Med Surg, Pre-Op, Intra-Op, Post-Op Review Questions
Pre - Op Questions
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18. 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 patients father died after receiving general anesthesia for abdominal surgery.
ANS: D The information about the patients father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.
Intra-operative Care Questions
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Post-Op Questions
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A patients 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 patients dressing. c. Increase the oxygen flow rate. d. Check the patients temperature.
ANS: A, C, B, D The first nursing action should be to increase the IV infusion rate. Since the most common cause of hypotension is volume loss, the IV rate should be increased. The next action should be to increase the oxygen flow rate to maximize oxygenation of hypoperfused organs. Because hemorrhage is a common cause of postoperative volume loss, the nurse should check the dressing. Finally, the patient should be assessed for vasodilation caused by rewarming.
1. 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 patients blood pressure (BP). b. Have the patient sit down in a chair. c. Give the patient something to drink. d. Notify the patients health care provider.
ANS: B, A, C, D The first priority for the patient with syncope is to prevent a fall, so the patient should be assisted to a chair. Assessment of the BP will determine whether the dizziness is due to orthostatic hypotension, which occurs because of hypovolemia. Increasing the fluid intake will help prevent orthostatic dizziness. Because this is a common postoperative problem that is usually resolved through nursing measures such as increasing fluid intake and making position changes more slowly, there is no urgent need to notify the health care provider.
17. 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.
ANS: A A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patients knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surgery.
16. 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 patients health care provider about the fever.
ANS: A A temperature of 100.8 F in the first 48 hours is usually caused by atelectasis, and the nurse should have the patient cough and deep breathe. This problem may be resolved by nursing intervention, and therefore notifying the health care provider is not necessary. Acetaminophen will reduce the temperature, but it will not resolve the underlying respiratory congestion. Because evidence of wound infection does not usually occur before the third postoperative day, assessment of the incision is not likely to be useful.
6. 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.
ANS: A Abnormal breath sounds may indicate the presence of an acute respiratory infection or chronic lung disease that will affect the choice of anesthesia and/or proceeding with the scheduled surgery. The other nursing actions also are appropriate but will not affect the immediate surgical procedure as much as the presence of abnormal breath sounds.
13. 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.
ANS: A Emergence delirium may be caused by a variety of factors. However, the nurse should first assess for hypoxemia. The other actions also may be appropriate, but are not the best initial action.
13. A patients 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.
ANS: A General anesthesia can be administered to patients with MH as long as precautions to avoid MH are taken and preparations are made to treat MH if it does occur. Other factors besides succinylcholine administration are associated with MH. Predictions about whether MH will occur based on family history are inconsistent, and it may not be possible to delay surgery.
11. 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).
ANS: A IV sedatives such as the benzodiazipines are administered for MAC. Inhaled, epidural, and topical agents are not included in MAC.
18. 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 patients 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).
ANS: A The calf pain, swelling, and warmth suggest that the patient has a deep vein thrombosis, which will require health care provider orders for diagnostic tests and anticoagulants. Because the stress response causes fluid retention for the first 2 to 5 days postoperatively, the difference between intake and output is expected. A temperature elevation to 100.3 F on the second postoperative day suggests atelectasis, and the nurse should have the patient deep breathe and cough. Pain with ambulation is normal, and the nurse should administer the ordered analgesic before patient activities.
2. 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
ANS: A The certified registered nurse anesthetist (CRNA) is independently responsible for all aspects of the administration of anesthetic agents. Although the responsibilities of a CRNA and an anesthesiologist have some overlap, the credentialing and roles are different. No supervision by a health care provider is necessary during anesthetic administration by a CRNA. The CRNA assesses the patient and makes the choice of anesthetic agent.
8. 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.
ANS: A The first step in general anesthesia is the injection of an intravenous (IV) induction agent, which rapidly induces sleep. The anesthesiologist (not the surgeon) determines the method of anesthesia used. Masks may still be used for inhalation, although many patients are intubated. Total IV anesthesia may be used for some patients but inhalation anesthetics also are commonly used.
14. 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/L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/L. 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.
ANS: A The nurse should be sure that the CBC results, which are normal, are available at the surgical facility to avoid delay of the procedure. With normal results, there is no need to notify the surgeon or anesthesiologist, discuss blood transfusion, or ask about recent infection.
1. 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.
ANS: A The patients statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. The other statements also may address the patients concerns, but further assessment is needed first.
16. 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.
ANS: A The role of the RNFA includes skills such as making and suturing incisions and maintaining hemostasis. The other actions should be delegated to other staff members such as the circulating nurse, scrub nurse, or surgical technician.
10. 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 patients incision in the chart. d. Ensure that the receiving nurse understands the postoperative orders.
ANS: A The scope of practice for nursing assistants includes repositioning and moving patients under the supervision of an RN. Providing report to another RN, assessing and documenting the wound appearance, and clarifying physician orders with another RN require RN level education and scope of practice.
4. 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.
ANS: A The value-belief pattern includes information about conflicts between a patients values and proposed medical care. In the cognitive-perceptual pattern, the nurse will ask questions about pain and sensory intactness. The sexuality-reproductive pattern includes data about the impact of the surgery on the patients sexuality. The coping-stress tolerance pattern assessment will elicit information about how the patient feels about the surgery.
15. 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 patients vital signs. c. recheck the dressing in 1 hour for increased drainage. d. notify the patients surgeon of a potential hemorrhage.
ANS: B New bright-red drainage may indicate hemorrhage, and the nurse should initially assess the patients vital signs for tachycardia and hypotension. The surgeon should then be notified of the drainage and the vital signs. The dressing may be changed or reinforced, based on the surgeons orders or institutional policy. The nurse should not wait an hour to recheck the dressing.
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.
ANS: B A slight drop in postoperative BP with a normal pulse and warm, dry skin indicates normal response to the residual effects of anesthesia and requires only ongoing monitoring. Hypotension with tachycardia and/or cool, clammy skin would suggest hypovolemic or hemorrhagic shock and the need for notification of the ACP, increased fluids, and high-concentration oxygen administration.
2. 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 patients insurance does not cover outpatient surgery. d. The patient had a glass of water a few hours before arriving.
ANS: B After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patients experience with outpatient surgery is assessed, but it does not have as much application to the patients physiologic safety. The patients insurance coverage is important to establish, but this is not usually the nurses role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration.
11. 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 patients pain. b. take the patients vital signs. c. read the postoperative orders. d. check the rate of the IV infusion.
ANS: B Because the priority concerns after surgery are airway, breathing, and circulation, the vital signs are assessed first. The other actions should take place after the vital signs are obtained and compared with the vital signs before transfer.
19. 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.
ANS: B Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.
13. 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.
ANS: B Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.
10. 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).
ANS: B The anesthesiologist is responsible for prescribing preoperative medications. The RNFA and surgeon are responsible for the surgery, but not for the preoperative sedation. The circulating nurse does not have authority to make a change in any medication.
17. Which of these actions included in the perioperative patient plan of care can the perioperative nurse delegate to a surgical technologist? a. Complete the patients 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.
ANS: B The education and certification for a surgical technologist includes the scrub and circulating functions in the OR. Patient teaching, communication with other departments about a patients condition, and the admission assessment require RN level education and scope of practice.
14. 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.
ANS: B The initial action should be to assess the bladder for distention. If the bladder is distended, providing the patient with privacy (by walking with them to the bathroom) will be helpful. Catheterization should only be done after other measures have been tried without success because of the risk for urinary tract infection. There is no indication to notify the surgeon about this common postoperative problem unless all measures to empty the bladder are unsuccessful.
7. A patient is seen at the health care providers 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 patients 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.
ANS: B The nurse should discuss the medication use with the patients health care provider because saw palmetto is used to decrease prostatic hyperplasia, and the patient may need to continue taking the medication or a prescription medication to prevent urinary retention. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anesthetics is not within the nurses scope of practice.
4. 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 patients support system for care at home.
ANS: B The nurses initial action should be to assess exactly the patients concerns about self-care. Referral to home health care and assessment of the patients support system may be appropriate actions but will be based on further assessment of the patients concerns. Written instructions should be given to the patient, but these are unlikely to address the patients stated concern about self-care.
12. 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.
ANS: B The patient is older and relatively immobile, two risk factors for development of deep vein thrombosis. The other potential complications are possible postoperative problems, but they are not supported by the data about this patient.
10. 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.
ANS: B The patient will be at risk for a fall after receiving the opioid, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.
6. Data that were obtained during the perioperative nurses 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.
ANS: B The patient with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety and having a sip of water 2 to 3 hours before surgery are not unusual for the preoperative patient. An allergy to cats and dogs will not impact the care needed during the intraoperative phase.
2. During recovery from anesthesia in the postanesthesia care unit (PACU), a patients 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.
ANS: B The patients borderline SpO2 and sleepiness indicate hypoventilation. The nurse should stimulate the patient and remind the patient to take deep breaths. Placing the patient in a lateral position is needed when the patient first arrives in the PACU and is unconscious. The stable BP and pulse indicate that no changes in fluid intake are required. The patient is not fully awake and has a low SpO2, indicating that transfer from the PACU is not appropriate.
15. 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 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 keep.
ANS: B The ring can be taped to the patients finger and noted on the preoperative checklist. There is no need for a release form or to discuss liability with the patient. Wearing the ring is obviously important to the patient, so the nurse should tape the ring in place rather than have a family member keep the ring for the patient.
8. 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.
ANS: B The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurses legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient signs the consent form.
12. 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 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
ANS: B This statement suggests that the patient may be pregnant, and pregnancy testing is needed before administration of anesthetic agents. Although the other data also may be communicated with the surgeon and anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.
3. 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.
ANS: B When a patient is allergic to latex, special nonlatex materials are used during surgical procedures and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available on the surgical date. The other actions also may be appropriate, but prevention of allergic reaction (either contact dermatitis or anaphylaxis) during surgery is the most important action.
6. Following gallbladder surgery, a patients T-tube is draining dark green fluid. Which action should the nurse take? a. Place the patient on bed rest. b. Notify the patients surgeon. c. Document the color and amount of drainage. d. Irrigate the T-tube with sterile normal saline.
ANS: C A T-tube normally drains dark green to bright yellow drainage, so no action other than to document the amount and color of the drainage is needed. The other actions are not necessary.
5. 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.
ANS: C Ambulation encourages peristalsis and the passing of flatus, which will relieve the patients discomfort. If distention persists, the patient may need to be placed on NPO status, but usually this is not necessary. Morphine administration will further decrease intestinal motility. Gas pains are usually caused by trapping of flatus in the colon, and reinsertion of the NG tube will not relieve the pains.
16. A patient is to receive atropine before surgery. The nurse teaches the patient to expect a. dizziness. b. weakness. c. dry mouth. d. forgetfulness.
ANS: C Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines.
8. 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. patients breath sounds are clear to auscultation. d. patients temperature is less than 100.4 F orally.
ANS: C One characteristic of ineffective airway clearance is the presence of adventitious breath sounds such as rhonchi or wheezes, so clear breath sounds are an indication of resolution of the problem. Spirometer use and increased fluid intake are interventions for ineffective airway clearance but may not improve breath sounds in all patients. Elevated temperature may occur with atelectasis, but a normal or near-normal temperature does not always indicate resolution of respiratory problems.
9. 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
ANS: C Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.
5. During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. Johns 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.
ANS: C St. Johns wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.
15. 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
ANS: C The corridors outside the OR are part of the semirestricted area where personnel must wear surgical attire and head coverings. Surgical masks may be worn in the holding room, although they are not necessary. Street clothes may be worn at the nursing station, which is part of the unrestricted area. Wearing a mask and scrubs is essential when going into the OR.
7. 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.
ANS: C The most essential nursing action in encouraging these postoperative activities is administration of adequate analgesia to allow the patient to accomplish the activities with minimal pain. Even with motivation provided by proper teaching, positive reinforcement, and concern about complications, patients will have difficulty if there is a great deal of pain involved with these activities.
7. The nurse from the general surgical unit is asked to bring the patients 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.
ANS: C The nurse from the general unit would not be wearing surgical scrub attire or a head covering and would be restricted to the nursing station or information desk, which are unrestricted areas. The clean care, scrub sink area, and corridors are semirestricted areas that require staff members wear surgical scrub attire and head coverings.
11. 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 patients wife to wait in the hall in order to focus preoperative teaching with the patient himself.
ANS: C The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.
3. 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.
ANS: C The patient should initially be positioned in the lateral recovery position to keep the airway open and avoid aspiration. The prone position is not usually used and would make it difficult to assess the patients respiratory effort and cardiovascular status. The Trendelenburg position is avoided because it increases the work of breathing. The patient is placed supine with the head elevated after regaining consciousness.
5. 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.
ANS: C The scrub nurse role includes maintaining asepsis in the operating field. The other actions would be appropriate to the circulating nurse role.
18. 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.
ANS: C, D, E, F These actions are included in surgical time out. IV line placement and identification of the patient by the surgeon are not included in the surgical time-out procedure.
9. A patient who has begun to awaken after 30 minutes in the postanesthesia care unit (PACU) is restless and shouting at the nurse. The patients 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 patients IV lines are secure.
ANS: D Because the patients assessment indicates physiologic stability, the most likely cause of the patients agitation is emergence delirium, which will resolve as the patient wakes up more fully. The nurse should ensure patient safety through interventions such as raising the bed rails and securing IV lines. Emergence delirium is common in patients recovering from anesthesia, so there is no need to notify the ACP. Insertion of an airway is not needed because the oxygen saturation is good. Orientation of the patient is needed but is not likely to be effective until the effects of anesthesia have resolved more completely.
9. 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.
ANS: D Because volatile liquid inhalation agents are rapidly metabolized, postoperative pain occurs soon after surgery. Hypertension and tachypnea are not associated with general anesthetics. Myoclonia may occur with nonbarbiturate hypnotics but not with the inhaled inhalation agents.
17. 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 patients head. b. Suction the patients mouth. c. Increase the oxygen flow rate. d. Perform the jaw-thrust maneuver.
ANS: D In an unconscious postoperative patient, a likely cause of hypoxemia is airway obstruction by the tongue, and the first action is to clear the airway by maneuvers such as the jaw thrust or chin lift. Increasing the oxygen flow rate and suctioning are not helpful when the airway is obstructed by the tongue. Elevating the patients head will not be effective in correcting the obstruction but may help with oxygenation after the patient is awake.
20. A 24-year-old who takes a diuretic and a -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
ANS: D The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of patient anxiety. The heart rate would be expectedin a patient taking a -blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.
14. 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.
ANS: D The most serious adverse effect of the neuromuscular blocking agents is weakness of the respiratory muscles leading to postoperative hypoxemia. Nausea and confusion are possible adverse effects of these drugs, but they are as great a concern as respiratory depression. Because these medications decrease muscle contraction, laryngospasm and bronchospasm are not concerns.
1. 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.
ANS: D The presence of a family member or friend reduces the stress associated with the preoperative period. Although the family may give information about the patients name and history, this information is obtained and confirmed by the nurse in other ways. Nursing staff, rather than family members, are responsible for prevention of cross-contamination.
3. 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
ANS: D The primary focus when setting up the OR is the prevention of cross-contamination and transmission of infection to the patient. Patient privacy, efficient completion of procedures, and smooth functioning of the OR team also are important, but the priority is protection of the patient from infection.
4. 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 surgeons gown.
ANS: D The sleeves of a sterile surgical gown are considered sterile only to 2 inches above the elbows, so touching the surgeons upper arm would contaminate the nurses gloves. Shoe covers are not sterile. Personal protective equipment is designed to protect caregivers, not the patient, and is not part of aseptic technique. Staff members such as the circulating nurse do not have to perform a surgical scrub before entering the OR.
