Pre-Op
Which of the following medications should be withheld prior to surgery to reduce the risk of excessive bleeding?
A) Aspirin
B) Lorazepam
C) Metformin
D) Lisinopril
A) Aspirin
Rationale: Aspirin is an antiplatelet agent and should be withheld before surgery because it increases the risk of bleeding.
Which of the following actions is most important for preventing surgical site infections (SSIs) during the intraoperative phase?
A) Administering prophylactic antibiotics within 1 hour before the surgical incision
B) Using a surgical drape that does not allow any exposure of the patient’s skin during the procedure
C) Maintaining the patient’s body temperature between 36-37°C (96.8-98.6°F) throughout the procedure
D) Restricting traffic in the operating room to only essential personnel during the procedure
A) Administering prophylactic antibiotics within 1 hour before the surgical incision
Rationale: Prophylactic antibiotics are most effective when given within 1 hour before the incision to prevent infection.
A patient is recovering from a cholecystectomy and reports a pain level of 7 out of 10 on the pain scale. Which of the following interventions should the nurse prioritize to manage this patient's pain?
A) Administer the prescribed opioid analgesic and reassess pain in 30 minutes.
B) Encourage the patient to perform deep breathing and coughing exercises to reduce pain.
C) Administer the prescribed nonsteroidal anti-inflammatory drug (NSAID) and monitor for gastrointestinal upset.
D) Reassure the patient that pain is normal and suggest using non-pharmacological methods, such as distraction.
A) Administer the prescribed opioid analgesic and reassess pain in 30 minutes.
Rationale: Given that the patient reports significant pain (7/10), opioid analgesics are appropriate for managing moderate to severe pain. Reassessing pain after administration is essential to gauge effectiveness.
Which of the following is considered the greatest risk factor for complications related to anesthesia during the preoperative period?
A) Obesity
B) Age over 60
C) Smoking history
D) History of substance use disorder
A) Obesity
Rationale: Obesity increases the risk of complications during anesthesia, such as difficulty with intubation, respiratory issues, and cardiovascular strain.
The patient is positioned in the lithotomy position for a gynecological procedure. After the procedure, the nurse observes that the patient is experiencing numbness and tingling in the lower extremities. Which of the following is the most likely cause of this finding?
A) Injury to the peroneal nerve due to improper positioning
B) Inadequate anesthesia leading to sensory nerve irritation
C) Excessive pressure on the femoral artery from the surgical table
D) Fluid overload, causing edema and nerve compression
A) Injury to the peroneal nerve due to improper positioning
Rationale: The lithotomy position can cause compression of the peroneal nerve, leading to numbness and tingling in the lower extremities.
A patient who underwent abdominal surgery is now 4 hours postoperatively. The nurse notes the patient has a temperature of 100.4°F (38°C), increased heart rate (98 bpm), and mild hypotension (BP 90/60 mm Hg). Which of the following is the most appropriate initial nursing action?
A) Administer antipyretics to lower the patient’s temperature.
B) Obtain a blood culture and send it to the lab for analysis.
C) Assess for signs of postoperative infection and notify the healthcare provider.
D) Reposition the patient to a more comfortable position and encourage oral hydration.
C) Assess for signs of postoperative infection and notify the healthcare provider.
Rationale: Mild fever and vital sign changes in the early postoperative period can be common and may indicate a normal inflammatory response. However, assessment for more specific signs of infection, such as changes in the surgical site or increased pain, is essential to rule out complications. The healthcare provider should be notified if the patient’s condition worsens.
Which of the following is the correct guideline for preoperative fasting in a patient scheduled for an elective surgery with general anesthesia?
A) NPO for 6 hours for solid food and 2 hours for clear liquids.
B) NPO for 8 hours for solid food and 4 hours for clear liquids.
C) NPO for 12 hours for solid food and 6 hours for clear liquids.
D) NPO for 8 hours for solid food and 2 hours for clear liquids.
D) NPO for 8 hours for solid food and 2 hours for clear liquids
Rationale: This is the most accurate guideline for preoperative fasting based on current evidence.
During a laparoscopic cholecystectomy, the surgical team experiences difficulty visualizing the surgical site due to excessive CO2 insufflation in the abdominal cavity. The patient’s blood pressure begins to rise, and the heart rate increases to 115 bpm. What is the most likely cause of these intraoperative changes?
A) Hypercarbia due to CO2 retention from insufficient ventilation
B) An allergic reaction to the anesthetic agent
C) A surgical complication resulting in hemorrhage
D) Hypothermia caused by the operating room environment
A) Hypercarbia due to CO2 retention from insufficient ventilation
Rationale: During laparoscopic surgery, excessive CO2 insufflation can lead to hypercarbia, which causes vasodilation, tachycardia, and increased blood pressure.
A nurse is caring for a postoperative patient who underwent a major surgery under general anesthesia. The patient is breathing with a rate of 6 breaths per minute and is difficult to arouse. Which of the following is the nurse’s priority action?
A) Administer naloxone as prescribed by the healthcare provider.
B) Encourage the patient to take deep breaths and cough.
C) Increase the oxygen flow to 100% via a nonrebreather mask.
D) Prepare for endotracheal intubation to secure the airway.
A) Administer naloxone as prescribed by the healthcare provider.
Rationale: The patient's respiratory depression and difficulty arousing are likely related to opioid-induced sedation, and naloxone is a reversal agent that can help reverse the effects of opioids and improve respiration.
When assessing a preoperative patient with a history of heart disease, which of the following findings should be immediately reported to the surgical team before proceeding with surgery?
A) A heart rate of 88 beats per minute.
B) A blood pressure of 136/78 mm Hg.
C) An irregular heart rhythm detected on auscultation.
D) Mild shortness of breath after walking 10 feet.
C) An irregular heart rhythm detected on auscultation
Rationale: An irregular heart rhythm in a patient with a history of heart disease can indicate a potentially serious arrhythmia and should be reported to the surgical team immediately to assess the risk before proceeding.
A patient undergoing surgery is receiving intravenous (IV) fluids to maintain adequate hydration and perfusion. The anesthesiologist reports a decrease in urine output despite adequate IV fluid administration. Which of the following is the most likely cause of this change?
A) Intraoperative hypotension leading to renal hypoperfusion
B) Inadequate fluid resuscitation causing dehydration
C) Excessive fluid administration leading to kidney overload
D) Intraoperative hyperglycemia leading to polyuria
A) Intraoperative hypotension leading to renal hypoperfusion
Rationale: Intraoperative hypotension is a common cause of reduced urine output during surgery due to decreased renal perfusion.
A nurse is caring for a postoperative patient who underwent abdominal surgery. The patient is at risk for deep vein thrombosis (DVT). Which of the following interventions is the most effective in reducing the risk of DVT in the immediate postoperative period?
A) Encourage the patient to perform leg exercises every hour while awake.
B) Apply a heating pad to the lower extremities to increase blood circulation.
C) Administer low-dose heparin as prescribed.
D) Restrict fluid intake to minimize the risk of edema and DVT formation.
A) Encourage the patient to perform leg exercises every hour while awake.
Rationale: Leg exercises, such as dorsiflexion and plantar flexion, can help improve circulation and reduce the risk of DVT in the postoperative period.
Mrs. Linda Harper is a 62-year-old woman scheduled for a knee replacement surgery tomorrow. She has a history of hypertension and type 2 diabetes, both of which are currently well-controlled with medication. She has been fasting for 8 hours as per preoperative instructions and is now in the preoperative holding area. The nurse is preparing Mrs. Harper for the procedure.
Question:
Which of the following actions is the most important for the nurse to take during the preoperative assessment?
A) Administer the prescribed preoperative medication, including her antihypertensive medication.
B) Review Mrs. Harper’s medical history and confirm that she has not had anything to eat or drink in the past 8 hours.
C) Ensure that Mrs. Harper is fully aware of the surgery details, including the expected recovery time and potential complications.
D) Instruct Mrs. Harper to use the incentive spirometer every hour while waiting in the preoperative holding area.
B) Review Mrs. Harper’s medical history and confirm that she has not had anything to eat or drink in the past 8 hours.
Rationale: Confirming that Mrs. Harper has adhered to the fasting protocol is a critical step in preventing complications like aspiration during surgery.
Mr. John Davis is a 45-year-old male who is undergoing a cholecystectomy (gallbladder removal) under general anesthesia. He has a history of hypertension, for which he is prescribed medication. During the surgery, the anesthesia provider reports that Mr. Davis' blood pressure is 90/50 mmHg, and his heart rate is 110 bpm. The surgical team is preparing to continue with the procedure, but the surgeon is concerned about the patient's hemodynamic status.
Question:
Which of the following actions should the nurse take to best support Mr. Davis' hemodynamic stability during the surgery?
A) Administer a bolus of IV fluids as prescribed to increase circulating volume and improve blood pressure.
B) Increase the rate of the general anesthetic to prevent any discomfort during the surgery.
C) Reduce the rate of the IV fluids to prevent fluid overload, since Mr. Davis has a history of hypertension.
D) Apply a warming blanket to the patient to maintain body temperature and prevent hypothermia.
A) Administer a bolus of IV fluids as prescribed to increase circulating volume and improve blood pressure.
Rationale: Hypotension and tachycardia are common intraoperative concerns. A bolus of IV fluids is the primary intervention to support hemodynamic stability by increasing blood volume, which can help raise blood pressure and stabilize the heart rate.
Mr. William Clark is a 68-year-old male who underwent a prostatectomy (removal of the prostate) 2 hours ago under general anesthesia. He is now in the post-anesthesia care unit (PACU) and is being monitored closely by the nurse. Mr. Clark's vital signs are as follows: BP 120/75 mmHg, HR 80 bpm, SpO2 95%, and respiratory rate 16 breaths/min. He is alert and oriented but reports some pain at the surgical site, rated 6/10. The nurse also observes that Mr. Clark's abdomen is slightly distended, and his bowel sounds are absent.
Question:
Which of the following actions is the nurse's priority in managing Mr. Clark's postoperative care at this time?
A) Administer the prescribed analgesic for pain relief as requested by Mr. Clark.
B) Assess Mr. Clark for signs of postoperative urinary retention, as prostate surgery often affects urinary function.
C) Encourage Mr. Clark to cough and deep breathe to prevent respiratory complications.
D) Notify the healthcare provider about the absence of bowel sounds and abdominal distention.
B) Assess Mr. Clark for signs of postoperative urinary retention, as prostate surgery often affects urinary function.
Rationale: After prostate surgery, urinary retention is a common concern due to the impact on the bladder and urethra. The nurse should assess Mr. Clark's ability to void and monitor for signs of retention (e.g., discomfort, bladder distension, inability to urinate).