the client develops manifestations of malignant hyperthermia?
Administer dantrolene. The nurse should administer dantrolene by IV bolus at 2 to 5 mg/kg to reverse the manifestations for a client who has malignant hyperthermia.
Which staff member will be best for the nurse manager to assign to update standard nursing care plans and policies for care of the client in the operating room (OR)?
Circulating RN who has been employed in the hospital OR for 7 years. The circulating RN is the best staff member for the nurse manager to assign. This nurse has the experience and background to write OR policy, has been employed in the hospital for 7 years, and is aware of hospital policy and procedures.
During surgery, who is most responsible for monitoring for possible breaks in sterile technique?
Circulating nurse All operating room team members are responsible, but the circulating nurse moves around the room and can see more of what is happening.
Who is the most likely person to administer blood products in an operating suite?
Circulating nurse The circulating nurse is the most likely person to administer blood products to a client in the operating suite. Circulating nurses or "circulators" are registered nurses who coordinate, oversee, and are involved in the client's nursing care in the operating room.
A nurse is planning care for a client who is postoperative and has a closed-wound drainage system in place. Which of the following interventions should the nurse plan to include?
Cleanse the drain plug with alcohol after emptying. After emptying the drain, the nurse should compress the top and bottom of the device together with one hand, while cleansing the plug with the other.
A nurse is creating a plan of care for a client who is preoperative for a total hip arthroplasty, practices Judaism, and adheres to a kosher diet. Which of the following interventions is the nurse's priority?
Determine if the client's faith conflicts with the treatment plan. The nurse's priority intervention when using the nursing process is assessment. The nurse should determine if the client's faith, religious practices, or views conflict with the current treatment plan or surgical procedure so that they can take the necessary steps to inform the provider and prevent issues during or after the surgical procedure.
An RN and an LPN/LVN are working together in caring for a client who needs all of these interventions after orthopedic surgery. Which action(s) would be best for the RN to accomplish?
Develop the discharge teaching plan in conjunction with the client. The best and most appropriate action for the nurse to take is to develop the discharge teaching plan with the client. Education and preparation for discharge are within the scope of practice of the RN, but not within that of the LPN/LVN.
The nurse completes the preoperative checklist on a client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure?
Diet-controlled diabetes mellitus The client's greatest risk factor is diabetes mellitus. Diabetes contributes an increased risk for surgery or postsurgical complications.
A client has undergone an 8-hour surgical procedure under general anesthesia. In assessing the client for complications related to positioning, the nurse is most concerned with which finding?
Diminished peripheral pulses in the lower extremities. The nurse is most concerned with diminished peripheral pulses in the lower extremities. This could indicate diminished blood flow.
A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which order does the nurse accomplish first?
Draw blood for glucose, electrolyte, and complete blood count values. The blood sample needs to be drawn and sent to the laboratory first to confirm that results are within normal limits. If blood work is abnormal, the surgery may be rescheduled.
A nurse is assessing a client who is 2 days postoperative following a total prostatectomy. The nurse notes that the client's right calf is red, edematous, and warm to the touch. Which of the following actions should the nurse take?
Elevate the clients right extremity. These findings suggest the client has deep-vein thrombosis. The nurse should keep the client's right extremity elevated to promote venous return.
An unidentified client from the emergency department requires immediate surgery, but he is not conscious and no one is with him. What must the nurse, who is verifying the informed consent, do?
Ensure written consultation of two noninvolved physicians. In a life-threatening situation in which every effort has been made to contact the person with medical power of attorney, consent is desired but not essential. In place of written or oral consent, written consultation by at least two physicians who are not associated with the case may be requested by the health care provider.
A nurse is caring for a client who is receiving moderate (conscious) sedation with midazolam. The client's respiratory rate decreases from 16/min to 6/min, and the oxygen saturation decreases from 92% to 85%. Which of the following medicaitons should the nurse administer?
Flumazenil The client's respiratory rate and oxygen saturation level indicate increased sedation caused by a benzodiazepine. The nurse should administer flumazenil, a benzodiazepine agonist, to reverse the sedative effects of the medication.
A nurse is caring for a client who is 12 hours postoperative from a gastrectomy and has an NG tube set to continuous low suction. Which of the following findings requires intervention by the nurse?
Gastric distention Gastric distention is an indication that the NG tube is not patent. The nurse should check the tubing for kinks, blockages, and loose connections. The nurse should also reposition the client to facilitate drainage and avoid removing or irrigating the tube unless directed to do so by the provider.
At 8:00 a.m., the registered nurse is admitting a client scheduled for sinus surgery to the outpatient surgery department. Which information given by the client is of most immediate concern to the nurse?
Having a small glass of juice at 7:00 a.m. Clients need to be NPO for a sufficient length of time before surgery to prevent aspiration of fluid into the lungs. Intake of food or fluids may delay the start time of the surgery, so the nurse must notify the surgeon and anesthesiologist for possible rescheduling.
A surgical client has signed do-not-resuscitate (DNR) orders before going to the operating room (OR). A complication requiring resuscitation occurs during surgery. What is the nurse's proper action?
Honor the DNR order. According to the Association of Perioperative Registered Nurses, suspending a DNR order during surgery violates a client's right to self-determination.
A nurse is providing discharge instructions for a client who is postoperative following abdominal surgery. Which of the following client statements indicates an understanding of the teaching?
I will eat foods that are high in protein and vitamin C during my recovery. The nurse should instruct the client to increase intake of foods with protein and vitamin C to promote wound healing.
The nurse is providing preoperative care for a client who will have an arthroscopy of the left knee. As part of the Joint Commission National Patient Safety Goals (NPSG), what will the nurse be required to do?
Mark the left knee site with the client awake and the surgeon present. The nurse will be required to mark the left knee site with the client awake and the surgeon present. The Joint Commission NSPG requires that the surgical site be marked by an independent licensed professional and should, when possible, involve the client. The surgeon is accountable and should be present
A nurse is assessing a client who received a preoperative IV dose of metoclopramide 1 hr ago. For which of the following findings should the nurse notify the provider?
Muscle rigidity Muscle rigidity is a manifestation of neuroleptic malignant syndrome, which is a potentially life-threatening adverse effect of metoclopramide. Other manifestations include hyperthermia, blood pressure irregularities, tachycardia, and diaphoresis. The nurse should report this finding to the provider.
The nurse is performing a dressing change on a client who underwent abdominal surgery 6 days prior. The nurse notes a moderate amount of serosanguineous drainage on the old dressing. What will the nurse do?
Notify the surgeon about possible wound dehiscence. Serosanguineous discharge persisting past the 5th postoperative day may indicate wound dehiscence and would be reported to the surgeon. The nurse would not just reinforce the dressing, but would notify the surgeon. Serosanguineous discharge does not indicate infection, but is an abnormal finding that needs to be reported.
A client had an open transverse colectomy 5 days ago. The nurse enters the client's room and recognizes that the wound has eviscerated. After covering the wound with a sterile, saline-soaked dressing, which of the following actions should the nurse take?
Obtain vital signs to assess for shock. The nurse should obtain vital signs to assess the client's current status.
Colostomy surgery is categorized as what type of surgery?
Palliative Palliative surgery is performed to relieve symptoms of a disease process, but does not cure the disease.
If sterile gauze falls to the ground and hits the front of the surgeon's gown on the way down, what does the nurse do to ensure proper infection control?
Picks the gauze up without touching the surgeon. To ensure proper infection control, the nurse picks up the gauze without touching the surgeon. The surgeon is sterile, but the gauze is now nonsterile and must be removed and counted.
After gastric surgery, a client arrives in the post-anesthesia care unit. Which nursing action is most appropriate for the RN to delegate to an experienced nursing assistant?
Position the client on the left side. Positioning the client on the left side would most likely be delegated to an experienced, unlicensed care provider.
A nurse in the PACU is assessing a client who is postoperative. Which of the following findings should the nurse report to the provider?
Presence of inspiratory stridor. The nurse should report inspiratory stridor to the provider because it is a manifestation of tracheal edema and requires intervention.
A nurse is providing preoperative teaching to a client who is scheduled for a gastrectomy in 1 week. The client is anxious about the upcoming surgery. Which of the following actions should the nurse take?
Provide concise, factual information. Providing concise, factual information allows for open communication and gives the nurse the opportunity to address the client's anxiety.
Five RNs from other units have been assigned to the post-anesthesia care unit for the day. A 16-year-old client with diabetes has also just arrived from the operating room (OR) after having laparoscopic abdominal surgery. The charge nurse assigns the RN with which kind of experience to care for this new client?
RN who has 5 years of experience in the delivery room The RN with delivery room experience would have experience with abdominal surgery and with postoperative care of clients with diabetes, and would be aware of possible postoperative complications for this client.
The nurse assesses a client's wound 24 hours postoperatively. Which finding causes the nurse the greatest concern and should be reported to the surgeon?
Redness and swelling around the incision The nurse's greatest concern is redness and swelling around the incision. This needs to be reported to the surgeon because these signs could indicate an infection.
A client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. This preoperative procedure is done to:
Reduce the number of intestinal bacteria. Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria.
Which assessment finding in a postoperative client after general anesthesia requires immediate intervention?
Respiratory rate of 6 breaths/min The most immediate postoperative assessment is respiratory assessment, and a rate less than 10 breaths/min is too low.
How does the nurse position a client with postoperative nausea and vomiting?
Side-lying, with the head in a neutral position The side-lying position with the client's head in a neutral position helps reduce postoperative nausea and vomiting.
A client has an acute case of opioid depression and receives a dose of naloxone (Narcan). Which statement is true about this client?
Supplemental pain reduction is needed. Supplemental pain reduction is needed. The client has breakthrough pain after the opioid antagonist is given, so other interventions to promote comfort are needed.
An older client's adult child tells the nurse that the client does not want life support. What does the nurse do first?
Talk to the client. The nurse would first talk to the client in order to determine the client's wishes and state of mind.
A preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes?
Teach the importance of incentive spirometry. The nurse would first teach the importance of incentive spirometry. Incentive spirometry is good for lung hygiene and it encourages deep breathing.
The charge nurse for a hospital operating room is making client assignments for the day. Which client is most appropriate to assign to the least-experienced circulating nurse?
The 52-year-old client with stage I breast cancer who is having a tunneled central venous catheter placed. The client with stage I breast cancer who is having a tunneled central venous catheter placed is the most stable client among all scheduled procedures. This assignment would be appropriate for the beginning nurse or one with less experience.
A surgical nurse enters a surgical suite to ensure surgical asepsis is maintained. Which of the following findings requires intervention by the nurse?
The scrub technologist is wearing a watch under his scrubs. Finger and wrist jewelry are likely contaminated with micro-organisms and bacteria. Therefore, the scrub technologist should remove jewelry before handling sterile objects.
A nurse is assessing a client's recovery from spinal anesthesia. Which of the following sensations should the nurse expect to return to the client first?
Touch Following spinal anesthesia, the first sensation the nurse should expect the client to feel is the sense of touch.
A nurse is assessing a client who is 2 hour postoperative following an appendectomy. Which of the following findings should the nurse report to the provider?
Urine output of 20 mL/hr The nurse should notify the provider if the client's urine output is less than 30 mL/hr. Decreased urine output can indicate hypovolemia and decreased perfusion of the kidneys.
A nurse is providing discharge teaching for a client who is postoperative following a rhinoplasty using general anesthesia. Which of the following instructions should the nurse include?
Use cool compresses on your eyes, nose, and face. The nurse should instruct the client to place cool compresses on his face to reduce swelling and ecchymosis.
A nurse is reviewing the medical record of a client who is scheduled for an elective surgery. Which of the following medications should the nurse expect the provider to discontinue prior to surgery to minimize the risk of complications?
Warfarin The nurse should anticipate that the provider will instruct the client to discontinue warfarin, an anticoagulant, because it increases the risk of bleeding during and following surgery.
Which intervention does the nurse implement for an older adult client to minimize skin breakdown related to surgical positioning?
Pad bony prominences. Padding bony prominences best minimizes skin breakdown.
A nurse is providing teaching for a client who is scheduled to undergo moderate sedation for a bronchoscopy. The nurse should verify that the client understands the procedure when the client states which of the following?
"I can expect to feel sleepy for several hours after the procedure." The nurse should instruct the client to expect to feel drowsy for several hours following moderate sedation and to avoid any activities which require concentration.
During a preoperative assessment, which statement by a client requires further investigation by the nurse to assess surgical risks?
"I had a heart attack 4 months ago." The statement by the client that he or she had a heart attack 4 months ago requires further investigation. Cardiac problems increase surgical risks, and the risk for a myocardial infarction during surgery is higher in clients who have heart problems.
The nurse reviews a routine discharge teaching plan concerning postoperative care with a client. Which statement by the client indicates that teaching about wound care was effective?
"I may need to restrict my activities for several months." To protect the integrity of the wound, activities may need to be restricted. The wound is usually open to air for healing, but draining wounds need to be covered. Bleeding and serosanguineous drainage is not normal after 5 days. The length of time it takes for a wound to heal varies, and can take up to 2 years to heal.
A nurse is providing preoperative teaching to a client who is scheduled to have a mastectomy with reconstructive surgery. Which of the following statements by the client indicates an understanding of the teaching?
"I will be able to shower after the doctor removes the drain." A client who has had a mastectomy with reconstructive surgery can shower after the provider removes the drain.
The nurse is instructing a client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching?
"It's better if they are too tight rather than too loose." Antiembolism stockings should fit properly to achieve the desired result. Stockings that are too tight will impede blood flow.
Which statement by a nursing student indicates a need for further teaching about operating room (OR) surgical attire?
"My scrubs will be sterile." Scrub attire is provided by the hospital and is clean, not sterile.
A client is having an arthroscopy of the left knee and has just been moved to the surgical holding area. Which statement by the nurse properly identifies the client while the nurse checks the identification label?
"What is your name, and where were you born?" The nurse must verify the client's identity with two types of identifiers. This practice prevents errors by drowsy or confused clients.
A nurse is providing preoperative teaching for a client who is about to have a below-the-knee amputation. Which of the following instructions should the nurse include?
"Your surgeon might prescribe an antibiotic before surgery." A client who has a surgical amputation of an extremity is at risk for infection. Therefore, the provider often prescribes a broad-spectrum, prophylactic antibiotic to reduce the risk of infection.
A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following nursing interventions should the nurse perform to prevent respiratory complications?
Advise the client to splint the surgical incision when coughing and deep breathing. Splinting the incision supports the surgical site and decreases pain during coughing and deep breathing.
A preoperative client wears a hearing aid and is extremely hard of hearing without it. What does the nurse do to help reduce this client's anxiety?
Ask if the client may wear the hearing aid until anesthesia is given. The nurse needs to ask if the client can wear the hearing aid to the operating room (OR). In some facilities, clients may wear eyeglasses and hearing aids until after anesthesia induction.
A nurse is caring for a client who is preoperative and is asking multiple question about risk of the procedure. Which of the following actions should the nurse take?
Ask the surgeon to speak to the client for clarification The nurse should notify the surgeon that the client has questions about the procedure. It is the responsibility of the surgeon to explain the risks and benefits of the surgery.
As the unit nurse is about to give a preoperative medication to a client going into surgery, it is discovered that the surgical consent form is not signed. What does the nurse do after verifying the procedure with the client?
Asks the client to sign the consent form. The unit nurse will ask the client to sign the consent form, after which the medication can be administered.
In conducting a postoperative assessment of a client, what is important for the nurse to examine first?
Breathing pattern Respiratory assessment is the first and most important. Assessing level of consciousness, oxygen saturation, and the surgical site are important, but not the priority.
Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist?
Creatinine, 1.9 mg/dL The nurse will immediately report a creatinine of 1.9 mg/dL (168 mcmol/L) to the anesthesiologist. A creatinine of 1.9 mg/dL (168 mcmol/L) is outside the normal range and may indicate renal problems.
As the nurse obtains informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response?
Contact the surgeon. The nurse will contact the surgeon to convey the client's question. The nurse is not responsible for explaining or providing detailed information about the surgical procedure. Rather, the nurse's role is to clarify facts that have been presented by the health care provider and dispel myths that the client or family may have heard about the surgical experience.
Which action does the nurse implement for a client with wound evisceration?
Cover the wound with a sterile, warm, moist dressing. Covering the wound with a sterile, warm, moist dressing protects the organs until the surgeon can repair the wound. Evisceration occurs when a wound opens up and body organs are exposed. Applying direct pressure to a wound traumatizes the organs. Irrigating the wound is not necessary. Replacing protruding tissue could induce infection.
A nurse is assessing a client who is preoperative. The nurse should identify that which of the following factors reported by the client increases the risk for a postoperative wound infection?
Long-term use of corticosteroids The nurse should identify that the use of corticosteroids inhibits leukocyte response, which increases the client's risk for infection.
The nurse anesthetist notices that a surgical client has an unexpected rise in the end-tidal carbon dioxide level, with a decrease in oxygen saturation and sinus tachycardia. What is the nurse anesthetist's initial action?
Immediately stop all inhalation anesthetic agents and succinylcholine. The nurse anesthetist's initial action is to stop all inhalation anesthetic agents and succinylcholine. This client is exhibiting early symptoms of malignant hyperthermia (MH). The most sensitive indication of MH is an unexpected rise in the end-tidal carbon dioxide level, along with a decrease in oxygen saturation. Another early indication is sinus tachycardia. Survival depends on early diagnosis and the actions of the entire surgical team. Time is crucial when MH is diagnosed, and MH requires immediate intervention.
A circulating nurse is monitoring the temperature in a surgical suite. The nurse should identify that cool temperatures reduce a client's risk for which of the following potential complications of surgery?
Infection The nurse should identify that a cool room temperature with humidity between 30% and 60%, along with a proper air exchange and filtering system, reduces the risk of infection for clients during surgery.
Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area?
Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. Insertion of a catheter is the best task within the scope of skills approved for the LPN/LVN.
A nurse is caring for a client who is 2 days postoperative following a cholecystectomy. The client has been vomiting for the past 24 hr and reports a pain level of 8 on a scale from 0 to 10. The nurse notes a hard, distended abdomen and absent bowel sounds. After conferring with the provider, which of the following actions should the nurse take first?
Insert an NG tube The greatest risk to the client is fluid and electrolyte imbalance as a result of accumulated fluid and gas in the gastrointestinal tract. The first action the nurse should take is to insert an NG tube to begin decompression of the bowel.
What pain management does a client who has been admitted to the post-anesthesia care unit typically receive?
Intravenous opioid analgesics Intravenous (IV) opioid analgesics are given in small doses to provide pain relief, but not to mask an anesthetic reaction.
A nurse is reviewing the medical record of a client who is to undergo eneral anesthesia for surgery. The nurse should report which of the following findings to the provider?
K+ 2.8 mEq/L The nurse should identify that the client's potassium level is below the expected reference range of 3.5 to 5 mEq/L, which places the client at risk for cardiac dysrhythmias. Therefore, the nurse should report this finding to the provider.
A client has just undergone a surgical procedure with general anesthesia. Which finding indicates that the client needs further assessment in the post-anesthesia care unit?
Snoring sounds when inhaling Snoring sounds when inhaling may indicate respiratory depression.
A client is transferred from the surgical suite to the PACU following oral surgery. While monitoring the client's vital signs, the nurse finds that the client's tongue has become swollen and is obstructing the airway. Which of the following actions should the nurse take first?
Use the head-tilt, chin-lift method to open the airway The first action the nurse should take when using the airway, breathing, circulation approach to client care is to establish a patent airway by tilting the client's head back and pushing the lower jaw forward.
A nurse is caring for a client who has a surgical wound with a Penrose drain in place. Which of the following interventions should the nurse plan to perform?
Use the sterile technique when performing dressing changes. The nurse should change the Penrose drain dressing using the surgical aseptic technique.