Ch 17-19 (Test 3)
What is the primary advantage of the use of midazolam (Versed) as an adjunct to general anesthesia? a. Amnestic effect b. Analgesic effect c. Antiemetic effect d. Prolonged action
A
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 emergency sprinklers in the operating room. c. Verify that a fire extinguisher is available during surgery. d. Confirm that all electrosurgical equipment is working properly.
A
Which information in the preoperative patient's medication history is most important to communicate to the health care provider? a. The patient takes garlic capsules every day. b. The patient quit using cocaine 10 years ago. c. The patient took a prescribed sedative the previous night. d. The patient uses acetaminophen (Tylenol) for aches and pains.
A
An older patient who had knee replacement surgery 2 days ago can only tolerate being out of bed with physical therapy twice a day. Which collaborative problem should the nurse identify as a priority for this patient? 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
Because of the rapid elimination of volatile liquids used for general anesthesia, what should the nurse anticipate the patient will need early in the anesthesia recovery period? a. Warm blankets b. Analgesic medication c. Observation for respiratory depression d. Airway protection in anticipation of vomiting
B
Which statement, if made by a new circulating nurse, reflects understanding of the circulating nurse role? a. "I will assist in preparing the operating room for the patient." b. "I will don sterile gloves to obtain items from the unsterile field." c. "I will remain gloved while performing activities in the sterile field." d. "I will assist with suturing of incisions and maintaining hemostasis as needed."
A
With what are the postoperative respiratory complications of atelectasis and aspiration of gastric contents associated? a. Hypoxemia b. Hypercapnia c. Hypoventilation d. Airway obstruction
A
Which action could the postanesthesia care unit (PACU) nurse delegate to unlicensed assistive personnel (UAP) who help to transport a patient to the clinical unit? a. Clarify the postoperative orders with the surgeon. b. Help with the transfer of the patient onto a stretcher. c. Document the appearance of the patient's incision in the chart. d. Provide hand off communication to the surgical unit charge nurse.
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 preoperative assessment alerts the nurse that special protection techniques should 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 finding would indicate to the nurse that a postoperative patient is at increased risk for poor wound healing? a. Potassium 3.5 mEq/L b. Albumin level 2.2 g/dL c. Hemoglobin 10.2 g/dL d. White blood cells 11,900/µL
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 patient is ready for discharge from Phase I PACU care to the clinical unit? a. Arouses easily, pulse is 112 BPM, RR is 24, dressing is saturated, SpO2 is 88% b. Awake, VS stable, dressing is dry and intact, no resp depression, SpO2 is 92% c. Difficult to arouse, pulse is 52, RR is 22, dressing is dry and intact, SpO2 is 91% d. Arouses, BP higher than preoperative and RR is 10, no excess bleeding, SpO2 is 90%
B
Which statement by a patient scheduled for surgery is most important to report to the health care provider? 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
Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for an open cholecystectomy? a. Care for the surgical incision b. Deep breathing and coughing c. Oral antibiotic therapy after discharge d. Medications to be used during surgery
B
A patient is transferred from the postanesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed first? a. Assess the patient's pain. b. Orient the patient to the unit. c. Take the patient's vital signs. d. Read the postoperative orders.
C
A patient undergoing an emergency appendectomy has been using St. John's wort to prevent depression. Which complication would the nurse expect in the postanesthesia care unit? a. Increased discomfort b. Increased blood pressure c. Increased anesthesia recovery time d. Increased postoperative wound bleeding
C
A patient who had major surgery is experiencing emotional stress as well as physiologic stress from the effects of surgery. What can this stress cause? a. Diuresis b. Hyperkalemia c. Fluid retention d. Impaired blood coagulation
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 patient's T-tube is draining dark green fluid after gallbladder surgery. What action by the nurse is the most appropriate? a. Notify the patient's surgeon. b. Place the patient on bed rest. c. Document the color and amount of drainage. d. Irrigate the T-tube with sterile normal saline.
C
A postoperative patient has a nursing diagnosis of ineffective airway clearance. The nurse determines that interventions for this nursing diagnosis have been successful if which is observed? 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 100.2°F orally.
C
Which action by the nurse will be most helpful to a patient who is expected to ambulate, deep breathe, and cough on the first postoperative day? a. Schedule the activity to begin after the patient has taken a nap. b. Administer prescribed analgesic medications before the activities. c. Ask the patient to state two possible complications of immobility. d. Encourage the patient to state the purpose of splinting the incision.
B
The nasogastric (NG) tube is removed on the second postoperative day, and the patient is placed on a clear liquid diet. Four hours later, the patient complains of frequent, cramping gas pains. What action by the nurse is the most appropriate? 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
The nurse assesses that the oxygen saturation is 89% in an unconscious patient who was transferred from surgery to the postanesthesia care unit (PACU) 15 minutes ago. Which action should the nurse take first? a. Suction the patient's mouth. b. Increase the oxygen flow rate. c. Perform the jaw-thrust maneuver. d. Elevate the patient's head on two pillows.
C
Which action describes how the scrub nurse protects the patient with aseptic technique during surgery? a. Uses waterproof shoe covers b. Wears personal protective equipment c. Changes gloves after touching the upper arm of the surgeon's gown d. Requires that all operating room (OR) staff perform a surgical scrub
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
While assessing a patient in the PACU, the nurse finds the patient's blood pressure is below the the preoperative baseline. The nurse determines that the patient has residual vasodilating effects of anesthesia when what is assessed? a. A urinary output >30 mL/hr b. An oxygen saturation of 88% c. A normal pulse with warm, dry, pink skin d. A narrowing pulse pressure with normal pulse
C
The nurse is reviewing the laboratory results for a preoperative patient. Which study result should be brought to the attention of the surgeon immediately? a. Serum K+ of 3.8 mEq/L b. Hemoglobin of 15 g/dL c. Blood glucose of 100 mg/dL d. White blood cell (WBC) count of 18,500/uL
D
What does progression of patients through various phases of care in a post-anesthesia care unit (PACU) primarily depend on? a. Condition of patient b. Type of anesthesia used c. Preference if surgeon d. Type of surgical procedure
A
A break in sterile technique during surgery would occur when the scrub nurse touches a. The mask with gloved hands b. Sterile gloves hands to the gown at chest level c. The drape at the incision site with gloved hands d. The lower arms to the instruments on the instrument tray
A
A patient is scheduled for a hemorrhoidectomy at an ambulatory surgery center. An advantage of performing surgery at an ambulatory center is a decreased need for? a. Diagnostic studies and perioperative medications. b. Preoperative and postoperative teaching by the nurse. c. Psychologic support to alleviate fears of pain and discomfort. d. Preoperative nursing assessment related to possible risks and complications.
A
A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of surgery. What response does the nurse expect when the ACP is notified? a. Surgery will be done as scheduled. b. Surgery will be rescheduled for the following day. c. Surgery will be postponed for 8 hours after the fluid intake. d. A nasogastric tube will be inserted to remove the fluids from the stomach.
A
A patient who had knee surgery received IV ketorolac 30 minutes ago and continues to complain of pain at a level of 7 (0 to 10 scale). Which action is most effective for the nurse to take at this time? a. Administer the prescribed PRN IV morphine sulfate. b. Notify the health care provider about the ongoing pain. c. Reassure the patient that postoperative pain is expected after knee surgery. d. Teach the patient that the effects of ketorolac typically last about 6 to 8 hours.
A
A patient who is scheduled for a therapeutic abortion tells the nurse, "Having an abortion is wrong." Which functional health pattern should the nurse further assess? a. Value-belief b. Cognitive-perceptual c. Sexuality-reproductive d. Coping-stress tolerance
A
A postoperative patient has not voided for 8 hours after return to the clinical unit. Which action should the nurse take first? a. Perform a bladder scan. b. Insert a straight catheter. c. Encourage increased oral fluid intake. d. Assist the patient to ambulate to the bathroom.
A
After receiving change-of-shift report about these postoperative patients, which patient should the nurse assess first? a. Obese patient who had abdominal surgery 3 days ago and whose wound edges are separating b. Patient who has 30 mL of sanguineous drainage in the wound drain 10 hours after hip replacement surgery c. Patient who has bibasilar crackles and a temperature of 100° F (37.8 °C) on the first postoperative day after chest surgery d. Patient who continues to have incisional pain 15 minutes after hydrocodone and acetaminophen (Vicodin) was given
A
During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem? a. Obesity b. Dehydration c. Enlarged liver d. Decreased peripheral pulses
A
Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a 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
Patient-Centered Care: A patient who is being admitted to the surgical unit for hysterectomy paces the floor, repeatedly saying, "I just want this over." What should the nurse do to promote a positive surgical outcome for the patient? a. Ask the patient what her specific concerns are about the surgery. b. Redirect the patient's attention to the necessary preoperative preparations. c. Reassure the patient that the surgery will be over soon and she will be fine. d. Tell the patient she should not be so anxious because she is having a common, safe surgery.
A
Priority decision: A patient in the PACU has emergence delirium manifested by agitation and thrashing. What should the nurse assess for first in the patient? a. Hypoxemia b. Neurologic injury c. Distended bladder d. Cardiac dysrhythmias
A
The PACU nurse applies warm blankets to a postoperative patient who is shivering and has a body temp of 96.0. What treatment may also be used to treat the patient? a. Oxygen therapy b. Vasodilating drugs c. Antidysrhythmic drugs d. Analgesics or sedatives
A
The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing? a. Witnessing the patient's signature b. Obtaining informed consent from the patient for the surgery c. Verifying that the consent for surgery is truly voluntary and informed d. Ensuring that the patient is mentally competent to sign he consent form
A
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's father died after general anesthesia for abdominal surgery. b. The patient drinks 3 cups of coffee every morning before going to work. c. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. d. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital.
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 blood pressure and temperature. c. Remind the patient about harmful effects of smoking. d. Ask the health care provider to prescribe a nicotine patch.
A
The nurse is preparing a patient for transport to the operating room. The patient is scheduled for a right knee arthroscopy. What actions should the nurse take at this time (select all hat apply)? a. Ensure that the patient has voided. b. Verify that the informed consent is signed. c. Complete preoperative nursing documentation. d. Verify that the right knee is marked with indelible marker, e. Ensure that the H&P, diagnostic reports, and vital signs are on the chart.
A, B, C, D, E
Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (select all that apply)? a. Garlic b. Fish oil c. Valerian d. Vitamin E e. Astragalus f. Ginkgo biloba
A, B, D, F
What type of procedural information should be given to a patient in preparation for ambulatory surgery (select all that apply)? a. How pain will be controlled b. Any fluid and food restrictions c. Characteristics of monitoring equipment d. What odors and sensations may be experienced e. Technique and practice of coughing and deep breathing, if appropriate
A, B, E
A patient's blood pressure in the postanesthesia care unit (PACU) has dropped from an admission blood pressure of 140/86 to 102/60 mm Hg with a pulse change of 70 to 96 beats/min. SpO2 is 92% on 3 L of oxygen. In which order should the nurse take these actions? (Put a comma and a space between each answer choice [A, B, C, D].) a. Increase 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
While ambulating in the room, a patient complains of feeling dizzy. In what order will the nurse accomplish the following activities? (Put a comma and a space between each answer choice [A, B, C, D].) a. Have the patient sit down in a chair. b. Give the patient something to drink. c. Take the patient's blood pressure (BP). d. Inform the patient's health care provider.
A, C, B, D
A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse's preoperative intervention to maintain patient safety? a. The patient has never had general anesthesia. b. The patient is planning to drive home after surgery. c. The patient had a sip of water 4 hours before arriving. d. The patient's insurance does not cover outpatient surgery.
B
A patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which initial response by the nurse is appropriate? a. "Surgical techniques have improved in recent years." b. "Tell me more about what happened to your mother." c. "You will receive medication to reduce your anxiety." d. "You should talk to the doctor again about the surgery."
B
A patient scheduled to undergo total knee replacement surgery under general anesthesia asks the nurse, "Will the doctor put me to sleep with a mask over my face?" Which response by the nurse is most appropriate? a. "Only your surgeon can tell you what method of anesthesia will be used." b. "I will check with the anesthesia care provider to find out what is planned." c. "General anesthesia is now given by injecting drugs into your veins, so you will not need a mask over your face." d. "Masks are no longer used for anesthesia. A tube will be inserted into your throat to deliver gas that will put you to sleep."
B
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 96%, and recent laboratory results are all normal. Which action by the nurse is most appropriate? a. Increase the IV fluid rate. b. Assess for bladder distention. c. Notify the anesthesia care provider (ACP). d. Demonstrate the use of the nurse call bell button.
B
A patient who has diabetes and uses insulin to control blood glucose has been NPO 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 blood glucose. d. Give half the usual dose of insulin because there will be no oral intake before surgery.
B
A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take? a. Notify the dietitian about the specific food allergies. b. Alert the surgery center about a possible latex allergy. c. Reassure the patient that all allergies are noted on the health record. d. Ask whether the patient uses antihistamines to reduce allergic reactions.
B
A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action should the nurse take first? a. Administer the prescribed opioid. b. Check the oxygen (O2) saturation. c. Take the blood pressure and pulse. d. Apply wrist restraints to secure IV lines.
B
A preoperative patient reveals that an uncle died during surgery because of a fever and cardiac arrest. Knowing the patient is at risk for malignant hyperthermia, the perioperative nurse alerts the surgical team. What is likely to happen next? a. The surgery will have to be cancelled b. Specific precautions can be taken to safely anesthetize the patient c. Dantrolene (Dantrium) must be given to prevent hyperthermia during surgery d. The patient should be placed on a cooling blanket during the surgical procedure
B
Five minutes after receiving the ordered preoperative midazolam 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. b. Offer the patient a urinal or bedpan. c. Ask the patient to wait until the drug has been fully metabolized. d. Tell the patient that a bladder catheter will be placed in the operating room.
B
In the postanesthesia care unit (PACU), a patient's vital signs are blood pressure 116/72 mm Hg, pulse 74 beats/min, respirations 12 breaths/min, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take first? a. Place the patient in a side-lying position. b. Encourage the patient to take deep breaths. c. Prepare to transfer the patient to a clinical unit. d. Increase the rate of the postoperative IV fluids.
B
The nurse assesses a patient who had a total abdominal hysterectomy 2 days ago. Which information about the patient is most important to communicate to the health care provider? a. The patient's temperature is 100.3° F (37.9° C). b. The patient's calf is swollen, warm, and painful. c. The 24-hour oral intake is 600 mL greater than the total output. d. The patient reports abdominal pain at level 6 (0 to 10 scale) when ambulating.
B
The nurse facilitates student clinical experiences in the surgical suite. Which action, if performed by a student, would require the nurse to intervene? a. The student wears a mask in the semirestricted area. b. The student wears street clothes in the semirestricted area. c. The student wears surgical scrubs in the semirestricted area. d. The student covers head and facial hair in the semirestricted area.
B
The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I don't understand what the doctor said about the surgery." Which action should the nurse take next? a. Provide a thorough explanation of the planned surgical procedure. b. Notify the surgeon that the informed consent process is not complete. c. Give the prescribed preoperative antibiotics and withhold sedative medications. d. Notify the operating room nurse to give a more complete explanation of the procedure.
B
The nurse working in the postanesthesia care unit (PACU) notes that a patient who has just been transported from the operating room is shivering and has a temperature of 96.5° F (35.8° C). Which action should the nurse take next? a. Notify the anesthesia care provider. b. Cover the patient with a warm blanket. c. Avoid giving opioid analgesics until the patient is warmer. d. Give acetaminophen (Tylenol) 650 mg suppository rectally.
B
To prevent agitation during the patient's recovery from anesthesia, when should the nurse begin orientation explanations? a. When the patient is awake b. When the patient first arrives in the PACU c. When the patient becomes agitated or frightened d. When the patient can be aroused and recognizes where he or she is
B
What condition should the nurse anticipate that may occur during epidural and spinal anesthesia? a. Spinal headache b. Hypotension and bradycardia c. Loss of consciousness d. Downward extension of nerve block
B
What is included in the routine assessment of the patients cardiovascular function on admission to the PACU? a. Monitoring arterial blood gas b. ECG monitoring c. Hypoventilation d. Airway obstruction
B
What is the physical environment of a surgery suite primarily designed primarily to promote? a. Electrical safety b. Medical and surgical asepsis c. Comfort and privacy of the patient d. Communication among the surgical team
B
What is the rationale for using preoperative checklists on the day of surgery? a. The patient is correctly identified and preoperative medications administered. b. All preoperative orders and procedures have been carried out and documented. c. Voiding is the last procedure before the patient is transported to the operating room. d. Patients' families have been informed as to where they can accompany and wait for patients.
B
When caring for a patient the second postoperative day after abdominal surgery for removal of a large pancreatic cyst, the nurse obtains an oral temperature of 100.8° F (38.2° C). Which action should the nurse take next? a. Place ice packs in the patient's axillae. b. Have the patient use the incentive spirometer. c. Request an order for acetaminophen (Tylenol). d. Ask the health care provider to prescribe a different antibiotic.
B
When transporting an inpatient to the surgical department, the nurse from another area of the hospital is able to access which area? a. Sterile core b. Holding area c. Corridors of the surgical suite d. Unprepared operating room
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 closely monitored after surgery.
B
For which nursing diagnoses or collaborative problems common in post-op patients has ambulation been found to be an appropriate intervention (SELECT ALL THAT APPLY) a. Impaired skin integrity r/t incision b. Impaired mobility r/t decreased muscle strength c. Risk for aspiration r/t decreased muscle strength d. Ineffective airway clearance r/t decreased respiratory excursion e. Constipation r/t decreased physical activity and impaired GI motility f. Venous thromboembolism r/t dehydration, immobility, vascular manipulation, or injury
B, D, E, F
A 38-yr-old woman is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to communicate to the anesthesiologist and surgeon before surgery? a. The patient's lack of knowledge about postoperative pain control b. The patient's history of an infection following a cholecystectomy c. The patient's report that her last menstrual period was 8 weeks ago d. The patient's concern about being able to resume lifting heavy items
C
A common reason that a nurse may need extra time when preparing older adults for surgery is their a. Ineffective coping b. Limited adaptation to stress c. Diminished vision and hearing d. Need to include caregivers in activities.
C
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
An experienced nurse orients a new nurse to the postanesthesia care unit (PACU). Which action by the new nurse, if observed by the experienced nurse, indicates that the orientation was successful? a. The new nurse assists a nauseated patient to a supine position. b. The new nurse positions an unconscious patient supine with the head elevated. c. The new nurse positions an unconscious patient on the side upon arrival in the PACU. d. The new nurse places a patient in the Trendelenburg position for a low blood pressure.
C
An older patient is being discharged from the ambulatory surgical unit following left eye surgery. The patient tells the nurse, "I don't know if I can take care of myself once I'm home." Which action by the nurse is most appropriate? a. Provide written instructions for the care. b. Assess the patient's home support system. c. Discuss specific concerns regarding self-care. d. Refer the patient for home health care services.
C
During surgery, a patient has a nursing diagnosis of risk for perioperative positioning injury. What is a common risk factor for this nursing diagnosis? a. Skin lesions b. Break in sterile technique c. Musculoskeletal deformities d. Electrical or mechanical equipment failure
C
How is the initial information given to the PACU nurses about the surgical pt? a. A copy of the written operative report b. A verbal report from the circulating nurse c. A verbal report from the anesthesia care provider (ACP) d. An explanation of the surgical procedure from the surgeon
C
In addition to ambulation, which nursing intervention could be implemented to prevent or treat the postoperative complication of syncope? a. Monitor vital signs after ambulation. b. Do not allow the patient to eat before ambulation. c. Slowly progress to ambulation with slow changes in position. d. Have the patient deep breathe and cough before getting out of bed.
C
On admission of a patient to the postanesthesia care unit (PACU), the blood pressure (BP) is 122/72 mm Hg. Thirty minutes after admission, the BP is 114/62, with a pulse of 74 and warm, dry skin. Which action by the nurse is most appropriate? a. Increase the IV fluid rate. b. Notify the anesthesia care provider (ACP). c. Continue to take vital signs every 15 minutes. d. Administer oxygen therapy at 100% per mask.
C
Priority Decision: When the nurse asks a preoperative patient about allergies, the patient reports a history of seasonal environmental allergies and allergies to a variety of fruits. What should the nurse do next? a. Note this information int he patient's record as hay fever and food allergies. b. Place an allergy alert wristband that identifies the specific allergies on the patient. c. Ask the patient to describe the nature and severity of any allergic responses experienced from these agents. d. Notify the anesthesia care provider (ACP) because the patient may have an increased risk for allergies to anesthetics.
C
Priority decision: To promote effective coughing, deep breathing, and ambulation in the postoperative patient, it is most important for the nurse to do? a. Teach the pt controlled breathing b. Explain the rationale for these activities c. Provide adequate and regular pain medication d. Use an incentive spirometer to motive the pt
C
Priority decision: Upon admission of a patient to the PACU, the nurse's priority assessment is? a. VS b. Surgical site c. Respiratory adequacy d. LOC
C
The nurse is caring for a patient the first postoperative day following a laparotomy for a small bowel obstruction. The nurse notices new bright-red drainage about 5 cm in diameter on the dressing. Which action should the nurse take first? a. Reinforce the dressing. b. Apply an abdominal binder. c. Take the patient's vital signs. d. Recheck the dressing in 1 hour.
C
The nurse is preparing a patient on the morning of surgery. The patient refuses to remove a wedding ring, saying, "I've never taken it off since the day I was married." Which response by the nurse is best? a. Have the patient sign a release form and leave the ring on. b. Tell the patient that the hospital is not liable for loss of the ring. c. Suggest that the patient give the ring to a family member to keep. d. Inform the operating room personnel that the patient is wearing a ring.
C
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. Teach the patient that these products may be continued preoperatively. b. Advise the patient to stop the use of herbs and supplements at this time. c. Discuss the herb and supplement use with the patient's health care provider. d. Reassure the patient that there will be no interactions with anesthetic agents.
C
The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife 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 all 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
The operating room nurse is providing orientation to a student nurse. Which action would the nurse list as a major responsibility of a scrub nurse? a. Document all patient care accurately. b. Label all specimens to send to the laboratory. c. Keep both hands above the operating table level. d. Take the patient to the postanesthesia recovery area.
C
The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery. The results are white blood cell (WBC) count 10.2 103/µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/µL. Which action should the nurse take? a. Notify the surgeon and anesthesiologist immediately. b. Ask the patient about any symptoms of a recent infection. c. Continue to prepare the patient for the surgical procedure. d. Discuss the possibility of blood transfusion with the patient.
C
What is the primary goal of the circulating nurse during preparation of the operating room, transferring and positioning the patient, and assisting the anesthesia team? a. Avoiding any type of injury to the patient b. Maintaining a clean environment for the patient c. Providing for patient comfort and sense of well being d. Preventing breaks in aseptic technique by the sterile members of the team
C
What should be included in the instructions given to the post-op patient before discharge? a. Need for follow-up care with home care nurses b. Directions for maintaining routine post-op diet c. Written information about self-caring during recuperation d. Need to restrict all activity until surgical healing is complete
C
Which action best describes the role of the certified registered nurse anesthetist (CRNA) on the surgical care team? a. Performs the same responsibilities as the anesthesiologist. b. Gives intraoperative anesthetics ordered by the anesthesiologist. c. Releases or discharges patients from the postanesthesia care area. d. Manages a patient's airway under the direct supervision of the anesthesiologist.
C
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.
Which tubes drain gastric contents (SELECT ALL THAT APPLY)? a. T-tube b. Penrose c. Nasogastric tube d. Indwelling catheter e. Gastrointestinal tube
C, E
When caring for a preoperative patient on the day of surgery, which actions included in the plan of care 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
A patient has received atropine before surgery and complains of dry mouth. Which action by the nurse is most appropriate? a. Check for skin tenting. b. Notify the health care provider. c. Ask the patient about any weakness or dizziness. d. Explain that 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. Complaint of nausea c. Disorientation to time d. Weak chest movement
D
The nurse assesses a patient on the second postoperative day after abdominal surgery to repair a perforated duodenal ulcer. Which finding is most important for the nurse to report to the surgeon? a. Tympanic temperature 99.2° F (37.3° C) b. Fine crackles audible at both lung bases c. Redness and swelling along the suture line d. 200 mL sanguineous fluid in the wound drain
D
At the end of the surgical procedure, the perioperative nurse evaluates the patient's response to the nursing care delivered during the perioperative period. What reflects a positive outcome related to the patient's physical status? a. The patient's right to privacy is maintained b. The patient's care is consistent with the perioperative plan of care c. The patient receives consistent and comparable care regardless of the setting d. The patient's respiratory function is consistent with or improved from baseline levels established preoperatively.
D
During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic studies? a. ECG and chest x-ray b. Serum glucose and CBC c. ABGs and coagulation tests d. BUN, serum creatinine, and electrolytes
D
Goals for patient safety in the operating room (OR) include the Universal Protocol. What is included in this protocol? a. All surgical centers of any type must submit reports on patient safety infractions to the accreditation agencies b. Members of the surgical team stop whatever they are doing to check that all sterile items have been properly prepared c. Members of the surgical team pause right before surgery to meditate for 1 minute to decrease stress and possible errors. d. A surgical timeout is performed just before the procedure is started to verify patient identity, surgical procedure, and surgical site.
D
Monitored anesthesia care (MAC) is being considered for a patient undergoing a cervical dilation and endometrial biopsy in health care provider's office. The patient asks the nurse, "What is the MAC?" The nurse's response is based on the knowledge that MAC a. Can be administered only by anesthesiologists or nurse anesthetists. b. Should never be used outside of the OR because of the risk of serious complications. c. Is so safe that it can be administered by nurses with direction from health care providers. d. Provides maximum flexibility to match the sedation level with the patient and procedure needs.
D
Postoperatively, the nurse should monitor the patient who received inhalation anesthesia for which complication? a. Tachypnea b. Myoclonus c. Hypertension d. Laryngospasm
D
The health care provider has ordered IV morphine q2-4hrs PRN for a patient following major abdominal surgery. When should the nurse plan to administer the morphine? a. Before all planned painful activities b. Every two to 4 hours during the first 48 hours c. Every 4 hours as the patient requests the medication d. After assessing the nature and intensity of the patient's pain
D
The patient will be placed under moderate sedation to allow realignment of a fracture in the emergency department. When the family asks about this anesthesia, what should the nurse tell them? a. Includes inhalation agents b. Induces high levels of sedation c. Frequently used for traumatic injuries d. Patients remain responsive and breathe without assistance
D
Thirty-six hours postoperatively, a patient has a temperature of 100 degrees. What is most likely cause this temperature elevation? a. Dehydration b. Wound infection c. Lung congestion and atelectasis d. Normal surgical stress response
D
To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious, what will the nurse do? A. Encourages deep breathing. B. Elevates the head of the bed. C. Administers oxygen per mask. D. Positions the patient in a side-lying position.
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 drainage is drained with a Hemovac? a. Bile b. Urine c. Gastric contents d. Wound drainage
D
Which short-acting barbiturate is most commonly used for induction of general anesthesia? a. Nitrous oxide b. Propofol (Diprivan) c. Isoflurane (Forane) d. Methohexital (Brevital)
D
Which procedures are done for curative purposes (select all that apply)? a. Gastroscopy b. Rhinoplasty c. Tracheotomy d. Hysterectomy e. Herniorrhaphy
D,E
The nurse notes drainage on the surgical dressing when the patient is transferred from the PACU to the clinical unit. In what order of priority should the nurse perform the following actions? Number the options in order. a. Reinforce the surgical dressing (2nd) b. Change the dressing and assess the wound as ordered (5th) c. Notify the surgeon of excessive drainage type and amount (4th) d. Recall the report from PACU for the number and type of drains in use (1st) e. Note and record the type, amount, and color and odor of the drainage (3rd)
a. 2 b. 5 c. 4 d. 1 e. 3
