a
2. A client undergoing which surgery will likely return to activities in their everyday lives more quickly?
A) Vaginal hysterectomy
B) Laparoscopic cholecystectomy
C) Right nephrectomy
D) Open-heart surgery
Ans: B
Feedback:
Clients who have surgery using a laparoscope are able to return to previous activity levels much sooner.
17. A client has been taking aspirin since his or her heart attack in 1997. The client is at risk for:
A) infection.
B) thrombophlebitis.
C) hemorrhage.
D) blood clots.
Ans: C
Feedback:
Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti-inflammatory drugs, aspirin) is important and should be reported to the surgeon.
6. A client in the immediate postoperative period begins to report nausea and ultimately begins vomiting. The nausea and vomiting are most likely related to:
A) movement of bowels during surgery.
B) inactivity and emotional upset.
C) the effects of anesthetic agents.
D) severe pain at the operative site.
Ans: C
Feedback:
Nausea and vomiting can occur postoperatively from the effects of anesthetic agents.
19. When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this is most likely a result of:
A) effects of anesthesia.
B) normal return of reflexes.
C) partial airway obstruction.
D) type of surgery.
Ans: C
Feedback:
Loud, irregular respirations may indicate obstruction of the airway, possibly from emesis, accumulated secretions, or client positioning that allows the tongue to fall to the back of the throat.
5. When educating a client in the postoperative period, it is important to educate the client to consume a diet high in:
A) protein.
B) calcium.
C) bicarbonate.
D) potassium.
Ans: A
Feedback:
After surgery, a diet with sufficient amounts of protein and vitamins A and C helps rebuild tissues and promotes wound healing.
15. A client is being discharged following surgery for cancer care. The client will require extensive dressing changes two times per day. The client is on a fixed income and cannot afford to purchase dressing supplies. The nurse contacts a local nonprofit agency to assist in the provision of dressings. This contribution in care will
assist in improving the client’s:
A) family relationships.
B) knowledge base.
C) decision making.
D) self-concept.
Ans: D
Feedback:
In addition to providing the client with the necessary technical care, education, extensive rehabilitation, and emotional support, nursing interventions may also include referral to agencies and support groups that can benefit the client after surgery and after discharge from the acute care facility.
10. The nurse anesthetist is monitoring the client during surgery and notices a ventricular dysrhythmia and unstable blood pressure. The nurse anesthetist notifies the surgeon. The operative team suspects:
A) myocardial infarction.
B) malignant hyperthermia.
C) mitral valve prolapse.
D) major blood loss.
Ans: B
Feedback:
The symptoms of malignant hyperthermia are masseter muscle rigidity, ventricular dysrhythmia, tachypnea, cyanosis, skin mottling, and unstable blood pressure.
20. The nurse is caring for a client admitted for an outpatient surgical procedure. Which action will the nurse include in the care? Select all that apply.
A) Begin discharge education as soon as the procedure is completed.
B) Allow family members to be present during discharge education.
C) Begin discharge education in the preoperative period.
D) Investigate the client’s home care and discharge transportation following the procedure.
E) Discuss discharge transportation during the preoperative period.
Ans: B, C, E
Feedback:
Client education begins during the preoperative period and continues throughout all perioperative phases of care. In the preoperative phase, assess the client’s and family’s readiness to learn and their knowledge base so that education can be individualized. If the client will be discharged on the day of surgery, be sure to identify someone who can take the client home and assist during the postoperative recovery period.
13. Which nursing action provides the greatest assistance in healing?
A) Maintaining a restful environment
B) Providing solid food in the first day
C) Allowing family members to visit often
D) Keeping the client recumbent
Ans: A
Feedback:
The nurse should plan for adequate periods of rest and sleep, maintaining a quiet, restful environment.
16. The nurse has been waiting until after the administration of a toddler’s anesthesia before removing the child’s clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will:
A) minimize blood loss.
B) enhance thermoregulation.
C) provide more accurate baseline vital signs.
D) prevent anxiety.
Ans: D
Feedback:
Relaxation can be enhanced by removing the child’s clothing, applying the grounding pad, and applying monitoring devices after the child is anesthetized. This action has no effect on vital signs, thermoregulation, or blood loss.
8. Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?
A) I can have a hamburger and French fries as soon as I wake up.
B) The better I eat before surgery, the more likely I will heal.
C) I might be sick to my stomach and throw up after surgery.
D) When I can eat again, the best meal would be steak and orange juice.
Ans: A
Feedback:
Oral fluid and food may be withheld until intestinal motility resumes.
22. Which personnel are legally responsible for obtaining the client’s informed
consent for a surgical procedure?
A) The surgeon
B) The registered nurse
C) The admissions clerk
D) The licensed practical nurse
Ans: A
Feedback:
The surgeon is legally responsible for obtaining the client’s informed consent.
3. A client has arrived in the same-day surgery suite. He or she states, “I am so worried about being put to sleep and having the surgery.” What would be the nurse’s best response?
A) You don’t have to worry. It will be fine.
B) Tell me what you are most worried about?
C) I will have the anesthesiologist talk to you?
D) Have you ever had surgery before?
Ans: B
Feedback:
The nurse should first assess what the client is most worried about, and then provide emotional support.
25. The nurse is preparing to start an IV in a client who is to go to surgery. The nurse would likely choose which gauge of IV catheter?
A) 22 gauge
B) 25 gauge
C) 18 gauge
D) 14 gauge
Ans: C
Feedback:
For any surgical client, a large-gauge (e.g., 18 gauge) IV device should be used in case a blood transfusion is necessary during the surgical or postoperative period.
9. Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?
A) A woman delivering by C-section
B) An adolescent for arthroscopic surgery
C) A young adult with a fractured leg
D) An older adult man with a fractured hip
Ans: D
Feedback:
The risk of hypothermia increases in the very young and the very old.
24. The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?
A) Immediately have the client sign the consent form.
B) Have the client’s family member sign the consent form.
C) Ask the client if he or she still wants to proceed with the procedure.
D) Notify the physician of the oversight.
Ans: D
Feedback:
Do not administer any medications that might alter judgment or perception before the client signs the consent form because many drugs commonly administered as preoperative medications, such as narcotics or barbiturates, can alter cognitive abilities and invalidate informed consent.
12. In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the 2nd postoperative day, the client’s bowel sounds are absent.
What does the nurse suspect?
A) Normal response
B) Abdominal infection
C) Hernia development
D) Paralytic ileus
Ans: D
Feedback:
A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.
23. The client has been transported to the operating suite and positioned on the operating table. Suddenly, the client states, "I don't want to do this. Get me out of here now!" Which action should occur?
A) The client should be given the anesthesia.
B) The surgeon should tell the client to remain calm and the procedure will be over soon.
C) The client should be told it is too late to change his or her mind.
D) The procedure should be stopped.
Ans: D
Feedback:
The client has the right to ask any questions and to withdraw consent at any point before the surgery begins.
11. What is the rationale for having the client void before surgery?
A) To assess for pregnancy in women
B) To assess for urinary tract infection
C) To prevent bladder distention
D) To prevent electrolyte imbalance
Ans: C
Feedback:
Having the client void before surgery will assist in the prevention of bladder distention during or after the procedure.
18. A client states he or she has a latex allergy. Which action should the nurse take?
A) Inform the client to tell the anesthesiologist.
B) Have the client take diphenhydramine before surgery.
C) Send the client to the OR with epinephrine.
D) Place an allergy identification band on the client.
Ans: D
Feedback:
Assist the client with allergies to medications, food, and latex before the surgical procedure; clearly mark them on the client record and on the client identification band.
4. After which surgery would a client likely see the greatest permanent changes in lifestyle following surgery?
A) Right total knee replacement
B) Left mastectomy
C) Ileostomy
D) Appendectomy
Ans: C
Feedback:
Permanent changes in the client’s activity level may occur as a result of surgery. The client with an ileostomy will encounter the greatest changes in lifestyle.
14. Which nursing action will assist in pain management for a client in the postoperative phase?
A) Client education
B) Relaxation techniques
C) Dim lighting
D) Provide food and medication
Ans: B
Feedback:
Nursing interventions vital in helping clients cope with pain include administering medications, positioning, relaxation techniques, psychological support, distraction techniques, and appropriate referrals to other health professionals.
7. A surgical client has been ordered a dose of IV cephalosporin. Why is it important that this drug be administered as close as possible to the time of surgery?
A) To prevent the development of atelectasis postoperatively.
B) To prevent the development of aspiration intraoperatively.
C) To allow for decreased level of white blood cells.
D) To maximize serum levels of the medication during surgery.
Ans: D
Feedback:
A cephalosporin antibiotic is administered just before the surgical procedure so that the level of medication circulating in the client’s blood will be high during surgery.
21. A preoperative client has called the nurse about his or her upcoming surgical procedure, 6 weeks from now. He or she is concerned about receiving blood after surgery for fear of acquiring a blood-borne disease. What is the nurse’s most
appropriate response?
A) Instruct the client to notify the physician promptly.
B) Remind the client that blood is tested prior to administration, guaranteeing it is free of disease.
C) Ask the client if he or she has ever had any other blood products in the past.
D) Explain to the client the practice of autologous blood donation.
Ans: D
Feedback:
Because of the fears of hepatitis B and human immunodeficiency virus infection associated with blood transfusion, donation of autologous blood (one’s own blood) for surgery is becoming a common practice. If the client wishes, provide the necessary information about blood donation if the client is seen a number of weeks before surgery.
1. The nurse knows the term perioperative phase refers to care given to the client:
A) before, during, and after the operative phase.
B) from the start of surgery until its conclusion.
C) immediately before an operative procedure.
D) immediately after the operative phase.
Ans: A
Feedback:
Perioperative nursing includes three distinct phases: preoperative, intraoperative, and postoperative.