Perioperative adaptive quizzing

A client is scheduled for gastrointestinal surgery. Which is the MOST important nursing action that would be implemented the evening before surgery? a) reviewing the client's pain history b) ensuring the client's bowel preparation is initiated c) discussing the importance of postoperative activity restrictions d) reviewing postoperative comfort measure strategies

b) ensuring the client's bowel preparation is initiated Rationale: It is essential that the gastrointestinal tract be cleansed in preparation for surgery

The nurse is caring for an infant who is to undergo surgery for hypertrophic pyloric stenosis (HPS). Which clinical scenario would the nurse recognize as important for surgical success? a) vomiting is not yet severe and projectile b) fluid and electrolyte imbalances are corrected c) small feedings of thickened formula are tolerated d) amount of drainage from gastric decompression is sufficient

b) fluid and electrolyte imbalances are corrected

The nurse is caring for a client who has just received epidural anesthesia. The nurse would monitor for which adverse effects? a) uterine atrophy b) hypotension c) decreased urine production d) precipitous second stage of labor

b) hypotension

Postoperative arterial blood gas values for a client in the postanesthesia care unit are pH 7.32, PaCO2 53 mmHg, HCO3 25 mEq/L, and PaO2 85 mmHg. Which action would the nurse take? a) plan to send the client to the medical-surgical unit b) ask the anesthesiologist to consider reintubation c) encourage the client to take deep breaths and cough d) increase the oxygen flow rate from 4 to 6 L/minute

c) encourage the client to take deep breaths and cough Rationale: Elevated PaCO2 and low pH are due to hypoventilation caused by general anesthesia

Which finding for a client who has just returned to the nursing unit after bronchoscopy and lung biopsy would be MOST important to report to the health care provider? a) client arousable, but lethargic b) cough productive of bloody mucus c) heart rate 126 beats per minute d) client report of dry and sore throat

c) heart rate 126 beats per minute Rationale: Tachycardia may indicate hemorrhage

Which complications would the nurse consider in a client who just had a total hip replacement and is experiencing restlessness and changes in mentation? a) bladder spasms b) polycythemia vera c) hypovolemic shock d) pulmonary hypertension

c) hypovolemic shock Rationale: These signs occur with hypovolemic shock because less blood is being circulated to vital centers in the brain

Which is the first sign that would assist the nurse in suspecting malignant hyperthermia in a client? a) abnormal rapid heart rate b) abnormal rapid breathing c) increased body temperature d) increased expired carbon dioxide

d) increased expired carbon dioxide Rationale: caused by an abnormal and continuous contraction of the skeletal muscles

After undergoing minor surgery, a postoperative child has recovered from anesthesia. Which observations alert the nurse the child may be ready for discharge? SELECT ALL THAT APPLY a) vital signs are stable b) temperature is 101F/38C c) pain rate is at baseline level d) the child is alert and oriented e) oxygen saturation is 75% on room air

a) vital signs are stable c) pain rate is at baseline level d) the child is alert and oriented

Nursing actions after a client has had general anesthesia are directed at preventing which postoperative respiratory complication? a) pleural effusion b) empyema c) pneumothorax d) atelectasis

d) atelectasis Rationale: This occurs after general anesthesia because of decreased respiratory depth and resulting collapse of alveoli

A postoperative client says to the nurse, "The person in the next room sings all night and keeps me awake." The client in the next room has dementia and is awaiting transfer to a nursing home. How can the nurse handle the situation? a) tell the next door client to stop singing b) close the doors to both clients' rooms at night c) give the complaining client the prescribed as-needed sedative d) move the postoperative client to a room at the end of the hall

d) move the postoperative client to a room at the end of the hall

Which action would the nurse plan to take to prevent aspiration in a client who has just returned to the nursing unit after bronchoscopy? a) administer oxygen through a nasal cannula b) have the client rest in the supine position c) suction oral secretions at frequent intervals d) withhold food until the gag reflex returns

d) withhold food until the gag reflex returns

After an acute episode of upper gastrointestinal (GI) bleeding, a client vomits undigested medications and reports severe epigastric and abdominal pain. The client has absent bowel sounds, rigid abdomen, a pulse rate of 134, and shallow respirations of 32 per minute. The primary health care provider has been contacted. Which action would the nurse take next? a) keep the client nothing by mouth (NPO) b) teach the client about coughing and deep-breathing exercises c) inquire whether any red or black stools have been noted d) place the client in the supine position with the legs elevated

a) keep the client nothing by mouth (NPO) Rationale: The assessment findings are classic indicators of a perforated ulcer, for which immediate surgery is indicated; this should be anticipated. Keeping the client NPO is necessary.

Which action would the circulating nurse classify as a priority during surgery? SELECT ALL THAT APPLY a) protecting client's privacy b) assessing blood loss and urine c) monitoring ventilation for nonintubated clients d) monitoring the level of anesthesia provided to the client e) providing supplies and equipment on the basis of the surgical team's needs

a) protecting client's privacy b) assessing blood loss and urine e) providing supplies and equipment on the basis of the surgical team's needs

As a part of an informed consent, a surgeon explains the details of the surgery and related care to the client. The nurse leader witnesses the complete process. The nurse leader would ensure the surgeon provided which information to the client? SELECT ALL THAT APPLY a) surgical procedure b) name of the surgeon c) explanation of the possible risks d) anesthetic medication used during preoperation e) name of the staff members who will be in the surgery

a) surgical procedure b) name of the surgeon c) explanation of the possible risks

A client who wakes up after a surgery spits out the oral airway placed during the recovery from anesthesia. What would this behavior indicate to the nurse? a) their gag reflex has returned b) they are confused due to anesthesia c) they are nauseated and want to vomit d) their airway is becoming obstructed

a) their gag reflex has returned

A client is likely to undergo reconstructive surgery for which purpose? a) to restore function and/or appearance b) to replace an organ or tissue c) to relieve or reduce symptoms d) to remove or excise an organ or tissue

a) to restore function and/or appearance

Which perioperative actions would the nurse plan when caring for a client scheduled for a septoplasty? SELECT ALL THAT APPLY a) teach the client how to use hot compresses b) encourage the client to quit smoking before surgery c) observe the surgical site for edema d) teach the client about postsurgery activities that are restricted e) assess the client's respiratory status f) encourage the client to take aspirin before surgery

b) encourage the client to quit smoking before surgery c) observe the surgical site for edema d) teach the client about postsurgery activities that are restricted e) assess the client's respiratory status

Which action by an unlicensed assistive personnel (UAP) who is assisting with the care of a client who just returned to the nursing unit after laryngoscopy indicates that the nurse needs to intervene? a) raises the head of the client's bed b) offers a breakfast tray to the client c) asks whether the client's throat is painful d) checks the client's oxygen (O2) saturation using pulse oximetry

b) offers a breakfast tray to the client Rationale: the gag reflex is diminished by the anesthesia, oral intake should not be offered until the nurse has assessed for return of the gag reflex

The nurse understands which group of the pediatric population is at a higher risk for developing respiratory complications upon administration of general anesthesia? a) infants b) children c) neonates d) adolescents

c) neonates

The nurse notes a client's blood pressure of 200/110 mmHg and swelling of the operative leg after a femoropopliteal bypass graft. Which action would the nurse take NEXT? a) evaluate the client's orientation b) check pedal pulses distal to the graft c) notify the client's health care provider d) monitor blood pressure every 15 minutes

c) notify the client's health care provider Rationale: Because the high blood pressure and leg swelling indicate possible graft leaking or rupture, the nurse would immediately notify the health care provider.

A female client is scheduled for a hysterectomy. While discussing the preoperative preparations, the nurse determines that the client's understanding of the surgery is inadequate. Which nursing intervention would be performed? a) describing the proposed surgery to the client b) proceeding with the preoperative plan c) notifying the surgeon that the client needs more information d) explaining gently to the client that she should have asked more questions

c) notifying the surgeon that the client needs more information

Which action would the nurse take FIRST when doing preoperative teaching for a client who is scheduled for a total laryngectomy? a) arrange for a speech therapist visit b) provide an explanation of the surgery c) develop a plan for communication after surgery d) ask what questions the client has about the procedure

d) ask what questions the client has about the procedure Rationale: The first action when preparing to teach a client is to assess the client's current knowledge level and client priorities for learning

Which initial action would the nurse take when obtaining consent for surgery? a) describe the risks involved in the surgery b) explain that obtaining the signature is routine for any surgery c) witness the client's signature, which the nurse's signature will document d) determine whether the client's knowledge level is sufficient to give consent

d) determine whether the client's knowledge level is sufficient to give consent Rationale: informed consent means that the client must comprehend the surgery, the alternatives, and the consequences

Which assessment finding would be important for the nurse to report to the health care provider when caring for a client who is in the postanesthesia care unit after receiving general anesthesia? a) attempting to push the airway out b) unresponsive to verbal stimulation c) respirations at 16 breaths/minute and unlabored d) systolic blood pressure decrease from 130 mmHg to 90 mmHg

d) systolic blood pressure decrease from 130 mmHg to 90 mmHg

A client who was admitted to the hospital with metastatic cancer has a temperature of 100.4 F, a distended abdomen, and abdominal pain. The client asks the nurse, "Do you think that I will need to have surgery?" How would the nurse respond? a) "You seem concerned about having surgery" b) "Some people with your problem do have surgery" c) "I'll find out for you. Your record will show if surgery is scheduled" d) "I don't know about any surgery. You'll have to ask your health care provider"

a) "You seem concerned about having surgery"

Which client statement would cause the nurse to stop the health care provider from initiating epidural anesthesia? a) 'I'm not exactly sure how an epidural works" b) "I understand that the epidural might or might not take my pain away" c) "I signed the consent form for an epidural at my last clinic appointment" d) "I'm aware that the epidural could cause my contractions to slow down"

a) 'I'm not exactly sure how an epidural works"

Which PRIORITY intervention would the nurse follow when caring for a client with malignant hyperthermia? SELECT ALL THAT APPLY a) administer 100% oxygen b) prepare for endotracheal intubation c) monitor the core body temperature d) stop all inhalation anesthetic agents e) insert an indwelling urinary catheter

a) administer 100% oxygen b) prepare for endotracheal intubation d) stop all inhalation anesthetic agents

A client is transferred to an acute care nursing unit after surgery. Which action of the nurse is MOST important and would be performed first? a) assess the patency of airway b) ask if the client is comfortable c) determine the level of consciousness d) review the order for intravenous fluids

a) assess the patency of airway

Which technique would the nurse use to maintain surgical asepsis? a) change the sterile field after sterile water is spilled on it b) put on sterile gloves before opening a container of sterile saline c) place a sterile dressing no more than half an inch from the edge of the sterile field d) clean the surgical area with a circular motion, moving from the outer edge toward the center

a) change the sterile field after sterile water is spilled on it

Which action would the nurse take to properly prepare the site for insertion when assessing a client's forearm for a potential intravenous (IV) catheter insertion site reveals an excessive amount of hair? a) clip the hair b) shave the area c) apply a securement device d) prepare the skin with a protectant solution

a) clip the hair

When performing a client's postoperative assessment, which parameter would alert the nurse to a common side effect of epidural anesthesia? a) decreased blood pressure b) increased oral temperature c) diminished peripheral pulses d) unequal bilateral breath sounds

a) decreased blood pressure

Which action will the nurse anticipate needing to take when a client develops hypotension immediately after receiving spinal anesthesia? a) increase intravenous flow rate b) reschedule the surgical procedure c) have the client move the extremities d) infuse the medication to increase heart rate

a) increase intravenous flow rate Rationale: hypotension is common after spinal anesthesia because of blood vessel dilation. Increasing IV fluids will correct the hypotension.

Which statement by the nurse regarding anesthetic drugs in pediatric clients require correction? a) "Pediatric clients are more affected by anesthesia than adults" b) "During general anesthesia, the upper airway obstruction risk is less in pediatrics" c) "Cardiac abnormalities are more common in pediatric clients receiving anesthesia" d) "The central nervous system pf pediatric clients is more sensitive to the effects of anesthetics"

b) "During general anesthesia, the upper airway obstruction risk is less in pediatrics"

Which actions will the nurse take when 100mL of blood is noted in the drainage system for a client who has just returned to the nursing unit after a radical neck dissection? SELECT ALL THAT APPLY a) notify the health care provider b) elevate the lower extremities c) obtain pulse and blood pressure d) suction the client's tracheostomy e) remove dressings and check incision

a) notify the health care provider c) obtain pulse and blood pressure

A client newly diagnosed with cancer of the pancreas is scheduled for surgery. The client asks the nurse, "Don't you think that some other treatment would be better than surgery?" How would the nurse respond? a) "It's a good idea to explore other acceptable treatments for your cancer. There is information available for you" b) "Surgery is the recommended approach. Perhaps you should discuss this further with the health care provider" c) "Maybe you will be more confident with a second option. I think you need a referral to another health care provider" d) "With your disease, your prognosis will improve if you follow the suggestion to have the recommended surgery"

b) "Surgery is the recommended approach. Perhaps you should discuss this further with the health care provider"

A complete blood count (CBC). urinalysis, and x-ray examination of the chest are prescribed for a client before surgery. The client asks why these tests are done. Which reply by the nurse is BEST? a) "Don't worry, these tests are routine" b) "They are done to identify health risks" c) "They determine whether surgery will be safe" d) "I don't know, your health care provider prescribed them"

b) "They are done to identify health risks"

Within how many hours after a surgical procedure requiring general anesthesia would the nurse expect a client to void? a) 4 hours b) 8 hours c) 10 hours d) 12 hours

b) 8 hours

Which items would the nurse include in assessment of the integumentary system for a preoperative client? SELECT ALL THAT APPLY a) inspect the neck for distended veins b) assess the skin turgor for signs of dehydration c) examine the skin for rashes or lesions d) question the client about any skin disorders e) palpate the chest for heaves or lifts

b) assess the skin turgor for signs of dehydration c) examine the skin for rashes or lesions d) question the client about any skin disorders

In which position would the nurse place a sedated client recovering from general anesthesia? a) supine b) side-lying c) high fowler d) trendelenburg

b) side-lying Rationale: Turning the client to the side promotes drainage of secretions and prevents aspiration, especially when the gag reflex is not intact

Which nursing assessment is a PRIORITY after a client undergoes an endarterectomy in a lower extremity? a) appetite b) skin color c) bowel habits d) tissue turgor

b) skin color Rationale: After removal of an arterial obstruction by endarterectomy, adequate circulation should be monitored by assessing bilateral pulses, skin color, and skin temperature.

The nurse is providing preoperative education to a client scheduled for orthopedic surgery at 8:00 AM the next day. Which instruction would the nurse include? a) "Have your dinner completed by 6:00 PM tonight and then no food or fluids after that" b) "Drink whatever fluids you want tonight and then only clear liquids tomorrow morning" c) "Consume a light evening meal tonight and then no food or liquids after midnight" d) "Eat lunch today and then do not drink or eat anything until after your surgery"

c) "Consume a light evening meal tonight and then no food or liquids after midnight"

Which response by the nurse asked "How will they 'knock me out' for this colonoscopy?" describes the route of administration for conscious sedation? a) "The medicine will be injected into your spine" b) "You will receive the anesthesia through a face mask" c) "You will receive medication through an intravenous (IV) catheter" d) "We will give you an oral medication about 1 hour before the procedure"

c) "You will receive medication through an intravenous (IV) catheter"

A client with a history of recurrent cholecystitis is scheduled for an abdominal cholecystectomy. Which would the nurse specifically emphasize when planning preoperative teaching for this client? a) possible complications b) food and fluid restrictions c) coughing and deep breathing d) isometric exercises of the extremities

c) coughing and deep breathing

Which finding on the first postoperative day after a client has an open reduction and internal fixation of a fractured hip will be MOST important to report to the health care provider? a) client report of level 8 incisional pain b) 50 mL of deep red drainage in wound drainage device c) swelling and redness in the calf of the operative leg d) client oral temperature elevation to 100.2 F

c) swelling and redness in the calf of the operative leg Rationale: Calf swelling and redness after orthopedic surgery suggests possible venous thrombosis and the nurse would immediately notify the provider

Which route of administration will be used to deliver conscious sedation to a client during a cardiac catheterization? a) via a face mask b) into the epidural space c) through an intravenous catheter d) around the nerves innervating the chest wall

c) through an intravenous catheter

A health care team is caring for a client with dental pain. Which task can be delegated to the unlicensed assistive personnel (UAP) to provide effective client care? a) administering analgesics b) administering intravenous antibiotics c) administering nerve block anesthesia d) administering mouthwash for oral hygiene

d) administering mouthwash for oral hygiene

Which action is the PRIORITY when the preoperative nurse learns that a client is taking several herbal supplements? a) provide the client with information about the usefulness of herbal therapies b) inform the client about taking supplemental vitamins rather than herbs c) teach the client about herbal supplements d) ask the client which herbs have been taken

d) ask the client which herbs have been taken

A child's blood test after receiving a general anesthetic indicates increased intracellular calcium levels. Which medication would the nurse anticipate administering to this client? a) aspirin b) naproxen c) ibuprofen d) dantrolene

d) dantrolene

Which action would the nurse take FIRST after noting stridor in a client who just arrived in the postanesthesia care unit (PACU) after receiving a general anesthetic? a) have the client cough b) check respiratory rate c) auscultate breath sounds d) notify the health care provider

d) notify the health care provider Rationale: Indicates laryngeal swelling and airway obstruction

The nurse would primarily focus on which concept when providing preoperative teaching? a) helping the client and family decide if surgery is necessary b) providing emotional support to the client and family c) giving specific details of the surgery to the client and family d) providing general information to reduce client and family anxiety

d) providing general information to reduce client and family anxiety