Safety Needs
Following a shoulder arthroscopy with a regional block, the patient denies any discomfort. The nursing care priority is to:
1. monitor for post-dural puncture headache.
2. check for bladder distention.
3. check sixth cranial nerve involvement.
4. protect the affected arm.
4. protect the affected arm.
The most common causes of ventricular tachycardia in PACU are:
1. hypoxia, heart disease, or drug toxicity.
2. pain and anxiety.
3. nausea and vomiting.
4. hypovolemia and decreased kidney function.
1. hypoxia, heart disease, or drug toxicity.
When providing discharge instructions for a patient who has undergone a laparoscopic cholecystectomy, the perianesthesia nurse should encourage:
1. frequent ambulation.
2. regular tub baths.
3. application of warm compresses.
4. bed rest for 24 hours.
1. frequent ambulation.
Parents of a child who has undergone a tonsillectomy calls into the unit and reports that their child has had slight ear pain for a few days. Is this an expected finding?
Yes
A patient with previously well-controlled diabetes mellitus type I is scheduled as an "add-on" case at the end of the OR daily schedule. The patient has received 7 units of regular recombinant human insulin (Humulin) for blood glucose of 265 mg/dl, and has been n.p.o. with an intravenous solution containing dextrose. The perianesthesia nurse anticipates the patient is at risk for:
1. hyperosmolar coma.
2. hypoglycemia.
3. diabetic ketoacidosis.
4. hyperglycemia.
2. hypoglycemia.
A patient that comes to the pre-operative area with Do Not Resuscitate (DNR) status:
1. has the DNR suspended intraoperatively.
2. can be resuscitated during the anesthetic period.
3. resumes DNR upon entering the PACU.
4. requires clarification between the patient and provider.
4. requires clarification between the patient and provider.
While caring for a postoperative patient with sickle cell disease, the priority nursing interventions are to prevent:
1. hypothermia and hypoxia.
2. hyperthermia and hypovolemia.
3. hyperthermia and hypoxia.
4. hypervolemia and hyperkalemia.
1. hypothermia and hypoxia.
When educating parents on the care of an infant who has undergone cleft lip repair, the perianesthesia nurse emphasizes the importance of:
1. applying warm compresses to sutures.
2. minimizing crying and restraining arms.
3. keeping the infant NPO for 24 hours.
4. using a straw for feedings.
2. minimizing crying and restraining arms.
What is the most commonly occurring post-operative and post-discharge complication?
Nausea and vomiting, which affects 1/3 of surgical patients each year
Numerous bruises are noted on the arms and neck area of a geriatric female during a preoperative interview. The perianesthesia nurse understands that:
1. the local police must be contacted.
2. family members need to be aware.
3. the need to notify the emergency department.
4. mandatory reporting is different for each state.
4. mandatory reporting is different for each state.
Which of the following patients is at the greatest risk of developing a latex allergy?
1. History of allergy to bee venom
2. History of allergies to strawberries
3. Family history of Malignant Hyperthermia
4. History of spina bifida
4. History of spina bifida
A 32 year old arrives to the PACU following a left rotator cuff repair. A bulky dressing is in place and the patient's arm is flexed and supported by a sling-styled immobilizer. The perianesthesia nurse will:
1. monitor the left arm radial pulse to assess for adequate circulation.
2. apply frequent heat applications to the shoulder to increase circulation.
3. maintain immobility of the left hand and wrist to avoid shoulder displacement.
4. discourage the administration of non-steroidal pain medications.
1. monitor the left arm radial pulse to assess for adequate circulation.
Two months following a surgical procedure, a patient is readmitted to the preoperative area and states that they remember hearing music in the operating room during their surgery. In reviewing the previous documentation, the perianesthesia nurse notes that the patient received midazolam preoperatively. When interviewing the patient, the perianesthesia nurse:
1. may consider implementing the Modified Brice Questionnaire.
2. may consider implementing the STOP/BANG Questionnaire.
3. should inform the patient that they may have had an adverse reaction to the midazolam
4. should reassure the patient that they were most likely were dreaming during anesthesia.
1. may consider implementing the Modified Brice Questionnaire.
What is the temperature range of a normothermic patient, according to ASPAN's practice recommendation?
36 - 38 degrees Celsius; 96.8 - 100.4 degrees Farenheit
A patient underwent an acromioplasty with an interscalene block. Shortly after admission to the PACU, the patient loses consciousness, has distended neck veins, and is hypoxic. According to the ACLS guidelines, the perianesthesia nurse suspects:
1. hypervolemia.
2. a tension pneumothorax.
3. hyperthermia.
4. bronchospasm.
2. a tension pneumothorax.
According to ASPAN minimum staffing recommendations, a phase II PACU would be appropriately staffed with:
1. one med-surg RN and one phase II competent LPN.
2. one phase II competent RN and one med-surg LPN.
3. a single phase II competent RN.
4. a single med-surg competent RN.
2. one phase II competent RN and one med-surg LPN.
Intense shivering can increase heat production up to
1. 10%
2. 50%
3. 100%
4. 500%
4. 500%
A patient who had received an interscalene block for shoulder surgery reports a numb mouth and tongue, tinnitus, no pain, and full range of motion of fingers. The perianesthesia nurse suspects:
1. appropriate blockade.
2. toxicity.
3. ischemia.
4. possible infection.
2. toxicity.
Name an adverse consequence of intraoperative hypothermia.
Increase risk of adverse myocardial outcomes
Prolonged and altered drug effects of many drug classes (such as muscle relaxants)
Increased rate of pressure ulcers
Increased need for blood transfusion
Impaired wound healing and increased incidence of post-op infection
A patient has undergone ORIF of a fractured tibia. The PACU nurse notices that the patient’s toes are extremely edematous. The patient complains of increased pain unrelieved by analgesics. The PACU nurse should:
1. continue to administer analgesics until an effect is noted.
2. apply ice and elevate extremity.
3. suspect compartment syndrome and notify the physician immediately.
4. attribute the patient’s condition to the surgical procedure.
3. suspect compartment syndrome and notify the physician immediately.
A patient with a history of Grand Mal seizures begins to have uncontrolled tonic-clonic movements in the PACU. The perianesthesia nurse’s primary responsibility to the patient is to:
1. prevent injury and aspiration.
2. monitor for recurrent seizures.
3. administer IV phenytoin.
4. check serum anticonvulsant levels.
1. prevent injury and aspiration.
Because the stomach of a fasting patient often contains clear acidic fluids, which of the following is correct?
1. Ingestion of fats and solids improves gastric emptying.
2. Ingestion of 150 ml of water improves gastric emptying.
3. Fasting for 12 hours preoperatively is recommended.
4. Fluids in children are withheld for at least 6 hours.
2. Ingestion of 150 ml of water improves gastric emptying.
Upon a patient's admission to the PACU, the anesthesiologist reports that the patient received anesthesia with thiopental, atracurium, morphine sulfate, and sevoflurane. The patient was reversed with neostigmine, atropine, and naloxone 5 minutes prior to admission to the PACU. The PACU nurse will observe for respiratory depression because:
1. thiopental is potentiated by the naloxone.
2. atracurium causes irreversible muscle relaxation.
3. morphine sulfate may last longer than naloxone's reversal action.
4. the combination of neostigmine and atropine increases respiratory depression.
3. morphine sulfate may last longer than naloxone's reversal action.
During recovery from spinal anesthesia, the patient denies sensation below his umbilicus. The perianesthesia nurse identifies the dermatome level as:
1. T4
2. T10
3. L1
4. S2
2. T10
The perianesthesia nurse knows that sodium nitroprusside should be:
1. mixed in a normal saline solution.
2. used within for 12 hours after reconstitution.
3. placed in bottles to prevent degradation.
4. covered with aluminum foil.
4. covered with aluminum foil.