Perioperative2
Exam
- 1.1. A patient is admitted to the emergency department complaining of severe abdominal pain. The patient is vomiting “coffee-ground” like vomitus. The patient is diagnosed with a bowel obstruction and is informed that he needs surgery. When can the patient anticipate the surgery will be scheduled?
- A.
A) Within 24 hours
- B.
B) Within the next week
- C.
C) Without delay because the bowel obstruction is emergent
- D.
D) Difficult to predict because the surgeon may be unavailable
- 2.2. You are doing a preoperative assessment on a patient going to surgery. The patient informs you that he ingests 5 to 10 ounces of alcohol each day and has for the last 15 years. What postoperative difficulties can the nurse anticipate for this patient?
- A.
A) Delirium tremens immediately following surgery
- B.
B) Delirium tremens within 72 hours after his last alcohol drink
- C.
C) Delirium tremens upon administration of general anesthesia
- D.
D) Delirium tremens 1 week after his last alcohol drink
- 3.3. How should a nurse teach a patient to perform deep breathing and coughing to use postoperatively?
- A.
A) The patient should take three deep breaths and cough hard three times.
- B.
B) The patient should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs.
- C.
C) The patient should take a deep breath in through the mouth and exhale all the air out through the mouth, take a short breath, and cough from deep in the lungs.
- D.
D) The patient should rapidly inhale, hold for 30 seconds, and exhale slowly.
- 4.4. The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without oophorectomy and the nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent?
- A.
A) “I know I'll be fine because the physician said he has done this procedure hundreds of times.”
- B.
B) “I know I'll have pain after the surgery.”
- C.
C) “The physician is going to remove my uterus and told me about the risk of hemorrhage.”
- D.
D) “Because the physician isn't taking my ovaries, I'll still be able to have children.”
- 5.5. You are doing patient teaching for a patient who is scheduled for an appendectomy. You must teach the patient about incision splinting and leg exercises. When is the best time for you to provide teaching?
- A.
A) Upon the patient's admission to the postanesthesia care unit (PACU)
- B.
B) When the patient returns from the PACU
- C.
C) During the intraoperative period
- D.
D) Before the surgical procedure
- 6.6. You are caring for a hospice patient who is scheduled for a surgical procedure to reduce the size of the tumor in an effort to relieve pain. How would this hospice patient's surgical procedure be classified?
- A.
Diagnostic
- B.
Laparoscopic
- C.
Curative
- D.
Palliative
- 7.7. During your preoperative teaching, you know to include exercise of the extremities. What is the purpose of teaching a patient leg exercises prior to surgery?
- A.
A) Leg exercises increase the patient's appetite postoperatively.
- B.
B) Leg exercises improve circulation and prevent blood clots.
- C.
C) Leg exercises help to prevent pressure sores to the sacrum.
- D.
D) Leg exercise help increase the patient's level of consciousness after surgery.
- 8.8. You are caring for a preoperative patient. You have given the patient a preoperative narcotic and the patient is now requesting to void. What action should you take?
- A.
A) Assist the patient to the bathroom.
- B.
B) Offer the patient a bedpan.
- C.
C) Wait until the patient gets to the operating room and is catheterized.
- D.
D) Have the patient go to the bathroom.
- 9.9. You are preparing your patient for surgery. Prior to obtaining your patient's signature on the operative permit, you ask the patient if she understands all aspects of the surgical procedure. The patient replies that she is very nervous and really does not understand what the surgical procedure is or how it will be performed. What is the most appropriate nursing action for you to take?
- A.
A) Have the patient sign the operative permit and place it in the chart
- B.
B) Call the physician to review the procedure with the patient
- C.
C) Explain the procedure to the patient and her family
- D.
D) Provide the patient with a pamphlet explaining the procedure
- 10.10. You are the nurse caring for a patient who is admitted to the emergency room with the diagnosis of acute appendicitis. You note during the assessment that the patient's ribs and xiphoid process are prominent. The patient states she exercises daily. The patient's mother indicates she is being treated for anorexia nervosa. What should you do?
- A.
A) Inform the postoperative nurse of the patient's risk for wound dehiscence.
- B.
B) Evaluate the patient's ability to manage her pain level.
- C.
C) Inform the surgical team and determine her electrolyte levels.
- D.
D) Instruct the patient on the need for proper nutrition to promote healing.
- 11.11. You are doing preoperative patient education with a patient who is a known smoker. What would be the best instruction to give to this patient?
- A.
A) Reduce smoking to prevent the development of pneumonia.
- B.
B) Stop smoking at least 6 weeks before the scheduled surgery to enhance pulmonary function and decrease infection.
- C.
C) Stop smoking at least 24 hours prior to surgery to promote pulmonary function.
- D.
D) Stop smoking 4 to 8 weeks before the scheduled surgery to enhance pulmonary function and decrease infection.
- 12.12. You are doing preoperative teaching with a patient scheduled for surgery in 1 month. During the preoperative teaching, the patient gives you a list of medications she takes, the dosage, and frequency. Which of the following interventions provides the patient with the most accurate information?
- A.
A) Instruct the patient to stop taking St. John's wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents.
- B.
B) Instruct the patient to continue taking ephedrine prior to surgery due to its effect on blood pressure.
- C.
C) Instruct the patient to discontinue synthroid due to its effect on blood coagulation and potential heart dysrrythmias.
- D.
D) Instruct the patient to continue any herbal supplements, and inform the patient that they have no effect on the surgical procedure.
- 13.13. You are caring for an elderly patient who is overweight. Your patient has been admitted to the surgical unit following a colon resection. What complication is this patient at increased risk for in the postoperative period?
- A.
A) Hyperglycemia
- B.
Azotemia
- C.
Falls
- D.
Infection
- 14.14. You are caring for a patient in the postoperative period following an abdominal hysterectomy. Your patient states, “I don't want to use my pain medication because it will make me dependent, and I won't get better as fast.” Which response is most important when explaining the use of pain medication?
- A.
A) “You will need the pain medication for at least 1 week to help in your recovery. What do you mean you feel you won't get better faster?”
- B.
B) “Pain medication will help to decrease your pain and increase your ability to breath. Dependency is a risk with pain medication, but you are young and won't have any problems.”
- C.
C) “Pain medication can be given by mouth to prevent the risk of dependency that you are worried about. The pain medication has shown to increase your risk of a slowed recovery.”
- D.
D) “Pain medication decreases your pain so you can move more easily. You will heal more quickly with decreased pain. Dependence only occurs when it is administered for an extended period of time.”
- 15.15. You are the nurse working in the preoperative holding area. Your patient has just received a preanesthetic medication. What should you instruct the patient to do?
- A.
A) Use the call light to summon the nurse for assistance.
- B.
B) Leave the bedpan at the bedside.
- C.
C) Have a bedside commode available for the patient.
- D.
D) Instruct the patient on catheterization.
- 16.16. You are admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder?
- A.
A) Adrenal insufficiency
- B.
Thyrotoxicosis
- C.
C) Impaired acid-base balance
- D.
Hyperglycemia
- 17.17. You are obtaining informed consent for a 16-year-old woman who is married and expecting her first child. She is scheduled for a cesarean section. She is still living with her parents and is on her parents' health insurance. When obtaining informed consent for the cesarean section, who is legally responsible for signing the operative permit?
- A.
A) Her parents
- B.
B) Her husband
- C.
C) The patient
- D.
D) The obstetrician
- 18.18. You are providing the preoperative teaching for a patient scheduled for surgery. You know to instruct the patient on the use of deep breathing, coughing, and the use of incentive spirometry. What is the rationale for these interventions?
- A.
A) To promote wound healing
- B.
B) To promote optimal lung expansion
- C.
C) To enhance peripheral circulation
- D.
D) To increase gas formation
- 19.19. One of the things taught to a patient during preoperative teaching is to have nothing by mouth for 8 hours before surgery. The patient asks the nurse why this is important. What is the most appropriate response for the patient?
- A.
A) “You will need to have food and fluid restricted for 8 hours before surgery so you are not at risk for aspiration.”
- B.
B) “The restriction of food or fluid will present the development of pneumonia related to decreased lung capacity.”
- C.
C) “The presence of food in the stomach interferes with the absorption of anesthetic agents.”
- D.
D) “By withholding food for 8 hours before surgery, you will not develop constipation in the postoperative period.”
- 20.20. Your patient is scheduled for a colon resection in the morning. The patient's orders include receiving a cleansing enema. The patient wants to know why this is necessary. You explain that the cleansing enema will
- A.
A) prevent aspiration of gastric contents.
- B.
B) prevent the development of gas postoperatively.
- C.
C) prevent contamination of the peritoneum.
- D.
D) allow for absorption of medications.
- 21.21. You are caring for a postoperative patient who is experiencing pain and anxiety. Which intervention will assist most in decreasing the patient's pain and anxiety?
- A.
A) The administration of a stronger pain medication
- B.
B) Allowing the patient to increase activity
- C.
C) The use of guided imagery with pain medication
- D.
D) The use of patient controlled analgesia
- 22.22. Your patient is going to the operating room for an aortobifemoral bypass. You administer the preoperative medication that has been ordered. After administering a preoperative medication to the patient, what should you do?
- A.
A) Allow him to walk to the bathroom unassisted.
- B.
B) Place the bed in low position with the side rails up.
- C.
C) Tell him that he'll be asleep before he leaves for surgery.
- D.
D) Take his vital signs.
- 23.23. You are doing preadmission assessments on patients scheduled for surgery. What is one purpose of a preadmission assessment?
- A.
A) Verifies completion of preoperative diagnostic testing
- B.
B) Discusses and reviews patient's spiritual beliefs
- C.
C) Initiates appropriate medications
- D.
D) Informs patient of need for postoperative transportation
- 24.24. You are the nurse in the preoperative holding area. What is included in the care you give to each patient? (Mark all that apply.)
- A.
A) Establish an intravenous line
- B.
B) Verify surgical site and mark site per institutional policy
- C.
C) Take measures to ensure each patient's comfort
- D.
D) Review operative plans
- E.
E) Prepare medications administered in the OR
- 25.25. During the intraoperative phase of nursing care, what is one aspect of giving nursing care?
- A.
A) Physiologic monitoring
- B.
B) Providing emotional support to family
- C.
C) Maintaining patient's respiratory status
- D.
D) Maintaining a sterile, controlled environment
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