NCLEX Lippincott Surgery Questions

A client is scheduled to have an elective mandibular osteotomy to correct a mandibular fracture sustained in an accident 6 months earlier. Which statement by the client indicates to the nurse that the client is having difficulty coping? 1. "I'll be glad to have my jaw fixed because my wife thinks I don't look like myself." 2. "I'm somewhat afraid to have the surgery, but I feel OK about it." 3. "My wife will help me, but I don't think I'll need that much help." 4. "I'm ready to get this over with."

1. "I'll be glad to have my jaw fixed because my wife thinks I don't look like myself."

A client will receive IV midazolam hydrochloride during surgery. Which finding indicates a therapeutic effect? 1. Amnesia 2. Nausea 3. Mild agitation 4. Blurred vision

1. Amnesia

Eight hours after laparoscopic abdominal surgery, a client has a distended bladder an is unable to void in bed using a urinal. The client can be out of bed as tolerated, but has not done so yet. What should the nurse do next? 1. Assist the client to stand at the bedside to use the urinal. 2. Pour running water over perineum to stimulate emptying of the bladder. 3. Encourage the client to ambulate to prevent further bladder distention. 4. Notify the health care provider to request a prescription for catheterization.

1. Assist the client to stand at the bedside to use the urinal.

During preadmission testing for same-day surgery, a client states that she had added garlic each day to her diet to help control her blood pressure. What should the nurse ask the client next? 1. "What type of surgery are you having?" 2. "What is your normal blood pressure?" 3. "How much garlic are you eating?" 4. "What type of anesthesia are you having?"

3. "How much garlic are you eating?"

The client has a latex allergy. what should the nurse teach the client to do before having surgery? 1. Determine that there will be a latex-safe environment for surgery 2. Report symptoms experienced with the latex allergy (e.g. rhinitis, conjunctivitis, flushing) 3. Notify the health care providers at the surgery center. 4. Wear a stainless steel medical alert bracelet into the surgical suite. 5. Ask to have the surgery at a hospital.

1. Determine that there will be a latex-safe environment for surgery 2. Report symptoms experienced with the latex allergy (e.g. rhinitis, conjunctivitis, flushing) 3. Notify the health care providers at the surgery center.

An older adult is being discharged following a repair of an inguinal hernia. The client is independent and lives alone, but the client's family lives 60 miles from the client's house. When at home, the client is to cleanse and inspect the incision for signs of infection. The client and family are able to read and understand written instructions. When giving discharge instructions, what should the nurse do? SATA 1. Explain the instructions to the client. 2. Ask the client to demonstrate the procedure. 3. Explain the instructions to a family member. 4. Provide written instructions for the client. 5. Give the family a link to a video showing the procedure.

1. Explain the instructions to the client. 2. Ask the client to demonstrate the procedure. 4. Provide written instructions for the client.

The nurse is reviewing the medical record of a client who is scheduled for a lumbar laminectomy. The nurse should report which finding to the surgeon? 1. Pimple on the lower back 2. Abnormal electrocardiogram 3. Hearing aid 4. Allergy to iodine

1. Pimple on the lower back

A client is admitted for an arthroscopy of the right shoulder through same day surgery. Which nurse is responsible for starting the client's discharge planning? 1. Preadmission Nurse 2. Preoperative Nurse 3. Intraoperative Nurse 4. Postoperative Nurse

1. Preadmission Nurse

The nurse is developing a plan to teach a client deep-breathing exercises to expand collapsed alveoli and prevent postoperative atelectasis and pneumonia. What information should be included in the plan? Select all that apply. 1. Splint or support the incision to promote maximal comfort. 2. Inhale slowly through the nostrils; exhale through pursed lips. 3. Hold the breathe for about 5 seconds to expand the alveoli. 4. Repeat this breathing method 5 to 10 times hourly. 5. Close one nostril while inhaling.

1. Splint or support the incision to promote maximal comfort. 2. Inhale slowly through the nostrils; exhale through pursed lips. 3. Hold the breathe for about 5 seconds to expand the alveoli. 4. Repeat this breathing method 5 to 10 times hourly.

When evaluating a client's preoperative cognitive-perceptual pattern, which question should the nurse ask the client? 1. "Do you have difficulty swallowing?" 2. "Do you need special equipment to walk?" 3. "Do you smoke?" 4. "Do you wear glasses?"

4. "Do you wear glasses?"

When the nurse administers IV midazolam hydrochloride, the client demonstrates signs of an overdose. What should the nurse do? 1. Ventilate with an oxygenated bag-valve mask. 2. Prepare ECG paddles in case the client has a cardiac arrest. 3. Administer 0.5mL 1:1,000 epinephrine. 4. Titrate flumazenil to reverse the effects of the IV midazolam hydrochloride.

1. Ventilate with an oxygenated bag-valve mask.

Which client is most at risk for potential hazards from the surgical experience? 1. an 80 year old client 2. a 50 year old client 3. a 30 year old client 4. a 15 year old client

1. an 80 year old client

When the nurse is preparing a teaching plan for an adult client about general anesthesia induction, which explanation by the nurse would be most appropriate? 1. "Your premedication will put you to sleep." 2. "You will breathe in an inhalant anesthetic mixed with oxygen through a facial mask and receive intravenous medication to make you sleepy." 3. "You will receive intravenous medication to make you sleepy." 4. "You will breathe in medication through a facial mask to make you sleepy."

2. "You will breathe in an inhalant anesthetic mixed with oxygen through a facial mask and receive intravenous medication to make you sleepy."

A client is prescribed morphine sulfate intramuscularly (IM). Which is true regarding administration of this controlled substance? 1. Morphine may only be administered by a registered nurse. 2. Another nurse must observe disposal of unused medication. 3. Another nurse must validate administration of the medication. 4. A registered nurse must observe the licensed practical/vocational nurse administer the medication.

2. Another nurse must observe disposal of unused medication.

The nurse is assessing a client's nutritional status before surgery. Which observation would indicate poor nutrition in a 5 foot 7 inch female client who is 21 years of age? 1. Poor posture 2. Brittle nails 3. Dull expression 4. Weight of 128 lb

2. Brittle nails

The nurse teaches a client who had cystoscopy about the urge to void when the procedure is over. What other information should the nurse tell the client to expect to do? 1. Ignore the urge to void. 2. Increase intake of fluids. 3. Ask for the bedpan. 4. Ring for assistance to go to the bathroom.

2. Increase intake of fluids.

A client who is a Jehovah's Witness consented to surgery only and not to receiving any blood products, including autotransfusion. During surgery, the client lost blood, the blood pressure dropped, and two units of blood were administered. Following surgery, during handover the nurse was informed that the blood had been administered. In which order, from first to last should the nurse complete these tasks. 1. Complete an incident report. 2. Initiate an ethics consultation. 3. Notify the unit manager. 4. Inform the next oncoming nurse during hand off of care report.

2. Initiate an ethics consultation. 3. Notify the unit manager. 1. Complete an incident report. 4. Inform the next oncoming nurse during hand off of care report.

The surgeon prescribes cefazolin 1 g to be given IV at 0730 when the client's surgery is scheduled at 0800. What is the primary reason to start the antibiotic exactly at 0730? 1. Legally the medication has to be given at the prescribed time. 2. The antibiotic is most effective in preventing if it is given 30 to 60 minutes before the operative incision is made. 3. The postoperative dose of cefazolin needs to be started exactly 8 hours after the preoperative dose of cefazolin. 4. The peak and titer levels are needed for antibiotic therapy.

2. The antibiotic is most effective in preventing if it is given 30 to 60 minutes before the operative incision is made.

When the nurse is conducting a preoperative interview with a client who is having a vaginal hysterectomy, the client states that she forgot to tell her surgeon that she ha a total hip replacement 3 years ago. Why should the nurse communicate this information to the periopertive nurse? 1. The prosthesis may cause a problem with the electrosurgical unit used to control bleeding. 2. The client should not have her hip externally rotated when she is positioned for the procedure. 3. The perioperative nurse can inform the rest of the team about the total hip replacement. 4. There is not enough time to notify the surgeon and note this finding on the history and physical information before the procedure.

2. The client should not have her hip externally rotated when she is positioned for the procedure.

A client who is scheduled for an open cholecystectomy has been smoking a pack of cigarettes a day for 20 years. For which postoperative complication is the client most at risk? 1. deep vein thrombosis 2. atelectasis 3. delayed would healing 4. prolonged immobility

2. atelectasis

The nurse receives the preoperative blood work report for a client who is scheduled to undergo surgery. Which laboratory finding should the nurse report to the surgeon and anesthesiologist? 1. red blood cells, 4.5 million/mm3 2. creatinine, 2.6 mg/dL 3. hemoglobin, 12.2 g/dL 4. Blood urea nitrogen, 15 mg/dL

2. creatinine, 2.6 mg/dL

Atropine sulfate is contraindicated as a preoperative medication for which client? A client with: 1. diabetes 2. glaucoma 3. pyelonephritis 4. chronic obstructive pulmonary disease (COPD)

2. glaucoma

Metoclopramide is prescribed as a premedication for a client about to undergo a gastroduodenoscopy. What expected therapeutic effect of this drug should the nurse assess in this client? 1. increased gastric pH 2. increased gastric emptying 3. reduced anxiety 4. inhibited respiratory secretions

2. increased gastric emptying

a client is to receive enoxaparin 6 hours before the scheduled time of laparoscopically assisted vaginal hysterectomy. What effect does the nurse recognize as an intended therapeutic action of the enoxparin? 1. increase in red blood cell production 2. reduction of postoperative thrombi 3. decrease in postoperative bleeding 4. promotion of tissue healing

2. reduction of postoperative thrombi

Which nursing intervention is most important in preventing postoperative complications? 1. progressive diet planning 2. pain management 3. bowel and elimination monitoring 4. early ambulation

4. early ambulation

After teaching the client how to use the patient-controlled analgesia (PCA) pump, the nurse determines that the client understands the use of the PCA when the client makes which statement? 1. "It's OK for my family to press the button for me if I'm too tired to do it myself." 2. "I should wait until the pain is really bad before I push the button to get more pain medicine." 3. "The machine will only give me the prescribed amount of pain medication even If I push the button too soon." 4. "I have to be careful about pushing the button too many times or I will overdose myself."

3. "The machine will only give me the prescribed amount of pain medication even If I push the button too soon."

The adult daughters of an older adult client inform the nurse that they fully expect their father to be combative after surgery. Preoperatively, they request that they nurse put all four side rails up and use restraints to keep him safe. What should the nurse tell the daughters? 1. "Certainly; we will want to be sure to keep your father safe too." 2. "We will call the health care provider to get a prescription right away." 3. "We will first try to keep him safe without restraint." 4. "Restraint use is prohibited at our hospital at all times."

3. "We will first try to keep him safe without restraint."

The nurse assesses that a client is restless and becoming agitated in the immediate postoperative period. The client's oxygen saturation is 91%. What should the nurse do next? 1. Administer a sedative. 2. Offer ice chips. 3. Administer Oxygen. 4. Apply wrist restraints.

3. Administer Oxygen.

Following surgery, a client is receiving 1,000 mL normal saline (IV) with 40 mEq KCl, which has been prescribed to be infused at 125 mL/h. The client states, "My IV hurts." What should the nurse do first? 1. Contact the client's heath care provider for a different IV prescription. 2. Slow down the infusion to a keep-open rate (20 to 50 mL/h) 3. Assess the IV site for signs of phelbitis, extravasation, or IV-related infection. 4. Check the hanging parenteral fluid and administration set for documentation as to when they were last changed.

3. Assess the IV site for signs of phelbitis, extravasation, or IV-related infection.

The nurse is caring for a client receiving morphine in an intravenous infusion use a patient-controlled anesthesia pump (PCA) for relief of postoperative pain. On assessment, the client's vital signs are as follows: heart rate, 84 bpm; respirations, 8 breaths/min; blood pressure, 104/56 mm Hg; and oxygen saturation of 88% on room air. What should the nurse do first? 1. Contact the health care provider to request a prescription for naloxone. 2. Stop the infusion of morphine. 3. Assist the client to sit and stimulate coughing/deep breathing. 4. Call the rapid response team.

3. Assist the client to sit and stimulate coughing/deep breathing.

On the day of surgery, a client has been breathing room air. The vital signs are normal, and the 02 Saturation is 89%. What should the nurse do first? 1. Lower the head of the bed. 2. Notify the health care provider (HCP). 3. Assist the client to take several deep breaths and cough. 4. Administer oxygen by nasal cannula at 2 L/min.

3. Assist the client to take several deep breaths and cough.

On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 0600 glucose level is 300 mg/dL. What should the nurse do? 1. Withhold all medications. 2. Administer the insulin dose dictated by the sliding scale. 3. Call the health care provider for specific prescriptions based on the glucose level. 4. Notify the surgery department.

3. Call the health care provider for specific prescriptions based on the glucose level.

A client had a colectomy 8 1/2 hours ago and has received 1,500 mL of dextrose 5% in water with normal saline solution. The client has just used a patient-controlled analgesia pump to administer morphine for pain, has been repositioned for comfort, and has stable pulse rate, respirations, and blood pressure. What should the nurse do next? 1. Check that the family is comfortable. 2. Assess vital signs following the use of morphine. 3. Dim the lights in the room. 4. Icrease nasal oxygen from 2 to 3 L.

3. Dim the lights in the room.

When administering IV midazolam hydrochloride to a client, what should the nurse do? 1. Assess the blood pressure. 2. Monitor the pulse oximeter. 3. Have client take deep breaths. 4. Help the client relax.

3. Have client take deep breaths.

The nurse is preparing to administer a preoperative medication that includes a sedative to a client who is having abdominal surgery. The nurse should first: 1. Have the family present. 2. Ensure that the operative area has been shaved. 3. Have the client empty the bladder. 4. Make sure the client is covered with a warm blanket.

3. Have the client empty the bladder.

A client is to have a below-the-knee amputation. Prior to the surgery, what should the circulating nurse in the operating room do? 1. Insert a Foley catheter. 2. Start an intravenous infusion. 3. Initiate a time-out. 4. Verify that the surgeon possesses the degree of expertise needed.

3. Initiate a time-out.

The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison on the leg. What should the nurse do first? 1. Document the prednisone with current medications. 2. Notify the surgeon of the poison ivy. 3. Notify the anesthesiologist of the prednisone administration. 4. Send the client to surgery.

3. Notify the anesthesiologist of the prednisone administration.

When the nurse asks the client who is having abdominal surgery to day if the client understands the procedure, the client replies, "No, not really; I talked about several different things with my surgeon, and I'm just not sure." What should the nurse do next? 1. Teach the client all the details of the planned procedure. 2. Utilize a second witness when the client signs for consent. 3. Notify the surgeon of the client's expressed lack of understanding. 4. Administer the prescribed preoperative narcotics and/or sedatives.

3. Notify the surgeon of the client's expressed lack of understanding.

The nurse is preparing a preoperative teaching plan for a client who is undergoing a bilateral breast reduction. Which aspect of the plan is the priority? 1. Reduction of risk potential 2. Physiologic adaptation 3. Psychosocial integrity 4. Health promotion and maintenance

3. Psychosocial integrity

The nurse is preparing to start an intravenous infusion and has raised the head of the client's bed. After the nurse applies gloves to insert an IV catheter, the client begins to rub the eyes and wipe away nasal drainage. What should the nurse do first? 1. Distract the client's attention. 2. Assess the client for pain. 3. Remove the gloves and assess the client's vital signs. 4. Lower the head of the client's bed.

3. Remove the gloves and assess the client's vital signs.

When attempting to check the pupils of a client scheduled to receive general anesthesia, the nurse notices that the client has trouble tilting the head back. What is the primary concern related to this finding? 1. The client has limited movement of the neck. 2. The client may have postoperative neck pain. 3. The client is at risk for difficult intubation. 4. The ability to assess the client's pupils is limited

3. The client is at risk for difficult intubation.

What therapeutic outcome does the nurse expect for a client who has received a premedication of glycopyrrolate? 1. increased heart rate 2. increased respiratory rate 3. decreased secretions 4. decreased amnesia

3. decreased secretions

Which approach is the best way for the nurse to begin the preoperative interview? Walk in the client's room: 1. and ask, "Are you Mrs. Smith?" 2. sit down, and take the client's blood pressure 3. sit down, maintain eye contact, and make an introduction. 4. and ask the client's name

3. sit down, maintain eye contact, and make an introduction.

Prior to being transported to the surgery suite, the nurse asks the client whether the client has any allergies. The client responds, "Does anyone communicate with anyone? I've been asked that question over and over!" What is the nurse's best response? 1. "I'm sorry! I just have to ask that question for the record." 2. "It's an important question, and we just have to check." 3. "You will hear it again and again as you go through surgery." 4. "This question is asked for verification and safety with each new phase of treatment."

4. "This question is asked for verification and safety with each new phase of treatment."

Before surgery, a client expresses a fear of surgery because 10 years ago the client's sister died in surgery related to complications of anesthesia. What should the nurse do? 1. Reassure the client that technology has changed over the last 10 years. 2. Encourage the client to further express concerns. 3. Explain to the client that it is normal to be afraid. 4. Ask the client if any family members had trouble when they had surgery.

4. Ask the client if any family members had trouble when they had surgery.

A client who had an esophageal hernia repair 4 hours ago has a pulse rate of 90; respiration rate of 16 breaths/min; blood pressure of 130/80 mm Hg; pulse oximeter of 91%, on room air; and a temperature of 100.4 F. What should the nurse do first? 1. Obtain a culture of the incision. 2. Notify the surgeon to obtain an antibiotic prescription. 3. Offer pain medication. 4. Assist the client to a sitting position to take deep breaths.

4. Assist the client to a sitting position to take deep breaths.

A client has been unable to void since having abdominal surgery 7 hours ago. What should the nurse do first? 1. Encourage the client to increase oral fluid intake. 2. Insert an intermittent urinary catheter. 3. Use an ultrasound bladder scanner to determine urine volume in the bladder. 4. Assist the client up to the toilet to attempt to void.

4. Assist the client up to the toilet to attempt to void.

Prior to going to surgery, the client tells the nurse that it is not possible to hear without a hearing aid and asks to wear it to surgery and recovery. What is the nurse's best response? 1. Explain to the client that it is policy not to take personal items to surgery because they may be lost or broken. 2. Tell the client that a nurse will bring the hearing aid to the postanesthesia care unit as soon as the client wakes up. 3. Explain to the client that the premedication that will cause sleepiness and it will not be necessary to hear anything. 4. Call the surgery unit to explain the client's concern, and ask if the client can wear the hearing aid to surgery.

4. Call the surgery unit to explain the client's concern, and ask if the client can wear the hearing aid to surgery.

On the first day after abdominal surgery, the nurse auscultates a client's abdomen for bowel sounds; there are none. What should the nurse do next? 1. Notify the health care provider (HCP). 2. Ask another nurse to validate the absence of bowel sounds. 3. Encourage the client to take more ice chips. 4. Document assessment findings in the client's medical record.

4. Document assessment findings in the client's medical record.

Following abdominal surgery, a client refuses to deep breathe and cough every 2 hours as prescribed. What should the nurse do first? 1. Ask the client's wife to insist that the client take the deep breaths every 2 hours. 2. Respect the client's wishes, and turn the client from side to side more frequently. 3. Suggest that the client increase the daily fluid intake to at lease 2,500 mL. 4. Explain the risks of not expanding the lungs and why the exercise is important.

4. Explain the risks of not expanding the lungs and why the exercise is important.

A client tells the nurse on admission that she is uneasy about having to leave her children with a relative while being in the hospital for surgery. What should the nurse do? 1. Reassure the client that her children will be fine and she should stop worrying. 2. Contact the relative to determine his/her capacity to be an adequate care provider. 3. Encourage the client to call the children to make sure they are doing well. 4. Gather more information about the client's feelings about the childcare arrangements

4. Gather more information about the client's feelings about the childcare arrangements.

A client who is to receive general anesthesia has a serum potassium level of 5.8 mEq/L. What should be the nurse's first response? 1. Call the operating room to cancel the surgery. 2. Send the client to surgery. 3. Make a note on the client's record. 4. Notify the anesthesiologist.

4. Notify the anesthesiologist.

Prior to surgery, the client is to take nothing by mouth after 0400. Which statement indicates the client did not follow the preoperative directions? The client: 1. Ate a gelatin dessert at 0330 2. Brushed the teeth at 0400 but did not swallow 3. Held a cold washcloth against the lips 4. Smoked a cigarette at 0600

4. Smoked a cigarette at 0600

The nurse is assessing the level of consciousness for a client who just had open heart surgery. When asked, the client can give his name but is not sure about where he is or the time of day. What should the nurse do next. 1. Notify the surgeon. 2. Rub the client's sternum to arouse the client. 3. Encourage the client's wife to orient the client. 4. Tell the client where he is and the time of day.

4. Tell the client where he is and the time of day.

During the preoperative interview, the nurse obtains information about the client's medication history. Which information is not necessary to record about the client? 1. current use of medications, herbs, and vitamins 2. over the counter medication use in the last 6 weeks 3. steroid use in the last year 4. all drugs taken in the last 18 months

4. all drugs taken in the last 18 months

The nurse explains to a family that they cannot go with the client past the doors that separate the public from the restricted area of the operating room suite. What is the purpose of this restriction? 1. Protection of the privacy of clients 2. Prevention of electrical sparks that could ignite the anesthetic gases 3. separation of the family from the surgical team during the operation 4. maintenance of an aseptic environment to prevent infection

4. maintenance of an aseptic environment to prevent infection