1.

Surgery:- the art science of treating diseases, injuries,

and deformities by operation and instrumentation.
2.
This type of surgery is used to determine the presence
of a pathalogic condition; (eg: lymph node biopsy)
1. Diagonsis
2. Cure
3. Palliation
4. Prevention
5. Exploration
6. Cosmetic improvement
Diagnosis- Determine the presence and extent of a
pathalogic condition
3. The type of surgery that will eliminate or repair a
pathologic condition is; (eg; remove a ruptured
appendix)
1. Diagnosis
2. Cure
3. Palliation
4. Prevention
5. Exploration
6. Cosmetic improvement
Cure- eliminate or repair a pathologic condtion
4. The Nurse must ensure this documents are in the

patient's chart, prior to surgery;

signed informed consent, lab and diagnostic data, H&P,
baseline vital signs & completed nursing notes.
5. When reviewing the preoperative forms, the nurse
notices that the informed consent form is not
present or signed. What is the best action for the
nurse to take?
A. Have the patient sign the consent form.
B. Have the family sign the form for the patient.
C. Call the surgeon to obtain consent for surgery.
D. Teach the patient about the surgery and get
verbal permission.
. Call the surgeon to obtain consent for surgery. The
informed consent for the surgery must be obtained by
the physician. The nurse can witness the signature on
the consent form and verify that the patient (or
caregiver if patient is a minor, unconscious, or
mentally incompetent to sign) understands the
informed consent. Verbal consents are not enough.
The state's nurse practice act and agency policies
must be followed.
6. As the nurse is preparing a patient for outpatient

surgery, the patient wants to give his hearing aid to

his wife so it will not be lost during surgery. Which
action by the nurse should be taken in this
situation?
A.Give the hearing aid to the wife as he wishes.
B. Tape the hearing aid to his ear to prevent loss.
C. Encourage the patient to wear it for the surgery.
 D. Tell the surgery nurse that he has his hearing
aid out.
Encourage the patient to wear it for the surgery.
7. The nurse is doing a preoperative assessment on a

male patient who has type 2 diabetes mellitus,

weighs 146 kg, and is 5 feet 8 inches tall. Which
patient assessment is a priority related to
anesthesia?
A. Has hemoglobin A1C of 8.5%
B. Has several seasonal allergies
C. Has body mass index of 48.8 kg/m2
D. Has history of postoperative vomiting
Has body mass index of 48.8 kg/m2 The patient's
body mass index is the priority because it indicates
the patient is severely obese. The patient's size may
impair the anesthesiologist's ability to ventilate and
medicate the patient properly, as well as the surgery
room staff's ability to position the patient safely. The
other factors are not the priority
8. The nurse is caring for a surgical patient, when the

family member asks what perioperative nursing

means. How should the nurse respond?
A Perioperative nursing occurs in preadmission
testing.
B Perioperative nursing occurs primarily in the
postanesthesia care unit.
C Perioperative nursing includes activities before,
during, and after surgery.
D Per operative nursing includes activities only during
the surgical procedure.
Perioperative nursing care occurs before, during, and
after surgery. Preadmission testing occurs before
surgery and is considered preoperative. Nursing care
provided during the surgical procedure is considered
intraoperative, and in the postanesthesia care unit, it
is considered postoperative. All of these are parts of
the perioperative phase, but each individual phase
does not explain the term completely
9. The nurse is caring for a patient who is scheduled

to undergo a surgical procedure. The nurse is

completing an assessment and reviews the
patient's laboratory tests and allergies and
prepares the patient for surgery. In which
perioperative nursing phase is the nurse working?
A Perioperative
B Preoperative
C Intraoperative
D Postoperative
Reviewing the patient's laboratory tests and allergies
is done before surgery in the preoperative phase.
Perioperative means before, during, and after
surgery. Intraoperative means during the surgical
procedure in the operating suite; postoperative
means after the surgery and could occur in the
postanesthesia care unit, in the ambulatory surgical
area, or on the hospital unit.
10. The nurse is caring for a patient in the

postanesthesia care unit. The patient has

developed profuse bleeding from the surgical site,
and the surgeon has determined the need to return
to the operative area. How will the nurse classify
this procedure?
A Major
B Urgent
C Elective
D Emergency
An emergency procedure must be done immediately
to save a life or preserve the function of a body part.
An example would be repair of a perforated
appendix, repair of a traumatic amputation, or control
of internal hemorrhaging. An urgent procedure is
necessary for a patient's health and often prevents
additional problems from developing. An example
would be excision of a cancerous tumor, removal of a
gallbladder for stones, or vascular repair for an
obstructed artery. An elective procedure is performed
on the basis of the patient's choice; it is not essential
and is not always necessary for health. An example
would be a bunionectomy, plastic surgery, or hernia
reconstruction. A major procedure involves extensive
reconstruction or alteration in body parts; it poses
great risks to well-being. An example would be a
coronary artery bypass or colon resection.
11. The nurse is caring for a patient in preadmission

testing. The patient has been assigned a physical

status classification by the American Society of
Anesthesiologists of ASA III. Which assessment
will support this classification?
A Normal, healthy patient
B Denial of any major illnesses or conditions
C Poorly controlled hypertension with implanted
pacemaker
D Moribund patient not expected to survive without
the operation
An ASA III rating is a patient with a severe systemic
disease, such as poorly controlled hypertension with
an implanted pacemaker. ASA I is a normal healthy
patient with no major illnesses or conditions. ASA II is
a patient with mild systemic disease. ASA V is a
moribund patient who is not expected to survive
without the operation and includes patients with
ruptured abdominal/thoracic aneurysm or massive
trauma.
12. The patient has presented to the ambulatory

surgery center to have a colonoscopy. The patient

is scheduled to receive moderate sedation
 (conscious sedation) during the procedure. How
will the nurse interpret this information?
A The procedure results in loss of sensation in an
area of the body.
B The procedure requires a depressed level of
consciousness
C The procedure will be performed on an outpatient
basis.
D The procedure necessitates the patient to be
immobile.
Moderate sedation (conscious sedation) is used
routinely for procedures that do not require complete
anesthesia but rather a depressed level of
consciousness. Not all patients who are treated on an
outpatient basis receive moderate sedation. Regional
anesthesia such as local anesthesia provides loss of
sensation in an area of the body. General anesthesia
is used for patients who need to be immobile and to
not remember the surgical procedure.
13. The nurse is caring for a patient in the

postanesthesia care unit who has undergone a left

total knee arthroplasty. The anesthesia provider
has indicated that the patient received a left
femoral peripheral nerve block. Which assessment
will be an expected finding for this patient?
A Sensation decreased in the left leg
B Patient report of pain in the left foot
C Pulse decreased at the left posterior tibia
D Left toes cool to touch and slightly cyanotic
Induction of regional anesthesia results in loss of
sensation in an area of the body—in this case, the
left leg. The peripheral nerve block influences the
portions of sensory pathways that are anesthetized in
the targeted area of the body. Decreased pulse, toes
cool to touch, and cyanosis are indications of
decreased blood flow and are not expected findings.
Reports of pain in the left foot may indicate that the
block is not working or is subsiding and is not an
expected finding in the immediate postoperative
period.
14. The nurse is preparing a patient for surgery. Which

goal is a priority for assessing the patient before

surgery?
A Plan for care after the procedure.
B Establish a patient's baseline of normal function.
C Educate the patient and family about the
procedure.
D Gather appropriate equipment for the patient's
needs.
The goal of the preoperative assessment is to identify
a patient's normal preoperative function and the
presence of any risks to recognize, prevent, and
minimize possible postoperative complications.
Gathering appropriate equipment, planning care, and
educating the patient and family are all important
interventions that must be provided for the surgical
patient; they are part of the nursing process but are
not the priority reason/goal for completing an
assessment of the surgical patient.
15. The nurse is completing a medication history for the

surgical patient in preadmission testing. Which

medication should the nurse instruct the patient to
hold (discontinue) in preparation for surgery according
to protocol?
A Warfarin
B Vitamin C
C Prednisone
D Acetaminophen
Medications such as warfarin or aspirin alter normal
clotting factors and thus increase the risk of
hemorrhaging. Discontinue at least 48 hours before
surgery. Acetaminophen is a pain reliever that has no
special implications for surgery. Vitamin C actually
assists in wound healing and has no special
implications for surgery. Prednisone is a
corticosteroid, and dosages are often temporarily
increased rather than held.
16. The nurse is prescreening a surgical patient in the

preadmission testing unit. The medication history

indicates that the patient is currently taking an
 anticoagulant. Which action should the nurse take
when consulting with the health care provider?
A Ask for a radiological examination of the chest.
B Ask for an international normalized ratio (INR).
C Ask for a blood urea nitrogen (BUN).
D Ask for a serum sodium (Na).
INR, PT (prothrombin time), APTT (activated partial
thromboplastin time), and platelet counts reveal the
clotting ability of the blood. Anticoagulants can be
utilized for different conditions, but its action is to
increase the time it takes for the blood to clot. This
action can put the surgical patient at risk for bleeding
tendencies. Typically, if at all possible, this
medication is held several days before a surgical
procedure to decrease this risk. Chest x-ray, BUN,
and Na are diagnostic screening tools for surgery but
are not specific to anticoagulants.
17. The nurse is encouraging the postoperative patient to

utilize diaphragmatic breathing. Which priority goal is

the nurse trying to achieve?
A Manage pain
B Prevent atelectasis
C Reduce healing time
D Decrease thrombus formation
After surgery, patients may have reduced lung
volume and may require greater effort to cough and
deep breathe; inadequate lung expansion can lead to
atelectasis and pneumonia. Purposely utilizing
diaphragmatic breathing can decrease this risk.
During general anesthesia, the lungs are not fully
inflated during surgery and the cough reflex is
suppressed, so mucus collects within airway
passages. Diaphragmatic breathing does not manage
pain; in some cases, if splinting and pain medications
are not given, it can cause pain. Diaphragmatic
breathing does not reduce healing time or decrease
thrombus formation. Better, more effective
interventions are available for these situations.
18. A school-age child is scheduled for a tonsillectomy. In

the preoperative area, the child is crying and shaking.

Which is the best nursing intervention by the nurse to
decrease the child's preoperative anxiety?
Permit the parent to remain with the child until the child
is taken to the operation suite.

A patient taking warfarin and digoxin for treatment of

19.

atrial fibrillation is instructed to discontinue the use

prior to surgery. What should the nurse closely monitor
this patient for?
Pulmonary embolism
20. When completing a preoperative assessment before
surgery, the nurse finds that the patient is taking the
herb ginkgo. What is the most appropriate nursing
action?
Inform the surgeon because the surgery would need to be
rescheduled.
21. The nurse asks the patient scheduled for a total hip

replacement to sign the operative permit as

directed in the health care provider's preoperative
prescriptions. The patient states that the health
care provider has not really explained what is
involved in the surgical procedure. What is the
most appropriate action by the nurse?
Notify the health care provider about the conversation
with the patient and delay the signature.
22. The nurse is assessing a patient who is scheduled for an

appendectomy and orders a serum potassium analysis.

What is the reason for the nurse's action?
The patient is on diuretic therapy.
23. A preoperative patient with suspected bowel

obstruction asks why his or her dose of warfarin is

being withheld. Which response by the nurse is most
accurate?
"This medication could cause excessive bleeding during
surgery if it is not stopped beforehand."
24. A patient with Alzheimer's disease arrives via
ambulance from a long-term care center to the
preoperative area for placement of a feeding tube.
The ambulance service hands the nurse a chart
and states the nursing home did not obtain consent
for the procedure. The patient is confused. What is
the nurse's best course of action?
Contact the family member identified as the patient's
power of attorney on the patient's medical record to
obtain consent.
25. The nurse is transporting a patient to the operating

room. What concern should be the first priority for the

nurse?
Safety of the patient
26. The nurse is doing a preoperative assessment on a

patient who has type 2 diabetes mellitus, weighs 146

kg, and is 5 feet 8 inches tall. Which patient assessment
is a priority related to anesthesia?
Has body mass index of 48.8
27. A patient has provided an informed consent for an

elective tubal ligation under general anesthesia. The

nurse recalls that the patient can revoke the consent
for the surgery at what stage?
When the patient is partially informed

Just before the scheduled surgery time

 After the patient has signed the consent form

When the patient is in the preoperative holding area

28. As the nurse is preparing a patient for outpatient

surgery, the patient wants to give the patient's hearing

aid to the spouse so it will not be lost during surgery.
Which action by the nurse should be taken in this
situation?
Encourage the patient to wear it for the surgery.
29. An alert patient needs a tracheostomy after being

intubated for seven days with an endotracheal tube

and cannot be weaned from the ventilator. The patient
does not want the tracheostomy, but their family
insists that the surgery be performed. What is the best
action for the nurse to take?
Advocate for the patient's rights.
30.
The nurse is preparing a patient who is scheduled
to undergo surgery in the morning. The patient
states they will eat a garlic-saturated dinner since
they won't be able to eat this favourite food for a
while. What should the nurse inform the patient
they may be at risk for?
The patient may experience excessive bleeding
during the surgery.
31.
The patient scheduled for a colectomy asks the
nurse why cefazolin has been prescribed by the
 health care provider. What is the most appropriate
response by the nurse?
"Cefazolin is being given for two days to prevent
postoperative infection."
32.
A patient who is being prepared for surgery tells
the nurse: "I am afraid I may die during surgery
without being able to confess my sins. I don't want
to die without receiving absolution." Which action
by the nurse would best meet this patients needs?
Inform the surgeon of the patient's fears and
contact the appropriate religious leader to talk with
the patient before surgery if possible.
33.
The nurse is preparing a patient for surgery. What
nursing actions are important to carry out prior to
surgery?
Remove jewelry in piercings if electrocautery
devices will be used.

Remove all prosthetics, including dentures, contact

lenses, and glasses.

Ascertain that the patient has an empty bladder

before going to operating room.

Remove cosmetics, nail polish, and artificial nails.

34.
The nurse is preparing several patients for surgical
procedures. What patient should the nurse most
closely monitor for bleeding as a result of
medication being taken?
A man who is taking clopidogrel after the placement
of a coronary artery stent
 35.
A patient is scheduled for knee replacement
surgery. The patient states that 5 years ago their
father died due to sudden cardiac arrest. What is
the most appropriate action by the nurse?
. Review the electrocardiogram of the patient
36.
The nurse is performing a preoperative
assessment for a patient scheduled for surgery.
What does the nurse explain to the patient is the
reason for obtaining accurate documentation of the
current medications being taken?
"Some medications may interact with anesthetics,
altering the potency and effect of the drugs."
37.
The nurse is conducting a preoperative class for a
group of older adults who are scheduled for hip
replacement surgery. During the planning meeting
for this class, which of the nurse's statements
reflects a correct understanding of the older adult
surgical patient?
"I will watch the participants for signs of excessive
anxiety."
38.
A public health nurse is advising a group of
patients to regularly exercise and take multivitamin
tablets. What should the nurse tell them about
multivitamin use if they need a surgical
intervention?
Multivitamin tablets can be taken until the day before
surgery
39.
A patient is scheduled for gastrointestinal surgery.
Upon checking the patient's history, it is found that
the patient is on long-term anticoagulation therapy.
What action should the nurse take?
 Instruct the patient to discontinue the
anticoagulation therapy and expect to administer IV
heparin during the perioperative period.
40.
The nurse is administering a preoperative
medication orally. What nursing action is
appropriate when performing this intervention?
Give the medicine with a small sip of water.
41.
A patient asks the nurse whether it is alright to take
regularly scheduled insulin on the morning of
surgery. What is the most appropriate nursing
action?
Inform the surgeon of the patient's insulin use and
ask whether the dose needs to be adjusted.
42.
A patient with an abdominal mass is scheduled for
surgery today. Before the patient is admitted to the
operating room, which preoperative documentation
must be attached to the chart?
A complete physical examination
43.
Five minutes after the patient receives preoperative
sedative medication by intramuscular (IM) injection,
they ask to get up to go to the bathroom to urinate.
What is the most appropriate action by the nurse?
Offer the patient a urinal and provide privacy.
44.
A patient is scheduled for a gastrectomy. During
the preoperative evaluation, the patient reports
taking ginseng regularly. What should the nurse
do?
Inform the surgeon.
45.
The nurse is preparing to administer a preoperative
dose of cefazolin prior to an open cholecystectomy.
 What is the best explanation to the patient about
why they are receiving this medication?
"It will prevent postoperative surgical-site infection."
46.
An older adult patient has been admitted before
having surgery for a bilateral mastectomy and
breast reconstruction. What should the nurse
include in the patient's preoperative teaching?
Information about where in the hospital she will be
taken postoperatively

Information about performing postoperative deep

breathing and coughing exercises
47.
The nurse is caring for a patient scheduled to
undergo a coronary artery bypass graft (CABG).
The patient reveals fearful feelings about the
projected length of time off work, as the patient is
the source of primary income for the family. What
is the nurse's best course of action
Consult a social worker to identify financial options
for the patient.
48.
The nurse is caring for a patient with valvular heart
disease who is scheduled for surgery. Which
preoperative medication does the nurse anticipate
administering to prevent complications related to
this condition?
Antibiotics
49.
A patient with a body mass index (BMI) of 45 is
admitted for abdominal surgery. The nurse
explains to the patient the potential complications
of abdominal surgery caused by obesity. Which
 statements should the nurse include in the
explanation?
The risk of wound infection is higher

Anesthesia administration is more difficult.

The risk of a postoperative incisional hernia may

be higher.

50.
A patient is about to undergo surgery for the first
time and reports anxiety and taking alprazolam at
bedtime last night. The vital signs show blood
pressure (BP) 158/88, heart rate (HR) 96, and
respiratory rate (RR) 24. What is the priority action
by the nurse?
Notify the anesthesia care provider (ACP).
51.
A patient with obesity (BMI 26.1 kg/m 2) is
scheduled for a laparoscopic hernia repair at an
outpatient surgery setting. What should the nurse
be prepared for prior to the surgery?
Explain to the patient that surgery will use minimally
invasive techniques.

An unconscious patient needs to undergo

52.

emergency surgery. There are no family members

or friends available. What action should the nurse
take regarding obtaining consent for the surgery?
Proceed with plans for surgery; consent is not
required for a true medical emergency.
 53.
A nurse is providing teaching about the risk of
postoperative bleeding to a patient who is
scheduled for surgery in two weeks. What
information should the nurse include?
Stop taking herbal medicines; they may increase
the risk of postoperative bleeding.

An older adult patient is undergoing preoperative

54.

assessment and teaching. What nursing

interventions are appropriate during the education
process?
Coordinate assessment with the team of health care
providers.

Speak slowly when giving preoperative instructions

to the patient.

Understand that the patient may have sensory and

cognitive deficits.
55.
An older adult patient is admitted to the surgical
unit for a right hemicolectomy. The nurse is
concerned regarding the hydration status of this
patient. What reason does the nurse have for this
concern?
There is a narrow margin of safety between
overhydration and underhydration in elderly patients.
56.
A nurse discusses pain medications when
providing preoperative teaching to a patient. The
patient asks the nurse about the effects of opioid
 medications. What should the nurse include in the
explanation?
Opioids relieve pain during preoperative procedures.

Opioids decrease intraoperative anesthetic

requirements.

Opioids decrease intraoperative pain.

A patient is scheduled for an appendectomy.

57.

During the preoperative assessment, the patient

states they developed allergic skin rashes when
exposured to rubber gloves when admitted to the
hospital a few years ago. The nurse should review
the patient's medical record for a history of what?
Reactions to latex

A patient who normally takes an oral antidiabetic

58.

agent twice a day, at morning and at bedtime, asks

the nurse what to do about the dose the morning of
the surgery. What is the best response by the
nurse?
Get instructions from the health care provider for any
special instructions.

59.
The nurse is to administer preoperative
medications for a patient who is scheduled for
surgery at 7:30: cefazolin intravenously (IV) to be
infused 30 minutes before surgery, midazolam IV
before surgery, and a scopolamine patch behind
 the ear. Which medication should the nurse
administer first?
Scopolamine
60.
A patient with diabetes is waiting in the
preoperative holding area for a hernia operation.
The patient asks the nurse if the daily insulin dose
should be taken. Which response is the most
appropriate?
"I will check with the surgeon and let you know."
61.
The nurse is admitting a patient to the same-day
surgery unit and informs the nurse that they took
kava last night to help them sleep. Which nursing
action would be most appropriate?
Inform the anesthesiologist of the patient's recent
use of kava.
62.
The nurse is caring for a patient with renal
dysfunction who is scheduled for surgery. What are
the priority nursing interventions in this situation?
Order renal function test preoperatively.

Report to perioperative team if the patient has a

problem voiding.
63.
The patient who is a devout Catholic is having
surgery the following day for a heart valve
replacement. The patient voices general concern
about the surgery. Which is the best method for the
nurse to use to help decrease the patient's
anxiety?
Provide web-based and audiovisual teaching
materials about the surgery.
 A nurse is preparing a patient for cataract surgery.
64.

The nurse needs to instill different eye drops into

the patient's eyes. How many minutes should the
nurse wait between each set of eye drops?
5 mins
65.
A patient is scheduled for surgery to repair a
deviated nasal septum and is to have nothing by
mouth (NPO) orders since midnight and now
surgery is delayed for several hours. The patient
tells the nurse, "I am very hungry and thirsty, and I
have a headache because I missed my morning
coffee." Which nursing actions are appropriate in
this case?
Keep the patient apprised of the situation.

Tell the anesthesia care provider about the

situation.
66.
The nurse is to administer preoperative antibiotics
to a group of patients. What patients are
determined to require this medication?
Patients undergoing gastrointestinal surgery

Patients undergoing joint replacement surgery

Patients with a history of valvular heart diseases

67.
The nurse is preparing a patient for surgery when
they state, "I am terrified to be put to sleep. What if
 I don't wake up?" What is the priority action by the
nurse?
Inform the anesthesia care provider (ACP) so that he
or she can talk further to the patient.
68.
The nurse is preparing to give a dose of cefazolin
1.5 g intravenous piggyback (IVPB) to a patient
before surgery. The vials available on the unit
contain 500 mg in powder form. The instructions
state to "dilute each 500 mg with 5 mL of sterile
water." After reconstituting the medication, the
nurse should draw up ____ total milliliters of
solution for dosage preparation? Record your
answer using a whole number.
15 ml
69.
Five minutes after receiving a preoperative
sedative medication by intravenous (IV) injection, a
patient asks to get up to go to the bathroom to
urinate. What is the most appropriate action for the
nurse to take?
Allow the patient to use the urinal/bedpan after
explaining the need to maintain safety.
70.
The patient tells the nurse in the preoperative
setting that they have noticed diffuse skin rashes
when hospitalized in the past and have food
allergies to bananas and avocados. What is the
priority action by the nurse?
Ask additional questions to assess for a possible
latex allergy.
A patient gives consent for surgery to the surgeon and a
nurse witnesses the consent. The patient then states they
do not want to have the surgery. The patient has one adult
child but no other immediate family. What action should
the nurse take next?
Inform the surgeon.
71.
A patient is instructed not to have anything to eat
or drink eight hours prior to surgery. When arriving
to the preoperative holding area, the patient
informs the nurse they ate eggs and toast about 2
hours ago. What is the best response by the
nurse?
"I will inform the anesthesia care provider and
surgeon to see what the options are."
72.
When reviewing the preoperative forms, the nurse
notices that the informed consent form is not
signed. What is the best action for the nurse to
take?
Notify the health care provider to obtain consent
for surgery.
73.
A patient due for surgery expresses concern about
choosing between ambulatory surgery and
inpatient regular surgery. Which information should
the nurse include when comparing ambulatory to
inpatient surgery for the patient?
It involves minimal laboratory tests.

It requires fewer preoperative medications.

It reduces the risk of hospital-acquired infections.

 74.
The nurse is taking a detailed history
preoperatively about a patient's medications. What
is the highest priority regarding the patient's
medication history?
Some medications are contraindicated for use
with anesthetics.
75.
While performing preoperative teaching, the patient
asks when to stop drinking water before the
surgery. Based on the most recent practice
guidelines established by the American Society of
Anesthesiologists, what is the best response by the
nurse?
The patient can drink clear liquids up to 2 hours
before surgery.