Care of the surgical patient

Perioperative

100

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks the nurse to get up to go to the bathroom to urinate. Which of the following is the most appropriate action for the nurse to take?

A) a. Assist patient to bathroom and stay next to door to assist patient back to bed when done. B) b. Allow patient to go to the bathroom since the onset of the medication will be more than 5 minutes. C) c. Offer the patient to use the urinal/bedpan after explaining the need to maintain safety. D) d. Ask patient to hold the urine for a short period of time since a urinary catheter will be placed in the operating room.

200

Which of the following is the primary reason for prioritizing the determination of the patient's current medications during a preoperative assessment?

A) a. Routine medications are usually withheld the day of surgery, requiring dosage and schedule adjustments. B) b. Some medications may alter the patient’s perceptions about surgery. C) c. Some medications may interact with anesthetics, altering the potency and effect of the drugs. D) d. Anesthetics alter renal and hepatic function, causing toxicity by other drugs.

300

As the nurse is preparing a patient for surgery, the patient refuses to remove a wedding ring. Which of the following is the most appropriate action by the nurse?

A) a. Note the presence of the ring in the nurse’s notes of the chart. B) b. Insist the patient remove the ring. C) c. Explain that the hospital will not be responsible for the ring. D) d. Tape the ring securely to the finger.

400

While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that:

A) a. She must be NPO after breakfast. B) b. She needs to be NPO after midnight. C) c. She can drink clear liquids up to 2 hours before surgery. D) d. She can drink clear liquids up until she is taken to the OR.

500

The nurse is admitting a patient to the same day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which of the following nursing actions would be most appropriate?

A) a. Inform the anesthesiologist of the patient’s ingestion of kava. B) b. Tell the patient that using kava to help sleep was a good idea. C) c. Tell the patient that the kava should continue to help him relax before surgery. D) d. Inform the patient about the dangers of taking herbal medicines without consulting his health care provider.

Nursing Management

100

The nursing goal of encouraging postoperative body movement is to?

a). contribute to optimal respiratory function b). improve circulation c). prevent venous stasis d). promote all of the above activities

200

The primary goal in withholding food before surgery is to prevent?

a). distention b). aspiration c). infection d). obstruction

300

Diabetics undergoing surgery are at risk for four complications? SELECT ALL THAT APPLY

a). hyperlipidemia b). hypoglycemia c). glucosuria d). acidosis e). hyperglycemia

400

Aspirin is withheld how many days prior to surgery?

a). 1-2 days b). 2-3 days c). 5-7 days d). 7-10 days

500

What are the nutritional concerns for the elderly surgical patient? SELECT ALL THAT APPLY

a). hypervolemia b). electrolyte imbalances c). hypovolemia d). dehydration

Intraoperative

100

The Circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities, include:

a). assisting the surgeon b). coordinating the surgical team c). setting up the sterile tables d). all of the above functions

200

Currently, the most commonly used volatile liquid anesthetic agent is?

a). ethrane b). florane c). nitrous oxide d). ultrane

300

A local infiltration anesthetic can last for up to?

a). 1 hour b). 3 hours c). 5 hours d). 7 hours

400

If an operating nurse is to assist a patient to the Trendelenburg position, he or she would place the patient?

a). flat on his back with his arms next to his sides b). on his back with the head lowered so that the plane of his body meets the horizontal on an angle c). on his back with his legs and thighs flexed at right angles d). on his side with the uppermost led adducted and flexed at the knee

500

Epinephrine is often used in combination with a local infiltration anesthetic because is:

a). causes vasoconstriction b). prevents rapid absorption if the anesthetic drug c). prolongs the local action of the anesthetic agent d). does all of the above

Postoperative

100

When assessing a patient's surgical dressing on the first postoperative day, the nurse notes new bright-red drainage about 5 cm in diameter. In response to this finding, the nurse should do which of the following?

A) a. Assess the patient’s blood pressure and heart rate. B) b. Remove the dressing and assess the surgical incision. C) c. Recheck the dressing in 1 hour for increased drainage. D) d. Notify the surgeon of a potential hemorrhage.

200

The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia unit. Which of the following should be the nurse's initial action upon the patient's arrival?

A) a. Check the physician’s postoperative orders. B) b. Assess the patient’s pain. C) c. Check the rate of the IV infusion. D) d. Assess the patient’s vital signs.

300

The nurse is preparing to administer cefazolin (Ancef) 2 grams in 100 ml IVPB to a postoperative patient. Which of the following IV rates will infuse this medication over 20 minutes

A) a. 100 ml/hr B) b. 150 ml/hr C) c. 200 ml/hr D) d. 300 ml/hr

400

In planning postoperative interventions to promote ambulation, coughing, deep breathing, and turning, the nurse recognizes that which of the following actions will best enable the patient to achieve the desired outcomes?

A) a. Giving the patient positive feedback when the activities are completed. B) b. Administering adequate analgesics to promote relative freedom from pain. C) c. Warning the patient about possible complications if the activities are not performed. D) d. Asking the patient to verbalize understanding of and demonstrate performance of activity.

500

Unless contraindicated by the surgical procedure, which of the following positions is preferred for the unconscious patient immediately postoperative?

A) a. Supine B) b. Lateral C) c. Semi-Fowler’s D) d. High-Fowler’s

Miscellaneous

100

A postoperative patient is transferred from the postanesthesia unit to the medical-surgical nursing floor. The nurse notes that the patient has an order for D5 ½ NS to infuse at 125 ml/hr. Until an IV pump is available, the nurse regulates the IV flow rate at which of the following drops (gtts)/min, noting that the tubing has a drop factor of 10 drops/ml?

A) a. 13 gtts/min B) b. 31 gtts/min C) c. 31 gtts/min D) d. 21 gtts/min

200

Protein replacement for nutritional balance can be accomplished with a diet that?

a). high in carbohydrates b). high in protein c). low in fats d). includes all of the above

300

Because liver disease is associated with a high surgical mortality rate, the nurse knows to alert the physician for?

a). a lactate dehydrogenase concentration of 300 units b). a serum albumin of 5.0 g/dL c). a blood ammonia concentration of 180mg/dL d). a serum globulin concentration of 2.8 g/dL

400

The potential effects of medication therapy must be evaluated before surgery. A drug classification that may cause electrolyte imbalance is?

a). corticosteroids b). diuretics c). phenothaizines d). insulin

500

Surgery would be contraindicated for a renal patient with?

a). a creatine kinase level of 120 U/L b). a blood urea nitrogen level of 42 mg/dL c). a serum creatinine level of 0.9 mg/dl d). a urine creatinine level of 1.2 mg/dL