EXAM 1 MED/SURGE
The patient asks the nurse why food is withheld before the surgery. What is the best response by the nurse?
"Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time"
The nurse is assisting the client with imagery as a relaxation strategy. Which statement by the client describes imagery?
"I am lying on the beach in Florida"
The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements?
"I took my Coumadin as usual last evening" "I took two ASA for joint pain this morning"
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective?
"I will support my incision with my hand when I cough and do deep breathing exercises"
After a patient is scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements?
"I'll be sleepy but able to respond to your questions"
A client with a history of alcoholism is scheduled for urgent surgery. The client asks the nurse, " Why is everyone so concerned about how much I drink?" What is the best response by the nurse?
"It is important for us to know how much and how often you drink to help prevent surgical complications"
A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate?
"It prevents aspiration and respiratory complications"
The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is:
"Leg exercises help prevent blood clots in your leg"
You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply?
"Many people have diagnostic or short therapeutic surgical procedures"
The nurse is educating a client schedule for elective surgery. The client currently takes ASA daily. What education should the nurse provide with regard to this medication?
"Stop taking the ASA 7 days prior to the surgery, unless otherwise directed by your physician"
A client has been transported to the OR for emergent surgery. Which statement by the nurse best supports the need for emergent surgery?
"The client was unresponsive, had a distended abdomen, and had unstable vital signs after a MVA"
The nurse is completing a preoperative assessment. The nurse notices the client is tearful and constantly wringing their hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" What is the nurse's best response?
"What are your concerns?"
Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?
"When is the last time you ate or drank"
Which of the following is the appropriate response to the statement "I'm so nervous about my surgery"
"You seem nervous about your surgery"
A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate?
"You will be lying on your side with your knees to your chest"
The parent of a 16-year old client asks the nurse, "How could the surgeon operate without my consent?" What is the best response by the nurse?
"Your child had life-threatening injuries that required immediate surgery"
The physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associated with cigarette smoking?
1-2 months
For the client who is taking ASA, it is important to stop taking this medication at least how many day(s) before surgery?
7
A client having a surgical procedure takes ASA 325 MG daily for prevention of platelet aggregation. When should the client stop taking the ASA before the surgery?
7 to 10 days
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to lab results?
A BUN level of 42 mg/dL
The surgical unit nurse is developing a postoperative plan of care. In which client's plan of care would the nurse document interventions of coughing and deep breathing, gastrointestinal assessment, and effective regulation of temperature?
A client with gastrointestinal surgery AND general anesthesia
The nurse expects informed consent to be obtained for insertion of:
A gastrostomy tube
A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?
A history of Diabetes
A patient is scheduled to have a heart valve replacement with a PORCINE VALVE. Which patient does the nurse understand may refuse the use of any porcine-based product?
A patient of Jewish faith
Which disciplines should be consulted when caring for a client with stage 3 heel ulcer?
A pillow or commercial heel protector to support the heels when the patient is supine
The on-call perioperative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent?
A repair of multiple stab wounds
A client is scheduled for an invasive procedure. What should the nurse document in the chart regarding procedure?
A signed consent form from the client
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?
Adrenal
A nurse practitioner would be applying the PRE-TRAJECTORY model of chronic illness when she:
Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy to get genetic testing
A physically fit 86-year old is scheduled for right knee replacement. Which factor is the client at an increased risk for complications during or after surgery?
Age
The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate?
Allowing unnecessary personnel to enter the OR environment
A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign?
An open reduction of a fracture
A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?
Apply a warm air blanket. gradually increasing body temperature
a 78-year old client is undergoing a surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase?
Appropriate position the client using adequate padding and support
For a client who has had a stroke, which nursing intervention can help prevent contractures in the lower legs?
Attaching braces or splints to each foot and leg
The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nurse assessment includes careful monitoring of which body system?
Cardiovascular system
The nurse is providing education to an English-speaking client who immigrated to the US 2 years ago. The nurse determines that further education may be needed when the client does which action?
Changes the subject
A RN who is responsible for coordinating and documenting a client care in the OR is a:
Circulating nurse
The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:
Circulating nurse
Which is the least important issue concerning safety for the perioperative team before proceeding to the OR?
Client's ambulatory aids
A 17-year old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:
Continuously monitor the sedated client
The nursing assistant was reluctant to allow the Muslim patient room for a prayer rug in her room. The inability to recognize the values, beliefs and practices of other because of strong ethnocentric preferences is which of the following?
Cultural blindness
What medication should the nurse prepare to administer in the event that the client has MALIGNANT HYPERTHERMIA?
Dantrolene Sodium
A 70-year old patient who is to undergo surgery arrives at the OR. The nurse, when reviewing the patient's medical record, understands that this patient will require a lower does of anesthetic agent because of which of the following?
Decreased lean tissue mass
The nurse recognizes older adults require lower dose of anesthetic agents due to:
Decreased lean tissue mass
The nurse recognizes that the older adult is at risk for surgical complications related to:
Decreased renal function
The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered?
Denies sensation to perineum and lower abdomen
The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is:
Diagnostic
The nurse is monitoring a presurgical patient for electrolyte imbalance. Which classification for medication may cause electrolyte imbalance?
Diuretics
The nurse is assisting with positioning the patient on the operating table the nurse understands that the most commonly used position is which of the following?
Dorsal recumbent
At which times does the nurse realize that it is best to begin teaching about care needed during the postoperative period?
During the preoperative period
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as
Emergency
Informed consent from the surgical client is essential in all of the following categories of surgery except:
Emergent surgery
A patient who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be appropriate?
Encourage increased fluid intake
Anorexia and cachexia are common problems at the end of life. The nurse plays an important role in managing symptoms and preventing complications. Which of the following are appropriate nursing interventions for these problems?
Encourage the patient to eat in an upright position. Recommend that the patient eat when hungry, regardless of usual meal times. Teach the patient how to increase the nutritional value of meals. (add dry milk, powder to milk)
Which of the following is a duty of the RN first assistant?
Handing Tissue. Suturing. Maintaining hemostasis. Providing exposure at the operative field.
A nurse on a surgical team has been assigned the role of a scrub nurse. What action by the scrub nurse is appropriate?
Handing instruments to the surgeon and assistants
The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?
Headache
Which state by the client INDICATES FURTHER TEACHING about epidural anesthesia is necessary?
I will become unconscious
An anxious client being prepared for surgery is encouraged to concentrate on pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used?
Imagery
A client with a skull fracture after falling from a ladder requires surgery. The nurse should anticipate transporting the client to surgery during what time frame?
Immediately
In advance of a client's scheduled appendectomy, the nurse spends significant time explaining to the client what will happen, both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to:
Increase the likelihood of a successful recovery
A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety R/T surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following?
Increased anxiety can increase the patient's postoperative pain level
An obese client is to undergoing abdominal surgery. During the procedure a surgical resident states, " The amount of fat we have to cut through is disgusting" What is the best response by the nurse?
Inform the resident that all communication needs to remain professional
As a circulating nurse, what task are you solely responsible for?
Keeping records
The nurse recognized the client has reached STAGE 3 of general anesthesia when the client:
Lies quietly on the table
A client is undergoing a perineal surgical procedure. The nurse should place the client in which position?
Lithotomy position
The patient is having a REPAIR OF VAGINAL PROLAPSE. What position does the nurse place the patient in?
Lithotomy position
The nurse understands that the purpose of the "time out" is to:
Maintain the safety of the client
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?
Malignant Hyperthermia
A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?
Mask is placed over the nose and extends to bottom lip
The nurse is conducting a health history of a preoperative client. The client shares that she experienced vaginal itching and burning and labial swelling after her partner tried a new brand of condoms. The nurse suspects that the client:
May have a latex allergy
A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast to be ready for the procedure. What is the nurse's next action?
Notify the surgeon
During the admission history the client reports to the nurse of taking the usual dose of Warfarin the previous day. What is an appropriate nursing action?
Notify the surgeon that the client took Warfarin the day before surgery
A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention?
O2 Sat of 85%
How would the OR nurse place a patient in the Trendelenburg position?
On his back with his head lowered so that the plane of his body meets the horizontal on an angle
An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position?
On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle
Hypothermia may occur as a result of
Open body wounds
Fentanyl is categorized as which type of IV anesthetic agent?
Opioid
A client is scheduled for a cholecystectomy. Which finding by the nurse is LEAST LIKELY to contribute to surgical complications?
Osteoporosis
A client is to receive general anesthesia with Sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?
Oxygen
The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered?
Pavulon (pancuronium bromide)
The nurse positions the client in the lithotomy position in preparation for:
Perineal surgery
Which health care professional has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery
Physician
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?
Place gauze under and over the ring and apply adhesive tape over it
A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively?
Postoperative pain control Cough and deep-breathing exercises IV fluids and other lines and tubes
The nurse is reviewing the pre-admission lab finding of the client scheduled for surgery. Which lab value would be of greatest concern for the nurse?
Potassium 6.2 mEq/L
When is the ideal times to discuss preoperative teaching?
Preadmission visit
In which phase of preoperative care will the nurse prepare the client's skin, encourage the client to void, and remove the client's dentures?
Preoperative
The scrub nurse is responsible for:
Preparing the sterile instruments for the surgical procedure
What is the major purpose of withholding food and fluid before surgery?
Prevent aspiration
The CIRCULATING NURSE is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?
Remove the entire sterile field from use
A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?
Report the infection to an immediate supervisor
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?
Request that the surgeon come and answer the questions
The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to:
Respond verbally during the procedure
Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out?
Review the scheduled procedure, site and client
A patient has received general anesthesia and is progressing through the stages. What is the proper manifestation sequence from STAGE 1 to STAGE 4
Ringing in the ears Pupil dialtion Unconsciousness Shallow respirations
A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?
Roll the client on to his/her side
A client is placed on the OR table for a surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants?
Scrub nurse
A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role?
Scrub role
In which position would a client undergoing a lumbar puncture be placed?
Side-lying, knees to chest
Which nursing assessment finding indicates the preoperative client has not met expected outcomes?
Sobs uncontrollably about pending amputation of foot
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiration complications?
Splint the incision site using a pillow during breathing and coughing exercises
The nurse is reading the previous shift's documentation of an open are on the client's sacrum. The wound is documented as a PARTIAL-THICKNESS wound whose etiology is pressure. The nurse anticipates the assessment of the client's sacrum will reveal a pressure ulcer in which stage?
Stage 2
Which assessment finding by the nurse and statement by an older adult would require the nurse to report SUSPECTED ELDER ABUSE?
Stage 2 decubitus ulcer on coccyx; "No one is able to turn or lift me anymore"
There are 4 stages of GENERAL ANESTHESIA. During which state does the OR nurse know not to touch the patient (except for safety reasons) because of possible uncontrolled movements?
Stage 2: Excitement
The client vomits during the surgical procedure. The best action by the nurse is:
Suction the client to remove saliva and gastric secretions
Which of the following techniques least exhibit surgical asepsis?
Suctioning the nasopharyngeal cavity of the client
A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member?
Surgeon
The nurse is caring for a client during an intraoperative procedure. When assessing vital signs, which result indicates a needs to alert the anesthesiologist immediately?
Temperature of 102.5F (39C)
A client at risk for malignant hyperthermia returns to the surgical unit. For what TIME PERIOD will the nurse monitor the client for development of malignant hyperthermia?
The client can develop malignant hyperthermia UP TO 24 HOURS after surgery
A client is having a surgical procedure that requires the client to be in the prone position. What is an expected client outcome?
The client remains free of perioperative positioning injury
In developing the plan of care for the intraoperative client, the nurse recognizes that it is essential to consider:
The client's cultural beliefs
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure?
The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure?
The patient participates willing in the preoperative preparation
The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:
To notify the surgeon
A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the OR, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia?
To prevent cerebrospinal fluid (CSF) leakage
An example of a curative surgical procedure is
Tumor excision
The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true?
Tumor excision
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?
Use diaphragmatic breathing
Which action would be incorporated in a teaching strategy for a hearing impaired client?
Use of slow, directed, and deliberate speech
The nurse is aware that which of the following nutrients promotes blood clotting?
Vitamin K
The nurse would identify which vitamin deficiency to prevent hemorrhaging during surgery?
Vitamin K
Which of the following is an inappropriate nursing action by the surgical nurse?
Wearing sterile gloves over artificial nails
A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life?
Weight loss and inadequate food intake
At what point does the preoperative period end?
When the client is transferred onto the operating table
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which client surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?
Wound healing