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Perioperative Nursing 001 1.) Which of t he foll owing is most dangerous complication during induction of spinal anesthesi a? A.

)Tach ycardia B.)H ypot ension C.)H yperthermi a D.)Brad ypnea Ans: B 2.) Which t ype of surger y is most likel y to predis pose a patient to postoperative atel ect asis, pneumonia or respirator y failure? A.)Upper abdominal surger y on an obese patient with a long histor y of smoking B.)Upper abdominal surger y on a pati ent with norm al pulm onar y function C.)Lower abdominal surger y on a you ng patient with di abetes mellitus D.)Surger y on the extremities of a nonsmoking football pla yer Ans: A 3.) Which of t he foll owing characterizes excitement stage of anesthesi a A.) Occurs from the administration of anesthesi a to the loss of consciousness B. ) Extends from t he loss of consciousness to the loss of li d refl ex, characterized b y struggling and talking C.) From the loss of lid reflex to the loss of most reflexes D.) From the loss of most refl exes to respi rator y and circulator y fail ure Ans: B

4.) To prevent headache aft er spinal anesthesi a the pati ent should be positioned: A.) S emi- fowlers B.) Fl at on bed for 6 to 8 hours C.) Prone position D.) Modifi ed trendel enburg Ans: B 5.) Which of t he foll owing nursing actions should be given hi ghest pri ori t y when admitting the patient into the operating room? A.) Level of consciousness B.) Vit al si gns C.) Patient identifi cation and correct operative consent D.) Positioni ng and skin preparation Ans: C 6.) What is the prim ar y reason for the gradual change of position of the pati ent aft er surger y? A.) To prevent muscle injur y B.) To prevent sudden drop of BP C.) To prevent respi rator y dist ress D.) To promote com fort Ans: B 7.) Which of t he foll owing assessm ent data is most import ant to determine when caring for a pati ent who has received spi nal anesthesi a? A.) The tim e of return of motion and sensati on in the l egs and toes B.) The character of respi ration C.) Level of consciousness D.) Amount of wound drainage Ans: A

8.) Which of t he foll owing post op fi nding s should the nurse report to the M.D.? A.) The pati ent pushes out the oral airway wit h his tounge B.) Urine output is 20ml/hr for the past t wo hours C.) VS are as follows: BP=110/70;PR=95;RR=19,Temp=36.8C D.) Wound drainage is serosanguinous Ans: B 9.) Which of t he foll owing is the earliest sign of poor respi rator y function? A.) C yanosis B.) Fast thread y pul se C.) Restl essness D.) Faintness Ans: C 10.) If wound eviscerations occurs, the immediat e nursing action is: A.) Cover the wound with sterile gauz e moistened with st eri le NSS B.) Cover the wound with water -soaked gauze C.) Cover the wound with sterile dr y gauze D.) Leave t he wound uncovered and pull the skin edges together Ans: A 11.) Appendectom y i s classi fied as A.) Ablative B.) Constructive C.) Reconst ructive D.) P alliative Ans: A

12.) The worst of all fears among cli ents undergoing surger y i s: A.) Fear of financi al burden B.) Fear of death C.) Fear of the unknown D.) Fear of loss of j ob Ans: C 13.) The best tim e to provide preoperative teaching on deep breathing, coughing and turning exercises is: A.) Before administ ration of preoperative medications B.) The afternoon or evening prior to surger y C.) Several da ys pri or to surger y D.) Upon admission of the cli ent in the recover y room Ans: B 14.) The followi ng are the appropri ate nursing acti ons before administration of preoperative medications EXCEPT: A.) Ascert ain the consent has been si gned B.) Ensure that NPO has been maint ained C.) Inst ruct pati ent t o empt y hi s bladder D.) Shave the sk in at the sit e of surger y Ans: D 15.) The pati ent has been observed paci ng along the hallwa y, goes to the bathroom frequentl y and asks questions repeatedl y during preoperative assessm ent. The most likel y cause of the behavi or is: A.) She is anxious about the surgi cal procedure B.) She is worri ed about separation from the famil y C.) She has urinar y t ract infection D.) She has an underl ying emotional problem

Ans: A 16.) Which of the following nursing acti ons would help the patient decrease anxiet y during th e preoperat ive period? A.) Explaini ng all procedures thoroughl y in chronologi cal order B.) Spending time li stening to the pati ent and answering questions C.) Encouraging sleep and limiting interruptions D.) R eass uring t he patient that the surgical staff are competent professional Ans: B 17.) Which of the following is the primar y purpos e of maint aini ng NPO for 6 to 8 hours before surger y? A.) To prevent m alnutrition B.) To prevent el ect rol yte im bal ance C.) To prevent aspi ration pneumoni a D.) To prevent int e stinal obst ruction Ans: C 18.) The followi ng ensure validit y of informed written consent EXC EPT: A.) The pati ent is of legal age with proper mental di sposition B.) The consent has been secured within 24 hours before the surger y C.) If the pati ent is unabl e to write, secure the cons ent from a relati ve D.) The consent is secured before administration of any m edi cation that alt er the level of consciousness Ans: C 19.) Which of the following drugs is administered to mini mize respi rat or y secretions preop?

A.) B.) C.) D.)

Valium (Di azepam) Nubain ( Nalbuphine HC L) Phenergan (Prom ethazine) Atropine Sul fat e

Ans: D 20.) Which of the following is experi enced b y the patient who is under spinal anesthesia? A.) The pati ent B.) The patient C.) The patient D.) The pati ent sensati on Ans: B 21.) The pati ent who has undergone TAHBSO complains of pain. Which of t he followi ng is an initial nursi ng act ion? A.) Administer the P RN anal gesi cs B.) Inst ruct to do deep breathing exercises C.) Ass ess the VS D.) Change the pati ents position Ans: C 22.) How frequent should the nurse monitor the VS of the patient in the recover y room? A.) Ever y 15 minutes B.) Ever y 30 mins C.) Ever y 45 mins D.) Ever y 60 mins Ans: A 23.) Which of the following drugs is given to relieve nausea and vomiting? A.) M epivacaine B.) Aquameph yton C.) Nubain is unconscious is awake experiences amnesia experiences total loss of

D.) Pl asil Ans: D 24.) The most important fact or in t he prevention of postop infection is: A.) Proper administration of antibiotics B.) Fl uid int ake of 2 -3L/da y C.) Practi ce of st rict aseptic t echniques D.) Frequent change of wound dressings Ans: C 25.) Which of the following primaril y prevents postop com plications? A.) Adequat e flui d i ntake B.) Earl y ambul ation C.) Well-b alanced di et D.) Administration of antimi crobials Ans: B Situation: A fem ale client, 23 y/o was admitted for the first time at t he Fatima Hospital with the chief compl aint of Ri ght Ili ac Pain, accompanied b y nausea and vomiting, chills and fever. She was diagnos ed to have acute appendicitis. She was s cheduled to have em ergenc y appendectom y under spinal anesthesi a 26.) Pre-op inst ructi ons to the cli ent would include the following EXCEPT: A.) Deep breathing and coughing exercise B.) Turning to sides C.) Foot and l eg exercises D.) reassuring her t hat narcotics will be given ever y 4 hours round the clock until she is discharged Ans: D

27.) The client gave her consent for t he surger y. To ensure t he legalit y of the cons ent, the followi ng conditions must be met EXCEPT: A.) She gave her consent freel y B.) She m ust underst and the nature of the surger y C.) The consent must be si gned b y a witness D.) Si gning should be done aft er the administration of pre -anest hesi a meds Ans: D 28.) The skin is shaved prior to surger y i n order to: A.) Facilitat e ski n i ncision B.) Indicate the sit e to be draped C.) To prevent wound infection D.) R educe post op scarring Ans: C 29.) The import ant nursing int ervention prior to administ ration of pre -anesthetic medication is: A.) Ask patient to empt y t he bl adder B.) Do deep breathing and coughing exercis es C.) Regul ate IVF accuratel y D.) Shave the skin Ans: A 30.) Immedi atel y fol lowing spinal anest hesia, the greatest risk is: A.) S evere hemorrhage B.) Severe H ypotension C.) Severe H ypogl yc emia D.) H ypertensive cri sis Ans: B

31.) Nursing measures to promot e the client s respi rator y function during recover y from anesthesi a are t he following EXCEP T: A.) Encourages deep breathing and coughing exercises B.) Administ er Hum idified ox ygen C.) Place in semi -fowlers position D.) Pl ace in supine position with head t urned to the side wit hout pillow support Ans: C 32.) Which of the following criteria must be met before the client is rel eased from the RR to the unit . A.) Breathes with ease, coughs fre el y B.) Has regained consciousness C.) Vit al si gns fluct uates erraticall y D.) Able t o move four extremities Ans: C 33.) Earl y si gns of poor respi rator y funct ion include whi ch of the following A.) C yanosis B.) H ypotension C.) Loss of consciousness D.) R estlessness Ans: D 34.) Post operativel y, the client must be encouraged to turn, cough and deep breathe: A.) Ever y 1 -2 hours B.) Ever y 4 hours C.) Ever y 30 Mins D.) Ever y 8 hours Ans: A 35.) A cli ent in shock must be placed in: A.) Hi gh-fowl ers position B.) Sims position

C.) Modi fied t rendel enburg D.) Prone position Ans: C 36.) The most important fact or in t he prevention of post op wound infection is: A.) Adequat e flui d i ntake B.) Proper administ ration of antibiotics C.) Practi ce of st rict aseptic t echnique D.) Frequent cleaning of the wound Ans: C 37.) When the pati ent vomits, the most important nursi ng objective is to prevent: A.) Deh ydration B.) Aspi ration C.) Rupture of suture line D.) M et. Alkalosis Ans: B 38.) Post operativel y, a patient is expected to void after: A.) 6 -8 hours B.) 2-4 hours C.) 12 -24 hours D.) 10-12 hours Ans: A 39.) Headache after spinal anest hesi a is due to: A.) P aral ysis of vasomotor nerves B.) Traction pl aced on structures within abdom en C.) Loss of CS F through dural hole D.) Administration of large amounts and heav y concentration of anesthetic agents Ans: C

40.) Nursing measures for post -op thrombophl ebitis include the following EXCEPT: A.) M aintai n bedrest B.) Elevat e affect ed leg with pillow support C.) Mas sage the painful extremities D.) Appl y antiem bol ic stockings Ans: C 41.) Nursing measures to reli eve hiccups include the following EXCEPT: A.) Exhal e and inhal e through a paper bag B.) Appl y pressure over the e yeball through closed e ye lids C.) Hold breath whil e taki ng a large pulp of water D.) Administer hi gh concent ration of ox ygen Ans: D 42.) Modifi ed radi cal mastectom y involves: A.) R emoval of t he entire breast, axillary l ymph nodes, pect oralis muscl e B.) Removal of the l ump of t he breast C.) Removal of the entire breast, axillar y and neck l ymph nodes, i ncluding pectoralis muscles D.) R emoval of t he entire breast but ni pple rem ains int act Ans: A 43.) Which of the following is not appropriat e nursing int ervention aft er modifi ed ra di cal mastectom y? A.) Pl ace in semi fowlers position and elevate arm on the affect ed side with pil low support B.) Check behind the cli ent for bl eeding C.) Monitor output from wound suction drainage

D.) Immobilize the arm on affected side in adduction Ans: D 44.) A fluid challenge is begun with a post -op gastri c surger y client. Which assessm ent will give the best indi cat ion of client response to this treatment? A.) CVP readings and hourl y urine out put B.) Blood pressure and api cal rat e checks C.) Lung soun ds and art eri al blood gases D.) El ectrol yt es, BUN, creatinine results Ans: A 45.) A cli ent is scheduled for a subtotal gastrectom y. In anti cipation of cl arif yi ng inform ation for client education, the nurse knows that vagotom y is done as part of t he surgic al t reatment for peptic ul cers in order to A.) Decrease secreti on of h ydrochloric acid B.) Improve the tone of the G I muscles C.) Increase bl ood suppl y to the jej unum D.) Prevent the transmission of pain impulses Ans: A 46.) Which of the following facts b est explains wh y the duodenum is not removed during a subt otal gastrectom y? A.) The head of the pancreas is adherent to the duodenal wall B.) The common bil e duct empti es into t he duodenal lum en C.) The wall of the jejunum cont ains no intestinal villi D.) The j ejunum receives its blood suppl y through t he duodenum

Ans: B 47.) During the immediat e postoperative period following gastric surger y, wh y m ust the nurse be particul arl y conscientious about encouraging a client to cough and deep -breathe at regular in t ervals? A.) M arked changes in intrat horaci c pressure will stimulat e gastri c drainage B.) The hi gh abdominal incision will l ead to shallow breathing to avoid pain C.) The phreni c nerve will have been perm anentl y damaged during the surgi cal procedure D.) De ep-breathing will prevent post op vomiting and intesti nal dist ention Ans: B 48.) Pri or to havi ng a subtot al gastrectom y, a client is told about t he dumping s yndrom e. The nurs e explains t hat it is: A.) The bod ys absorption of toxins produced by li quefaction of dead tissue B.) Form ation of an ulcer at the m argin of the gastroj ejunal anastomosis C.) Obst ructi on of venous flow from the stomach into the portal s ystem D.) R apid empt ying of food and fluid from the stomach into the jej unum Ans: D 49.) Which of the following st atem ents by a client recovering from a subtot al gastrectom y would i ndicat e a need for additional teaching about the di et protocol for dumping s yndrome? A.) I plan t o eat a diet low in carboh ydrates and hi gh in protein and fat B.) I pl an to eat a diet hi gh in CHO and low in CHON and fat

C.) I will eat slowl y and avoid drinking fluids during m eals D.) I will tr y to assume a recumbent position aft er m eals for 30 m ins to 1 hour to enhance digestion and reli eve s ymptoms Ans: B 50.) A 40 y/ o femal e client has arrived in the post anesthesia room following a cholec yst ectom y and a common bil e duct exploration. She is semi conscious. Her vital signs are within normal limits. Which of the following nursi ng actions would be inappropri ate? A.) Appl y a warm bl anket to her bod y B.) Place her in a semi - fowl ers position C.) Att ached her T -t ube to gravit y drainage D.) S et up low, int ermittent sucti on for her NGT Ans: B