Chapter 17, 18
Which action should the perioperative nurse take to best protect the patient from burn injury during surgery?a.Ensure correct placement of the grounding pad. b.Check all emergency sprinklers in the operating room. C. Verify that a fire extinguisher is available during surgery D. Confirm that all electro surgical equipment has been properly serviced.
A
Which information in the preoperative patient's medication history is most important to communicate to the health care provider before surgery? a. The patient takes garlic capsules every day. b. The patient quit using cocaine 10 years ago. c. The patient uses acetaminophen for aches and pains. d. The patient took a prescribed sedative the previous night.
A
Which statement, if made by a new circulating nurse, is appropriate? a.I will assist in preparing the operating room for the patient. b.I will remain gloved while performing activities in the sterile field. c.I will assist with suturing of incisions and maintaining hemostasis as needed. d.I must don full surgical attire and sterile gloves while obtaining items from the unsterile field
A
The nurse is providing preoperative teaching to a group of patients. Which patient should the nurse plan to teach coughing and deep breathing exercises? A. A 20-yr-old man who is scheduled for a tonsillectomy B. A 40-yr-old woman who is scheduled for an open cholecystectomy C. A 30-yr-old woman who is scheduled for a transsphenoidal hypophysectomy D. A 50-yr-old man who is scheduled for an evacuation of a subdural hematoma
B
Which action in the perioperative patient plan of care can the charge nurse delegate to a surgical technologist? a. Teach the patient about what to expect in the operating room (OR). b. Pass sterile instruments and supplies to the surgeon and scrub technician. c. Monitor and interpret the patient's echocardiogram (ECG) during surgery. d. Give the postoperative report to the postanesthesia care unit (PACU) nurse.
B
Which data identified during the perioperative assessment alert the nurse that special protection techniquesshould be implemented during surgery? a.Stated allergy to cats and dogs b.History of spinal and hip arthritis c.Verbalization of anxiety by the patient d.Having a sip of water 3 hours previously
B
Which nursing action should the operating room (OR) nurse manager delegate to the registered nurse first assistant (RNFA) when caring for a surgical patient? a. Adjust the doses of administered anesthetics. b. Make surgical incisions and suture as needed. c. Provide postoperative teaching about coughing. d. Coordinate transfer of the patient to the operating table.
B
Which preoperative patient has the greatest risk of bleeding as a result of prescribed medication? A. A woman who takes metoprolol for the treatment of hypertension. B. A man who is taking clopidogrel after the placement of a coronary artery stent. C. A man whose type 1 diabetes is controlled with insulin injections four times daily. D. A man who recently started taking finasteride for the treatment of benign prostatic hyperplasia.
B
Which statement by a patient scheduled for knee surgery is most important to report to the health care provider before surgery? a. "I have a strong family history of cancer." b. "I had a heart valve replacement last year." c. "I had bacterial pneumonia 3 months ago." d. "I have knee pain whenever I walk or jog."
B
A patient requests that the nurse give his hearing aid to a family member so it will not be lost in surgery. What is the appropriate action by the nurse? A. Give the hearing aid to the wife as he wishes. B. Tape the hearing aid to his ear to prevent loss. C. Encourage the patient to wear it for the surgery. D. Tell the surgery nurse that he has his hearing aid out.
C
A patient undergoing an emergency appendectomy has been using St. Johns wort to prevent depression. Which complication would the nurse expect in the postanesthesia care unit? A. Increased pain B. Hypertensive episodes C. Longer time to recover from anesthesia D. Increased risk for postoperative bleeding
C
A patient who takes a diuretic and a -blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery? a. Hematocrit 36% b. Blood pressure 144/82 c. Serum potassium 3.2 mEq/L d. Pulse rate 54-58 beats/minute
C
A pre operative client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse? A. If it's any help, everyone is nervous before surgery B. I will be happy to explain the entire surgical procedure to you C. Can you share with me what you've been told about your surgery D. Let me tell you about the care you'll receive after surgery and the amount of pain you can expect.
C
The nurse educator facilitates student clinical experiences in the surgical suite. Which action, if performedby a student, would require the nurse educator to intervene? a.The student wears a mask at the sink area. b.The student wears street clothes in the unrestricted area. c.The student wears surgical scrubs in the semirestricted area. d.The student covers head and facial hair in the semirestricted area
C
Which action most effectively demonstrates that a new staff member understands the role of scrub nurse? 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 are
C
Which action will the perioperative nurse take after surgery is completed for a patient who received ketamine as an anesthetic agent? a. Question the order for giving a benzodiazepine. b. Ensure that atropine is available in case of bradycardia. c. Provide a quiet environment in the postanesthesia care unit. d. Anticipate the need for higher than usual doses of analgesic agents.
C
Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for abdominal surgery for an open cholecystectomy? 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
A 17-yr-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
A 59-yr-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 surgery.
A
A patient arrives at the ambulatory surgery center for a scheduled laparoscopy procedure in outpatient surgery. Which information is of most concern to the nurse? A. Patient is planning to drive home after surgery. B. Patient had a sip of water 4 hours before arriving. C. Patients insurance does not cover outpatient surgery. D. Patient has not had surgery using general anesthia before.
A
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
A patient scheduled to undergo total knee replacement surgery under general anesthesia asks the nurse, Willthe doctor put me to sleep with a mask over my face? Which response by the nurse is most appropriate? a.A drug may be given to you through your IV line first. I will check with the anesthesia careprovider. 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
Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a patient's dislocated shoulder. What action does the nurse anticipate? a. Starting an IV in the patient's unaffected arm b. Securing an airtight fit for the inhalation mask c. Preparing for placement of an epidural catheter d. Giving deep sedation under physician supervision
A
A patient who is scheduled for a therapeutic abortion tells the nurse, Having an abortion is not right. Which functional health pattern should the nurse further assess? a. Value-belief b. Cognitive-perceptual C. Sexuality-reproductive d. Coping-stress tolerance
A
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
Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? A. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. B. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. C. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. D. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.
A
The nurse has just reassessed the condition of a post operative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? A. Urinary output of 20 ml / hr B. 2. Temperature of 37.6 ° C ( 99.6 ° F ) C.Blood pressure of 100/70 mm Hg D. Serous drainage on the surgical dressing
A
The nurse is teaching a client about coughing and deep-breathing techniques to prevent postoperative complications. Which statement is most appropriate for the nurse to make to the client at this time as it relates to these techniques? A. Use of an incentive spirometer will help prevent pneumonia B. Close monitoring of your oxygen saturation will detect hypoxemia. C. Administration of intravenous fluids will prevent or treat fluid imbalance. D. Early ambulation and administration of blood thinners will prevent pulmonary embolism.
A
The surgical unit nurse has just received a patient with a history of smoking from the postanesthesia care unit. Which action is most important at this time? A. Auscultate for adventitious breath sounds. B. Obtain the patients blood pressure and temperature. C. Remind the patient about harmful effects of smoking. D. Ask the health care provider about prescribing a nicotine patch.
A
A 38-year-old female is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? A. The patients lack of knowledge about postoperative pain control measures B. The patients statement that her last menstrual period was 8 weeks previously C. The patients history of a postoperative infection following a prior cholecystectomy D. The patients concern that she will be unable to care for her children postoperatively
B
A patient being admitted to the same-day surgery unit informs the nurse they took kava last evening to sleep. Which nursing action would be most appropriate? A. Tell the patient that using kava to help sleep is often helpful. B. Inform the anesthesia care provider of the patient's recent use of kava. C. Tell the patient that the kava should continue to help the patient to relax before surgery. D. Inform the patient about the dangers of taking herbal medicines without consulting a health care provider.
B
A patient informs the nurse prior to the surgical procedure that she is so nervous about the procedure and had to take alprazolam (Xanax) last night, but it did not relieve the anxiety. What is the priority action by the nurse? A. Review the surgery with the patient. B. Notify the anesthesia care provider (ACP). C. Administer another dose of alprazolam (Xanax). D. Tell the patient that everything will be okay with the surgery.
B
A patient who has diabetes and uses insulin to control blood glucose has been NO since midnight before having a knee replacement surgery. Which action should the nurse take 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 D. Administer a lower dose of insulin because there will be no oral intake before surgery.
B
A patient who has never had any prior surgeries tells the nurse doing the preoperative assessment about an allergy to bananas and avocados. Which action is most important for the nurse to take? a. Notify the dietitian about the food allergies. b. Alert the surgery center about a possible 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 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 surgery. The best response would be to have her a. skip her insulin altogether the night before 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 usual insulin dose.
B
Five minutes after receiving the ordered preoperative midazolam (Versed) by IV injection, the patient asks to get up to go to the bathroom to urinate. Which action by the nurse is most appropriate? 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 medication onset is 10 minutes. D. Ask the patient to wait because catheterization is performed just before the surgery.
B
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 stam that the surgeon needs to give a more complete explanation of the procedure
B
The patient tells the nurse in the 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 the 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
Which action best describes the role of the certified registered nurse anesthetist (CRNA) on the surgical careteam? a.Performs the same responsibilities as the anesthesiologist. b.Releases or discharges patients from the postanesthesia care area. c.Administers intraoperative anesthetics ordered by the anesthesiologist. d.Manages a patients airway under the direct supervision of the anesthesiologist
B
While in the holding area, a patient reveals to the nurse that his father had a high fever after surgery. What action by the nurse is a priority? a. Place a medical alert sticker on the front of the patient's chart. b. Alert the anesthesia care provider of the family member's reaction to surgery. c. Give 650 mg of acetaminophen (Tylenol) per rectum as a preventive measure. d. Reassure the patient that his temperature will be monitored closely after surgery.
B
A patient in the surgical holding area is being prepared for a spinal fusion. Which action by a member of the surgical team requires immediate 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 the operating room with hair uncovered d. Putting on a surgical mask, cap, and scrubs before entering the operating room
C
The nurse in an ambulatory surgery center has administered the following preoperative medications to a patient scheduled for general surgery: diazepam, cefazolin, and famotidine. What mode of transportation to the operating room (OR) would be the most appropriate for the nurse to arrange for this patient? A. Seated in a wheelchair accompanied by a responsible family member. B. Ambulatory and accompanied by a hospital escort and a family member. C. Stretcher with side rails up and accompanied by OR transportation personnel. D. Ambulatory accompanied by an OR staff member or transportation personnel.
C
The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 cups of coffee every day. b. The patient stopped taking aspirin 10 days ago. c. The patient's father died after general anesthesia for abdominal surgery. d. The patient drank 4 ounces of apple juice 6 hours before coming to the hospital.
C
The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes; weighs 146 kg; and is 5 feet 8, inches tall. Which patient assessment is a priority related to anesthesia? A. Hemoglobin A1C of 8.5% B. Several seasonal allergies C. A body mass index of 48.8 kg/m2 D. A history of postoperative vomiting
C
The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits His wife usually answers most questions that are 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 patients wife to wait in the hall in order to focus preoperative teaching with the patient himself
C
While performing preoperative teaching, the patient asks when he is no longer able to eat or drink. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, what is the best response by the nurse? A. "Stay NPO after midnight." B. "Maintain NPO status until after breakfast." C. "You may drink clear liquids up to 2 hours before surgery." D. "You may drink clear liquids up until she is moved to the OR."
C
When caring for a preoperative patient on the day of surgery, which actions can the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) a. Teach incentive spirometer use. b. Explain routine preoperative care. c. Obtain and document baseline vital signs. d. Remove nail polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room.
C, D, E
Which actions will the nurse include in the surgical time-out procedure before surgery (Select all that apply.)? a. Check for patency of IV lines. b. Have the surgeon identify the patient. c. Have the patient state name and date of birth. d. Verify the patient identification band number. e. Ask the patient to state the surgical procedure.
C, D, E
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,D
A client with a gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse should take which most appropriate action in the care of this client? A. Obtain a court order for the surgery. B. Have the charge nurse sign the informed consent immediately. C. Send the client to surgery without the consent form being signed. D. Obtain a telephone consent from a family member following agency policy.
D
A patient has received atropine betore surgery and complains of dry mouth. Which action by the nurse IS best? A. Check for skin tenting B. Notify the health care provider C. Ask the patient about any dizziness D. Tell the patient dry mouth is an expected side effect
D
A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. While in the postanesthesia care unit (PACU), what assessment finding is most important for the nurse to report? a. Lethargy b. Report of nausea c. Disorientation to time d. Weak chest movement
D
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 medications. c. Proceed with the preoperative checklist, including site identification. d. Notify the anesthesia care provider of when and what the patient last ate.
D
A patient received inhalation anesthesia during surgery. Postoperatively the nurse should monitor the patientfor which complication?a.Tachypnea b.Myoclonus c.Hypertension D. Laryngospasm
D
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
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. Which response by the nurse is best? A. Have the patient sign a release and leave the ring on. B. Tape the wedding ring securely to the patients 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
D
The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. The patient reports use of garlic and ginkgo biloba. Which action by the nurse is most appropriate? A. Ascertain that there will be no interactions with anesthetic agents. B. Teach the patient that these products may be continued preoperatively. C. Advise the patient to stop the use of all herbs and supplements at this time. D. Discuss the herb and supplement use with the patients health care provider.
D
The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery in a few days. The results are white blood cell (WBC) count 10.2 10°/L; hemoglobin 15 g/dL: hematocrit 45%: platelets 150 103/L. Which action should the nurse take? A. Cal the surgeon and anesthesiologist immediate v B. Ask the patient about any symptoms of a recent infection C. Discuss the possibility of blood transfusion with the patient D. Send the patient to the holding area when the operating room calls
D
When caring for a patient who has received a general anesthetic, the circulating nurse notes red, raised wheals on the patient's arms. Which action should the nurse take? a. Apply lotion to the affected areas. b. Cover the arms with sterile drapes. c. Recheck the patient's arms during surgery. d. Notify the anesthesia care practitioner (ACP).
D
Which action best describes how the scrub nurse maintains aseptic technique during surgery? surgery? a.Uses waterproof shoe covers b.Wears personal protective equipment C. Insists that all operating room (OR) staff perform a surgical scrub D. Changes gloves after touching the upper arm of the surgeons gown.
D
An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What information should the nurse include in the patient's preoperative teaching? (Select all that apply.) A. Various options for reconstructive surgery B. The risks and benefits of her particular surgery C. Risk factors for breast cancer and the role of screening D. Where in the hospital she will be taken after surgery is over E. How to perform postoperative deep-breathing and coughing exercises
D, E