Med Surg Exam 2

ASA scale 1-6 meaning

1= healthy 6= brain dead

A 68-year-old male scheduled for a herniorrhaphy at an ambulatory surgical center expresses concern that he will not have enough care at home and asks if he can stay in the hospital after the surgery. The best response by the nurse is a."Who is available to help you at home after the surgery?" b."I'm sure you will be able to manage at home after surgery. It is a simple procedure." c."We will teach you everything you need to know to be able to care for yourself after surgery." d."Your health insurance will pay for inpatient care only if complications develop during surgery."

A

The hospice nurse visits with the wife of a dying patient. The nurse is most concerned if the patient's wife makes which statement? a."I don't think that I can live without my husband to take care of me." b."I wonder if expressing my sadness makes my husband feel worse." c."We have shared so much that it is hard to realize that I will be alone." d."I don't feel guilty about leaving him to go to lunch with my friends."

A

*A nurse is teaching a female client who has tobacco use disorder about nicotine replacement therapy. Which of the following statements by the client indicates understanding of the teaching?* A. "I should avoid eating right before I chew a piece of nicotine gum." B. "I will need to stop using the nicotine gum after one year." C. "I know that nicotine gum is a safe alternative to smoking if I become pregnant." D. "I must chew the nicotine gum quickly for about 15 minutes."

A The client should avoid eating or drinking anything 15 minutes prior to and during chewing the gum

semirestricted area

A designated area in which only personnel wearing scrub suits and hair caps that enclose all facial hair are allowed.

*A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect?* Select all apply A. Dizziness B. Diarrhea C. Jaundice D. Tinnitus E. Headache

A, D, E

Vitamins important in having before surgery:

A,B,C

*A nurse is reviewing the health records of several clients in the post anesthesia care unit (PACU) to identify risk factors that can lead to postoperative complications. Which of the following clients are at risk for complications?* (Select all that apply) A. A client who has a WBC of 22,500/uL B. A client who uses an insulin pump C. A client taking warfarin daily D. A client who has heart failure E. A client who has a BMI of 26

A. A client who has a WBC of 22,500/uL B. A client who uses an insulin pump C. A client taking warfarin daily D. A client who has heart failure

*A nurse is planning care for a client to prevent postoperative atelectasis. Which of the following interventions should the nurse include in the plan of care?* (Select all that apply) A. Encourage the use of the incentive spirometer every 2 hours B. Instruct to splint incision when coughing and deep breathing. C. Reposition the client every 2 hours D. Administer antibiotic therapy E. Assist with early ambulation.

A. Encourage the use of the incentive spirometer every 2 hours B. Instruct to splint incision when coughing and deep breathing. C. Reposition the client every 2 hours E. Assist with early ambulation.

*A nurse is providing instructions to a client who has been experiencing insomnia and has a new prescription for temazepam. The nurse should inform the client that which of the following manifestations are adverse effects of temazepam?* A. Incoordination B. Hypertension C. Pruritis D. Sleep driving E. Amnesia

A. Incoordination D. Sleep driving E. Amnesia

Postoperative Assessment

Airway breathing circulation gastrointestinal surgical site lab and diagnostic test

*A nurse is planning care for a client who has cancer and is taking a glucocorticoid as a adjuvant medication for pain control. Which of the following interventions should the nurse include in the plan of care?* Select all apply A. Monitor for urinary retention B. Monitor blood glucose C. Monitor blood potassium level D. Monitor for gastric bleeding E. Monitor for respiratory depression

B. Monitor blood glucose C. Monitor blood potassium level D. Monitor for gastric bleeding Glucocorticoids raise good ghost level cause hypokalemia and put a client at risk for peptic ulcer

*The nurse is caring for a client who has a prescription for bethanechol to treat urinary retention. The nurse should identify that which of the following findings is a manifestation of muscarinic stimulation?* A. Dry mouth B. Hypertension C. Excessive perspiration D. Fecal impaction

C

Palliative care

Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.

*A nurse is reviewing the healthcare record of a client who reports urinary incontinence and asks about a prescription for oxybutynin. The nurse should recognize that oxybutynin is contraindicated in the presence of which of the following conditions?* A. Bursitis B. Sinusitis C. Depression D. Glaucoma

D. It can increase intraoccular pressure

*A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A. Decreased appetite B. Explosive diarrhea C. Decreased pulse rate D. Orthostatic hypotension

D. Orthostatic hypotension

Surgery is performed for:

Diagnosis Cure Palliation Prevention Cosmetic improvement Exploration

extended observation

Extended care/observation unit Goal - Prepare patient for self-care

Four specific fears associated with dying

Fear of pain; fear of SOB; fear of loneliness/ abandonment; fear of meaninglessness

Adaptive Grief

Grief that helps accept the reality of death Healthy process Revealed in positive memories and seeing some good from the death

B-adrenergic blockers

Mask symptoms of hypoglycemia Prolong hypoglycemic effects of insulin

Preop Health History Critical to include:

Medical conditions surgical history menstrual/obstetric history family disease reactions/problems w anesthesia

circulating nurse

Not scrubbed, gowned, or gloved Remains in unsterile field Documents

The 5 Rs

Relevance Risks Rewards Roadblocks Repetition

SBIRT

Screening, Brief Intervention, and Referral to Treatment for substance abuse

Three types of information before surgery:

Sensory process procedural

Acute intervention for substance use disorder

Support ABCs educate provide detoxification care

Antiemetics

Treat/ decrease nausea and vomiting

scrub nurse

a nurse who assists surgeons during surgery, wearing sterile attire and handling sterile equipment and supplies

*A nurse is caring for a patient who develops malignant hyperthermia. Which of the following actions should the nurse take?* (Select all that apply) a. infuse iced IV fluids b. provide 100% oxygen c. place a cooling blanket on the client d. treat the complication while the surgeon continues surgery e. administer IV dantrolene

a, b, c, e

*A 17-year-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which intervention is most appropriate?* a. witness the permit after the surgeon obtains consent b. call a parent or legal guardian to sign the permit since the patient is under 18 c. notify the hospital attorney that an emancipated minor is consenting for surgery d. obtain verbal consent since written consent is not necessary for emancipated minors

a. witness the permit after the surgeon obtains consent rationale: An emancipated minor may sign his or her own permit. The nurse should be available to witness the signature, but no further action is needed.

dysfunctional grief

abnormal or distorted grief that may be either unresolved or inhibited (self neglect, denial of loss for greater than 6 months)

AOD area

admission, observation and discharge area

Fast Tracking

admiting patients directly to phase 2

*A nurse is caring for a client who develops a systemic toxic reaction following a regional block. Which of the following actions should the nurse take?* a. monitor blood creatinine levels b. provide airway support c. turn the client to the right side d. administer a diuretic

b. provide airway support

Opiods (narcotics)

decrease pain

Anticholinergics

decreases oral secretions

holding area, surgical care improvement project (SCIP) meausures:

drug administration patient warming application of SCDs Minor procedures

Bensodiazepines

drugs that lessen anxiety, tension, agitation, and panic attacks

fluid and electrolytes complications

fluid deficit fluid overload electrolyte imbalance acid base imbalance

anticipatory grief

grief that occurs before the loss

integumentary complications

hematoma infection

Patients with diabetes need ---- preop test done

hemoglobin A1C test

hospice care

holistic, compassionate care given to dying people and their families so patients can die pain free and comfortably

strongest positive coping mechanism

hope

Review of Systems (ROS)

iinterviwing patient and support partner to find of about family history, allergies, surgical history etc.

Palliative care main aspects

improves quality of life, decrease costs of health care, and alleviates burden of care

postanesthesia phase 2 occurs in:

inpatient setting and intensive care area

urinary complications

retention, UTI

why are patients put on NPO status before surgery:

so patient wont aspirate when intubated

medicine to treat magliant hypothermia

treat dantolene

Dehiscence

wound reopens from pressure

*A nurse is planning care for a client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan care?* A. Keep the client NPO until pharyngeal response returns. B. Monitor the insertion site for hematoma. C. Palpate the bladder to detect urinary retention. D. Maintain the client on bed rest for 12 hours following the procedure.

A. Keep the client NPO until pharyngeal response returns.

respiratory complications

-airway obstruction -aspiration -hypoexemia -pneumonia -pulmonary edema -atelectasis

spinal and epidural anesthesia common side effects

-bradycardia -hypotension -nausea/vomiting

Gastrointestinal complications

-constipation - hiccups -nausea and vomiting -postoperative ileus

Neuropsychologic complications

-delirium -fever -pain -hypothermia

cardiovascular complications

-dysrhythmias -hemorrhage -hypertension -hypotension syncope

PACU admission Report

-general information -patient history -intraoperative management -intraoperative course

Postanesthetic Phase 1

-initial recovery period in Pacu -Hand off report -Nursing care focus (immediate postoperative care, ECG and monitoring)

postanesthesia phase 2 nursing care focus

-preparation for care in the home -extended observation

nursing assessment before surgery

-psychosocial assessment -cultural and spitirtual assessment -history and physical assesment - chart review

National Patient Safety Goals (NPSGs) preprocedural verification process:

-verification of relevant documentation -required blood products and equipment -diagnostic tests - procedure site marked

*Substance use problems in older adults are usually related to* a. use of drugs and alcohol as a social activity b. continuing the use of illegal drugs initiated during middle age c. misuse of prescribed and over-the-counter drugs and alcohol d. a pattern of binge drinking for weeks or months with periods of sobriety

c. misuse of prescribed and over the counter drugs and alcohol

*An 80-year-old patient is receiving palliative care for heart failure. What are the primary purpose(s) of her receiving palliative care?* (Select all that apply) A. Improve her quality of life. B. Assess her coping ability with disease. C. Have time to teach patient and family about disease. D. Focus on reducing the severity of disease symptoms. E. Provide care that the family is unwilling or unable to give.

A. Improve her quality of life. D. Focus on reducing the severity of disease symptoms. The focus of palliative care is to reduce the severity of disease symptoms. The goals of palliative care are to prevent and relieve suffering and to improve quality of life for patients with serious, life-limiting illnesses.

Kubler-Ross stages of grief

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

*A nurse is providing preoperative teaching to a client who is to have abdominal surgery. Which of the following statements should the nurse make?* (Select all that apply) a. "Take your medication medication with a sip of water before surgery." b. "Splint the abdominal incision with a pillow when coughing and deep breathing." c. "Bed rest is recommended for the first 48 hours." d. "Anti-embolism stockings are applied before surgery." e. "You may eat solid foods up to 4 hours before surgery."

A,B,D

*A nurse is providing instructions to a female client who has a new prescription for zolpidem. Which of the following instructions should the nurse include?* A. "Notify the provider if you plan to become pregnant." B. "Take the medication 1 hr before you plan to go to sleep." C. "Allow at least six hours for sleep when taking zolpidem." D. "To increase the effectiveness of zolpidem take it with a bedtime snack."

A. "Notify the provider if you plan to become pregnant."

*A nurse is teaching a client about a new prescription for celecoxib. Which of the following information should the nurse include in the teaching?* A. Increases the risk for a myocardial infarction B. Decreases the risk of stroke C. Inhibits COX-1 D. Increases platelet aggregation

A. Increases the risk for a myocardial infarction

While in the PACU, the patient's blood pressure drops from an admission pressure of 126/82 to 106/78 with a pulse change of 70 to 94. The nurse administers oxygen and then a. Increases the rate of the IV fluids b. Notifies the anesthesia care provider c. Performs neurovascular checks on the lower extremities d. Uses a cardiac monitor to assess the patient's heart rhythm

A

*A nurse is planning care for a client whohas brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client?* A. Dexamethasone B. Methylphenidate C. Hydroxyzine D. Amitriptyline

A Dexamethasone decreases inflammation and swelling

Hemoglobin A1c

A test that measures the level of hemoglobin A1c in the blood as a means of determining the average blood sugar concentrations for the preceding two to three months. (keep blood sugar below 7 to make sure no infections in BS before surgery)

*The charge nurse is planning a staff education session to discuss medications used during the care of a client experiencing alcohol withdrawal. Which medications should the charge nurse include in the discussion?* (Select all that apply) A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. Acamprosate

A, B Used during withdrawal to decrease anxiety

*A nurse in the post anesthesia care unit is caring for a client who is experiencing malignant hyperthermia. Which of the following actions should the nurse take?* (Select all that apply) A. Place a cooling blanket on the client B. Administer oxygen at 100% C. Administer iced 0.9% sodium chloride D. Administer potassium chloride IV E. Monitor core body temperature

A, B, C, E

*A nurse is admitting a toddler to the hospital following acetaminophen toxicity. Which of the following medications should the nurse expect to administer to the client?* A. Acetylcysteine B. Pegfilgrastim C. Misoprostol D. Naltrexone

A. Acetylcysteine

*A nurse is caring for a client who reports nausea and vomiting 2 days postoperative fllowing hysterectomy. Which of the following actions should the nurse perform first?* A. Assess bowel sounds. B. Administer antiemetic medication C. Restart prescribed IV fluids D. Insert a prescribed nasogastric tube.

A. Assess bowel sounds (Using the nursing process, the first step is to assess the client. Assessing bowel sounds is the correct action by the nurse.

*The children caregivers of an elderly patient whose death is imminent have not left the bedside for the past 36 hours. In the nurse's assessment of the family, what findings indicates the potential for an abnormal grief reaction to occur?* (Select all that apply)? A. Family members cannot express their feelings to one another. B. The dying patient is becoming more restless and agitated. C. A family member is going through a difficult divorce. D. Family talks with and reassures the patient at frequent intervals. E. Siblings who were estranged from each other have now reunited.

A. Family members cannot express their feelings to one another. C. A family member is going through a difficult divorce. You must be able to recognize signs and behaviors among family members who may be at risk for abnormal grief reactions. These may include dependency and negative feelings about the dying person, inability to express feelings, sleep disturbances, a history of depression, difficult reactions to previous losses, perceived lack of social or family support, low self-esteem, multiple previous bereavements, alcoholism, and substance abuse. Caregivers with concurrent life crises are especially at risk.

*A nurse is caring for a client who has cancer and is taking morphine and carbamazepine for pain. Which of the following effects the nurse monitor when given these medications together?* Select all apply A. Need for reduced dosage of the opioid B. Reduced adverse affects of the opioid C. Increased analgesic effects D. Enhanced CNS stimulation E. Increased opioid tolerance

A. Need for reduced dosage of the opioid B. Reduced adverse affects of the opioid C. Increased analgesic effects

*A nurse is caring for a client who is receiving a local anesthetic of lidocaine during the repair of the skin laceration. For which of the following adverse reactions should the nurse monitor as an adverse reaction to the anesthetic?* A. Seizures B. Tachycardia C. Hypertension D. Fever

A. Seizures

*Anurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following manifestations should the nurse monitor as an adverse effect of this medication?* A. Urinary retention B. Tachypnea C. Hypertension D. Irritating cough

A. Urinary retention

*A nurse is caring for a client who manifests indications of hypovolemia while in the PACU. Which of the following findings requires action by the nurse?* (Select all that apply.) A. Urine output less than 25 mL/hr B. Hematocrit 48% C. BUN 24 mg/dL D. Tenting of skin over the sternum E. Apical pulse rate 62/min

A. Urine output less than 25 mL/hr B. Hematocrit 48% C. BUN 24 mg/dL D. Tenting of skin over the sternum

*While caring for a patient who is experiencing alcohol withdrawal, the nurse should* (Select all that apply) a. monitor neurologic status on a routine basis b. provide a quiet, non stimulating, dimly lit environment c. pad the side rails and place suction equipment at the bedside d. orient the patient to the environment and person with each contact e. administer antiseizure drugs and sedatives to relieve symptoms during withdrawal

A. monitor neurologic status on a routine basis C. pad the side rails and place suction equipment at the bedside D. orient the patient to environment and person with each contact E. administer antiseizure drugs and sedatives to relieve symptoms during withdrawal

The 5 A's

Ask Advise Assess Assist Arrange

*A nurse is providing teaching to a client who has a new prescription for clonidine to assist with maintenance of abstinence from opioids. The nurse should instruct the client to monitor for which of the following adverse effects?* A. Diarrhea B. Dry mouth C. Insomnia D. Hypertension

B

During admission of the patient to the holding area or operating room before surgery, the perioperative nurse must a.Verify the patient's understanding of the risks of surgery. b.Ensure the patient's identity with a formal identification process. c.Prepare the skin by scrubbing the surgical site with an antimicrobial agent. d.Perform a preoperative assessment with a patient history and physical examination.

B

During the administration of any regional anesthetic, it is most important that the nurse a. Monitor for ascending neurologic depression and unconsciousness b. Ensure that airway equipment, emergency drugs, and monitors are immediately available c. Monitor the patient's response to the anesthesia, assessing the extent of loss of sensation d. Have reversal drugs such as anticholinesterase agents (e.g., neostigmine [Prostigmin]) available in case of respiratory arrest

B

*A nurse is teaching a client who has a new prescription for remelton. The nurse should instruct the client to avoid which of the following foods while taking this medication?* A. Baked potato B. Fried chicken C. Whole grain bread D. Citrus fruits

B Fried foods prolong the absorption of the medication

*A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering pamidronate?* A. Inspect the skin for redness and irritation when changing the intradermal patch B. Assess the IV site for thrombophlebitis frequently during administration C. Instruct the client to sit upright or stand for 30 minutes following oral administration D. Watch for manifestations of anaphylaxis for 20 min after IM administration

B Pamodronate is irritating to veins

*A nurse is teaching a client who has a new prescription for baclofen to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching?* (Select all that apply) A. "I will stop taking this medication right away if I develop dizziness." B. "I know the doctor will gradually increase my dose of this medication for a while." C. "I should increase fiber to prevent constipation from this medication." D. "I won't be able to drink alcohol while I'm taking this medication." E. "I should take this medication on an empty stomach each morning."

B, C, D

A patient admitted to the emergency department after an auto crash is found to have a blood alcohol concentration of 210 mg/dL (0.21 mg%). The patient is alert, can relate information related to the crash, and does not appear intoxicated. Which action by the nurse is most appropriate? a.Request a repeat blood test be completed. b.Obtain an accurate history of alcohol intake. c.Administer the antidote for alcohol intoxication. Assess the patient for alcohol withdrawal delirium

B- alcohol intolerant people can drink a lot without impairment

*The home health nurse visits a 40-year-old patient with metastatic breast cancer who is receiving palliative care. The patient has pain at a level of 7 (0-10 point scale). In prioritizing activities for the visit, what would the nurse so first?* A. Auscultate for breath sounds. B. Give as needed pain medication. C. Check pressure points for skin breakdown. D. Ask family about patient's food and fluid intake.

B. Administer PRN pain medication. Meeting the patient's physiologic and safety needs is the priority. Physical care focuses on the needs for oxygen, nutrition, pain relief, mobility, elimination, and skin care. The patient is not experiencing oxygenation problems; the priority is to treat the severe pain with pain medication.

*A 67-year-old woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis, she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common end-of-life (EOL) psychologic manifestation is she most likely demonstrating?* A. Peacefulness B. Decreased socialization C. Decreased decision-making D. Anxiety about unfinished business

B. Decreased socialization Decreased socialization is a common psychosocial manifestation of approaching death.

*A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. The nurse should identify that which of the following medications can cause an adverse effect when administerred concurrently with fentanyl?* A. Ampicillin B. Diazepam C. Furosemide D. Prednisone

B. Diazepam

*While caring for his dying wife, the husband states that his wife is a devout Roman Catholic, but he is a Baptist. Who is considered the most reliable source for spiritual preferences concerning EOL care for the dying wife?* A. A priest B. Dying wife C. Hospice staff D. Husband of dying wife

B. Dying wife

*A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide?* Select all apply A. Take ergotamine as a prophylaxis to prevent a migraine headache. B. Identify and avoid trigger factors. C. Lie down in a dark quiet room at the onset of a migraine. D. Avoid foods that contain tyramine. E. Avoid exercise that can increase heart rate.

B. Identify and avoid trigger factors. C. Lie down in a dark quiet room at the onset of a migraine. D. Avoid foods that contain tyramine.

The nurse explains to a patient with advanced cancer about the differences between hospice and palliative care. Which statement, if made by the patient, indicates that teaching was effective? a."Hospice care is not available if I am in the hospital." b."Palliative care provides better methods of pain control." c."Hospice care will help me and my family prepare for death." d."Palliative care does not include any advance directives."

C

The nurse is preparing to discharge a patient from the ambulatory surgery center following an inguinal hernia repair. The nurse delays the release of the patient upon discovering that the patient a. Had IV morphine 45 minutes ago b. Has an oxygen saturation of 92% c. Has not voided since before surgery d. Had one episode of vomiting 30 minutes ago

C

*A nurse is taking history for a client who reports that taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken for the client is contraindicated with aspirin?* A. Digoxin B. Metformim C. Warfarin D. Nitroglycerin

C Warfarin and other anticoagulants are increased by aspirin

*A nurse is assessing a client's laboratory values before surgery. Which of the following results should the nurse report to the provider?* (Select all that apply) a. Potassium 3.9 mEq/L b. Sodium 145 mEq/L c. Creatinine 2.8 mg/dL d. Blood glucose 235 mg/dL e. WBC 17,850/mm3

C,D,E

*A nurse is verifying informed consent for a client who is having a paracentesis. Which of the following actions should the nurse take?* (Select all that apply) a. explain to the client the purpose of having the procedure b. inform the client of risks to having the procedure c. ensure the client understood information about the procedure d. witness the client signing the informed consent form e. determine if the client is capable of understanding the reason for the procedure

C,D,E

*A nurse is caring for a client who has end stage cancer and is receiving morphine. The clients family member asks why the provider prescribed myethylnaltrexone. Which of the following responses should the nurse make?* A. "The medication will increase respirations." B. "The medication will prevent dependence on morphine." C. "The medication to relieve constipation." D. "The medication works with the morphine to increase pain relief."

C. "The medication to relieve constipation."

*A nurse in the operating room is caring for a client who received a dose of succinylcholine. During operation, the client suddenly develop rigidity and a rise in body temperature. The nurse should expect a prescription for which of the following medications?* A. Neostigmine B. Naloxone C. Dantrolene D. Vecuronium

C. Dantrolene ask on skeletal muscles to reduce metabolic activity and treat malignant hypa thermia

*A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is oversedated. Which of the following medications should the nurse anticipate administering to this client?* A. Ketamine B. Naltrexone C. Flumazenil D. Fluvoxamine

C. Flumazenil

*A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine. For which of the following manifestations indicating a possible adverse reaction should the nurse instruct the client to stop taking the medication and notify the provider?* Select all apply A. Nausea B. Visual disturbances C. Positive home pregnancy test D. Numbness in tingling in fingers E. Muscle pain

C. Positive home pregnancy test D. Numbness in tingling in fingers E. Muscle pain

*A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol. Which of the following should the nurse include in the teaching?* A. Increases the risk for seizure activity B. Provides a form of aversion therapy C. Decreases cravings D. Can increase blood pressure

C. Propranolol is used during withdrawal to decrease cravings

*The family attorney informed a patient's adult children and wife that the patient did not have an advance directive after he suffered a serious stroke. Who is responsible for making the decision about end-of-life (EOL) measures when the patient cannot communicate his or her specific wishes?* A. Notary and attorney B. Physician and family C. Wife and adult children D. Physician and nursing staff

C. Wife and adult children In the event that the person is not capable of communicating his or her wishes, the surrogate decision maker who is usually the next of kin (spouse or other family members) determines what measures will or will not be taken.

*A nurse is planning to administer morphine IV to a client who is postoperative. Which actions should the nurse take?* A. Monitor for seizures and confusion with repeated doses. B. protect the client skin from the severe diarrhea that occurs with morphine. C. Withhold this medication if respiratory rate is less than 12 per minute. D. Give morphine intermittent via IV bolus over 30 seconds or less.

C. Withhold this medication if respiratory rate is less than 12 per minute.

*A nurse has been working full time with terminally ill patients for 3 years. He has been experiencing irritability and mixed emotions when expressing sadness since 4 of his patients died on the same day. To optimize the quality of his nursing care, he should examine his own* A. full-time work schedule. B. past feelings toward death. C. patterns for dealing with grief. D. demands for involvement in patient care.

C. patterns for dealing with grief. Caring for dying patients is intense and emotionally charged, and you need to be aware of how grief affects you personally. You will have feelings of loss, helplessness, and powerlessness when dealing with death. Feelings of sorrow, guilt, and frustration need to be expressed. Recognizing personal feelings allows openness in exchanging feelings with the patient and family.

"A nurse in an acute mental health facility is caring for a client who is experiencing withdrawl from opioid use and has a new prescription for clonidine. Which of the following actions should the nurse identify as the priority?* A. Administer the chlonidine on the prescribed schedule B. Provide ice chips at the client's bedside C. Educate the client on the effects of clonidine D. Obtain baseline vital signs

D

A patient becomes restless and agitated in the postanesthesia care unit (PACU) as he begins to regain consciousness. The first action the nurse should take is to a. Turn the patient to a lateral position. b. Orient the patient and tell him that the surgery is over. c. Administer the ordered postoperative pain medication. d. Check the patient's oxygen saturation with pulse oximetry.

D

*A nurse is caring for a client who is admitted to undergo a surgical procedure. Which of the following pre-existing conditions can be a contraindication for the use of ketamine as an intravenous anesthetic?* A. Peptic ulcer disease B. Breast cancer C. Diabetes mellitus D. Schizophrenia

D Ketamine can produce hallucinations making schizophrenia even worse

*A nurse is reviewing the health history of a client who has migraine headache and is to begin prophylaxis therapy with propanolol. Which of the following findings in the client history should the nurse report to the provider?* A. The client had a prior myocardial infarction. B. The client takes warfarin for arterial fibrillation. C. The client takes an SSRI for depression. D. An ECG indicates a 1st degree heart block.

D Propanolol is contraindicated with heart blocks

*A nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. The nurse should I didn't file which of the following information as true regarding butorphanol?* A. Butorphanol has a greater risk for abuse than morphine. B. Butorphanol causes a higher incidence of respiratory depression than morphine. C. Butorphanol cannot be reversed with an opioid antagonist. D. Butorphanol can cause abstinence syndrome in opioid-dependent clients.

D. Butorphanol can cause abstinence syndrome in opioid-dependent clients.

*For the past 5 years, Tom has repeatedly asked his mother to donate his deceased father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing?* A. Adaptive grief B. Disruptive grief C. Anticipatory grief D. Prolonged grief disorder

D. Prolonged grief disorder Prolonged grief disorder is prolonged and intense mourning. It includes symptoms such as recurrent distressing emotions, intrusive thoughts related to the loss of a loved one, severe pangs of emotion, self-neglect, and denial of the loss for longer than 6 months.

*A nurse in an emergency department is performing admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect?* A. Body temperature 35°C (95 F) B. Lung crackles C. Cool dry skin D. Respiratory depression

D. Respiratory depression

*A nurse is caring for a client who arrived in the PACU following a total hip arthroplasty. The client is not responding to verbal stimuli. Which of the following actions should the nurse perform first?* A. Compare and contrast the peripheral pulses B. Apply a warm blanket. C. Assess the pt's dressings. D. Place the client in the lateral position.

D. The greatest risk to the client is injury from aspiration. The first action is to position the client laterally.

The Grief Wheel

Loss: 1. shock (numbness, denial, disbelief) 2. Protest (strong powerful feelings of anger and guilt) 3. Disorganization ( overwhelming bleakness, despair, anxiety) 4. Reorganization (return to normal functioning)

perioperative nurse

Prepares room with team Patient advocate throughout surgical experience

*After admitting a postoperative patient to the clinical unit, which assessment data require the most immediate attention?* a. O2 saturation of 85% b. respiratory rate of 13/min c. temperature of 100.4 F (38 C) d. blood pressure of 90/60 mm Hg

a. O2 saturation of 85% rationale: During the initial assessment, identify signs of inadequate oxygenation and ventilation. Start pulse oximetry monitoring because it provides a noninvasive means of assessing the adequacy of oxygenation. Pulse oximetry may show low oxygen saturation (<90% to <92%) with respiratory compromise. This requires your prompt intervention.

*The nurse would suspect cocaine toxicity in the patient who is experiencing* a. agitation, dysrhythmias, and seizures b. blurred vision, restlessness, and irritability c. diarrhea, nausea and vomiting, and confusion d. slow, shallow respirations; bradycardia; and hypotension

a. agitation, dysrhythmia, and seizures

*A nurse is assisting an anesthesiologist who is delivering nitrous oxide by face mask to a client during the induction of anesthesia. Which of the following is the priority nursing action?* a. assess oxygen saturation b. measure blood pressure c. palpate pulse rate d. check temperature

a. assess oxygen saturation

*The nurse's primary responsibility for the care of the patient undergoing surgery is* a. developing an individualized plan of nursing care for the patient b. carrying out specific tasks related to surgical policies and procedures c. ensuring that the patient has been assessed for safe administration of anesthesia d. performing a preoperative history and physical assessment to identify patient needs

a. developing an individualized plan of nursing care for the patient rationale: A primary role of the nurse is to assess the patient to develop an individual plan of care

*A nurse is caring for a client who is scheduled for an exploratory laparotomy. The client's temperature is 39 C (102.2 F) orally. Which of the following actions should the nurse take?* a. inform the surgeon of the elevated temperature b. transfer the patient to the preoperative unit c. apply ice packs to the groin d. encourage the client to increase intake of clear liquids

a. inform the surgeon of the elevated temperature

*A 59-year-old man scheduled for a herniorrhaphy in 2 days reports that he takes ginkgo daily. What is the priority intervention?* a. inform the surgeon, since the procedure may have to be rescheduled b. notify the anesthesia care provider, since this herb interferes with anesthetics c. ask the patient if he has noticed any side effects from taking this herbal supplement d. tell the patient to continue to take the herbal supplement up to the day before the surgery

a. inform the surgeon, since the procedure may have to be rescheduled rationale: Ginkgo can increase bleeding during and after surgery. The surgeon should decide how long to discontinue it before surgery.

*A patient admitted for scheduled surgery has a positive brief screening test result for alcohol use disorder. Which initial action is most appropriate?* a. notify the health care provider b. complete a detailed alcohol use assessment c. initiate a referral to a specialty treatment center d. provide patient teaching on postoperative health risks

b. Complete the detailed alcohol use assessment

*When positioning a patient in preparation for surgery, the nurse understands that injury to the patient can occur because of* (Select all that apply) a. loss of pain perception b. incorrect musculoskeletal alignment c. vasoconstriction of the peripheral vessels d. hypovolemia contributing to decreased perfusion e. inability to sense pressure over bony prominences

a. loss of pain perception b. incorrect musculoskeletal alignment d. hypovolemia contributing to decreased perfusion e. inability to sense pressure over bony prominences rationale: Whatever position is used, great care is taken to prevent injury to the patient. Because anesthesia blocks the sensory nerve impulses, the patient does not feel pain, discomfort, or sense stress placed on the nerves, muscles, bones, and skin. General anesthesia causes peripheral vessels to dilate. Position changes affect where the pooling of blood occurs. Hypovolemia and cardiovascular disease can further compromise the patient's status by contributing to decreased perfusion

*An overweight patient (BMI 28.1 kg/m2) is scheduled for a laparoscopic cholecystectomy at an outpatient surgery setting. The nurse knows that* a. surgery will involve multiple small incisions b. this setting is not appropriate for this procedure c. surgery will involve removing a part of the liver d. the patient will need special preparation because of obesity

a. surgery will involve multiple small incisions rationale: Many operative procedures are performed as ambulatory surgery (i.e., same-day or outpatient surgery). Obesity is not a contraindication to surgery in the outpatient setting. This patient is not classified as obese based on the BMI. The case implied that a laparoscopic technique will be used that involves several small incisions and meets the requirement of a minimally invasive technique.

*The nurse is caring for a patient undergoing surgery for a knee replacement. What is critical to the patient's safety during the procedure?* (Select all that apply) a. universal protocol is followed b. the ACP is an anesthesiologist c. the patient has adequate health insurance d. the patient's family is in the surgery waiting area e. the patient's allergies are conveyed to the surgical team

a. universal protocol is followed e. the patient's allergies are conveyed to the surgical team rationale: Intraoperative nursing care includes determining the patient's allergy status in response to food, drugs, and latex. Preventing use of the wrong site, wrong procedure, and wrong surgery has become known as the Universal Protocol. The Universal Protocol is part of a global patient safety initiative.

Types of Grief

anticipatory, adaptive, and dysfunctional grief

*When admitting a patient, the nurse must assess the patient for substance use based on the knowledge that long-term use of addictive substances leads to* a. development of coexisting psychiatric illnesses b. the higher risk for complications from underlying health problems c. potentiation of effects of similar drugs taken when the individual is drug free d. increased availability of dopamine, resulting in decreased sleep requirements

b. a higher risk for complications from underlying health problems

*The patient tells the nurse in preoperative setting that she has noticed she has a reaction when wearing rubber gloves. What is the most appropriate action?* a. notify the surgeon so that surgery can be cancelled b. ask additional questions to assess for a possible latex allergy c. notify the OR staff at once so they can use latex-free supplies d. no action is needed because the patient's rubber sensitivity has no bearing on surgery

b. ask additional questions to assess for a possible latex allergy rationale: The nurse should ask additional screening questions to determine the patient's risk for a latex allergy. Use latex precaution protocols for patients found as having a positive latex allergy test result or a history of signs and symptoms related to latex exposure. Many health care facilities have created latex-free product carts to use with patients with latex allergies.

*The most appropriate nursing intervention for a patient who is being treated for an acute exacerbation of chronic obstructive pulmonary disease who is not interested in quitting smoking is to* a. accept the patient's decision and not intervene until the patient expresses desire to quit b. ask the patient to identify the risks and benefits of quitting and what barriers to quitting are present c. realize that some smokers never quit, and trying to assist them increases the patient's frustrations d. motivate the patient to quit by describing how continued smoking will worsen the breathing problems

b. ask the patient to identify the risks and benefits of quitting and what barriers to quitting are present

*A patient who normally takes 40 units of glargine insulin (long acting) at bedtime asks the nurse what to do about her dose the night before her surgery. The best response would be to have her* a. skip her insulin altogether the night before the surgery b. get instructions from her surgeon or HCP on any insulin adjustments c. take her usual dose at bedtime and eat a light breakfast in the morning d. eat a moderate meal before bedtime and then take half her insulin dose

b. get instructions from her surgeon or HCP on any insulin adjustments rationale: Insulin is not usually omitted completely. The patient should obtain instructions from her HCP or surgeon about any dosage adjustments that she should make the day before and the morning of surgery (if applicable).

*Activities that the nurse might perform in the role of a scrub during surgery include* (Select all that apply) a. checking electrical equipment b. preparing the instrument table c. assisting with draping the patient d. passing instruments to the surgeon and assistants e. documenting activities occurring in the operating room

b. preparing the instrument table c. assisting with draping the patient d. passing instruments to the surgeon and assistants rationale: When serving in the role of a scrub nurse (sterile), the nurse follows the designated surgical hand antisepsis, glove and gown sterile attire, assists with draping the patient. and prepares and manages the sterile field and instrumentation. When serving in the role of a circulating nurse, the nurse stays in the unsterile field and checks mechanical and electrical equipment and maintains documentation.

A patient tells the nurse that she is worried about her 17-year-old son who has been socializing with some friends she thinks are using drugs. The best response by the nurse to the patient's concern is a."You need to stop his association with these friends to prevent him from using drugs." b."Most young people experiment with drugs, but very few become addicted to illegal substances." c."You should learn about the early signs and symptoms of drug abuse and share your concerns with your son." d."You need to make an appointment for your son with a drug counselor so he can be taught about the harmful effects of drugs."

c

Preoperative instruction that is appropriate for all patients includes a. Techniques of deep breathing and coughing b. Descriptions of the planned surgical procedure c. Physical procedures or preparation required before surgery d. Withholding of all oral fluids or food after midnight on the day of surgery

c- MAKE SURE PATIENT GETS INFORMATION

*A nurse has administered midazolam (Versed) IV bolus to a client before a procedure. The client's blood pressure is 86/40 mm Hg and pulse is 134/min. Which of the following IV medications should the nurse administer?* a. Naloxone b. Morphine c. Flumazenil d. Atropine

c. Flumazenil

*What are the priority interventions the nurse performs when admitting a patient to the PACU?* a. assess the surgical site, noting presence and character of drainage b. assess the amount of urine output and the presence of bladder distention c. assess for airway patency and quality of respirations and obtain vital signs d. review results of intraoperative laboratory values and medications received

c. assess for airway patency and quality of respirations and obtain vital signs rationale: Assessment in the postanesthesia care unit (PACU) begins with evaluation of the airway, breathing, and circulation (ABC) status of the patient. Inadequate oxygenation and ventilation or respiratory compromise require your prompt intervention.

*IV induction for general anesthesia is the method of choice for most patients because* a. the patient is not intubated b. the agents are nonexplosive c. induction is rapid and controlled d. emergence is longer but with fewer complications

c. induction is rapid and controlled rationale: Routine general anesthesia is usually established with an IV induction agent, which may be a hypnotic, anxiolytic, or dissociative agent. When used during the initial period of anesthesia, these agents induce a pleasant sleep with a rapid onset of action that patients find desirable

*Discharge criteria for the Phase II patient include* (Select all that apply) a. no nausea or vomiting b. ability to drive self home c. no respiratory depression d. written discharge instructions understood e. opioid pain medication given 45 minutes ago

c. no respiratory depression d. written discharge instructions understood e. opioid pain medication given 45 minutes ago rationale: Phase II discharge criteria that must be met include the following: all PACU discharge criteria (Phase I); no IV opioid drugs given in the past 30 minutes; patient's ability to void (if appropriate with regard to surgical procedure or orders); patient's ability to ambulate if it is not contraindicated; presence of a responsible adult to accompany or drive patient home; and written discharge instructions given and understood.

*A nurse is caring for a client who reports a headache following an epidural regional nerve block. Which of the following actions should the nurse take?* a. decrease the client's fluid intake b. apply pressure to the puncture site c. place the clients head of bed flat d. instruct the client to lie prone

c. place the clients head of bed flat

*Preoperative considerations for older adults include* (Select all that apply) a. using only large-print educational materials b. speaking louder for patients with hearing aids c. recognizing that sensory deficits may be present d. providing warm blankets to prevent hypothermia e. teaching important information early in the morning

c. recognizing that sensory deficits may be present d. providing warm blankets to prevent hypothermia rationale: Many older adults have sensory deficits. Preoperative and operating rooms are cool; provide warm blankets as needed.

*Proper attire for the semi restricted area of the surgery department is* a. street clothing b. surgical attire and head cover c. scrub attire, head cover, and shoe covers d. street clothing with the addition of shoe covers

c. scrub attire, head cover, and shoe covers rationale: The semirestricted area includes the surrounding support areas and corridors. Only authorized staff members can access the semirestricted areas. All staff in the semirestricted area should wear clean surgical attire. This includes scrub attire that has been laundered in an accredited laundry facility, long sleeved jacket, shoes dedicated for surgical use or shoe covers, surgical head cover and mask that covers all head and facial hair, and any appropriate personal protective equipment (e.g., face shield).

*A 70-kg postoperative patient has an average urine output of 25 mL/hr during the first 8 hours. The priority nursing intervention(s) given this assessment would be to* a. notify the surgeon and expect obtaining blood work to evaluate renal function b. perform a straight catheterization to measure the amount of urine in the bladder c. continue to monitor the patient because this is a normal finding during this time period d. evaluate the patient's fluid volume status since surgery and obtain a bladder ultrasound

d. evaluate the patient's fluid volume status since surgery and obtain a bladder ultrasound rationale: Because of the risk of infection associated with catheterization, the nurse should first try to confirm that the bladder is full. Consider fluid intake during and after surgery and determine bladder fullness by percussion, by palpation, or by a portable bladder ultrasound study to assess the volume of urine in the bladder and avoid unnecessary catheterization

*A priority nursing intervention to aid a preoperative patient in coping with fear of postoperative pain would be to* a. inform the patient that pain medication will be available b. teach the patient to use guided imagery to help manage pain c. describe the type of pain expected with the patient's particular surgery d. explain the pain management plan, including the use of a pain rating scale

d. explain the pain management plan, including the use of a pain rating scale rationale: If a patient fears pain and discomfort after surgery, the nurse should reassure the patient that a pain management plan will be in place. The nurse should teach the patient to ask for medications after surgery when pain is present and assure him or her that taking these medications will not contribute to an addiction. The nurse should teach the patient how to use some form of pain rating scale (e.g., 0 to 10, FACES) and to request pain medication before the pain becomes severe.

*when scrubbing at the scrub sink, the nurse should* a. scrub from elbows to hands b. scrub without mechanical friction c. scrub for a minimum of 10 minutes d. hold the hands higher than the elbows

d. hold the hands higher than the elbows rationale: To perform a surgical scrub, the fingers and hands should be scrubbed first, progressing to the forearms and elbows. The hands should always be held away from surgical attire and higher than the elbows to prevent contamination from clothing or from detergent suds and water draining from the unclean area above the elbows to the clean and previously scrubbed areas of the hands and fingers.

*A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. What should the nurse do first? a. tell the patient to come back tomorrow, since he ate a meal b. have the patient void before giving any preoperative medication c. proceed with the preoperative checklist, including site identification d. notify the anesthesia care provider of when and what the patient last ate

d. notify the anesthesia care provider of when and what the patient last ate rationale: Follow the nothing-by-mouth (NPO) protocol of each surgical facility. Restricting fluids and food is designed to minimize the potential risk of pulmonary aspiration and decrease the risk of postoperative nausea and vomiting. If a patient has not followed the NPO instructions, surgery may be delayed or cancelled. The nurse should notify the anesthesia care provider at once

*A patient is admitted to the PACU after major abdominal surgery. During the initial assessment the patient tells the nurse he thinks he is going to "throw up." A priority nursing intervention is to* a. increase the rate of the IV fluids b. give antiemetic medication is ordered c. obtain vital signs, including O2 saturation d. position patient in lateral recovery position

d. position patient in lateral recovery position rationale: If the patient is nauseated and may vomit, place the patient in a lateral recovery position to keep the airway open and reduce the risk of aspiration if vomiting occurs.

*A preoperative nurse is caring for a client who is having a colon resection. Which of the following actions should the nurse take?* a. encourage the client to void after preoperative medication administration b. administer antibiotics 2 hr prior to surgical incision c. remove hair using a manual razor d. remove nail polish on fingers and toes

d. remove nail polish on fingers and toes

Documents required before surgery:

history and physical forms informed consent blood transfusions advance directives power of attorney

Patients with diabetes mellitus are at risk for:

hypo/hyperglycemia ketosis cardiovascular alterations delayed wound healing infections

Preop nursing assessment goals:

identify risk factors, establish baseline data , determine psychologic status, determine physiologic factors of procedure

restricted areas include:

operating rooms scrub sinks sterile core surgical attire

Hospice care admission criteria

patient must desire services and must be eligible for services

Hospice care requires

physician certification that life expectancy is under 6 months and has to have two providers

Preop worries of Obesity:

slower healing slower recovery from anesthesia ( adipose tissue collects anesthesia)

Importance of Genitourinary assessment before surgery

to have a history of urinary or renal disease, make sure BUN and Creatine test are ordered to make sure no voiding issues