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1.

Question

The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour
ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the
next hour?

 1. Urinary output of 20 mL/hour
 2. Temperature of 37.6 ° C (99.6 ° F)
 3. Blood pressure of 100/70 mm Hg
 4. Serous drainage on the surgical dressing

2. Question

A postoperative client asks the nurse why it is so important to deep-breathe and cough after
surgery. When formulating a response, the nurse incorporates the understanding that retained
pulmonary secretions in a postoperative client can lead to which condition?

 1. Pneumonia
 2. Hypoxemia
 3. Fluid imbalance
 4. Pulmonary embolism

3. Question

The nurse is developing a plan of care for a client scheduled for surgery. The nurse should
include which activity in the nursing care plan for the client on the day of surgery?

 1. Avoid oral hygiene and rinsing with mouthwash.
 2. Verify that the client has not eaten for the last 24 hours.
 3. Have the client void immediately before going into surgery.
 4. Report immediately any slight increase in blood pressure or pulse

4. Question

A client with a perforated gastric ulcer is scheduled for surgery. The client cannot sign the
operative consent form because of sedation from opioid analgesics that have been administered.
The nurse should take which most appropriate action in the care of this client?

 1. Obtain a court order for the surgery.
 2. Have the charge nurse sign the informed consent immediately.
 3. Send the client to surgery without the consent form being signed.
 4. Obtain a telephone consent from a family member, following agency policy

5. Question

A preoperative client expresses anxiety to the nurse about upcoming surgery. Which response by
the nurse is most likely to stimulate further discussion between the client and the nurse?

 1. “If it’s any help, everyone is nervous before surgery.”
 2. “I will be happy to explain the entire surgical procedure to you.”
 3. “Can you share with me what you’ve been told about your surgery?”
 4. “Let me tell you about the care you’ll receive after surgery and the amount of pain
you can anticipate

6. Question

The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The
client has a history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse
determines that the client needs additional teaching if the client makes which statement?

 1. “Aspirin can cause bleeding after surgery.”
 2. “Aspirin can cause my ability to clot blood to be abnormal.”
 3. “I need to continue to take the aspirin until the day of surgery.”
 4. “I need to check with my health care provider about the need to stop the aspirin
before the scheduled surgery.”

8. Question

The nurse assesses a client’s surgical incision for signs of infection. Which finding by the nurse
would be interpreted as a normal finding at the surgical site?

 1. Red, hard skin
 2. Serous drainage
 3. Purulent drainage
 4. Warm, tender skin

9. Question concerned with which sign that could indicate an evolving complication?
 1. Increasing restlessness
 2. A pulse of 86 beats/minute
 3. Blood pressure of 110/70 mm Hg
 4. Hypoactive bowel sounds in all four quadrants

10. Question

A client who has undergone preadmission testing has had blood drawn for serum laboratory
studies, including a complete blood count, coagulation studies, and electrolytes and creatinine
levels. Which laboratory result should be reported to the surgeon’s office by the nurse, knowing
that it could cause surgery to be postponed?

 1. Sodium, 141 mEq/L
 2. Hemoglobin, 8.0 g/dL
 3. Platelets, 210,000/mm3
 4. Serum creatinine, 0.8 mg/dL

11. Question

The nurse receives a telephone call from the postanesthesia care unit stating that a client is being
transferred to the surgical unit. The nurse plans to take which action first on arrival of the client?

 1. Assess the patency of the airway.
 2. Check tubes or drains for patency.
 3. Check the dressing to assess for bleeding.
 4. Assess the vital signs to compare with preoperative measurements

12. Question

The nurse is reviewing a health care provider’s (HCP’s) prescription sheet for a preoperative
client that states that the client must be NPO after midnight. The nurse would telephone the HCP
to clarify that which medication should be given to the client and not withheld?

 1. Prednisone
 2. Ferrous sulfate
 3. Cyclobenzaprine (Flexeril)
 4. Conjugated estrogen (Premarin
13. A client is brought to the emergency department (ED) after a motorcycle accident. The client
has suffered a ruptured spleen. What is the immediate priority?
 A
 Aggressive pain control

 B
 Assessment of neurologic status

 C
 Calling the family members

 D
Emergent surgery to control bleeding

14. A female patient is having a biopsy of a nodule found in the right breast. Which classification
identifies this surgery?
 A
 Cosmetic

 B
 Diagnostic

 C
 Minor

 D
 Urgent

15. classification for this surgery?
A
Emergent

B
Palliative

C
Restorative

D
Urgent
16. A client is brought to the hospital unconscious and needs emergency surgery. The client’s
only family member cannot come to the hospital before the surgery. Which is the best option for
obtaining informed consent for the client’s emergent surgery?
A
Contact the family member by phone and obtain verbal consent with two witnesses.

B
Have the hospital administrator appoint a temporary legal guardian.

C
Obtain written consultation with two surgeons that the surgery is needed.

D
Proceed with surgery and have the family member sign the consent as soon as possible
anticipate to be ordered?

16. colon resection surgery the following day. The surgeon has ordered bowel preparation the
night before. Which action is a priority?
A
Administer antibiotics with a sip of water.

B
Encourage the client to drink plenty of juice.

C
Teach the client to eat only low-fat foods the night before surgery.

D
Tell the client not to get up and go to the bathroom alone

17. When the nurse brings a client’s preoperative medications, the client responds, “I don’t need
that. I had a good night’s sleep last night.” What is the nurse’s best response?
A
“I will ask your surgeon if you have to take the medication.”

B
“I will make a note that you refused to take the medication.”

C
“Let me teach you about your medications for surgery.”

D
“The doctor ordered this medication so you should take it.

1.) A patient is now in the recovery room after having vaginal surgery. Due to the positioning of
the procedure, you would want to assess for what while the patient is in recovery?

 A. Bowel Sounds
 B. Dysrhythmia
 C. Homan's Sign
 D. Hemoglobin Level

The answer is C. Vaginal surgeries require the patient to be in the lithotomy position. This
position can put the patient at risk for a deep vein thrombosis. Therefore, the nurse would want
to check for this by using Homan's Sign.

2.) After surgery your patient is semicomatose with vital signs within normal limits. As the
nurse, what position would be best for this patient?

 A. Semi-Fowlers
 B. Prone
 C. Low-Fowlers
 D. Side positioning preferably on the left side

The answer is D. A patient who are semicomatose are at risk for aspiration (due to secretions
pooling in the mouth or vomiting which is a common side effect of sedation). Placing the patient
onto their side preferably the left will help decrease the risk of aspiration and help promote
cardiovascular circulation.

3.) After surgery your patient starts to shiver uncontrollably. What nursing intervention would
you do FIRST?

 A. Apply warm blankets & continue oxygen as prescribed
 B. Take the patient's rectal temperature
 C. Page the doctor for further orders
 D. Adjust the thermostat in the room

The answer is A. Shivering is an early sign that the patient is starting to experience hypothermia.
Immediately, the nurse would need to control the shivering by applying warm blankets and
continue oxygen. When the patient starts to experience hypothermia, vital organs are not
receiving as much oxygenated blood due to the vasoconstriction. Therefore, oxygen would need
to be continued. Then the nurse would take the patient's temperature.

4.) The nurse is monitoring the patient who is 24 hours post-opt from surgery. Which finding
requires intervention?

 A. BP 100/80
 B. 24-hour urine output of 300 ml
 C. Pain rating of 4 on 1-10 scale
 D. Temperature of 99.3' F

The answer is B. The nurse needs to watch the patient's urinary output closely. Urinary output
within a 24-hour period should be at least 30 ml/hr. In this case, the patient is only urinating 12.5
ml/hr.
5.) A patient is 6 days post-opt from abdominal surgery. The patient is to be discharged later
today. The patient uses the call light and asks you to come to his room and look at his surgical
site. On arrival, you see that approximately 2 inches of internal organs are protruding through the
incision. What intervention would you NOT do?

 A. Put the patient in prone position with knees extended to put pressure on the site
 B. Cover the wound with sterile normal saline dressing
 C. Monitor for signs of shock
 D. Notify the MD and administer as prescribed antiemetic to prevent vomiting

The answer is A. The patient is experiencing wound evisceration. This is an emergent situation.
The patient should be placed in low Fowler's position with the knees bent to prevent abdominal
tension.

6.) A patient reports he hasn't had a bowel movement or passed gas since surgery. On
assessment, you note the abdomen is distended and no bowel sounds are noted in the four
quadrants. You notify the MD. What non-invasive nursing interventions can you perform
without a MD order?

 A. Insert a nasogastric attached to intermittent suction
 B. Administer IV fluids
 C. Encourage ambulation, maintain NPO status, and monitor intake & output
 D. Encourage at least 3000 ml of fluids per day

The answer is C. This patient is most likely experiencing a paralytic ileus which is failure for the
bowels to move its contents. The only correct non-invasive option is to encourage ambulation,
maintain NPO status, and monitor intake & output. Inserting a NG tube or administering IV
fluids is invasive and requires a MD order. Patients with potential paralytic ileus are to be NPO
(nothing by mouth) so encouraging fluid intake is incorrect.

7.) What is a potential postoperative concern regarding a patient who has already resumed a solid
diet?

 A. Failure to pass stool within 12 hours of eating solid foods
 B. Failure to pass stool within 48 hours of eating solid foods
 C. Passage of excessive flatus
 D. Patient reports a decreased appetite

The answer is B. After a patient resumes solid food, they should have a bowel movement within
48 hours. The patient may be experiencing constipation and appropriate interventions must be
followed.

8.) A nurse is developing a care plan for a patient who is at risk for developing pneumonia after
surgery. Which of the following is not an appropriate nursing intervention?

 A. Encourage patient intake of 3000 ml/day of fluids if not contraindicated
 B. Encourage patient to use the incentive spirometer device 10 times every 1-2 hours
while awake
 C. Encourage early ambulation and patient to eat meals in beside chair
 D. Repositioning every 3-4 hours

The answer is D. All options are correct expect for repositioning every 3-4 hours. If the patient is
unable to reposition themselves or ambulate, they must be repositioned every 1 to 2 hours
minimally.

9.) When assessing your patient who is post-opt, you notice that the patient's right calf vein feels
hard, cordlike, and is tender to the touch. The patient reports it is aching and painful. What
would be an inappropriate nursing intervention for this patient?

 A. Allow the patient to dangle the legs to help increase circulation and alleviate pain
 B. Instruct the patient to not sit in one position for a long period of time
 C. Elevate the extremity 30 degrees without allowing any pressure on affected area
 D. Administer anticoagulants as ordered by MD

The answer is A. All options are correct expect for Allow the patient to dangle the legs to help
increase circulation and alleviate pain. The patient should NOT dangle the legs because this
causes blood to pool in the lower extremities which will put the patient at risk for another blood
clot formation.

10.) A patient is recovering from surgery. The patient is very restless, heart rate is 120 bpm and
blood pressure is 70/53, skin is cool/clammy. As the nurse you would?

 A. Continue to monitor the patient
 B. Notify the MD
 C. Obtain an EKG
 D. Check the patient's blood glucose

The answer is B. This is an emergency situation. The patient is more than likely experiencing a
hemorrhage of some type. Notifying the MD would be the first line of action and then you could
check the patient's blood glucose and obtain an EKG. This patient is probably going to need a
surgical intervention.

11.) A patient is taking Aspirin 325 mg PO by mouth daily. The patient is scheduled for surgery
in a week. What education do you provide the patient with before surgery?

 A. Educate the patient to take the scheduled dose of Aspirin the day of surgery to help
prevent blood clots
 B. To hold his morning dose of Aspirin because the nurse will give it to him before
surgery
 C. None of the above are correct
 D. The medication should be discontinued for 48 hours prior to the scheduled surgery
date
The answer is D. Aspirin alters the normal clotting factors and increases the patient's chances of
hemorrhaging. Therefore, it should be held for at least 48 hours prior to surgery as specified by
the surgeon.

12.) You are observing your patient use the incentive spirometry. What demonstration by the
patient lets you know the patient understands how to use the device properly?

 A. The patient inhales slowly on the device and maintains the flow indicator between 600
to 900 level
 B. The patient blows on the mouthpiece rapidly.
 C. The patient uses the incentive spirometry once a day
 D. The patient rapidly inhales on the devices and exhales

The answer is A. All of the options are wrong expect for "The patient inhales slowly on the
device and maintains the flow indicator between 600 to 900 level". The other options do not
demonstrate how to properly use the incentive spirometry.

13.) As the nurse you are getting the patient ready for surgery. You are completing the
preoperative checklist. Which of the following is not part of the preoperative checklist?

 A. Assess for allergies
 B. Conducting the Time Out
 C. Informed consent is signed
 D. Ensuring that the history and physical examination has been completed

The answer is B. The time out is conducted by the OR nurse prior to surgery. All of the other
options are conducted by the nurse getting the patient ready for surgery.

14.) You are completing the history on a patient who is scheduled to have surgery. What health
history increases the risk for surgery for the patient?

 A. Urinary Tract infections
 B. History of Premature Ventricle Beats
 C. Abuse of street drugs
 D. Hyperthyroidism

The answer is C. If a patient has a history of street drug abuse this puts them at risk in surgery.
This information is very important for the anesthesiologist due to the complications that can arise
from the anestheisa. All of the other options are important to note but not a risk for surgery.