Perioperative Nursing & Urinary Elimination
A patient is scheduled for surgery and tells the nurse, “I don't really understand what the surgeon is going to do.” What should the nurse do?
A. Explain the surgical procedure in detail
B. Ask the patient to sign the consent form
C. Notify the surgeon/provider that the patient needs additional information
D. Tell the patient that the procedure is routine
Answer: C
Notify the surgeon/provider that the patient needs additional information
What is cultural competence?
The ability to provide effective, respectful care that recognizes and incorporates a patient's cultural beliefs, values, practices, and needs.
Question: Which nursing intervention best promotes sleep?
A. Offering caffeine before bedtime
B. Maintaining a consistent bedtime routine
C. Performing unnecessary assessments throughout the night
D. Encouraging vigorous exercise immediately before bed
B. Maintaining a consistent bedtime routine
What assessment finding is commonly associated with inadequate oxygenation?
A. Cyanosis
B. Increased appetite
C. Warm, flushed skin
D. Bradycardia in every patient
A. Cyanosis
What is the most effective way to reduce the transmission of infection?
A. Wearing gloves at all times
B. Hand hygiene
C. Wearing a surgical mask for every patient
D. Avoiding all patient contact
B. Hand hygiene
Which factors can contribute to urinary retention? Select all that apply.
☐ Anesthesia
☐ Certain medications
☐ Enlarged prostate
☐ Immobility
☐ Adequate hydration
Answers: Anesthesia, certain medications, enlarged prostate, and immobility.
A patient has limited English proficiency. What is the best action?
A. Ask a young family member to interpret
B. Speak louder
C. Use a qualified medical interpreter
D. Avoid discussing complex information
C. Use a qualified medical interpreter
Which is considered the most reliable indicator of a patient's pain?
A. Facial expression
B. Vital signs
C. The patient's self-report
D. The nurse's observation
C. The patient's self-report
Which position generally promotes lung expansion in a patient experiencing difficulty breathing?
A. High-Fowler's
B. Supine
C. Trendelenburg
D. Prone with the head flat
A. High-Fowler's
Which patient is at greatest risk for falling?
A. A young adult with a minor leg laceration
B. A confused older adult receiving medication who reports dizziness
C. An ambulatory adult with no health concerns
D. A patient wearing corrective lenses
B. a confused older adult receiving medication who reports dizziness
Question: Which intervention is most important for preventing postoperative atelectasis?
A. Limiting oral fluids
B. Encouraging coughing and deep breathing
C. Keeping the patient flat in bed
D. Restricting movement
B. Encouraging coughing and deep breathing
A patient refuses a treatment because of a religious belief. What should the nurse do first?
A. Tell the patient the belief is incorrect
B. Respectfully explore the patient's beliefs and concerns
C. Immediately notify security
D. Force the treatment
B. Respectfully explore the patient's beliefs and concerns
Question: A patient reports difficulty falling asleep because of hospital noise. What is the best nursing intervention?
A. Tell the patient to ignore the noise
B. Cluster nursing care when possible
C. Wake the patient every hour
D. Increase room lighting
Answer: B
What is the primary purpose of oxygen therapy?
A. To eliminate all respiratory disease
B. To increase the amount of oxygen available to body tissues
C. To decrease blood circulation
D. To replace the need for ventilation
B. To increase the amount of oxygen available to body tissues
In an emergency, which approach should the nurse use when assessing a patient?
A. ABCs — airway, breathing, circulation
B. Documentation first
C. Pain assessment first in every situation
D. Medication administration first
ABCs
A patient reports burning during urination, urinary frequency, and suprapubic discomfort. The nurse suspects:
A. Urinary retention
B. Urinary tract infection
C. Renal failure
D. Diabetes insipidus
B. Urinary tract infection
A nurse assumes that a patient from a particular cultural group will have specific dietary preferences. The patient states that these assumptions are incorrect. What should the nurse do?
A. Continue with the assumed diet
B. Ask the patient about individual preferences and needs
C. Tell the patient most people from the culture eat that way
D. Ask the dietitian what would be best for the patient to eat
B. Ask the patient about individual preferences and needs
A patient reports pain as 8/10 but is smiling and talking with family. What should the nurse do?
A. Assume the pain is mild
B. Document that the patient appears comfortable
C. Accept the patient's report and assess/manage the pain
D. Tell the patient that the pain rating is inconsistent
C: Accept the patient's report and assess/manage the pain
A patient suddenly develops shortness of breath, chest pain, and an oxygen saturation of 84%. What should the nurse do first?
A. Leave the patient alone to rest
B. Assess airway and breathing and provide appropriate oxygen/support
C. Offer food and sit the patient upright
D. Document the findings before intervening
B. Assess airway and breathing and provide appropriate oxygen/support
A nurse discovers a fire in a patient's room. According to the RACE approach, what does the R represent?
A. Run
B. Rescue
C. Remove equipment
D. Report
B. Rescue
A patient is 2 hours postoperative. The nurse observes bright-red blood rapidly soaking the surgical dressing. Which action has the highest priority?
A. Document the drainage
B. Reinforce the dressing
C. Assess the patient and notify the provider immediately
D. Wait 30 minutes and reassess
C. Assess the patient and notify the provider immediately
Which nursing behaviors demonstrate culturally sensitive care? Select all that apply.
☐ Ask open-ended questions about beliefs and preferences
☐ Avoid stereotyping
☐ Respect religious practices when possible
☐ Use qualified interpreters when needed
☐ Assume all members of a cultural group have identical beliefs
Answers: Ask open-ended questions, avoid stereotyping, respect religious practices, and use qualified interpreters.
Which medication class is commonly used for moderate to severe acute pain?
A. Opioids
B. Antacids
C. Antihistamines
D. Antibiotics
A. Opioids
A patient with impaired circulation has cool skin, delayed capillary refill, weak peripheral pulses, and increasing confusion. These findings should make the nurse concerned about:
A. Improved perfusion
B. Impaired tissue perfusion
C. Normal aging
D. Adequate oxygen delivery
B. Impaired tissue perfusion
During a mass-casualty event, which patient would generally receive the highest priority for immediate intervention?
A. Patient with minor abrasions who is walking
B. Patient with no respirations after airway repositioning
C. Patient with severe respiratory distress who may survive with immediate intervention
D. Patient requesting medication for chronic pain
C. Patient with severe respiratory distress who may survive with immediate intervention