Practice Test 1 NURS327

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 to 2 months Explanation: Patients who smoke are urged to stop 4 to 8 weeks before surgery to significantly reduce pulmonary and wound healing complications.

The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated.

5% DW

The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance?

An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide

The circulating nurse is preparing a patient for a surgical procedure. What primary responsibility does the circulating nurse have in the perioperative experience?

Discussing the complications of the surgical procedure with the patient

Why should the nurse be vigilant with assessment of perioperative risks on the older adult patient? Select all that apply

Liver size decreases, reducing the metabolism of anesthetics Ciliary action decreases, reducing cough reflex Fatty tissue increases, prolonging the effects of anesthesia

Which route of medication administration should the nurse consider first after IV removal in a postoperative client with an NPO order?

Rectal

A nurse is working as part of the surgical team in the semi-restricted area. Which of the following would be appropriate to wear? Select all that apply

Scrub clothes Caps

A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis?

Shock

A nurse caring for a patient who is receiving an IV solution via a central vein suspects the complication of an air embolism. Which of the following are signs and symptoms consistent with that diagnosis? Select all that apply.

Tachycardia Dyspnea Cyanosis Shoulder Pain

How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? Select all that apply.

The patient avoids communication with the nurse The patient repeatedly asks questions that have been previously answered The patient talks incessantly Explanation: People express fear in different ways. Some patients may ask repeated questions, regardless of information already shared with them. Others may withdraw, deliberately avoiding communication by reading, watching television, or talking about trivialities. Consequently, the nurse must be empathetic, listen well, and provide information that helps alleviate concerns. If the patient talks about his or her fears, then they are no longer hidden.

A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress because of the pain, the medications, sleep deprivation, and hospital surroundings. Which nursing intervention to treat the client's pain should the nurse question when ordered by the doctor?

Advil for pain management

The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply.

An elevated hematocrit level Electrolyte imbalance

A nurse knows that she mist obtain a signed informed consent for which of the following procedures? Select all that apply.

Arteriography Open reduction of a fracture Cystoscopy Paracentesis Explanation: Informed consent is not currently required for insertion of an intravenous or urethral catheter.

A 76-year-old client had surgery for an abdominal hernia. The PACU nurse observes that the client is confused and is trying to climb out of the bed and pull at the cardiac monitor lines. At this time, what interventions by the nurse are appropriate? Select all that apply.

Assess for hypoxia Assess urine output Reorient the client

Which intervention should the nurse implement during the intraoperative period to protect the client from injury? Select all that apply

Assess the client for allergies Verify scheduled procedure with client Confirm the consent form is signed

The nurse determines that a patient is at risk for the development of thrombophlebitis. What interventions can the nurse provide to prevent this? (Select all that apply.)

Assisting the patient with leg exercises Avoiding placement of pillow or blanket rolls under the patient's knees Encouraging early ambulation

Which action by the nurse indicates understanding of one basic principle of providing effective pain management?

Awakening a new postoperative client to take pain medication

Solu-medrol and prednisone are glucocortico steroids used to prevent or control inflammation in the lungs and airways. As such, which lab value would take priority in the coordination of care for a patient receiving this therapy?

Bedside blood glucose reading of 388 mg/dl

The nurse suspects the client is developing postoperative pneumonia. Which clinical manifestation would support the nurse's conclusion? Select all that apply.

Chills Crackles Tachypnea

A nurse is preparing to insert a peripheral intravenous access device into the arm of a client. When preparing the skin for insertion, which of the following should the nurse use to prevent possible health-care associated bloodstream infections?

Chlorhexidine Explanation: Although povidone-iodine or alcohol may be used, the preferred agent to clean the skin prior to insertion of an intravenous device is chlorhexidine. Normal saline would not be appropriate.

A patient is complaining of a headache after receiving sinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia? Select all that apply.

Degree of patient hydration Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used

The nurse is reviewing a preoperative informed consent when preparing the client for surgery./. Which contents of the informed consent are required? Select all that apply

Explanation of procedure Potential risks Benefits of surgery Description of alternatives Explanation: Informed consents should be in writing and contain an explanation of procedure and risks, description of benefits and alternative, an offer to answer questions about procedure, ability to withdraw consent, and statement informing the client if the protocol differs from customary procedure. An estimated time of procedure and personnel present are not required in the informed consent.

Which factor increases blood urea nitrogen (BUN)?

Gastrointestinal bleeding Explanation: Factors that increase BUN include gastrointestinal bleeding, decreased renal function, dehydration, increased protein intake, fever, and sepsis.

A client is recovering from abdominal surgery. The statement by the client that most indicates the nurse needs to educate the client about pain and pain control is

I should expect to have pain

A client who has developed a painless penile ulcer is diagnosed with syphilis. What treatment would the physician prescribe?

IV penicillin G; single dose Explanation: A single dose of parenterally administered penicillin G is used to treat primary and secondary syphilis.

During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?

Metabolic acidosis

The wife of a client is concerned because her husband is requiring increasingly high doses of analgesia. She states, "He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasn't just raised and raised." What would be the nurse's best response?

Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the client relief.

A nurse would implement droplet precautions for a client with which condition? Select all that apply.

Pertussis Mumps Parvovirus B 19 Explanation: Disorders requiring droplet precautions include pertussis, mumps, and parvovirus B 19. Scabies and viral hemorrhagic infections such as Ebola would require contact precautions.

The nurse is assessing a client for local complications of intravenous therapy. Which are local complications? Select all that apply.

Phlebitis Extravasation Hematoma

A nurse implements aseptic technique as a means to break the chain of infection at which element?

Portal of Entry Explanation: The use of aseptic technique interrupts the chain of infection at the portal of entry. Employee health, environmental sanitation, and disinfection and sterilization interfere with the reservoir element. Hand hygiene, control of secretions, and excretions and proper trash and waste disposal interfere with the portal of exit. Isolation, proper food handling, airflow control, standard precautions, sterilization, and hand hygiene interfere with the means of transmission.

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery?

Post-discharge diet

An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client?

Prevention of respiratory complications Explanation: All answers are correct, but the obese client has an increased susceptibility to respiratory complications, and maintaining a patent airway would be the priority.

The nurse is caring for a young adult client with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in his lower extremities. When creating a nursing care plan for this client, what variables should the nurse consider? Select all that apply.

Prior effectiveness in relieving the pain Client's comorbid conditions type of procedure be performed Changes in neurologic function due to the procedure

An older adult has been medicated with an oral opioid for postoperative pain. To make the pain medication more effective, the nurse first

Provides the client with a fresh gown and bed linens

When assessing a client with infectious diarrhea, which of the following would lead a nurse to suspect that the client is experiencing severe dehydration?

Rapid, thready pulse Explanation: Severe dehydration is manifested by signs of shock such as rapid, thready pulse, cyanosis, cold extremities, rapid breathing, lethargy, and coma. Dry oral mucous membranes and increased thirst suggest mild dehydration. These findings along with sunken eyes suggest moderate dehydration.

The client is postoperative for a right total-knee arthroplasty, and medications include lidocaine 5% (Lidoderm). Past history includes a left mastectomy and herpes zoster following treatment with chemotherapy. The best nursing action is to:

Remove the patch after 12 hours

The nurse is providing an education program to reduce the incidence of infection currently on the rise in the community. What areas should the nurse focus on when presenting this program? Select all that apply.

Sanitation techniques regulated health practices Immunization programs Explanation: Methods of infection prevention include sanitation techniques (e.g., water purification, disposal of sewage and other potentially infectious materials), regulated health practices (e.g., the handling, storage, packaging, and preparation of food by institutions), and immunization programs.

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.

The client must be prepared to take on more self-care than he or she may have done in the past. The client will leave the hospital sooner than in the past Need for teaching is increased Explanation: The increasing use of ambulatory, same-day, or short-stay surgery, means that clients leave the hospital sooner, which increases the need for teaching, discharge planning, preparation for self-care, and referral for home care and rehabilitation services.

The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure?

Up to 2 hours before surgery Explanation: The major purpose of withholding food and fluid before surgery is to prevent aspiration. Until recently, fluid and food were restricted preoperatively overnight and often longer. The American Society of Anesthesiologists reviewed this practice and made new recommendations for people undergoing elective surgery who are otherwise healthy. Specific recommendations depend on the age of the patient and the type of food eaten. For example, adults may be advised to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products. Healthy patients are allowed clear liquids up to 2 hours before an elective procedure (Crenshaw, 2011).

The nurse is caring for a postsurgical client who speaks very little English. How should the nurse most accurately assess this client's pain?

Use a chart with English on one side and the client's native language on the other side so he can rate his pain

When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the folloiwing would the nurse include?

You shouldn't experience a headache after this type of anesthesia