Professional Documents
Culture Documents
A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the
result of an automobile crash. The nurse knows that this type of surgery belongs in what category?
a. Minor, diagnostic
b. Minor, elective
c. Major, emergency
d. Major, palliative
c. This surgery would involve a major body organ, has the potential for postoperative complications,
requires hospitalization, and must be done immediately to save the patient's life. Elective surgery is a
procedure that is preplanned by essentially healthy people. Diagnostic surgery is performed to
confirm a diagnosis. Palliative surgery is not curative, rather it is done to relieve or reduce the
intensity of an illness.
2. A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional
anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply.
a. Loss of consciousness
c, d. A localized loss of sensation and possible loss of reflexes occurs with a regional anesthetic. Loss of
consciousness and relaxation of skeletal muscles occurs with general anesthesia. Prolonged pain relief
after other anesthesia wears off and infiltration of the underlying tissues in an operative area occur
with topical anesthesia.
3. A nurse has been asked to witness a patient signature on an informed consent form for surgery.
What information should be included on the form? Select all that apply.
c) Notice that once the form is signed, the patient cannot withdraw consent
4. A 72-year-old woman who is scheduled for a hip replacement is taking several medications on a
regular basis. Which drug category might create a surgical risk for this patient?
a. Anticoagulants
b. Antacids
c. Laxatives
d. Sedatives
a. Anticoagulant drug therapy would increase the risk for hemorrhage during surgery.
5. A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for
what postoperative complication?
c. Hemorrhage
d. Gas pains
b. Fatty tissue is less vascular and, therefore, less resistant to infection and more prone to delayed
wound healing.
a, c, f.
Sedatives, such as diazepam (Valium), midazolam (Versed), or lorazepam (Ativan) are given to
alleviate anxiety and decrease recall of events related to surgery. Anticholinergics, such as atropine
and glycopyrrolate (Robinul) are given to decrease pulmonary and oral secretions and to prevent
laryngospasm. Neuroleptanalgesic agents, such as fentanyl citrate-droperidol (Innovar) are given to
cause a general state of calm and sleepiness. Histamine-2 receptor blockers, such as cimetidine
(Tagamet) and ranitidine (Zantac) are given to decrease gastric acidity and volume. Narcotic
analgesics, such as morphine, are given to facilitate patient sedation and relaxation and to decrease
the amount of anesthetic agent needed.
7. A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be
most effective in preoperative teaching for ambulatory surgery?
a. Lecture
b. Discussion
c. Audiovisuals
d. Written instructions
d. Written instructions are most effective in providing information for same-day surgery
A 70-year-old male is scheduled for surgery. He says to the nurse, "I am so frightened—what if I don't
wake up?" What would be the nurse's best response?
b. This answer allows the patient to talk about his feelings and fears, and is therapeutic.
A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is
interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's
correct response?
a. "The pump allows the patient to be completely free of pain during the postoperative period."
b. "The pump allows the patient to take unlimited amounts of medication as needed."
c. "The pump allows the patient to choose the type of medication given postoperatively."
d. "The pump allows the patient to self-administer limited doses of pain medication."
d. PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within
physician-prescribed time and dose limits. Patients activate the delivery of the medication by pressing
a button on a cord connected to the pump or a button directly on the pump.
Which statements best describe the preoperative period when a client is being prepared for surgery?
Select all that apply.
A. It begins when the client makes an appointment with a surgeon to discuss the need for surgery.
C. It is a time during which a client's need for surgery is established. D. During this time, the client
receives testing and education related to the impending surgery.
F. It is a time when clients and families receive instruction for after discharge.
B, D, E
Which is the most important priority for nurses when caring for a client preoperatively?
A. Client safety
D. Client teaching
What are the advantages for clients whose surgery is accomplished in a same-day surgery center
(outpatient surgery center)? Select all that apply.
A. Cost-effective care
E. Service-oriented processes
A, D, E, F
What is the most appropriate category of surgery for a client who can barely ambulate with a walker
at home, who is having a left total knee replacement?
A. Urgent
B. Palliative
C. Reconstructive
D. Simple
What is the best classification for the surgery when a female client has a biopsy of a nodule found in
the right breast?
A. Cosmetic
B. Diagnostic
C. Minor
D. Palliative
A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is
interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's
correct response?
a. "The pump allows the patient to be completely free of pain during the postoperative period."
b. "The pump allows the patient to take unlimited amounts of medication as needed."
c. "The pump allows the patient to choose the type of medication given postoperatively."
d. "The pump allows the patient to self-administer limited doses of pain medication."
d. PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within
physician-prescribed time and dose limits. Patients activate the delivery of the medication by pressing
a button on a cord connected to the pump or a button directly on the pump.
What is the best classification for surgery when a client with Crohn's disease has a colostomy?
A. Preventative
B. Reconstructive
C. Curative
D. Palliative
A client with appendicitis is to have an uncomplicated appendectomy performed. What is the best
classification for this surgery?
A. Elective
B. Curative
C. Diagnostic
D. Minor
An older client is having a cataract removal surgery. What is the best category for this surgery?
A. Urgent
B. Emergent
C. Elective
D. Cosmetic
A hypertensive client with a large abdominal aortic aneurysm is having a surgical repair. What is the
best category for this surgery?
A. Urgent
B. Emergent
C. Radical
D. Curative
Which surgical approach does the nurse expect will be used for a client having an uncomplicated
cholecystectomy at the same-day surgery clinic?
A. Simple
B. Open
C. Minimally invasive
D. Radical
What is the nurse's priority action when interviewing a preoperative client who had a right hip
replacement?
Which manifestations would the nurse expect for a client with a history of malignant hyperthermia
(MH)? Select all that apply.
C. Tachypnea
D. Skin mottling
A, C, D, E, F
Which are the most sensitive indicators of malignant hyperthermia that the nurse would monitor for
in a client? Select all that apply.
A. Rise in the end-tidal carbon dioxide level with a decrease in oxygen saturation
D. Hypotension
E. Tachycardia
F. Cyanosis
A, E
When the nurse is screening a preoperative client, which factors increase the risk for complications
during the perioperative period? Select all that apply.
A. Age 72
B. 35 pounds overweight
F. Type 2 diabetes
A, B, E, F
Which classification will a client having surgery, who also had a myocardial infarction (MI) 6 weeks
ago, fit best based on the American Society of Anesthesiologists (ASA) system?
A. ASA class I
B. ASA class II
D. ASA class IV
What is the nurse's best response when a preoperative client speaks about fear of a reaction if blood
is given during his or her surgery?
A. "The likelihood that you will need a blood transfusion during your surgery is minimal, so do not
worry about it."
B. "You could donate some of your own blood, which is an autologous donation, a few weeks before
your surgery."
C. "With today's technology and procedures, it is very unlikely that you would have a reaction to
donated blood."
D. "The nursing staff follows very strict rules and procedures to prevent such an event from ever
happening."
Which common laboratory tests does the nurse expect will be completed on a client prior to surgery?
Select all that apply.
A. Lipid profile
B. Urinalysis
C. Metabolic panel
D. Clotting studies
B, C, D, E
Informed consent implies to the nurse that a client understands which of the following? Select all that
apply.
E. The risks associated with the surgical procedure and its potential outcomes
A, C, E, F
Which statement best describes the interprofessional collaborative roles of the nurse and surgeon
when obtaining informed consent?
A. The nurse is responsible for having the informed consent form on the chart for the surgeon to
witness.
B. The nurse may serve as a witness that the client has been informed by the surgeon before surgery
is performed.
C. The nurse may serve as witness to the client's signature after the surgeon has the consent form
signed, but before preoperative sedation is given and surgery is performed.
D. The nurse has no duties regarding the consent form if the client has signed the informed consent
form for the surgeon, even if the client then asks additional questions about the surgery.
After a client is prepared for surgery and before preoperative drugs are given and the client is
transferred to surgery, which intervention can the nurse delegate to the assistive personnel (AP)?
Which postoperative interventions would the preoperative nurse typically teach a client to prevent
complications following surgery? Select all that apply.
A. Range-of-motion exercises
C. Incision splinting
A blind client is to have a surgical procedure. What is the nurse's best response when the client asks if
he or she will be permitted to sign the consent form?
A. "Yes, but you will need to make an X instead of signing your name." B. "No, but you can give
instructions for a responsible adult to sign for you."
C. "Yes, but your signature will need to be witnessed by two people." D. "No, but your next of kin can
sign the informed consent for you."
Which drugs usually taken daily by a client would the surgeon instruct the nurse to be sure to
administer prior to surgery? Select all that apply.
A. Daily multivitamin
B. Anticonvulsant
C. Stool softener
D. Beta blocker
F. Anticoagulant
B, D
What would the nurse suspect when assessing an older preoperative client and finding brittle nails;
dry, flaky skin; muscle wasting; and dry, sparse hair?
A
A preoperative client's vital signs before transport to the surgery holding area are: (BP 90/60 mm Hg,
HR 110/minute, RR 24/minute, T 100.9oF [38.3oC]). What is the nurse's priority action?
Which phase of client care in a postanesthesia care unit (PACU) requires the nurse to perform the
most intensive observations and assessments?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
Which action does the nurse perform first for a postoperative client arriving on the medical-surgical
unit after discharge from the postanesthesia care unit (PACU)?
A. Calculate the client-controlled analgesia (PCA) pump maximum dose per hour to avoid an overdose.
B. Compare the client's core body temperature with bilateral peripheral temperatures.
D
Which client signs and symptoms does the nurse consider postoperative complications rather than
expected responses to the experience? Select all that apply.
C. Pulmonary embolism
D. Paralytic ileus
E. Sore throat
F. Sedation
A, C, D
Which information will the nurse on a medical-surgical unit expect to be included in a client "handoff"
report from a postanesthesia care unit (PACU) nurse? Select all that apply.
A. Is Jewish
C. Is allergic to strawberries
H. Weighs 280 lb (122.2 kg) and is 5 feet 11 inches (180 cm) tall
B, E, F, G
What is the nurse's best first action for a client who is 6 hours postoperative from abdominal surgery
and now has profuse bleeding from the incision?
With which clients will the nurse remain especially vigilant for respiratory complications during the
first 24 hours after surgery? Select all that apply.
B, D, F
What is the nurse's first action when a client develops an abdominal wound evisceration after a hard
sneeze?
D. Attempt to reduce the evisceration by gently moving the contents back into the abdomen.
What is the nurse's best action to prevent harm for a client who arrives at the postanesthesia care
unit (PACU) with a respiratory rate of 10 breaths/min and an SpO2 an SpO2 of 94% after receiving
fentanyl during surgery?
A. Monitor the client for the effects of anesthetic for at least 1 hour.
C. Perform deep suction and stimulate the client by pinching the skin on the sternum.
D. Closely monitor vital signs and pulse oximetry readings until the client is responsive.
B
Which action for care of a client after major abdominal surgery will the nurse perform to prevent
harm?
A. Use the knee gatch of the bed to bend the knees and relieve pressure.
B. Gently massage the lower legs and calves to promote venous blood return to the heart.
C. Encourage the client to request pain medication before the pain becomes too severe.
D. Teach the client to splint the wound for support and comfort when getting out of bed.
Which assessment criteria indicate to the nurse that the client who had surgery 12 hours ago is
experiencing respiratory difficulty? Select all that apply.
B, C, E
What is the nurse's best action/response when the family of an 89-year-old who had surgery
yesterday states that they are concerned because although the client knew who everyone was, he
was unable to tell them what day it is or the name of the vice president?
A. Ask the family how long the client has had memory problems and whether any close relatives have
been diagnosed with dementia or Alzheimer disease.
B. Reassure the family that the drugs and anesthetics used in surgery often make the older adult need
a little longer to return to his presurgical baseline.
When assessing the hydration status of an older postoperative client, where will the nurse assess for
skin dryness and tenting?
B. Forearm
C. Sternum
D. Shin
With which client is the nurse most alert for postoperative nausea and vomiting (PONV)?
Which assessment finding indicates to the nurse that a client's peristaltic activity has resumed after
surgery?
C
Which parameter is most important for the nurse to assess for the client admitted to the
postanesthesia care unit (PACU) after surgery under epidural anesthesia?
C. Assessing the response to pinprick stimulation from the feet to mid-chest level
D. Comparing blood pressure taken in the right arm to blood pressure taken in the left arm
What is the nurse's best action when assessment of a client's nasogastric tube drainage shows the
presence of 140 mL of greenish-yellow drainage?
Which nonverbal manifestations in an older adult client indicate to the nurse that the client is likely
having acute pain? Select all that apply.
A. Restlessness
B. Profuse sweating
C. Difficult to arouse
D. Confusion
A, B, D, E
What is the nurse's interpretation of a postoperative client's laboratory results that show an increase
in band cells (immature neutrophils)?
D. The clotting factors have been consumed, increasing the risk for bleeding.
Which drug does the nurse prepare to administer to a postoperative client who has received an
overdose of a benzodiazepine?
A. Hydromorphone
B. Flumazenil
C. Midazolam
D. Naloxone
Which actions will the nurse take to prevent hypoxemia in the postoperative client? Select all that
apply.
F. Remind the client to use incentive spirometry every hour while awake.
B, C, D, F
Which action does the nurse take to prevent harm from skin irritation, wound contamination, and
infection for a postoperative client who has a Penrose drain?
D. Shortens the drain by pulling it out a short distance and trimming off the excess external portion
The nurse is about to give the prescribed pain medication to a client 30 minutes before a scheduled
dressing change. The client states that the drug makes him feel sick and he would rather "tough it
out." What is the nurse's best first response?
C. "Your surgeon would not have prescribed the drug if it wasn't needed."
D. "Remember that the pain of the dressing change would be worse than feeling sick."
What is the nurse's best action when crusting on about half of the suture line and oozing of a small
amount of serosanguinous drainage is present during the dressing change of client's abdominal
dressing on the second postoperative day?
A. Loosen the sutures or staples in the area where crusts have formed.
B. Clean the suture line with sterile saline and apply new dressings.
Which precaution or issue will the nurse reinforce to the postoperative client about correct use of the
patient-controlled analgesia (PCA) device?
A. "Push the button when you feel the pain beginning rather than waiting until the pain is at its
worst."
B. "Push the button every 15 minutes whether you feel pain at that time or not."
C. "Instruct your family or visitors to press the button for you when you are sleeping."
D. "Try to go as long as you possibly can before you press the button."
Which action will the nurse take next after emptying 80 mL of sanguineous drainage from the Jackson-
Pratt drain in the client's hip after hip surgery?
D. Clamp the drain for 2 hours and release the clamp for 2 hours.
During the immediate postoperative period, the nurse should give highest priority to:
True of False
The role of the circulating nurse in the OR is to handle the sterile equipment during surgery?
False
True or False
The preoperative phase ends when the patient is safely transported to the OR and care is assumed by
the OR nurse?
True
-Preoperative:
-Intraoperative:
-Postoperative:
A nurse who helped found the field of perioperative nursing during the Crimean War was:
a. Clara Barton
b. Florence Nightingale
c. Lillian Wald
d. Mary Breckinridge
Answer: B
a. AMA
b. AORN
c. Bellevue Hospital
Answer: D
e. Strive
Answer: B
e. The plan of care is implemented correctly before, during, and after surgery
Answer: E
The pre-incision TIME OUT should be performed by which member(s) of the perioperative team?
c. Perioperative RNs
Answer: A
This perioperative RN prepares the OR, helps with anesthesia induction if requested, and works
outside the sterile field to ensure the perioperative team has everything it needs.
a. PACU nurse
b. Pre-admission nurse
c. RN circulator
e. Scrub person
Answer: C
b. Includes the OR
e. Used for communication of information between the surgical suite and the rest of the health care
facility
Answer: E
When updating the patient's support person during surgery, a nurse should:
a. Call the surgeon away from the operation, but only if the support person demands it.
e. Tell the patient that she is not allowed to talk to the support person
Answer: B
Advanced practice nurses in the perioperative setting may do all of the following except which one?
Answer: C
d. Can result from failure to perform the TIME OUT before surgery
Answer: D
Approximately what percentage of serious medical errors are thought to associated with
miscommunication during patient hand-offs?
a. < 1%
b. 10%
c. 50%
d. 80%
e. 100%
Answer: D
b. The circulating RN and scrub nurse count instruments, sponges, needles, and other sharps
c. The patient's name, date of birth, procedure, and procedure site are confirmed
Answer: B
following?
care unit
Answer: A