NUR 372 Peri-Operative & End Of Life

B (Do not discuss organ donation with the familY)

1. A nurse discovers that a patient has just passed away. What is the first action that the nurse should take? A) Declare time of death. B) If in the hospital, call the physician. C) Inform the family about organ donation. D) Remove all lines and the heart monitor. E) Begin post-mortem care.

BABCFA (•First dressing change is done by the surgeon, unless saturated/soiled. Reinforce the dressing as needed. Dressings—first dressing change usually performed by surgeon------Drains—provide an exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing ----------Check amount of drainage, color, and frequency of dressing change; reinforce dressing and report to provider. -----Red, warm, edematous tissue with purulent drainage, along with complaints of increased pain, indicates infection. ------Assess for excess, bloody, or cloudy drainage. Excessive or bloody drainage may indicate surgical-site bleeding. Cloudy drainage may indicate infection. Absent drainage may indicate a clogged drain.)

1. A patient is 1 day postoperative with a surgical drain in place. The nurse notices that there has been no output from the drain over the last 6 hours. What is the nurse's best action? A) Document the finding as it is expected to have no drainage after 24 hours. B) Assess the drain for a clog or kink. C) Remove the drain as it is no longer needed. D) Change out the dressing. E) Notify the surgeon. 2. The nurse is performing a postoperative assessment of a patient's surgical site. Which findings are indicative of a potential infection and should be promptly reported to the healthcare provider? Select all that apply. A) Red, warm, edematous tissue surrounding the incision B) Purulent drainage emanating from the incision site C) Increased pain at the incision site D) Clear, serous drainage noted on the dressing E) A slight blue hue to the tissue adjacent to the suture with coolness on palpitation F) Cloudy drainage from the incision. G) Absent drainage from the incision. 3. A patient is post-operative day one following a laparotomy. . The nurse notices the original following surgery is saturated with serosanguineous fluid. What is the most appropriate nursing action? A) Contact the surgeon to evaluate the need for an earlier dressing change. B) Change the dressing, noting the type and amount of fluid on the dressing. C) Change the dressing and reinforce with additional gauze to absorb the fluid. Document the type and amount of fluid on the dressing. D) Document the findings and continue to monitor the dressing as per the previous plan.

BCA (•Keep head of bed elevated 15 to 30 degrees unless contraindicated. May require oral suctioning. If vomiting occurs, turn patient to side. •Provide supplemental oxygen as indicated. Never remove the oral airway until the gag reflex returns in the PACU)

1. Following surgery, the primary consideration is Maintaining a Patent Airway. What should the HOB be set at unless contraindicated? a) Flat b) 15-30 deg c) 30-45 deg d) 45-90 deg 2. A patient in phase I of the PACU begins vomiting. What should the nurses first action be? a) Provide O2 NC b) Provide Oral Suctioning c) Turn the patients head to the side d) Raise the HOB to 30-45 degrees 3. A patient enters the PACU and is breathing normally. The nurse should? a) Assess gag reflex b) Remove oral airway as soon as they awake c) Assess O2 sat d) Remove oral airway before they wake

ADB

1. In the lithotomy position where should the nurse prioritize checking for pressure injuries? a) Feet, Ankles, Hands, Knees b) Buttocks and Low back c) Arms, Elbows, Shoulders, Upper Back d) Head and neck 2. Which letter is true regarding lithotomy position? a) DVT often forms in upper extremities b) This position improves lung capacity during operation c) Use arm rolls to protect the brachial plexus by dispersing pressure over wider areas d) The buttocks should not hang over the end of the OR bed. 3.When transitioning a patient out of the lithotomy position, what is the best practice to minimize cardiovascular effects? A) Quick repositioning to a standing position B) Slow, smooth postural transitions C) Immediate placement into Trendelenburg position D) Performing passive range-of-motion exercises to lower extremities

ABDF (C Corrected: Position the patient's buttocks so they do not hang off the edge of the torso section of the bed) (E Corrected: Avoid hyperabduction of hips and leaning against inner thighs)

1. Select all that apply: Which interventions should be implemented to ensure proper positioning and prevent injury in a patient placed in lithotomy position? A) Ensure fingers are away from the break in the OR bed when leg section is elevated B) Use stirrups that disperse support and pressure over wide areas C) Place the buttocks at the very edge of the torso section of the bed D) Check distal pulses before and after positioning E) Place the hips in hyperabduction to improve surgical access F) DVTs often appear in the lower extremities when in this position

ACEBDACACABDA

1. Severe bleeding 2. Prostatic hyperplasia 3. Cosmetic surgery 4. Infected wound exploration/irrigation 5. Simple hernia (not strangulated) 6. Extensive burns 7. Thyroid disorders 8. Fractured skull 9. Cataracts 10. Bladder or intestinal obstruction 11. Closed fractures 12. Repair of scars 13. Strangulated hernia A. Emergent B. Urgent C. Required D. Elective E. Optional

CAC

1. The preoperative phase of surgical care concludes when the patient: A) Signs the consent form. B) Is anesthetized in the operating room. C) Is transferred onto the operating room (OR) bed. D) Arrives at the preoperative holding area. 2. The intraoperative phase of surgical care begins when the patient is transferred onto the OR bed and ends when? A) When the patient admission to the PACU B) When the patient wakes from anesthesia. C) When the patient surgery wounds are closed by the surgeon. D) After the surgeon declares the end of surgery and leaves the OR. 3. The postoperative phase of surgical care starts with the admission of the patient to the postanesthesia care unit (PACU) and ends ___? A) 24 hours after the patient wakes from anesthesia. B) As soon as the patient leaves the PACU. C) With a follow-up evaluation in the clinical setting or home D) When the patient is ready to be discharged from the hospital.

CD (Must be reconstituted and used immediately. Cannot be stored in liquid state. 20 mg vial is reconstituted with 60ml sterile water for injection.)

1. The treatment for Malignant Hyperthermia (MH) is ______? a) Rapid IV push of Dantrolene 2.5 mg/kg rapid IV bolus reconstituted with chilled normal saline. Repeat PRN b) Rapid IV push of Dantrolene 5 mg/kg rapid IV bolus reconstituted with chilled normal saline. Repeat PRN c) Rapid IV push of Dantrolene 2.5 mg/kg rapid IV bolus reconstituted with sterile water. Repeat PRN d) Rapid IV push of Dantrolene 5 mg/kg rapid IV bolus reconstituted with sterile water. Repeat PRN 2. •If MH occurs and there is not time to complete a final surgical count, ________? a) no surgical count will be used b) CT will be used. c) MRI will be used. d) x-ray will be used. ***How many mL of the reconstitution solution should the nurse gather for reconstitution of the 20mg vial of dantrolene with?

DCCD (Educating clients on preventing or recognizing complications begins in the preoperative phase. Applying SCDs and frequently monitoring vital signs happen after the preoperative phase. Only electric clippers should be used to remove hair.)

1. What action by the nurse best encompasses the preoperative phase? A) Documenting the application of sequential compression devices (SCDs) B) Monitoring vital signs every 15 minutes C) Shaving the client using a straight razor D) Educating clients on signs and symptoms of infection 2. A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? a) Document that surgery has started. b) Acquire ordered blood products. c) Verify consent. d) Organize all sponges and tools. 3. Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? a) The 72-year-old client who takes no routine medications. b) The 52-year-old client that quit smoking 2 years ago. c) The 35-year-old client with non-insulin dependent diabetes. d) A 18-year-old who reported last using marijuana 9 months ago. 4. To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes: a) Positioning the client in a supine position b) Providing Incentive Spirometry every 6 hours. c) Assessing breath sounds. d) Ambulating the client as soon as possible

BCB (Ondansetron -Zofran and Promethazine -Phenergan are used for controlling Nausea and Vomiting. In the PACU, assessment of postoperative nausea, vomiting risk, prophylactic treatment is crucial. You should Intervene at first indication of nausea.)

1. Which of the following environmental modifications should the nurse prioritize to alleviate the patient's anxiety? Select all that apply. A) Increase the room temperature B) Dim the lights in the patient's room C) Maintain a quiet environment D) Turn on the television for distraction E) Provide PRN Promethazine (Phenergan) 2. The nurse is caring for a patient who is experiencing pain and anxiety. Which of the following actions would best support this patient's comfort and relaxation? A) Providing the patient with a warm meal B) Administering prescribed short-acting opioids IV as indicated C) Encouraging the patient to watch action movies D) Advising the patient to practice deep breathing exercises **What medications are indicated for nausea? When should you give them in the PACU?

DBAD (Volatile -inhalation or gas- anesthetic agents used currently include isoflurane, sevoflurane, desflurane, and nitrous oxide. Nitrous oxide is generally used with adjunct IV agents.)

1. Which type of anesthesia involves the use of volatile agents and muscle relaxants? A) Regional anesthesia B) Spinal anesthesia C) Epidural anesthesia D) General anesthesia 2. A patient is scheduled for surgery on the lower extremities. Which type of anesthesia is typically injected into the intrathecal space surrounding the spinal cord? A) General anesthesia B) Spinal anesthesia C) Epidural anesthesia D) Regional anesthesia 3. When a local anesthetic is used to block or anesthetize a nerve or nerve fibers, this is referred to as: A) Regional anesthesia B) General anesthesia C) Spinal anesthesia D) Nerve block 4. For a patient undergoing hand surgery, which type of anesthesia would be most appropriate to anesthetize a nerve in an extremity for surgery in a specific area? A) General anesthesia B) Spinal anesthesia C) Epidural anesthesia D) Nerve block

CABBEEBCEE

1. •Chest rolls and close respiratory monitoring 2. •Application of sequential compression devices 3. •Crushed fingers 4. •Use stirrups that disperse support and pressure over wide areas; check distal pulses before and after positioning. 5. •Place padded roll under lower armpit. 6. •Risk of tilting and falling during procedure 7. •Hip dislocations, fractures, and muscle and nerve injuries 8. •Arms on arm boards are flexed and pronated, with upper arms at less than 90-degree angle to the OR bed; pads placed above and below elbows to free ulnar nerve. 9. Image 10. Use a pressure-reducing OR mattress with additional padding as needed; check that earlobes are not folded over; place pillow between knees and under ankles; be sure neck is in alignment. A) Supine B) Lithotomy C) Prone D) Jackknife E) Lateral

ECABDECBADCC

1. •Pressure to ear, shoulder, ribs, hip, greater femoral head, knee, and ankle 2. •Pressure to cheeks, eyes, ears, breasts, genitalia, patellae, and toes 3. •Pressure to: occiput, scapulae, thoracic vertebrae, olecranon process, sacrum, coccyx, knees, and heels 4. •Pressure injuries to feet, ankles, and knees 5. In addition to prone risks: there is risk for DVT in lower extremities. Provide anti-embolic or sequential compression stockings (hint: not supine) 6. • Brachial plexus injury 7. •Risk for dislodgement of airway, monitoring cords, and IV lines. Use extreme caution turning the patient!!! 8. •Hip dislocations, fractures, and muscle and nerve injuries 9. •Venous pooling of blood in the legs. •Arm boards level with OR mattress, less than 90-degree extensions and palms up; ankles uncrossed 10. Image 11. Patient is put to sleep on the stretcher, prior to rolling to the OR table. 12. Lock both beds; use a minimum of four people for turning patient; secure airway and all cords and lines. A) Supine B) Lithotomy C) Prone D) Jackknife E) Lateral

BDEACBC

1. •Within 24-30 hours 2. •Failure to have surgery is not catastrophic 3. •Personal preference 4. •Without delay 5. •Within a few weeks/months 6. •Closed fractures, infected wounds 7. •Prostatic hyperplasia, gallstones, cataracts A. Emergent B. Urgent C. Required D. Elective E. Optional

CADD

1.A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment? A. Blood pressure B. Apical heart rate C. Respiratory rate D. Temperature 2.A nurse is planning preoperative care for a client who will undergo surgery. Which of the following is the priority action by the nurse? A. Determine what the client knows about the surgery. B. Identify the client's usual coping mechanisms. C. Review the client's current home environment. D. Discuss if family members will assist with postoperative care. 3.A nurse is caring for a client who is 2 days postoperative following abdominal surgery and observes that the client's wound has eviscerated. After calling for help, Which of the following actions should the nurse take first? A. Raise the head of the client's bed 15° to 20°. B. Place the client supine with knees bent. C. Assess the client for manifestations of shock. D. Cover the area with a sterile dressing, moistened with 0.9% sodium chloride irrigation. 4. A nurse is caring for four clients who are postoperative from surgery 24 hr ago. At 1200 the nurse assesses the clients. Which of the following clients is the nurse's priority? A. A client who has a prescription for insulin and his premeal capillary blood glucose was 110 mg/dL and his post-meal capillary blood glucose is now 160 mg/dL B. A client whose wound drainage at 0800 was sanguineous and now it is serosanguineous C. A client who reports pain as 4 on a scale of 1 to 10 at 0800 now reports pain as 6 D. A client whose blood pressure at 0800 was 138/86 mm Hg and at 1200 is 106/60 mm H

CCBB

13. A nurse is developing a plan of care for a client who is postoperative. Which of the following interventions should the nurse include in the plan to prevent pulmonary complications? A. Perform range-of-motion exercises B. Place suction equipment at the bedside C. Encourage the use of an incentive spirometer D. Administer an expectorant 14. A nurse is caring for four postoperative clients. The nurse can delegate obtaining vital signs to an assistive personnel (AP) for which of the following clients? A. A client who is 1 hr postoperative following a thyroidectomy B. A client who is 2 hr postoperative following an abdominal hysterectomy C. A client who is 3 days postoperative following gastric bypass surgery D. A client who is 3 days postoperative following a craniotomy 15.An assistive personnel (AP) reports to the nurse that a client who is 3 days postoperative following an abdominal hysterectomy has a dressing that is saturated with blood. Which of the following tasks should the nurse delegate to the AP? A. Change the abdominal dressing. B. Obtain vital signs. C. Palpate for possible bladder distention. D. Observe the incision site. 16.A nurse is working with an assistive personnel (AP) while caring for a surgical client who is 1 day postoperative. Which task should the nurse take responsibility for completing? A. ?Measuring vital signs B. ?Removing the abdominal dressing C. ?Helping the client into the shower D. ?Ambulating the client in the hallway

BBCB (Aspirin PO Rationale: Aspirin therapy is used for existing thromboembolic disorders, not for DVT prophylaxis.) ( B. Enoxaparin subcutaneous Rationale: Enoxaparin is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses of enoxaparin are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time, making it the preferred treatment for DVT prophylaxis following orthopedic surgery.) (C. Heparin infusion Rationale: Heparin therapy by infusion is used to treat existing DVT, not prophylaxis. ) (D. Warfarin PO Rationale: Warfarin therapy is started after dosing with enoxaparin. Both medications are given to allow the warfarin time to reach therapeutic level)

17.A nurse is caring for a client who is postoperative. The nurse should base her pain management interventions primarily on which of the following methods of determining the intensity of the client's pan? A. Vital sign measurement B. The client's self-report of pain severity C. Visual observation for nonverbal signs of pain D. The nature and invasiveness of the surgical procedure 18.A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? A. Aspirin PO B. Enoxaparin subcutaneous C. Heparin infusion D. Warfarin PO 19.A nurse is providing preoperative teaching for a client who will undergo surgery. The nurse explains that the client will wear anti-embolism stockings during and after the procedure. When the client asks what the stockings do, which of the following responses should the nurse make? A. "They protect your legs and heels from skin breakdown." B. "They help keep you warm after your surgery." C. "They improve your circulation to keep blood from pooling in your legs." D. "They make it easier for you to do leg exercises after your surgery." 20.A nurse is assessing a client who has developed atelectasis postoperatively. Which of the following findings should the nurse expect? A. Facial flushing B. Increasing dyspnea C. Decreasing respiratory rate D. Friction rub

CAA

21.A nurse is preparing to witness informed consent for a client who is preoperative. The client asks the nurse, "Are there other options besides surgery?" Which of the following responses should the nurse make? A. "It is time to sign the consent so your treatment can begin." B. "I would not have this type of surgery if I were you." C. "Have you discussed other treatments with your provider?" D. "I can inform the surgeon you do not want the surgery." 22.A nurse is planning care for a client who is postoperative and at risk for paralytic ileus. Which of the following interventions should the nurse plan to take to promote peristalsis? A. Increase ambulation. B. Decrease fluid intake. C. Increase protein intake. D. Offer the client the bedpan every 2 hr. 23.A nurse is reviewing the diagnostic test results of an older adult female client who is preoperative for a knee arthroplasty. The nurse should notify the surgeon of which of the following results? A. WBC count 20,000/mm3 B. Hematocrit 40% C. Creatinine 0.9 mg/dL D. Potassium 3.8 mEq/L

CDBC (facilitation of deep breathing as the most important desired effect of opioids aside from pain relief. Following thoracic type surgeries, the client's has increased pain with moving, deep breathing and coughing. Opioid medications help minimize the discomfort experienced with deep breathing and coughing which prevents the development of postoperative pneumonia. The nurse should also encourage the client to splint his incision to help minimize pain.)

5.A nurse is caring for client who just returned from the PACU with an IV fluid infusion and an NG tube in place following abdominal surgery. Which of the following data is the priority for the nurse to assess? A. The coping ability of the client B. The client's bowel sounds 24 to 48 C. The surgical dressing D. The patency of the NG tube 6.A nurse is caring for a client who has returned to the unit following a surgical procedure. The client's oxygen saturation is 85%. Which of the following actions should the nurse take first? A. Administer oxygen at 2 L/min. B. Administer prescribed analgesic medication. C. Encourage coughing and deep breathing. D. Raise the head of the bed. 7.A nurse is providing teaching to a client who is postoperative following coronary artery bypass graft (CABG) surgery and is receiving opioid medications to manage discomfort. Aside from managing pain, which of the following desired effects of medications should the nurse identify as most important for the client's recovery? A. It decreases the client's level of anxiety. B. It facilitates the client's deep breathing. C. It enhances the client's ability to sleep. D. It reduces the client's blood pressure. 8.A nurse is assessing a client who is 48 hr postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider? A. Blood pressure 102/66 mm Hg B. Straw-colored urine from an indwelling urinary catheter C. Yellow-green drainage on the surgical incision D. Respiratory rate 18/min

BCBD

9. A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions? A. Elevating her feet B. Massaging her legs C. Flexing her ankles D. Ambulating soon after surgery 10.A nurse on a medical-surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis? A. Myringotomy B. Laparoscopic appendectomy C. Hip arthroplasty D. Cataract extraction 11.A nurse is caring for a client who is preoperative. The nurse signs as a witness on the client's consent form. The nurse's signature on the consent form indicates which of the following? A. Determines the client does not have a mental illness B. Confirms the client appears competent to provide consent C. Asserts the nurse has explained the risks and benefits of the procedure D. Records that the client's spouse agrees the procedure is necessary 12.A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock? A. Decrease in the respiratory rate from 20 to 16/min. B. Decrease in the urinary output from 50 mL to 30 mL per hour. C. Increase in the temperature from 37.5° C (99.5° F) to 38.6° C (101.5° F). D. Increase in the heart rate from 88 to 110/min.

CDGHJ (Indicators of Hypovolemic Shock/Hemorrhage: Cool & moist skin, Rapid & weak & thready pulse, Decreasing pulse pressure, Concentrated urine, •Rapid respirations, •Low blood pressure, •Pallor & •Cyanosis)

A PACU nurse is educating on the signs of hypovolemic shock from hemorrhage following surgery. What S/S should the nurse include? a) Polyuria b) Bounding Pulse c) Tachycardia d) Hypotension e) Widening pulse pressure f) Warm, dry skin g) Pallor h) Cyanosis i) Bradypnea j) tachypnea k) Fever

BCD (B is correct because intensive nursing care is required in Phase I for immediate recovery. -------- C is correct as monitoring for immediate postoperative complications is a key component of Phase I care.-------------D is correct because transitioning a patient to an inpatient nursing unit or Phase II PACU is part of Phase I care. ------------A is not correct because preparation for transfer to a long-term care facility is more characteristic of Phase II, where the patient is being prepared for transfer to an inpatient nursing unit, an extended care setting, or discharge. ---------------E is not correct because discharging a patient to home occurs after Phase II, not during the immediate recovery phase in PACU.)

A nurse is caring for patients in the Postanesthesia Care Unit (PACU). Which of the following patient care activities would be most appropriate for a patient in Phase I of recovery? Select all that apply. A. Preparing the patient for transfer to a long-term care facility B. Providing intensive nursing care C. Monitoring for immediate postoperative complications D. Facilitating patient transitions to an inpatient nursing unit E. Discharging the patient to home with instructions

E (Drains—provide an exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing. Check amount of drainage, color, and frequency of dressing change; reinforce dressing and report to provider.)

A nurse knows that a drain placed on a surgical wound is used to _____? a) Prevent Superficial Infection b) Promote clotting c) Remove infected tissue d) Promote Debridement e) Prevent abscess formation

CED (Dehiscence/evisceration requires immediate notification and intervention by the surgeon; maintain low Fowler's position, minimize movement, and cover wound with sterile saline dressing.)

A nurse notices an abdominal surgical wound has dehisced. Order the nurses priority of actions 1-3: 1. 2. 3. a) Place in semi-fowlers b) Place in high fowlers c) Place in low fowler's d) notify surgeon e) cover wound with sterile saline dressing f) cover wound with sterile alginate dressing. g) Administer analgesia

D (A is correct but, •This is a conversation for the physician to have with the patient/family member not the nurse)

A patient asks a nurse the difference between a Full support DNR and a comfort care DNR. The nurse's best response is? a) A Comfort Care DNR does not allow mechanical and invasive ventilation but a a Full support DNR does. b) A Comfort Care DNR does not allow cardiac antiarrhythmics but a full support DNR does. c) The only thing we can provide with a Comfort care DNR is pain medications, neither will allow us to perform CPR in in the case of cardiac arrest. d) I will contact your HCP to best discuss these differences with you.

ABD

A patient has designated "Full Support DNR" as their code status. Which of the following interventions would be included in the plan of care for this patient? Select all that apply. A) Intensive monitoring of vital signs B) Administration of IV fluids and medications as prescribed C) Performance of defibrillation or cardioversion if needed D) Use of non-invasive ventilation if the patient is in respiratory distress E) Intubation and mechanical ventilation if the patient stops breathing

ABDE (DO NOT: Administer CPR. Insert artificial airway. Administer resuscitative drugs. Defibrillate or cardiovert. Provide respiratory assistance such as mechanical ventilation. Initiate resuscitative IV or initiate cardiac monitoring.) (The healthcare providers WILL: Suction the airway. Administer oxygen. Position for comfort. Splint or immobilize. Control bleeding. Provide pain medications. Provide emotional support. Contact other appropriate healthcare providers such hospice, home health, etc.)

A patient with a terminal illness has a code status of Comfort Care DNR. Which interventions align with this code status? Select all that apply. A) Administration of pain medication to relieve symptoms B) Providing emotional support to the patient and family C) Preparing to perform chest compressions if the patient's heart stops D) Positioning the patient to prevent aspiration E) Offering spiritual care services if requested by the patient or family F) Intubation and mechanical ventilation if the patient stops breathing G) Initiate cardiac monitoring

AA (•Reorient as needed. A patient should be place in side lying first if they are throwing up. An antiemetic should be administered at the first sign of nausea or after the airway is protected from aspiration by side lying position)

An older patient is at high risk for many post-operative complications following anesthesia and surgery. Examples: •Decreased physiologic reserve •Monitor carefully, frequently •Increased confusion •Dosage •Hydration •Thermoregulation •Increased likelihood of postoperative confusion, delirium •Hypoxia, hypotension, hypoglycemia •Pain 1. An elderly patient in the PACU is delirious when they awake following anesthesia and surgery. What is the most appropriate nursing action ? a) Re-orient the client with your voice b) Administer PRN Promethazine (Phenergan) c) Notify the CRNA or Anesthesiologist d) Administer short-acting opioids IV e) Dim the lights and lower the HOB 2. A nurse is caring for a client in the PACU after surgery requiring general anesthesia. The client tells the nurse, "I think I'm going to be sick." What is the primary action taken by the nurse? A. Position the client in the side-lying position. B. Administer an anti-emetic. C. Obtain an emesis basin. D. Ask the client for more clarification.

ACG (B Corrected: maintain low Fowler's position) (--------------------) (D corrected: cover wound with sterile saline dressing.) (--------------------) (Dehiscence/evisceration requires immediate notification and intervention by the surgeon; maintain low Fowler's position, minimize movement, and cover wound with sterile saline dressing.) (--------------------) (What is a dehiscence and what is a evisceration? Surgical wound-healing complications include wound dehiscence; wound rupture along the surgical suture line; and wound evisceration, the extrusion of viscera outside the body through the surgical incision)

During a postoperative assessment, the nurse discovers that a patient's abdominal surgical wound has signs of dehiscence with possible evisceration. Which of the following nursing interventions should the nurse perform? Select all that apply. A) Notify the surgeon immediately. B) Place the patient in a supine and flat position. C) Minimize the patient's movement. D) Rinse the wound with sterile cool water and apply an alginate dressings. E) Apply pressure to the wound edges to close the dehiscence until help arrives. F) Remove all remaining sutures to prevent strangulation. G) Cover wound with sterile saline dressing. **What is a dehiscence and what is a evisceration?

E (•Things to expect when a patient passes: They will void and have a bowel movement, Eyes or mouth may not close completely, May exhale when turned as remaining air exits body. Family can react in many different ways- allow them as much time as they need)

Following 2 hours of CPR, a physician has just declared a patient to be dead. As the nurse turns the patient during post-mortem care an exhalation breath is heard. The nurse assesses and sees that the patient's eyes and mouth are partially open as well and the patient has voided. What is the most appropriate nursing action? A) Attempt to close the eyes and mouth using gentle pressure. Then clean up the void and patient. B) Leave the eyes and mouth as they are and cover the face with a sheet. Then clean up the void and patient. C) Notify the physician that the patient's eyes and mouth are not fully closed and the patient just voided. D) Resume CPR and call for help as the patient may still be alive. E) Understand that the eyes and mouth open, voiding, and exhalation when moving are expected parts of the post-mortem process.

Y (Pressure to structures on dependent side: ear, shoulder, ribs, hip, greater femoral head, knee, and ankle) (Risk of tilting and falling during procedure) (Brachial plexus injury) (Venous pooling that shifts toward dependent side) (Diminished capacity of dependent lung) ( DVT in lower extremities) (Place padded roll under lower armpit.) (Slow, smooth postural transitions to diminish cardiovascular effects)

Lateral Position: Pressure to ________? •Risk of _______? • _________ injury? •Venous pooling___________? •Diminished capacity of _________? DVT in ___________? •Place padded roll __________? ____________ diminish cardiovascular effects? Answer "Y" If you know.

BDEG (A: Place chest rolls for respiratory monitoring is for PRONE Position. For Lateral •Place padded roll under LOWER armpit.)

Lateral Position: Select all that apply: A) Place chest rolls for respiratory monitoring B) Monitor for venous pooling on the dependent side C) Use restraints only if the patient is fully conscious D) Assess for pressure areas including the dependent ear, shoulder, and hip E) Position the lower leg flexed for stability F) Allow the upper arm to dangle to prevent shoulder injury G) Venous pooling that shifts toward dependent side lung I) Place padded roll under upper armpit.

ABDE (The buttocks should not hang off the edge of the torso section of the bed. Use stirrups that disperse support and pressure over wide areas; check distal pulses before and after positioning. Avoid hyperabduction of hips and leaning against inner thighs. Slow, smooth postural transitions to diminish cardiovascular effects Ensure fingers are away from the break in the OR bed when leg section is elevated.)

Lithotomy Position: Select all that apply: A) Assess for hip dislocations or fractures post-operatively B) Use stirrups that disperse pressure over wide areas C) Place the patient's buttocks 6 inches over the edge of the torso section of the bed D) Check distal pulses before and after positioning E) Monitor for DVT in lower extremities F) Encourage the patient to hyperabduction of hips for better surgical access

CBBE (Malignant hyperthermia -MH- can be caused by exposure to a, volatile gas anesthetic and/or succinylcholine. Nitrous oxide is a volatile gas that cannot cause MH. First signs: Increased CO2, decreased O2 sat, tachycardia. Next signs: dysrhythmias, muscle rigidity, hypotension, tachypnea, skin-mottling, cyanosis, myoglobinuria Late manifestation: hyperthermia -as high as 111.2. The most specific sign of MH is skeletal muscle rigidity. However, the first sign noted by the anesthesia or nursing staff is an unexplained tachycardia. For the anesthesia provider, hypercarbia -increased CO2, is the most sensitive indicator of potential MH. Myoglobinuria is another early sign. The patient's urine turns from dark amber to brown. Hyperthermia, the classic sign of MH, is usually a late sign.)

MH (malignant hyperthermia) is a hypermetabolic state leads to increase in intracellular calcium ion concentration. The sustained contractions result in signs of hypermetabolism. The reaction usually begins to occur soon after the exposure, but it has been known to be delayed until the patient is in the recovery area. 1. Malignant hyperthermia can NOT be caused by which letter? a) Succinylcholine b) Isoflurane c) Nitrous Oxide d) Desflurane 2. What is the initial sign of Malignant Hyperthermia that a nurse should monitor for during anesthesia? A) Bradycardia, Fever, Muscular Rigidity B) Tachycardia, Increased CO2, decreased O2 C) Fever, Muscular Spasms, Tachypnea D) Anesthesia Awareness, Skin-mottling, Tachycardia 3. Which letter(s) are a late manifestations of Malignant Hyperthermia should a nurse be vigilant about during the postoperative period? A) Hypothermia B) Fever C) Polyuria D) Thrombocytopenia E) Dysrhythmias

AABBBABA (•Circulating Nurse: Assist with termination of surgery. If surgery can be terminated, provide closing sutures and dressings. If there is not time to complete a final surgical count, x-ray will be used. Apply cooling blanket. Place Foley, if one isn't already placed) (_----------------------) (•CRNA: •Administer IV Dantrolene. 2.5 mg/kg rapid IV bolus. Repeat PRN. Available in 20 mg vials, reconstitute with sterile water for injection. Administer rapid IV push. Administer 100% O2. Obtain ABGs. Infuse iced normal saline IV)

Malignant Hyperthermia (MH) 1. Assist with termination of surgery 2. If surgery can be terminated, provide closing sutures and dressings. 3. Administer IV Dantrolene (skeletal muscle relaxant) 4. Administer 100% O2 5. Obtain ABGs 6. Apply cooling blanket 7. Infuse iced normal saline IV 8. Place Foley, if one isn't already placed A) Circulating Nurse Actions B) CRNA actions

A (The most specific sign of MH is skeletal muscle rigidity. However, the first sign noted by the anesthesia or nursing staff is an unexplained tachycardia. •First signs: Increased CO2, decreased O2 sat, tachycardia)

Often the first sign a nurse may notice of Malignant Hyperthermia is ___? a) tachycardia b) hypoxia c) hypercapnia d) fever e) muscular rigidity

Y (Pressure to cheeks, eyes, ears, breasts, genitalia, patellae, and toes) (-------------------_) (Risk for dislodgment of airway, monitoring cords, and IV lines) (-------------------_) (Use extreme caution turning the patient!!!) (-------------------_) (Diminished lung capacity) (-------------------) (Injury to shoulders, arms, and upper extremity nerves) (-------------------_) (Chest rolls and close respiratory monitoring) (-------------------_) (Arms on arm boards are flexed and pronated, with upper arms at less than 90-degree angle to the OR bed; pads placed above and below elbows to free ulnar nerve.) (-------------------_) (Patient is put to sleep on the stretcher, prior to rolling to the OR table. Lock both beds; use a minimum of four people for turning patient; secure airway and all cords and lines.)

Prone Position: •Pressure to _____? •Risk for ________? •Use extreme caution_______? •Diminished _________? •Injury to _______? •_________and close respiratory monitoring? •Arms on arm boards are ___________ with upper arms at ____________; pads placed ______________? Patient is put to sleep ____________? Lock both beds; ________________?.

ABDEHJ (•Arms on arm boards are flexed and pronated, with upper arms at less than 90-degree angle to the OR bed; pads placed above and below elbows to free ulnar nerve. Patient is put to sleep on the stretcher, prior to rolling to the OR table. Lock both beds; use a minimum of four people for turning patient; secure airway and all cords and lines.)

Prone Position: Select all that apply: A) Use caution when turning the patient to prevent dislodgement of the airway B) Place chest rolls for respiratory monitoring C) Allow the arms to hang freely off the sides of the OR bed D) Pads placed above and below elbows to free ulnar nerve. E) Monitor for pressure to cheeks, eyes, ears, and genitalia F) Ensure fully extended to prevent movement G) Ensure arms on arm boards are flexed and palms are up H) Ensure upper arms at less than 90-degree angle to the OR bed I) Use a minimum of 3 people when turning the patient J) Patient must be asleep before entering the OR

ABEFGHI

Select all that apply for the components of Preoperative Assessment: A) Health history and physical exam B) Medications and allergies C) Patient's preference for postoperative pain management D) Patient's family history of surgical complications E) Drug or alcohol use F) Respiratory and cardiovascular status G) Hepatic, renal function H) Arrangement/condition of the patient's teeth I) Nutritional, fluid status

ACEF (•Blood type, screen, & crossmatch is during. Preoperative Assessment)

Select all that apply for the data collected during Pre- Admission gathering of admission data: A) Initiates the nursing assessment process B) Gather Informed consent, Blood consent/refusal, and Anesthesia consent C) Verifies completion of preoperative diagnostic testing according to patient's needs D) Blood type, screen, & crossmatch E) Begins discharge planning by assessing patient's need for postoperative transportation and care F) Admission data: demographics, health history, other information pertinent to the surgical procedure

ABDEFGIK

Select all that apply: A nurse is aware that which of the following are potential complications of general anesthesia? A) Hypoxia B) Respiratory and cardiovascular dysfunction C) Neurogenic Bladder D) Hypotension E) Hypertension F) Fluid and electrolyte imbalances G) Residual muscle paralysis H) Steven Johnsons Syndrome (SJS) I) Malignant hyperthermia (MH) L) Disseminated Intravascular Coagulation (DIC) K) Dementia, prolonged awakening, paresthesias

CDEH (A Corrected: All materials in contact with the surgical wound or used within the sterile field must be sterile) (-------------------) (B Corrected: Gowns considered sterile in front from chest to level of sterile field, sleeves from 2 inches above elbow to cuff) (-------------------) (F Corrected: Movement at least 1-foot distance from sterile field must be maintained) (-------------------) (G Corrected: •Sterile fields prepared as close as possible to time of use)

Select all that apply: A nurse is reviewing the basic guidelines for surgical asepsis. Which of the following practices should the nurse follow? A) All materials within the operating room must be sterile B) Gowns are sterile on the back from shoulder to the front waist level of sterile field C) Gowns are sterile in front from chest to level of sterile field D) Sterile drapes are used to create a sterile field, and only the top of draped tables are considered sterile E) Movements of the surgical team are from sterile to sterile, and from unsterile to unsterile only F) Movement at least 3-foot distance from sterile field must be maintained G) Sterile fields are prepared well in advance to ensure readiness H) Sleeves below the elbow are considered sterile

ABDEFGHI (Antidepressants are not listed on slide)

Select all that apply: A nurse understands that which of the following medications may potentially affect the surgical experience? A) Corticosteroids B) Diuretics C) Antidepressants D) Antibiotics E) Anticoagulants F) Anticonvulsant medications G) Opioids H) Over-the-counter and herbals I) Insulin

ABDEGH (Pregnancy test for ALL female patients from first period to menopause! Urinalysis - includes pregnancy test) (**Patients must have a chest x-ray no matter what) (**What is the quickest way to cancel a surgery? K+ imbalance.)

Select all that apply: Which of the following are components of the preoperative assessment? A) Obtaining informed consent B) Performing a chest X-ray on all patients C) Administering a pregnancy test for all female patients D) Checking serum potassium levels to prevent cancellation of surgery E) Completing a history and physical examination F) Evaluating hepatic function only if the patient has a known liver disease G) Conducting coagulation studies H) Ensuring blood type, screen, and crossmatch are done **Patients must have a ____ no matter what? **What is the quickest way to cancel a surgery?

ABDHJLM (Immediate Preoperative Nursing Interventions: Patient changes into gown, hair covered, mouth inspected, jewelry removed, valuables stored in a secure place. Administering preanesthetic medication. •Providing psychosocial interventions. Reducing anxiety, decreasing fear. Respecting cultural, spiritual, religious beliefs. Maintaining patient safety)

Select all that apply: Which of the following are immediate preoperative nursing interventions? A) Ensuring the patient changes into a gown and hair is covered. B) Inspecting the mouth and ensuring jewelry is removed and valuables are secured. C) Gathering all pre-anaesthetic medication for the scrub nurse. D) Maintaining the preoperative record. E) Transporting the patient to the operating room (OR). F) Bathing the patient with a chlorhexidine scrub. G) Allowing the patient to keep all jewelry on if it holds religious significance. H) Transporting the patient to the presurgical area. I) Providing the patient with water and crackers. J) Attending to the family's needs K) Starting an 18 gauge IV. L) Managing nutrition, fluids. M) Preparing bowel and skin.

DEGLMOR (•First signs: Increased CO2, decreased O2 sat, tachycardia) (•Next signs: dysrhythmias, muscle rigidity, hypotension, tachypnea, skin-mottling, cyanosis, myoglobinuria -brown/amber, •*Late manifestation: hyperthermia)

Select all that apply: Which of the following are later signs of Malignant Hyperthermia (MH) that a nurse should assess for? A) Hypercapnia B) Bradycardia C) Tachycardia D) Generalized muscle rigidity E) Dusky skin mottling and cyanosis F) Profuse flushing G) Brown Urine H) Anuria I) Polyuria J) Decreased creatine kinase levels K) Hypoactive bowel sounds L) Hyperthermia as high as 111.2 F M) Hypotension N) Hypertension O) Dysrhythmias P) Hyperkalemia Q) Bradypnea R) Tachypnea

DEFG (A corrected: Informed consent Should be in writing before all non-emergent surgery) (B & C corrected: The Surgeon must explain the procedure, benefits, risks, complications, etc. The Nurse clarifies information and witnesses signature)

Select all that apply: Which statements are true regarding informed consent based on the provided information? A) Informed consent must be in writing before all surgeries. B) It is the nurse's responsibility to explain the procedure in detail to the patient. C) The surgeon is required to clarify all surgical information and witnesses signature D) Informed consent is legally required. E) Consent is only valid if signed before administering psychoactive premedication. F) The nurse must witness the patient's signature on the consent form. G) Consent must accompany the patient to the operating room (OR). H) Informed consent can be oral for any non-emergent surgery.

ABGH (C corrected: Hospice can occur: in hospital, at home, or inpatient) (D corrected: Hospice care cannot occur at the same time as curative treatment but, Palliative care can occur simultaneously with curative treatment.) (E Corrected: Hospice care is only appropriate for End Stage disease with 6 months of less left of life as prognosis. Palliative care can occur at any stage of the disease) (F corrected: Unlike Hospice care, Palliative care can occur simultaneously with curative treatment and does not require that a patient is not seeking curative treatments.)

Select all the TRUE statements: A) Palliative care can be provided at any stage of a disease. B) Hospice care is appropriate for patients with a prognosis of 6 months or less. C) Hospice care can only occur inpatient or at a hospital. D) Palliative or Hospice care cannot occur at the same time as curative treatment. E) Hospice care can occur at any stage of a disease. F) Palliative care requires that a patient is not seeking curative treatments. G) Both Hospice and Palliative care focuses on optimizing comfort, reducing stress, and reducing symptoms. H) Death is accepted in Hospice Care.

ABDFG (•Arm boards level with OR mattress, less than 90-degree extensions and palms up; ankles uncrossed)

Supine Position: Select all that apply: A) Check pressure points including occiput and heels B) Ensure arm boards are level with the OR bed C) Cross the patient's ankles to maintain alignment D) Apply sequential compression devices to prevent venous pooling E) Position the arms above the head for comfort F) Monitor for signs of pressure ulcers in areas like the scapulae and sacrum G) Ensure arms less than 90 degree extensions H) Ensure Palms are down

Y (Pressure points: occiput, scapulae, thoracic vertebrae, olecranon process, sacrum, coccyx, knees, and heels) (---------------------) (Venous pooling of blood in the legs) (---------------------) (Arm boards level with OR mattress, less than 90-degree extensions and palms up; ankles uncrossed) (---------------------) (Application of sequential compression devices)

Supine Postion in OR Pressure Points? Venous Pooling? Arm Position? Intervention? Answer "Y" if you know.

ABCE

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. A) nutritional status B) age C) physical condition D) gender E) health status F) ethnicity

B (•This is a conversation for the physician to have with the patient/family member. However, as the nurse it is important to be present and ensure the patient and family that you are there as a support and to honor their wishes)

The nurse is caring for a patient who is unable to make their own healthcare decisions. The patient's adult children disagree about the code status. In this situation, what is the most appropriate initial action by the nurse? A) Implement a Full Code status until the disagreement is resolved. B) Contact the healthcare provider to discuss the family's disagreement. C) Encourage the family to come to a consensus on their own. D) Place the patient on Full Support DNR until the disagreement is resolved.

B (Restricted zone: scrub clothes, shoe covers, caps, and masks) (Unrestricted zone: street clothes allowed) (Semi-restricted zone: scrub clothes and caps)

What attire is appropriate for a nurse to wear in the semi-restricted zone of the surgical environment? A) Street clothes B) Scrub clothes and caps C) Shoe covers and masks D) Full surgical attire including gloves and gown ***what is worn in unrestricted zone?? ***what is worn in restricted zone??

ABCDF (•Decreased subcutaneous fat; more susceptible to temperature changes)

When providing care for geriatric patients undergoing surgery, a nurse recognizes that which of the following considerations are important? A) Cardiac reserves are lower in older adults. B) Renal and hepatic functions may be impaired. C) Gastrointestinal activity is likely to be reduced. D) Older adults may experience respiratory compromise. E) There is an increased amount of subcutaneous fat in older adults. F) Older adults may need more time and various education formats to understand and retain communicated information. H) Geriatric patients typically require less postoperative pain management.

ABCDE

Which letter(s) are TRUE regarding Discharge planning? a) Patients must receive written and verbal instructions regarding follow-up care, complications, wound care, activity, medications, diet b) Nurses must discuss actions to take if complications occur c) Written & verbal instructions should be given to a responsible adult who will accompany patient or to the patient if they are able d) Following general anesthesia patients are not to drive home or be discharged to home alone e) Sedation, anesthesia may cloud memory, judgment, affect decision-making ability

ABCD

Which letter(s) are true regarding patient safety and Protecting the Patient from Injury? A) Operative field must be adequately exposed B) Patient position must not obstruct/compress respirations, vascular supply, or nerves C) Apply light restraint before induction in case of excitement D) Extra safety precautions for older adults, patients who are thin or obese, and anyone with a physical deformity

ABCE (Nurse's Roll: •Communicate with family and physicians ---•Be aware of own experiences, values, and beliefs so as not to introduce them to the patient/family--- •Be empathetic but do not pity--- •Be honest and supportive--- •Be a good listener---•Be on time with medications) (•Do not discuss organ donation with family)

Which of the following are appropriate actions for a nurse to take after a patient has passed away? Select all that apply. A) Call the physician to report the death. B) Consult state regulations regarding the pronouncement of death. C) Contact the eye and organ bank if the patient is an organ donor. D) Discuss options for organ donation with the family. E) Provide post-mortem care, including bathing and removal of medical equipment. F) Place the patient back into their admitting clothes.

ABCE (•Provide care for patient until patient has recovered from effects of anesthesia: •Return to cognitive baseline, Clear airway, Controlled nausea and vomiting, •Stable vital signs)

Which of the following are reason(s) that a patient may need to stay in the PACU until the issue is resolved? a) Patient has not returned to cognitive baseline b) Patient's airway is not clear c) Patient's nausea and vomiting is still occuring d) Patient's wound has no healed e) Patient's vital signs are not stable