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Surgery Exam Key Answer
Surgery Exam Key Answer
School of Nursing
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 1
SAINT LOUIS UNIVERSITY
School of Nursing
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 2
SAINT LOUIS UNIVERSITY
School of Nursing
Physiologic needs must be met Auscultation refers to the skill of listening to sounds
before an individual is able to move toward produced within the body created by movement of
psychological health and well-being. air or fluid.
b) Self-actualization d) Manipulation
Self-actualization is the highest level of need Manipulation refers to the use of the hands to
determine motion of a body part.
c) Safety and security needs
48. In order to help prevent the development of an
Safety and security needs, while lower level, are not external rotation deformity of the hip in a patient
essential to physiologic survival. who must remain in bed for any period of time, the
most appropriate nursing action would be to use
d) Belongingness
a) a trochanter roll extending from the crest of the
Belongingness and affection needs are not essential
ilium to the midthigh.
to physiologic survival.
A trochanter roll, properly placed, provides
20. Which of the following items is considered the
resistance to the external rotation of the hip.
single most important factor in assisting the health
professional in arriving at a diagnosis or determining b) pillows under the lower legs.
the persons needs?
Pillows under the legs will not prevent the hips from
a) History of present illness rotating externally.
The history of the present illness is the single most c) a hip-abductor pillow.
important factor in assisting the health professional
in arriving at a diagnosis or determining the A hip-abductor pillow is used for the patient after
persons needs. total hip replacement surgery.
The physical examination is helpful but often only A footboard will not prevent the hips from rotating
validates the information obtained from the history. externally.
c) Diagnostic test results 49. To prevent footdrop, the patient is positioned in:
Diagnostic test results can be helpful, but they often a) Order to keep the feet at right angles to the leg
only verify rather than establish the diagnosis.
When the patient is supine in bed, padded splints or
d) Biographical data protective boots are used.
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 3
SAINT LOUIS UNIVERSITY
School of Nursing
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 4
SAINT LOUIS UNIVERSITY
School of Nursing
The IV route is the preferred parenteral route in 70. In which type of shock does the patient
most acute care situations because it is much more experiences a mismatch of blood flow to the cells?
comfortable for the patient, and peak serum levels
a) Distributive
and pain relief occur more rapidly and reliably.
Distributive or vasogenic shock results from
b) Epidural
displacement of blood volume, creating a relative
Epidural administration is used to control hypovolemia.
postoperative and chronic pain.
b) Cardiogenic
c) Subcutaneous
Cardiogenic shock results from the failure of a heart
Subcutaneous administration results in slow as a pump.
absorption of medication.
c) Hypovolemic
d) Intramuscular
In hypovolemic shock, there is a decrease in the
Intramuscular administration of medication is intravascular volume.
absorbed more slowly than intravenously
d) Septic
administered medication.
In septic shock, overwhelming infection results in a
64. Mu opioids have which of the following effects
relative hypovolemia.
on respiratory rate:
71. Which stage of shock is best described as that
a) Stimulation, then depression
stage when the mechanisms that regulateblood
Mu opioids also cause bradycardia, hypothermia, pressure fail to sustain a systolic pressure above 90
and constipation. mm Hg?
b) No change a) Progressive
Kappa opioids result in no change in respiratory In the progressive stage of shock, the mechanisms
rate. that regulate blood pressure can no longer
compensate, and the mean arterial pressure falls
c) Stimulation, only below normal limits.
68. Which of the following solutions is hypotonic? In the compensatory state, the patients blood
pressure remains within normal limits due to
a) 0.45% NaCl. vasoconstriction, increased heart rate, and
increased contractility of the heart.
Half-strength saline is hypotonic
d) Irreversible
b) Lactated Ringers solution.
The refractory or irreversible stage of shock
Lactated Ringers is isotonic.
represents the point at which organ damage is so
c) 0.9% NaCl. severe that the patient does not respond to
treatment and cannot survive.
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 5
SAINT LOUIS UNIVERSITY
School of Nursing
72. When the nurse observes 87. When the indication for surgery is without delay,
that the patients systolic blood pressure is less than the nurse recognizes that the surgery will be
8090 mm Hg, respirations are rapid and shallow, classified as
heart rate is over 150 beats per minute, and urine
output is less than 30 cc per hour, the nurse a) emergency.
recognizes that the patient is demonstrating which
Emergency surgery means that the patient requires
stage of shock?
immediate attention and the disorder may be life-
a) Compensatory threatening.
In refractory or irreversible shock, the patient 90. When the patient is encouraged to concentrate
requires complete mechanical and pharmacologic on a pleasant experience or restful scene, the
support. cognitive coping strategy being employed by the
nurse is
86. Regarding the surgical patient, which of the
following terms refers to the period of time that a) imagery.
constitutes the surgical experience?
Imagery has proven effective for oncology patients.
a) Perioperative phase
b) optimistic self-recitation.
Perioperative period includes the preoperative,
Optimistic self-recitation is practiced when the
intraoperative, and postoperative phases.
patient is encouraged to recite optimistic thoughts
b) Preoperative phase such as I know all will go well.
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 6
SAINT LOUIS UNIVERSITY
School of Nursing
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 7
SAINT LOUIS UNIVERSITY
School of Nursing
Dyspnea refers to labored leather being rubbed together, she records her
breathing or shortness of breath. finding as
Hemoptysis refers to expectoration of blood from A pleural friction rub is heard secondary to
the respiratory tract. inflammation and loss of lubricating pleural fluid.
d) Hypoxemia b) crackles.
Hypoxemia refers to low oxygen levels in the blood. Crackles are soft, high-pitched, discontinuous
popping sounds that occur during inspiration.
101. In relation to the structure of the larynx, the
cricoid cartilage is c) sonorous wheezes.
a) the only complete cartilaginous ring in the larynx. Sonorous wheezes are deep, low-pitched rumbling
sounds heard primarily during expiration.
The cricoid cartilage is located below the thyroid
cartilage. d) sibilant wheezes.
b) used in vocal cord movement with the thyroid Sibilant wheezes are continuous, musical, high-
cartilage. pitched, whistle-like sounds heard during inspiration
and expiration.
The arytenoid cartilages are used in vocal cord
movement with the thyroid cartilage. 110. Which of the following terms refers to lung
tissue that has become more solid in nature due to
c) the largest of the cartilage structures. a collapse of alveoli or infectious process?
The thyroid cartilage is the largest of the cartilage a) Consolidation
structures; part of it forms the Adams apple.
Consolidation occurs during an infectious process
d) the valve flap of cartilage that covers the opening such as pneumonia.
to the larynx during swallowing.
b) Atelectasis
The epiglottis is the valve flap of cartilage that
covers the opening to the larynx during swallowing. Atelectasis refers to collapse or airless condition of
the alveoli caused by hypoventilation, obstruction to
102. Which respiratory volume is the maximum the airways, or compression.
volume of air that can be inhaled after maximal
expiration? c) Bronchiectasis
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 8
SAINT LOUIS UNIVERSITY
School of Nursing
Gastric fluid may be grassy green, A deficiency of alpha-antitrypsin is a risk factor for
brown, clear, or odorless while an aspirate from the development of COPD, but it is not the most
lungs may be off-white or tan. Hence, checking important risk factor.
aspirate is not the best method of determining
nasogastric tube placement in the stomach. 119. Which type of chest configuration is typical of
the patient with COPD?
c) Testing of pH of gastric aspirate
a) Barrel chest
Gastric pH values are typically lower or more acidic
than that of the intestinal or respiractory tract, but Barrel chest results from fixation of the ribs in the
not always. inspiratory position.
Placement of external end of tube under water and Pigeon chest results from a displaced sternum.
watching for air bubbles is not a reliable method for
c) Flail chest
determining nasogastric tube placement in the
stomach. Flail chest results when the ribs are fractured.
117. Emphysema is described as: d) Funnel chest
a) A disease of the airways characterized by Funnel chest occurs when there is a depression in
destruction of the walls of overdistended alveoli. the lower portion of the sternum and is associated
Emphysema is a category of COPD. with Mafans syndrome or rickets.
b) A disease that results in a common clinical 121. Of the following oxygen administration devices,
outcome of reversible airflow obstruction. which has the advantage of providing high oxygen
concentration?
Asthma is the disease described.
a) Non-rebreather mask
c) The presence of cough and sputum production
for at least a combined total of two or three months The non-rebreather mask provides high oxygen
in each of two consecutive years. concentration but is usually poor fitting.
Bronchitis is the disease described. b) Venturi mask
d) Chronic dilatation of a bronchus or bronchi The Venturi mask provides low levels of
supplemental oxygen.
Bronchiectasis is the condition described.
c) Catheter
118. Which of the following is the most important
risk factor for development of Chronic Obstructive The catheter is an inexpensive device that provides
Pulmonary Disease? a variable fraction of inspired oxygen and may cause
gastric distention.
a) Cigarette smoking
d) Face tent
Pipe, cigar and other types of tobacco smoking are
also risk factors. A face tent provides a fairly accurate fraction of
inspired oxygen, but is bulky and uncomfortable. It
b) Occupational exposure
would not be the device of choice to provide high
While a risk factor, occupational exposure is not the oxygen concentration.
most important risk factor for development of
123. When performing endotracheal suctioning, the
COPD.
nurse applies suctioning while withdrawing and
c) Air pollution gently rotating the catheter 360 degrees for which
of the following time periods?
Air pollution is a risk factor for development of
COPD, but it is not the most important risk factor. a) 10-15 seconds
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 9
SAINT LOUIS UNIVERSITY
School of Nursing
dysrhythmias may The right ventricle lies anteriorly, just beneath the
develop, leading to cardiac arrest. sternum.
Applying suction for 30-35 seconds is hazardous and Use of inches to identify the location of the apex
may result in the patients developing hypoxia, beat is inappropriate based upon variations in
which can lead to dysrhythmias and, ultimately, human anatomy.
cardiac arrest.
d) 1 to the left of the xiphoid process
c) 20-25 seconds
Auscultation below and to the left of the xiphoid
Applying suction for 20-25 seconds is hazardous and process will detect gastrointestinal sounds, but not
may result in the patients developing hypoxia, the apex beat of the heart.
which can lead to dysrhythmias and, ultimately,
cardiac arrest. 127. Which of the following terms describes the
amount of blood ejected per heartbeat?
d) 0-5 seconds
a) Stroke volume
Applying suction for 0-5 seconds would provide too
little time for effective suctioning of secretions. Stroke volume is determined by preload, afterload,
and contractility.
125. Which term is used to describe the ability of
the heart to initiate an electrical impulse? b) Cardiac output
126. The nurse auscultates the apex beat at which Normally, in the absence of disease of the
of the following anatomical locations? vasculature, there is a difference of no more than 5
mm Hg between arm pressures.
a) Fifth intercostal space, midclavicular line
b) must be equal in both arms.
The left ventricle is responsible for the apex beat or
the point of maximum impulse, which is normally The pressures in each arm do not have to be equal
palpable in the left midclavicular line of the chest in order to be considered normal.
wall at the fifth intercostal space.
c) may vary 10 mm Hg or more between arms.
b) Mid-sternum
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 10
SAINT LOUIS UNIVERSITY
School of Nursing
c) P wave d) ischemia
The P wave is an ECG characteristic reflecting Ischemia is insufficient tissue oxygenation and may
conduction of an electrical impulse through the occur in any part of the body.
atria.
138. Of the following risk factors, which is
d) QT interval considered modifiable?
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 11
SAINT LOUIS UNIVERSITY
School of Nursing
Unstable angina is also called Orthopnea is the inability of the patient to breathe
crescendo or pre-infarction angina and indicates the except in the upright (sitting) position.
need for a change in treatment.
d) Thromboangitis obliterans
b) intractable angina.
Thomroangitis obliterans is a peripheral vascular
Intractable or refractory angina produces severe, disease also known as Burgers disease.
incapacitating chest pain that does not respond to
conventional treatment. 149. When the nurse notes that the post cardiac
surgery patient demonstrates low urine output (<
c) variant angina. 25 ml/hr) with high specific gravity (> 1.025), the
nurse suspects:
Variant angina is described as pain at rest with
reversible ST-segment elevation and is thought to be a) Inadequate fluid volume
caused by coronary artery vasospasm.
Urine output of less than 25 ml/hr may indicate a
d) refractory angina. decrease in cardiac output. A high specific gravity
indicates increased concentration of solutes in the
Intractable or refractory angina produces severe, urine which occurs with inadequate fluid volume.
incapacitating chest pain that does not respond to
conventional treatment. b) Normal glomerular filtration
146. Which of the following medications are used to Indices of normal glomerular filtration are output of
reverse the effects of heparin? 25 ml or greater per hour and specific gravity
between 1.010 and 1.025.
a) Protamine sulfate
c) Overhydration
Protamine sulfate is known as the antagonist to
heparin. Overhydration is manifested by high urine output
with low specific gravity.
b) Streptokinase
d) Anuria
Streptokinase is a thrombolytic agent.
The anuric patient does not produce urine.
c) Clopidigrel (Plavix)
159. When the nurse observes that the patient
Clopidigrel (Plavix) is an antiplatelet medication that always has difficulty breathing when lying flat, the
is given to reduce the risk of thrombus formation nurse records that the patient is demonstrating
post coronary stent placement.
a) Orthopnea
d) Aspirin
Patients with orthopnea prefer not to lie flat and
The antiplatelet effect of aspirin does not reverse will need to maintain their beds in a semi- to high
the effects of heparin. Fowlers position
147. Which of the following terms refers to leg pain b) Dyspnea on exertion.
that is brought on walking and caused by arterial
insufficiency? Dyspnea on exertion refers to difficulty breathing
with activity.
a) Intermittent claudication
c) Hyperpnea.
Intermittent claudication is leg pain that is brought
on by exercise and relieved by rest. Hyperpnea refers to increased rate and depth of
respiration.
b) Dyspnea
d) Paroxysmal nocturnal dyspnea.
Dyspnea is the patients subjective statement of
difficulty breathing. Paroxysmal nocturnal dyspnea refers to orthopnea
that occurs only at night.
c) Orthopnea
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 12
SAINT LOUIS UNIVERSITY
School of Nursing
d) Ability to sleep through the night 171. The nurse teaches the patient which of the
following guidelines regarding lifestyle modifications
Frequent urination, causing interruption of sleep, for hypertension?
should be reported immediately.
a) Maintain adequate dietary intake of potassium
169. Which of the following terms is given to
hypertension in which the blood pressure, which is In general, one serving of a potassium-rich food
controlled with therapy, becomes uncontrolled such as banana, kale, broccoli, or orange juice will
(abnormally high) with the discontinuation of meet the daily need for potassium.
therapy?
b) Reduce smoking to no more than four cigarettes
a) Rebound per day
Rebound hypertension may precipitate a The patient should be guided to stop smoking.
hypertensive crisis.
c) Limit aerobic physical activity to 15 minutes,
b) Essential three times per week
Essential or primary hypertension denotes high The general guideline is to advise the patient to
blood pressure from an unidentified source. increase aerobic activity to 30 to 45 minutes most
days of the week.
c) Primary
d) Stop alcohol intake
Essential or primary hypertension denotes high
blood pressure from an unidentified source. In general, alcohol intake should be limited to no
more than 1 oz of ethanol per day.
d) Secondary
174. Which of the following terms refers to an
Secondary hypertension denotes high blood abnormal decrease in white blood cells, red blood
pressure from an identified cause, such as renal cells, and platelets?
disease.
a) Pancytopenia
170. Officially, hypertension is diagnosed when the
patient demonstrates a systolic blood pressure Pancytopenia may be congenital or acquired.
greater than ______ mm Hg and a diastolic blood
pressure greater than _____ mm Hg over a b) Anemia
sustained period.
Anemia refers to decreased red cell mass.
a) 140, 90
c) Leukopenia
According to the categories of blood pressure levels
Leukopenia refers to a less-than-normal amount of
established by the JNC VI, stage 1 hypertension is
WBCs in circulation.
demonstrated by a systolic pressure of 140159 or a
diastolic pressure of 9099. d) Thrombocytopenia
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 13
SAINT LOUIS UNIVERSITY
School of Nursing
179. Which of the following One observation of a residual gastric content over
terms describes a gastric secretion that combines 100 cc does not have to be reported to the
with vitamin B-12 so that it can be absorbed? physician. If the observation occurs two times in
succession, the physician should be notified.
a) Intrinsic factor
c) give the tube feeding.
Lack of intrinsic factor is a common finding in the
aged patient. If the amount of gastric residual exceeds 100 cc, the
tube feeding should be withheld at that time.
b) Amylase
d) withhold the tube feeding indefinitely.
Amylase is an enzyme that aids in the digestion of
starch. If the amount of gastric residual exceeds 100 cc, the
tube feeding should be withheld at that time, but
c) Pepsin not indefinitely.
Pepsin is a gastric enzyme important in protein 221. Which type of jaundice in adults is the result of
digestion. increased destruction of red blood cells?
d) Trypsin a) Hemolytic
Trypsin is an enzyme that aids in the digestion of Hemolytic jaundice results because, although the
protein liver is functioning normally, it cannot excrete the
bilirubin as quickly as it is formed.
195. The most significant nursing problem related to
continuous tube feedings is b) Hepatocellular
a) potential for aspiration Hepatocellular jaundice is the result of liver disease.
Because the normal swallowing mechanism is c) Obstructive
bypassed, consideration of the danger of aspiration
must be foremost in the mind of the nurse caring Obstructive jaundice is the result of liver disease.
for the patient receiving continuous tube feedings.
d) Non-obstructive
b) interruption of GI integrity
Non-obstructive jaundice occurs with hepatitis.
Tube feedings preserve GI integrity by intraluminal
delivery of nutrients. 243. To facilitate entry of a catheter into the male
urethra, the penis should be positioned at which of
c) disturbance in the sequence of intestinal and the following degree angles (in relation to the
hepatic metabolism body)?
196. When the nurse prepares to give a bolus tube c) 180 degrees
feeding to the patient and determines that the
A 180-degree angle will result in the penis being
residual gastric content is 150 cc, her best action is
parallel to the body and inappropriately positioned
to
for catheterization.
a) reassess the residual gastric content in 1 hour.
d) 270 degrees
If the gastric residual exceeds 100 cc 2 hours in a
A 270-degree angle is a physical impossibility.
row, the physician should be notified.
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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 14
SAINT LOUIS UNIVERSITY
School of Nursing
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