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Peri-operative Nursing

100 Questions
Peri-operative Nursing

Medical-surgical nursing is a nursing specialty area concerned with the care of adult patients in a broad range of settings. The Academy of Medical-Surgical Nurses (AMSN) is a specialty nursing organization dedicated to nurturing medical-surgical nurses as they advance their careers. Traditionally, medical-surgical nursing was an entry-level position that most nurses viewed as a stepping stone to specialty areas. Medical-surgical nursing is the largest group of professionals in the field of nursing. Advances in medicine and nursing have resulted in medical-surgical nursing evolving into its own specialty.

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Questions and Answers
  • 1. 
    The nurse is preparing a client for surgery. What is the most effective method for obtaining an accurate blood pressure reading from the client?
    • A. 

      Obtain a cuff that covers the upper one third of the client’s arm

    • B. 

      Position the cuff approximately 4 inches above the antecubital arm

    • C. 

      Use a cuff that is wide enough to cover the upper two thirds of the client’s arm

    • D. 

      Identify the Korotkoff sounds, and take a systolic reading at 10 mmHg after the first sound

  • 2. 
    Which of the following items on a client’s presurgery laboratory results would indicate a need to contact the surgeon?
    • A. 

      Platelet count of 250,000/cu.mm

    • B. 

      Total cholesterol of 325 mg/dl

    • C. 

      Blood urea nitrogen (BUN)) 17 mg/dl

    • D. 

      Hemoglobin 9.5 mg/dl

  • 3. 
    To prevent complications of immobility, which activities would the nurse plan for the first postoperative day after a colon resection?
    • A. 

      Turn, cough, and deep breathe every 30 minutes around the clock

    • B. 

      Get the client out of bed and ambulate to a bedside chair

    • C. 

      Provide passive range of motion three times a day

    • D. 

      It is not necessary to worry about complications of immobility on the first postoperative day

  • 4. 
    In the recovery room, the postoperative client suddenly becomes cyanotic. What is the most appropriate nursing action?
    • A. 

      Start administration of oxygen through a nasal cannula

    • B. 

      Call for assistance

    • C. 

      Reposition the head and determine patency of airway

    • D. 

      Insert an oral airway and suction the nasopharynx

  • 5. 
    A client is scheduled for surgery in the morning. Preoperative orders have been written. What is the most important to do before surgery?
    • A. 

      Remove all jewelries or tape wedding ring

    • B. 

      Verify that all laboratory work is complete

    • C. 

      Inform family or next of kin

    • D. 

      Have all consent forms signed

  • 6. 
    The nurse is caring for a first day postoperative surgical client. Prioritize the patient’s desired dietary progression. Arrange in sequence the dietary progression from 1 to 4: 1. Full liquid; 2. NPO; 3. Clear liquid; 4. Soft
    • A. 

      1, 2, 3, 4

    • B. 

      2, 3, 1, 4

    • C. 

      2, 1, 4, 3

    • D. 

      4, 3, 2, 1

  • 7. 
    A postoperative client receives a dinner tray with gelatin, pudding, and vanilla ice cream. Based on the foods on the client’s tray, what would the nurse anticipate the client’s current diet order to be:
    • A. 

      Bland diet

    • B. 

      Soft diet

    • C. 

      Full liquid diet

    • D. 

      Regular diet

  • 8. 
    The nurse is preparing the preoperative client for surgery. The following statements that indicate the client is knowledgeable about his impending surgery, except:
    • A. 

      “After surgery, I will need to wear the pneumatic compression device while sitting in the chair”

    • B. 

      “The skin prep area is going to be longer and wider than the anticipated incision”

    • C. 

      “I cannot have anything to drink or eat after midnight on the night before the surgery”

    • D. 

      “To ensure my safety, a ‘time out’ will be conducted in the operating room”

  • 9. 
    Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery?
    • A. 

      To prevent malnutrition

    • B. 

      To prevent electrolyte imbalance

    • C. 

      To prevent aspiration pneumonia

    • D. 

      To prevent intestinal obstruction

  • 10. 
    The nurse will provide preoperative teaching on deep breathing, coughing and turning exercises. When is the best time to provide the preoperative teachings?
    • A. 

      Before administration of preoperative medications

    • B. 

      The afternoon or evening prior to surgery

    • C. 

      Several days prior to surgery

    • D. 

      Upon admission of the client in the recovery room

  • 11. 
    Which of the following factors ensure validity of informed written consent, except:
    • A. 

      The patient is of legal age with proper mental disposition

    • B. 

      If the patient is a child, secure consent from the parents or legal guardian

    • C. 

      The consent is secured before administration of preoperative medications

    • D. 

      If the patient is unable to write, the nurse signs the consent for the patient

  • 12. 
    Which of the following drugs is administered to minimize respiratory secretions preoperatively?
    • A. 

      Valium (diazepam)

    • B. 

      Phenergan (promethazine)

    • C. 

      Atropine sulfate

    • D. 

      Demerol (Meperidine)

  • 13. 
    Which of the following is experienced by the patient who is under general anesthesia?
    • A. 

      The patient is unconscious

    • B. 

      The patient is awake

    • C. 

      The patient experiences slight pain

    • D. 

      The patient experiences loss of sensation in the lower half of the body

  • 14. 
    Which of the following is most dangerous complication during induction of spinal anesthesia?
    • A. 

      Cardiac arrest

    • B. 

      Hypotension

    • C. 

      Hyperthermia

    • D. 

      Respiratory paralysis

  • 15. 
    Which of the following postoperative patients is at risk for respiratory complications?
    • A. 

      The obese patient with long history of smoking who had undergone upper abdominal surgery

    • B. 

      The patient with normal pulmonary function who had undergone upper abdominal surgery

    • C. 

      An adolescent patient with diabetes mellitus who had undergone cholecystectomy

    • D. 

      A football player who had undergone knee replacement surgery

  • 16. 
    The patient had undergone spinal anesthesia for appendectomy. To prevent spinal headache, the nurse should place the patient in which of the following positions?
    • A. 

      Semi-Fowler’s

    • B. 

      Flat on bed for 6 to 8 hours

    • C. 

      Prone position

    • D. 

      Modified Trendelenburg position

  • 17. 
    The nurse is admitting a patient to the operating room. Which of the following nursing actions should be given highest priority by the nurse?
    • A. 

      Assessing the patient’s level of consciousness

    • B. 

      Checking the patient’s vital signs

    • C. 

      Checking the patient’s identification and correct operative permit

    • D. 

      Positioning and performing skin preparation to the patient

  • 18. 
    Which of the following assessment data is most important to determine when caring for a patient who has received spinal anesthesia?
    • A. 

      The time of return of motion and sensation in the patient’s legs and toes

    • B. 

      The character if the patient’s respiration

    • C. 

      The patient’s level of consciousness

    • D. 

      The amount of wound drainage

  • 19. 
    The nurse is transferring the patient from the postanesthesia care unit to the surgical unit. Which of the following is the primary reason for gradual change of position of the patient?
    • A. 

      To prevent muscle injury

    • B. 

      To prevent sudden drop of blood pressure

    • C. 

      To prevent respiratory distress

    • D. 

      To promote comfort

  • 20. 
    The nurse is caring for a patient who had undergone exploratory laparotomy. Which of the following postop findings should the nurse report to the physician?
    • A. 

      The patient pushes out the oral airway with his tongue

    • B. 

      The patient’s urine output is 20 ml/hr for the past 2 hours

    • C. 

      The patient’s vital signs are as follows: BP = 100/70 mmHg; PR = 95 bpm; RR = 9 minute; T = 36.8°C

    • D. 

      The patient’s wound drainage

  • 21. 
    The patient had undergone thyroidectomy. Which of the following are the earliest signs of poor tissue perfusion and poor respiratory function?
    • A. 

      Cyanosis, lethargy

    • B. 

      Fast, thready pulse, bradypnea

    • C. 

      Apprehension and restlessness

    • D. 

      Faintness, pallor

  • 22. 
    The diabetic patient who had undergone abdominal surgery experiences wound evisceration. Which of the following is the most appropriate immediate nursing action?
    • A. 

      Cover the wound with sterile gauze moistened with sterile normal saline

    • B. 

      Cover the wound with sterile dry gauze

    • C. 

      Cover the wound with water-soaked gauze

    • D. 

      Leave the wound uncovered and pull the skin edges together

  • 23. 
    The patient had undergone total hip replacement. He complains of pain in the operative site. Which of the following is the appropriate initial nursing action?
    • A. 

      Administer the ordered analgesic

    • B. 

      Instruct the patient to do deep breathing and coughing exercises

    • C. 

      Assess the patient’s pain level and vital signs

    • D. 

      Change the patient’s position

  • 24. 
    Which of the following are not members of the sterile team in the operating room, except:
    • A. 

      Surgeon

    • B. 

      Scrub nurse

    • C. 

      Radiology technician

    • D. 

      Circulating nurse

  • 25. 
    The best position for kidney, chest, or hip surgery is:
    • A. 

      Supine

    • B. 

      Trendelenburg

    • C. 

      Lithotomy

    • D. 

      Lateral

  • 26. 
    When discussing the details of having a procedure done in a facility's ambulatory surgery department, the nurse includes which of the following as advantages? (Select all that apply.)
    • A. 

      Facilitates faster postsurgical recovery

    • B. 

      Reduces hospital-oriented expenses

    • C. 

      Allows for more one-on-one attention by staff

    • D. 

      Cuts preparation time for surgical procedures

    • E. 

      Minimizes risk for acquiring a nosocomial infection

    • F. 

      The anesthetic drugs used result in faster "wake-up" time

  • 27. 
    The nurse is very busy and needs to delegate some tasks to the nursing assistive personnel (NAP). Which of the following would be the most appropriate task to delegate?
    • A. 

      Postoperative client teaching

    • B. 

      Demonstrating postoperative exercises

    • C. 

      Transporting the preoperative client from the unit to the holding area

    • D. 

      Reviewing the preoperative assessment to make sure that the client’s vital signs have been documented

  • 28. 
    Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. For which of the following should the nurse provide instruction and rationale?
    • A. 

      Incentive spirometry

    • B. 

      Specific details regarding the progression of diet

    • C. 

      Working the call button for the nurse

    • D. 

      Using the patient-controlled analgesia (PCA) pump

  • 29. 
    A 47-year-old female client has been scheduled to undergo surgery for removal of her gallbladder. Preoperatively the nurse is teaching the client what to expect when she wakes up in the postanesthesia care center. The nurse tells the client that her vision may be blurry due to which of the following reasons?
    • A. 

      The client’s blood pressure may be high from the postoperative pain.

    • B. 

      The client may be slow to arouse from the anesthesia, causing her vision to be blurred upon waking.

    • C. 

      The anesthesia provider applies ointment to clients’ eyes to prevent corneal damage.

    • D. 

      The lighting in the postanesthesia area will be subdued, causing the client to have blurred vision upon waking.

  • 30. 
    A 24-year-old male client has been scheduled to undergo surgery for an ACL repair of his right knee. The client states that he is confused about what the surgeon will be doing. The best response from the nurse is:
    • A. 

      "The surgeon went over this procedure with you in his office"

    • B. 

      "Let me get the surgeon to talk with you before we proceed so that you fully understand what will be happening"

    • C. 

      To share with the client what he can expect in regard to the procedure

    • D. 

      "This is just a simple procedure—you should feel much better afterwards"

  • 31. 
    A 64-year-old male client has been scheduled to undergo surgery for a total knee replacement. The client would like to be able to use his own blood for the surgery, if needed. The nurse explains that there are several advantages to the client's having an autologous infusion, but there are some drawbacks as well. Which of the following would be considered a drawback to an autologous infusion?
    • A. 

      The client has a decreased risk for contracting HIV.

    • B. 

      There is an decreased risk for infection.

    • C. 

      The client has less risk for a transfusion reaction.

    • D. 

      The client may have a decreased hemoglobin and hematocrit level on the day of surgery.

  • 32. 
    A 36-year-old female diabetic client is having an elective breast augmentation procedure done. Which of the following tests must be done on the day of surgery?
    • A. 

      Complete blood count (CBC)

    • B. 

      Blood glucose

    • C. 

      Serum electrolytes

    • D. 

      Coagulation studies

  • 33. 
    A 48-year-old male client with a history of chronic obstructive pulmonary disease (COPD) is scheduled for an inguinal hernia repair. The nurse instructs that client that he can expect the health care provider to order which of the following tests before surgery?
    • A. 

      Human immunodeficiency virus (HIV) antibody

    • B. 

      Prolactin level

    • C. 

      Pulmonary function test

    • D. 

      Glucose tolerance test

  • 34. 
    The nurse knows that the client is most likely going to arrive for the surgical procedure having adhered to the required bowel preparation if:
    • A. 

      The client understands the need for the laxative

    • B. 

      The laxative ordered is pleasant tasting

    • C. 

      The bowel preparation is an uncomplicated process

    • D. 

      The client has the appropriate support at home

  • 35. 
    Which surgical classification would be the most appropriate for a cardiac catheterization scheduled on a 44-year-old male client who is in the hospital with chest pain?
    • A. 

      Major

    • B. 

      Minor

    • C. 

      Ablative

    • D. 

      Elective

  • 36. 
    The nurse recognizes which of the following as the greatest barrier to meeting a preoperative client’s nursing diagnosis of deficient knowledge regarding surgical procedure?
    • A. 

      Effects of preoperative medication

    • B. 

      Complicated nature of the information

    • C. 

      Fear or anxiety regarding the procedure

    • D. 

      Emotional denial regarding surgical outcomes

  • 37. 
    The initial client education–related nursing action by the preadmission nurse is to:
    • A. 

      Respond to questions presented by the family regarding the client’s surgery

    • B. 

      Call the client before the surgery to restate presurgery routine

    • C. 

      Provide the client with a list of preoperative requirements

    • D. 

      Arrange a time for presurgical blood work to be drawn

  • 38. 
    Which of the following statements made by the nurse shows the most informed understanding of the role of family in the client’s postoperative recovery?
    • A. 

      "The family will be the ones you will be dealing with regarding postoperative needs."

    • B. 

      "When the family is more relaxed about caring for the client, the client is more relaxed."

    • C. 

      "The more the family understands what to expect during recovery, the more comfortable they are in caring for the client."

    • D. 

      "Teaching the family what they need to know before the surgery will maximize their effectiveness regarding the client’s postoperative care."

  • 39. 
    Which of the following best describes the primary nursing role regarding a client’s consent to surgery immediately before surgery?
    • A. 

      Explaining the procedure to the client in a fashion that is easily understood

    • B. 

      Placing the signed consent in the client’s medical record

    • C. 

      Ensuring that the client understands the possible risks of the procedure before signing the consent

    • D. 

      Reviewing the client’s surgical consent as a part of the routine preoperative checklist

  • 40. 
    Which of the following client evaluations is most reflective of compliance for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
    • A. 

      Client will present for scheduled blood laboratory work 48 hours before surgery.

    • B. 

      Client’s preoperative blood laboratory work results are present on preoperative chart.

    • C. 

      Client will share the preoperative routines of surgical care with family to facilitate compliance.

    • D. 

      Client will understand the preoperative routines of surgical care before leaving provider’s office.

  • 41. 
    Which of the following client outcomes is most therapeutic for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
    • A. 

      Client will share the preoperative routines of surgical care with family to facilitate compliance.

    • B. 

      Client will understand the preoperative routines of surgical care before leaving provider’s office.

    • C. 

      Client will call laboratory to schedule appointment for preoperative blood draw for required testing.

    • D. 

      Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery.

  • 42. 
    Which of the following goals is most appropriate for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
    • A. 

      Client will understand the need for scheduled surgery before leaving the provider’s office.

    • B. 

      Client will understand the preoperative routines of surgical care before leaving provider’s office.

    • C. 

      Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery.

    • D. 

      Client will be able to successfully accomplish the preoperative bowel preparation by morning of scheduled surgery.

  • 43. 
    A client scheduled for an ambulatory surgery procedure requiring anesthetics arrives with a low-grade fever and a productive sough. The postponement of the procedure is most likely a result of the:
    • A. 

      Client’s increased risk for a respiratory tract infection

    • B. 

      Possibility of a respiratory complication during anesthesia

    • C. 

      Increased risk for the client's infecting staff and other clients

    • D. 

      Client’s impaired resistance as a result of a respiratory tract infection

  • 44. 
    A client with a history of sleep apnea has had a same-day surgery procedure that will require the administration of morphine postoperatively to manage pain. This client will be assessed most appropriately by the perioperative nurse for the risk for respiratory complications by frequently:
    • A. 

      Listening to breath sounds

    • B. 

      Monitoring pulse oximetry

    • C. 

      Evaluating spirometer use

    • D. 

      Counting respirations per minute

  • 45. 
    A client who has type 2 diabetes is scheduled for the removal of a skin lesion on his right shoulder at an ambulatory surgery unit. The nursing diagnosis the client is at greatest risk for postoperatively is:
    • A. 

      Risk for injury

    • B. 

      Risk for infection

    • C. 

      Impaired wound healing

    • D. 

      Imbalanced nutrition: less than body requirements

  • 46. 
    A 74-year-old is accompanied by his daughter to the ambulatory surgery department for the surgical removal of a suspicious skin lesion. The client has experienced dysphasia since a cerebral vascular accident 3 years ago. The most effective way for the nurse to secure the necessary preoperative interview information is to:
    • A. 

      Question the client’s daughter

    • B. 

      Review the client’s past medical records

    • C. 

      Present the questions in a simple format

    • D. 

      Rely on the client’s preadmission survey

  • 47. 
    Which of the following preoperative assessment findings would most likely delay a planned procedure requiring general anesthetic?
    • A. 

      A cough and low-grade fever

    • B. 

      The pulse oximetry reading of 97% on room air

    • C. 

      A blood pressure that is 10 systolic points higher than baseline

    • D. 

      The client’s report of “being so nervous about this procedure”

  • 48. 
    The perioperative nurse realizes that the most effective means of evaluating the client’s understanding of previous teaching is to:
    • A. 

      Provide written material on the subject to be reviewed after discharge

    • B. 

      Reinforce the material with family as the procedure is being performed

    • C. 

      Discuss it with the client and family in the immediate preoperative period

    • D. 

      Offer to answer any questions that the client or family have just before discharge

  • 49. 
    Which of the following statements made by a nurse reflects the greatest insight into the responsibility an ambulatory care nurse has to the client’s family?
    • A. 

      “A client’s family deserves the attention of the nursing staff.”

    • B. 

      “Family is important to my client, and so family is important to me.”

    • C. 

      “I consider myself as having several clients: the surgical client and all the family that’s present.”

    • D. 

      “I am responsible for keeping the family informed of the status of their loved one both during and after the procedure.”

  • 50. 
    Which of the following statements made by a nurse reflects the greatest insight into the planning needs of a same-day surgical experience?
    • A. 

      “Time is a precious resource in same-day surgery units; being organized allows for the best utilization of time.”

    • B. 

      “Everything must be checked and verified as being ready before the client is admitted into the surgical area.”

    • C. 

      “With only a few hours from time of admission to the beginning of the procedure, things have to be effectively organized.”

    • D. 

      “I take the time to review the client’s preadmission and preoperative data in order to formulate the most individualized plan of care possible.”

  • 51. 
    Upon admission to the postanesthesia care unit (PACU), the client who has no orthopedic or neurological restrictions is positioned with the:
    • A. 

      Bed flat and the client’s arms to the sides

    • B. 

      Client’s neck flexed and body positioned laterally

    • C. 

      Head of the bed slightly elevated with the client’s head to the side

    • D. 

      Client’s arms crossed over the chest and the bed in high-Fowler’s position

  • 52. 
    A client who is scheduled for surgery is found to have thrombocytopenia. A specific postoperative concern for the nurse for this client is:
    • A. 

      Hemorrhage

    • B. 

      Wound infection

    • C. 

      Fluid imbalance

    • D. 

      Respiratory depression

  • 53. 
    A prostate biopsy is an acceptable procedure to be performed as an ambulatory surgery on an otherwise healthy adult male because the American Society of Anesthesiologists (ASA) considers that a:
    • A. 

      Physical status class 1

    • B. 

      Physical status class 2

    • C. 

      Physical status class 4

    • D. 

      Physical status class 5

  • 54. 
    After discharge from the postanesthesia care unit (PACU), the client returned to the surgical nursing unit at 10:00 AM. It is now 11:30 AM, and the client is not experiencing any complications or difficulties. The nurse will plan to measure the client’s vital signs:
    • A. 

      Every 15 minutes

    • B. 

      Every 30 minutes

    • C. 

      Every 1 hour

    • D. 

      Every 4 hours

  • 55. 
    The client had surgery in the morning that involved the right femoral artery. To assess the client’s circulation status to the right leg, the nurse will make sure to check the pulse at the:
    • A. 

      Radial artery

    • B. 

      Ulnar artery

    • C. 

      Brachial artery

    • D. 

      Dorsalis pedis artery

  • 56. 
    A client who receives general or regional anesthesia in an ambulatory surgery center:
    • A. 

      Has to meet identified criteria in order to be discharged home

    • B. 

      Will remain in the phase I recovery area longer than a hospitalized client

    • C. 

      Is allowed to ambulate as soon as being admitted to the recovery area

    • D. 

      Is immediately given liberal amounts of fluid to promote the excretion of the anesthesia

  • 57. 
    Following abdominal surgery, the nurse suspects that the client may be having internal bleeding. Which of the following findings is indicative of this complication?
    • A. 

      Increased blood pressure

    • B. 

      Incisional pain

    • C. 

      Abdominal distention

    • D. 

      Increased urinary output

  • 58. 
    The client asks the nurse the purpose of having medications (Demerol and Vistaril) given before surgery. The nurse should inform the client that these particular medications:
    • A. 

      Reduce preoperative fear

    • B. 

      Promote emptying of the stomach

    • C. 

      Reduce body secretions

    • D. 

      Ease the induction of the anesthesia

  • 59. 
    The female client on the surgical unit is being prepared for abdominal surgery with general anesthesia. In preparing this client for surgery, the nurse should:
    • A. 

      Leave all of her jewelry intact

    • B. 

      Provide her with sips of water for a dry mouth

    • C. 

      Remove her makeup and nail polish

    • D. 

      Remove her hearing aid before transport to the operating room

  • 60. 
    The client tells the nurse that “blowing into this tube thing (incentive spirometer) is a ridiculous waste of time.” The nurse explains that the specific purpose of the therapy is to:
    • A. 

      Directly remove excess secretions from the lungs

    • B. 

      Increase pulmonary circulation

    • C. 

      Promote lung expansion

    • D. 

      Stimulate the cough reflex

  • 61. 
    In the postoperative period, the nurse recognizes that an early sign of malignant hyperthermia is:
    • A. 

      Fever

    • B. 

      Tachycardia

    • C. 

      Muscle relaxtion

    • D. 

      Skin pallor

  • 62. 
    The client is scheduled for abdominal surgery and has just received the preoperative medications. The nurse should:
    • A. 

      Keep the client quiet

    • B. 

      Obtain the consent

    • C. 

      Prepare the skin at the surgical site

    • D. 

      Place the side rails up on the bed or stretcher

  • 63. 
    The nurse is completing the preoperative checklist for an adult client who is scheduled for an operative procedure later in the morning. Which of the following preoperative assessment findings for this client indicates a need to contact the anesthesiologist?
    • A. 

      Temperature is 100° F.

    • B. 

      Pulse is 90 beats per minute.

    • C. 

      Respiratory rate is 20 breaths per minute.

    • D. 

      Blood pressure is 130/74 mm Hg.

  • 64. 
    A client is in the postanesthesia care unit (PACU) recovering from a vagotomy and pyloroplasty. Which of the following is a normal expectation of the client in this stage of recovery?
    • A. 

      Returned normal bowel sounds on auscultation

    • B. 

      Pain that is relieved with noninvasive comfort measures

    • C. 

      Voluntary bladder control and function

    • D. 

      A subdued level of consciousness and neurological function

  • 65. 
    The nurse is evaluating the client in the hospital’s postanesthesia care unit (PACU) and determines that the Aldrete score is 8. Based on this assessment, the nurse anticipates that the client will:
    • A. 

      Be sent to the intensive care unit

    • B. 

      Be discharged back to his or her room on the nursing unit

    • C. 

      Remain in the PACU until the score improves

    • D. 

      Return to the operating room for surgical evaluation

  • 66. 
    The client will have an incision in the lower left abdomen. Which of the following measures by the nurse will help decrease discomfort in the incisional area when the client coughs postoperatively?
    • A. 

      Applying a splint directly over the lower abdomen

    • B. 

      Keeping the client flat with her feet flexed

    • C. 

      Turning the client onto the right side

    • D. 

      Applying pressure above and below the incision

  • 67. 
    The nurse is evaluating the outcome “Client describes surgical procedures and postoperative treatment” and determines that the client has not achieved this outcome. The nurse should:
    • A. 

      Obtain the consent, because this is expected with preoperative anxiety

    • B. 

      Teach the client all about the procedure

    • C. 

      Ask the unit manager to assist with a teaching plan

    • D. 

      Inform the surgeon so that information can be provided

  • 68. 
    Which of the following statements most accurately reflects nursing accountability in the intraoperative phase?
    • A. 

      “I would like to see the client have a regional anesthetic rather than a general anesthetic.”

    • B. 

      “There seems to be a missing sponge, so a recount should be done of all the sponges that have been removed.”

    • C. 

      “Did the client receive the medications and sign the consent?”

    • D. 

      “The client looks to be reactive and stable.”

  • 69. 
    A 92-year-old client is scheduled for a colectomy. Which normal physiological change that accompanies the aging process increases this client’s risk for surgery?
    • A. 

      An increased tactile sensation

    • B. 

      An increased metabolic rate

    • C. 

      A relaxation of arterial walls

    • D. 

      Reduced glomerular filtration rate

  • 70. 
    The nurse is completing the preoperative checklist for an adult female client who is scheduled for an operative procedure later in the morning. Which of the following preoperative assessment findings for this client indicates a need to contact the surgeon?
    • A. 

      Hemoglobin (Hgb) 14 g/100 mL

    • B. 

      Blood urea nitrogen (BUN) 15 mg/100 mL

    • C. 

      Platelets 300,000/mm3

    • D. 

      Serum creatinine 3.2 mg/100 mL

  • 71. 
    The nurse is working in a postoperative care unit in an ambulatory surgery center. Of the following clients that have come to have surgery, the client at the greatest risk during surgery is a:
    • A. 

      78-year-old taking an analgesic agent

    • B. 

      43-year-old taking an antihypertensive agent

    • C. 

      27-year-old taking an anticoagulant agent

    • D. 

      10-year-old taking an antibiotic agent

  • 72. 
    An appendectomy is appropriately documented by the nurse as:
    • A. 

      Diagnostic surgery

    • B. 

      Palliative surgery

    • C. 

      Ablative surgery

    • D. 

      Reconstructive surgery

  • 73. 
    An obese client is admitted for abdominal surgery. The nurse recognizes that this client is more susceptible to the postoperative complication of:
    • A. 

      Anemia

    • B. 

      Seizures

    • C. 

      Protein loss

    • D. 

      Dehiscence

  • 74. 
    A 43-year-old client is scheduled to have a gastrectomy. Which of the following is a major preoperative concern?
    • A. 

      The client’s brother had a tonsillectomy at age 11

    • B. 

      The client smokes a pack of cigarettes a day

    • C. 

      The client has an intravenous (IV) infusion.

    • D. 

      The client has a history of employment as a computer programmer.

  • 75. 
    The nursing student is preparing an elderly patient for surgery. The patient is scheduled for a general anesthetic. Which side effect should the nurse monitor the patient for?
    • A. 

      Hypothermia

    • B. 

      Pulmonary edema

    • C. 

      Cerebral ischemia

    • D. 

      Increased ability to resist stress

  • 76. 
    You are the circulating nurse. Which task are you solely responsible for?
    • A. 

      Monitoring the patient and documents

    • B. 

      Estimating the patient's blood loss

    • C. 

      Setting up the sterile tables

    • D. 

      Keeping track of drains and sponges

  • 77. 
    A 21-year-old patient is positioned on the OR bed prior to knee surgery. The anesthesiologist administers the anesthetic. What is the next step in the care of this patient?
    • A. 

      Grounding

    • B. 

      Hanging IV fluids

    • C. 

      Giving blood

    • D. 

      Intubating

  • 78. 
    You are the circulating nurse in an operating room that has several surgeries scheduled. You would know to monitor which patient during the intraoperative period because he or she is at increased risk for hypothermia?
    • A. 

      A 72-year-old woman

    • B. 

      A 17-year-old boy

    • C. 

      A 45-year-old woman

    • D. 

      A 12-year-old girl

  • 79. 
    The anesthetist is coming to the unit to see a patient prior to surgery that is scheduled for tomorrow morning. What information, obtained during the admission assessment, should be given to the anesthetist during the visit?
    • A. 

      Last bowel movement

    • B. 

      Latex allergy

    • C. 

      Number of pregnancies

    • D. 

      Difficulty falling asleep

  • 80. 
    Surgical asepsis is a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the operating room?
    • A. 

      Reusable shoe covers

    • B. 

      Mask covering the nose and mouth

    • C. 

      Goggles

    • D. 

      Gloves

  • 81. 
    As an OR nurse, you have an increased awareness regarding asepsis. You know that a basic guideline for maintaining surgical asepsis is what?
    • A. 

      Sterile surfaces or articles may touch other sterile surfaces.

    • B. 

      Sterile supplies can be used on another patient if the packages are intact.

    • C. 

      The outer lip of a sterile solution is considered sterile.

    • D. 

      The scrub nurse may pour a sterile solution from a nonsterile bottle.

  • 82. 
    Your patient is a 35-year-old female who has been administered general anesthesia. The patient is in stage II (the excitement stage) of anesthesia. Which intervention might you need to implement during this stage?
    • A. 

      Rub the patient's back

    • B. 

      Restrain the patient

    • C. 

      Encourage the patient to express feelings

    • D. 

      Stroke the patient's hand

  • 83. 
    What is the best rationale for intubation during a surgical procedure?
    • A. 

      The tube provides an airway for ventilation.

    • B. 

      The tube protects the esophagus.

    • C. 

      The patient may receive an anti-emetic through the tube.

    • D. 

      The patient's heart rate can be monitored with the tube.

  • 84. 
    You are the circulating nurse in an outpatient surgery center. Your patient is scheduled to receive moderate sedation. You know that a patient receiving this form of anesthesia should what?
    • A. 

      Never be left unattended by the nurse

    • B. 

      Receive an anti-emetic

    • C. 

      Remember most of the procedure

    • D. 

      Be able to maintain his or her own airway

  • 85. 
    A nurse is caring for a patient following surgery under a spinal anesthetic. What interventions can the nurse implement to prevent a spinal headache?
    • A. 

      Have the patient sit in a chair

    • B. 

      Ambulate the patient

    • C. 

      Limit fluids

    • D. 

      Keep the patient lying flat

  • 86. 
    You are the nurse caring for a patient who will receive a transsacral block. In what surgeries would a transsacral block be useful for pain control?
    • A. 

      Thoracotomy

    • B. 

      Inguinal hernia repair

    • C. 

      Breast reduction

    • D. 

      Closed reduction of a right humerus

  • 87. 
    You are the circulating nurse caring for a 78-year-old patient who is scheduled for a total hip replacement. Which of the factors should you consider during the preparation of the patient in the operating room?
    • A. 

      The patient should be placed in Trendelenburg position.

    • B. 

      The patient must be firmly restrained at all times.

    • C. 

      Pressure points should be assessed and well padded.

    • D. 

      The preoperative shave should be done by the circulating nurse.

  • 88. 
    The operating room nurse is taking the patient into the OR when the patient informs the operating nurse that his grandmother spiked a 104°F temperature in the operating room and nearly died 15 years ago. What relevance does this information have regarding your patient?
    • A. 

      The patient may be nervous.

    • B. 

      The patient may be at risk for developing malignant hyperthermia.

    • C. 

      The grandmother's surgery has no relevance to the patient's surgery.

    • D. 

      The patient may be at risk for hypothermia.

  • 89. 
    You note a colleague making an inappropriate remark about the patient's weight. The patient is unconscious at the time. What should you do?
    • A. 

      Ignore the comment because the patient is unconscious.

    • B. 

      Discourage the comments.

    • C. 

      Report the comment to the supervisor.

    • D. 

      Realize humor is needed in the workplace.

  • 90. 
    You are caring for a male patient who has had spinal anesthesia. The patient is under a physician's order to lie flat postoperatively. When the patient asks to go to the bathroom, you encourage him to comply with the physician's order. What is the rationale for complying with this order?
    • A. 

      Hypotension

    • B. 

      Respiratory depression

    • C. 

      A headache

    • D. 

      Pain at the lumbar injection site

  • 91. 
    You are packing a patient's abdominal wound with sterile, half-inch Iodoform gauze. You drop some of the gauze onto the patient's abdomen 2 inches (5 cm) away from the wound. What should you do?
    • A. 

      Apply povidone-iodine (Betadine) to that section of the gauze and continue packing the wound.

    • B. 

      Pick up the gauze and continue packing the wound after irrigating the abdominal wound with Betadine solution.

    • C. 

      Continue packing the wound and inform the physician that an antibiotic is needed.

    • D. 

      Discard the gauze packing and repack the wound with new Iodoform gauze.

  • 92. 
    You are the nurse performing wound care on a 68-year-old male patient. Which of the following practices violates surgical asepsis?
    • A. 

      Holding sterile objects above the waist

    • B. 

      Considering a 1 inch (2.5 cm) edge around the sterile field as being contaminated

    • C. 

      Pouring solution onto a sterile field cloth

    • D. 

      Opening the outermost flap of a sterile package away from the body

  • 93. 
    A patient is scheduled for surgery the next day. What is the best approach to this surgery?
    • A. 

      A surgical approach

    • B. 

      A medical approach

    • C. 

      An interdisciplinary approach

    • D. 

      A nursing approach

  • 94. 
    What is the basis of the collaboration of the surgical team that results in the best outcome for the patient?
    • A. 

      Historical precedence

    • B. 

      Patient request

    • C. 

      Physician need

    • D. 

      Evidence-based practice

  • 95. 
    Which of the following events subjects the surgical patient to possible injury in the intraoperative phase of the surgical experience? (Mark all that apply.)
    • A. 

      Reflexes

    • B. 

      Ability to communicate

    • C. 

      Loss of pain sense

    • D. 

      Consciousness

    • E. 

      Normal vital signs

  • 96. 
    You are a circulating nurse in the day surgery center. You know that each patient has the potential for complications intraoperatively. What are these complications? (Mark all that apply.)
    • A. 

      Malignant hypothermia

    • B. 

      Pain

    • C. 

      Hypothermia

    • D. 

      Anaphylaxis

    • E. 

      Nausea

  • 97. 
    You are preparing to take your patient into the operating room. As the circulating nurse, one of your responsibilities is to review the patient's record. What are you reviewing the record for?
    • A. 

      Progress notes

    • B. 

      History and physical

    • C. 

      Admission papers signed by patient

    • D. 

      Intake and output record

  • 98. 
    You are the circulating nurse for several surgeries today. What would be one of your major goals for each of these patients?
    • A. 

      Latex-allergy symptoms treated rapidly

    • B. 

      Surgery unsuccessful

    • C. 

      Maintenance of the patient's dignity

    • D. 

      Complications treated rapidly

  • 99. 
    The circulating nurse meets the patient in a warm and friendly manner. The nurse discusses what the patient can expect in surgery. What basic communication skills does the nurse use?
    • A. 

      Talk slowly and softly

    • B. 

      Use medically acceptable terms

    • C. 

      Give pre-operative medications first

    • D. 

      Touch

  • 100. 
    What position used for surgery can cause irreparable nerve damage?
    • A. 

      Trendelenburg

    • B. 

      Prone

    • C. 

      Dorsal recumbent

    • D. 

      Lithotomy