Perioperative Care Quiz
A patient who is just waking up after having a general anesthetic is agitated and confused. Which action should the nurse take first? a.Check the O2 saturation. b.Administer the ordered opioid. c.Take the blood pressure and pulse. d.Notify the anesthesia care provider.
a
A patient with a dislocated shoulder is prepared for a closed, manual reduction of the dislocation with monitored anesthesia care (MAC). The nurse anticipates the administration of: a.IV midazolam (Versed). b.inhaled desflurane (Suprane). c.epidural lidocaine (Xylocaine). d.eutectic mixture of local anesthetics (EMLA).
a
A patient's family history reveals that the patient may be at risk for malignant hyperthermia (MH) during anesthesia. The nurse explains to the patient that: a.anesthesia can be administered with minimal risks with the use of appropriate precautions and medications. b.as long as succinylcholine (Anectine) is not administered as a muscle relaxant, the reaction should not occur. c.surgery must be performed under local anesthetic to prevent development of a sudden, extreme increase in body temperature. d.surgery will be delayed until the patient is genetically tested to determine whether he or she is susceptible to malignant hyperthermia.
a
A preoperative patient in the holding area asks the nurse, "Will the doctor put me to sleep with a mask over my face?" The most appropriate response by the nurse is, a."A drug will be given to you through your IV line, which will cause you to go to sleep almost immediately." b."Only your surgeon can tell you for sure what method of anesthesia will be used. Should I ask your surgeon?" c."General anesthesia is now given by injecting medication into your veins, so you will not need a mask over your face." d."Masks are not used anymore for anesthesia. A tube will be inserted into your throat to deliver a gas that will put you to sleep."
a
Any patient guilt about having a therapeutic abortion may be identified when the nurse assesses the functional health pattern of: a.value-belief. b.cognitive- perceptual. c.sexuality-reproductive. d.coping-stress tolerance.
a
During the preoperative interview, a patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which response by the nurse is most appropriate? a. "Tell me more about what happened to your mother." b. "You will receive medications to reduce your anxiety." c. "You should talk to the doctor again about the surgery." d. "Surgical techniques have improved a lot in recent years."
a
On the day of surgery, the nurse is admitting a patient with a history of cigarette smoking. Which action is most important at this time? a.Auscultate for adventitious breath sounds. b.Ask whether the patient has smoked recently. c.Remind the patient about harmful effects of smoking. d.Calculate the cigarette smoking history in pack-years.
a
The clinic nurse reviews the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results are white blood cell count (WBC) 10.2 × 103/µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 × 103/µL. Which action should the nurse take? a.Send the CBC results to the surgery facility. b.Call the surgeon and anesthesiologist immediately. c.Ask the patient about any symptoms of a recent infection. d.Discuss the possibility of blood transfusion with the patient.
a
The nurse is obtaining the health history for a patient who is scheduled for outpatient knee surgery. Which statement by the patient is most important to report to the health care provider? a."I had a heart valve replacement last year." b."I had bacterial pneumonia 6 months ago." c."I have knee pain whenever I walk or jog." d."I have a strong family history of breast cancer."
a
When caring for a patient during the second postoperative day after abdominal surgery, the nurse obtains an oral temperature of 100.8° F. Which action should the nurse take first? a.Have the patient use the incentive spirometer. b.Assess the surgical incision for redness and swelling. c.Administer the ordered PRN acetaminophen (Tylenol). d.Notify the patient's health care provider about the fever.
a
Which action should the postanesthesia care unit (PACU) nurse delegate to nursing assistive personnel (NAP) who help with the transfer of a patient to the surgical unit? a.Help with the transfer of the patient onto a stretcher. b.Give a verbal report to the surgical unit charge nurse. c.Document the appearance of the patient's incision in the chart. d.Ensure that the receiving nurse understands the postoperative orders.
a
Which description best defines the role of the nurse anesthetist as a member of the surgical team? a.Functions independently in the administration of anesthetics b.Has the same credentials and responsibilities as an anesthesiologist c.Is responsible for intraoperative administration of anesthetics ordered by the anesthesiologist d.Requires supervision by the anesthesiologist or surgeon while administering anesthesia to a patient
a
Which nursing action should the operating room (OR) nurse manager delegate to the registered nurse first assistant (RNFA)? a.Make surgical incisions and suture incisions as needed. b.Coordinate transfer of the patient to the operating table. c.Provide postoperative teaching about coughing to the patient. d.Set up instrument tables at the beginning of the surgical procedure.
a
While caring for a patient who had abdominal surgery on the second postoperative day, which information about the patient is most important to communicate to the health care provider? a.The right calf is swollen, warm, and painful. b.The patient's temperature is 100.3° F (37.9° C). c.The 24-hour oral intake is 600 ml greater than the total output. d.The patient complains of abdominal pain at level 6 (0-10 scale).
a
A patient's blood pressure in the PACU has dropped from an admission blood pressure of 138/84 to 100/58 with a pulse change of 68 to 94. SpO2 is 98% on 3L of oxygen. In which order should the nurse take these actions? Put a comma and space between each answer choice (a, b, c, d, etc.) ____________________ a. Raise the IV infusion rate. b. Assess the patient's dressing. c. Increase the oxygen flow rate. d. Check the patient's temperature.
a, c, b, d
A 36-year-old woman is admitted for an outpatient surgery. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? a.The patient's lack of knowledge about postoperative pain control measures b.The patient's statement that her last menstrual period was 8 weeks previously c.The patient's history of a postoperative infection following a prior cholecystectomy d.The patient's concern that she will be unable to care for her children postoperatively
b
A 42-year-old patient is recovering from anesthesia in the postanesthesia care unit (PACU). On admission to the PACU, the blood pressure (BP) is 124/70. Thirty minutes after admission, the blood pressure falls to 112/60, with a pulse of 72 and warm, dry skin. The most appropriate action by the nurse at this time is to: a.increase the rate of the IV fluid replacement. b.continue to take vital signs every 15 minutes. c.administer oxygen therapy at 100% per mask. d.notify the anesthesia care provider (ACP) immediately.
b
A 75-year-old is to be discharged from the ambulatory surgical unit following left eye surgery. The patient tells the nurse, "I do not know if I can take care of myself with this patch over my eye." The most appropriate nursing action is to: a.refer the patient for home health care services. b.discuss the specific concerns regarding self-care. c.give the patient written instructions regarding care. d.assess the patient's support system for care at home.
b
A diabetic patient who uses insulin to control blood glucose has been NPO since midnight before having a mastectomy. The nurse will anticipate the need to: a.withhold the usual scheduled insulin dose because the patient is NPO. b.obtain a blood glucose measurement before any insulin administration. c.give the patient the usual insulin dose because stress will increase the blood glucose. d.administer a lower dose of insulin because there will be no oral intake before surgery.
b
A patient arrives at the ambulatory surgery center for a scheduled outpatient surgery. Which information is of most concern to the nurse? a.The patient has not had outpatient surgery before. b.The patient is planning to drive home after surgery. c.The patient's insurance does not cover outpatient surgery. d.The patient had a glass of water a few hours before arriving.
b
A patient is seen at the health care provider's office several weeks before hip surgery for preoperative assessment. The patient reports use of echinacea, saw palmetto, and glucosamine/chondroitin. The nurse should: a.ascertain that there will be no interactions with anesthetic agents. b.discuss the supplement use with the patient's health care provider. c.teach the patient that these products may be continued preoperatively. d.advise the patient to stop the use of all herbs and supplements at this time.
b
A patient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take? a.Notify the dietitian about the food allergies. b.Alert the surgery center about the latex allergy. c.Reassure the patient that all allergies are noted on the medical record. d.Ask whether the patient uses antihistamines to reduce allergic reactions.
b
A postoperative patient has not voided for 7 hours after return to the postsurgical unit. Which action should the nurse take first? a.Notify the surgeon. b.Perform a bladder scan. c.Assist the patient to ambulate to the bathroom. d.Insert a straight catheter as indicated on the PRN order.
b
An 83-year-old who had a surgical repair of a hip fracture 2 days previously has restrictions on ambulation. Based on this information, the nurse identifies the priority collaborative problem for the patient as: a.potential complication: hypovolemic shock. b.potential complication: venous thromboembolism. c.potential complication: fluid and electrolyte imbalance. d.potential complication: impaired surgical wound healing.
b
As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." The nurse should: a.have the patient sign a release and leave the ring on. b.tape the wedding ring securely to the patient's finger. c.tell the patient that the hospital is not liable for loss of the ring. d.suggest that the patient give the ring to a family member to keep.
b
Before the administration of preoperative medications, the nurse is preparing to witness the patient signing the operative consent form when the patient says, "I do not really understand what the doctor said." Which action is best for the nurse to take? a.Provide an explanation of the planned surgical procedure. b.Notify the surgeon that the informed consent process is not complete. c.Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. d.Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.
b
Data that were obtained during the perioperative nurse's assessment of a patient in the preoperative holding area that would indicate a need for special protection techniques during surgery include: a.a stated allergy to cats and dogs. b.a history of spinal and hip arthritis. c.verbalization of anxiety by the patient. d.having a sip of water 2 hours previously.
b
During recovery from anesthesia in the postanesthesia care unit (PACU), a patient's vital signs are blood pressure 118/72, pulse 76, respirations 12, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take at this time? a.Place the patient in a side-lying position. b.Encourage the patient to take deep breaths. c.Prepare to transfer the patient from the PACU. d.Increase the rate of the postoperative IV fluids.
b
Ten minutes after receiving the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. The most appropriate action by the nurse is to: a.assist the patient to the bathroom and stay with the patient to prevent falls. b.offer a urinal or bedpan and position the patient in bed to promote voiding. c.allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes. d.ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.
b
When a patient is transferred from the postanesthesia care unit (PACU) to the clinical surgical unit, the first action by the nurse on the surgical unit should be to: a.assess the patient's pain. b.take the patient's vital signs. c.read the postoperative orders. d.check the rate of the IV infusion.
b
When the nurse caring for a patient before surgery has a question about a sedative medication to be given before sending the patient to the surgical suite, the nurse will communicate with the: a.surgeon. b.anesthesiologist. c.circulating nurse. d.registered nurse first assistant (RNFA).
b
Which information about medication use in a preoperative patient is most important to communicate to the health care provider? a.The patient uses acetaminophen (Tylenol) occasionally for aches and pains. b.The patient takes garlic capsules daily but did not take any on the surgical day. c.The patient has a history of cocaine use but quit using the drug over 10 years ago. d.The patient took a sedative medication the previous night to assist in falling asleep.
b
Which of these actions included in the perioperative patient plan of care can the perioperative nurse delegate to a surgical technologist? a.Complete the patient's admission assessment. b.Pass sterile instruments and supplies to the surgeon. c.Teach the patient about what to expect in the operating room (OR). d.Give the postoperative report to the postanesthesia care unit (PACU) nurse.
b
While caring for a patient with abdominal surgery the first postoperative day, the nurse notices new bright-red drainage about 6 cm in diameter on the dressing. In response to this finding, the nurse should first: a.reinforce the dressing. b.take the patient's vital signs. c.recheck the dressing in 1 hour for increased drainage. d.notify the patient's surgeon of a potential hemorrhage.
b
A patient complains of dizziness when ambulating in the room on the first postoperative day. In what order will the nurse accomplish the following activities? (All the activities are appropriate.) Put a comma and space between each answer choice (a, b, c, d, etc.) ____________________ a. Take the patient's blood pressure (BP). b. Have the patient sit down in a chair. c. Give the patient something to drink. d. Notify the patient's health care provider.
b, a, c, d
A patient is to receive atropine before surgery. The nurse teaches the patient to expect: a.dizziness. b.weakness. c.dry mouth. d.forgetfulness
c
After a new nurse has been oriented to the postanesthesia care unit (PACU), the charge nurse will evaluate that the orientation has been successful when the new nurse: a.places a patient in the Trendelenburg position when the blood pressure (BP) drops. b.assists a patient to the prone position when the patient is nauseated. c.turns an unconscious patient to the side when the patient arrives in the PACU. d.positions a newly admitted unconscious patient supine with the head elevated.
c
After orienting a new staff member to the scrub nurse role, the nurse preceptor will know that the teaching was effective if the new staff member: a.documents all patient care accurately. b.labels all specimens to send to the lab. c.keeps both hands above the operating table level. d.takes the patient to the postanesthesia recovery area.
c
After removal of the nasogastric (NG) tube on the second postoperative day, the patient is placed on a clear liquid diet. Four hours later, the patient complains of sharp, cramping gas pains. Which action should the nurse take? a.Reinsert the NG tube. b.Give the PRN IV opioid. c.Assist the patient to ambulate. d.Place the patient on NPO status.
c
An alert 82-year-old who has poor hearing and vision is receiving preoperative teaching from the nurse. His wife answers most questions directed to the patient. Which action should the nurse take when doing the teaching? a.Use printed materials for instruction so that the patient will have more time to review the material. b.Direct the teaching toward the wife because she is the obvious support and caregiver for the patient. c.Provide additional time for the patient to understand preoperative instructions and carry out procedures. d.Ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.
c
During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. John's Wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may a.experience increased pain. b.have hypertensive episodes. c.take longer to recover from the anesthesia. d.have more postoperative bleeding than expected.
c
Following gallbladder surgery, a patient's T-tube is draining dark green fluid. Which action should the nurse take? a.Place the patient on bed rest. b.Notify the patient's surgeon. c.Document the color and amount of drainage. d.Irrigate the T-tube with sterile normal saline.
c
In intervening to promote ambulation, coughing, deep breathing, and turning by a postoperative patient on the first postoperative day, which action by the nurse is most helpful? a.Discuss the complications of immobility and poor cough effort. b.Teach the patient the purpose of respiratory care and ambulation. c.Administer ordered analgesic medications before these activities. d.Give the patient positive reinforcement for accomplishing these activities.
c
The nurse evaluates that the interventions for the nursing diagnosis of ineffective airway clearance in a postoperative patient have been successful when the: a.patient drinks 2 to 3 L of fluid in 24 hours. b.patient uses the spirometer 10 times every hour. c.patient's breath sounds are clear to auscultation. d.patient's temperature is less than 100.4° F orally.
c
The nurse from the general surgical unit is asked to bring the patient's hearing aid to the surgical suite. The nurse will take the hearing aid to the: a.clean core. b.scrub sink areas. c.nursing station or information desk. d.corridors of the operating room area.
c
Which action by an inexperienced member of the surgical team requires rapid intervention by the charge nurse? a.Wearing street clothes into the nursing station b.Wearing a surgical mask into the holding room c.Walking into the hallway outside an operating room without the hair covered d.Putting on a surgical mask, cap, and scrubs before entering the operating room
c
Which action will the nurse include in the plan of care immediately after surgery for a patient who received ketamine (Ketalar) as an anesthetic agent? a.Administer larger doses of analgesic agents. b.Monitor for severe slowing of the heart rate. c.Provide a quiet environment in the postanesthesia care unit. d.Avoid the use of benzodiazepines in the postoperative period.
c
Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for a colon resection? a.Care for the surgical incision b.Medications used during surgery c.Deep breathing and coughing techniques d.Oral antibiotic therapy after discharge home
c
When preparing the patient for surgery, which actions will the nurse include in the surgical time-out procedure (select all that apply)? a.Check for placement of IV lines. b.Have the surgeon identify the patient. c.Confirm the hospital chart identification (ID) number. d.Have the patient state name and date of birth. e.Ask the patient to state the surgical procedure. f.Verify the patient ID band number.
c, d, e, f
A 24-year-old who takes a diuretic and a β-blocker to control blood pressure is scheduled for abdominal surgery. Which patient information is most important to communicate to the health care provider before surgery? a.Pulse rate 59 b.Hematocrit 35% c.Blood pressure 142/78 d.Serum potassium 3.3 mEq/L
d
A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. At completion of the surgery, it is most important that the nurse monitor the patient for a.nausea. b.confusion. c.bronchospasm. d.weak chest-wall movement.
d
A patient who has begun to awaken after 30 minutes in the postanesthesia care unit (PACU) is restless and shouting at the nurse. The patient's oxygen saturation is 99%, and recent lab results are all normal. Which action by the nurse is most appropriate? a.Insert an oral or nasal airway. b.Notify the anesthesia care provider. c.Orient the patient to time, place, and person. d.Be sure that the patient's IV lines are secure.
d
A surgical patient received a volatile liquid as an inhalation anesthetic during surgery. Postoperatively the nurse should monitor the patient for: a.tachypnea. b.myoclonia. c.hypertension. d.incisional pain.
d
The nurse notes that the oxygen saturation is 88% in an unconscious patient who was transferred to the postanesthesia care unit (PACU) 10 minutes previously. Which action should the nurse take first? a.Elevate the patient's head. b.Suction the patient's mouth. c.Increase the oxygen flow rate. d.Perform the jaw-thrust maneuver.
d
The perioperative nurse encourages a family member or a friend to remain with a patient in the preoperative holding area until the patient is taken into the operating room primarily to: a.ensure the proper identification of the patient before surgery. b.protect the patient from cross-contamination with other patients. c.assist the perioperative nurse to obtain a complete patient history. d.help relieve the stress of separation for the patient and significant others.
d
When the nurse interviews a patient who is to have outpatient surgery using a general anesthetic, which information is most important to communicate to the surgeon and anesthesiologist before surgery? a.The patient drinks 3 or 4 cups of coffee every morning before going to work. b.The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. c.The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. d.The patient's father died after receiving general anesthesia for abdominal surgery.
d
Which action will the scrub nurse use to maintain aseptic technique during surgery? a.Use waterproof shoe covers. b.Wear personal protective equipment. c.Insist that all operating room (OR) staff perform a surgical scrub. d.Change gloves after touching the upper arm of the surgeon's gown.
d
Which outcome measure will be best for the operating room (OR) nurse manager to use in determining the effectiveness of the physical environment and traffic control measures in the operating room? a.Smooth functioning of the OR team b.Effective protection of patient privacy c.Rapid completion of surgical procedure d.Low incidence of perioperative infection
d
