Intraoperative Care

1. What is the physical environment of a surgery suite primarily designed

to promote?
a. Electrical safety
b. Medical and surgical asepsis
c. Comfort and privacy of the patient
d. Communication among the surgical team
2. When transporting an inpatient to the surgical department, a nurse from
another area of the hospital is able to access which area?
a. Sterile core
b. Holding area
c. Corridors of surgical suite
d. Unprepared operating room
3. Which nursing actions are completed by the scrub nurse (select all that
apply)?
a. Prepares instrument table
b. Documents intraoperative care
c. Remains in the sterile area of the operating room (OR)
d. Checks mechanical and electrical equipment
e. Passes instruments to surgeon and assistants
f. Monitors blood and other fluid loss and urine output
4. What is the primary goal of the circulating nurse during preparation of
the OR, transferring and positioning the patient, and assisting the
anesthesia team?
a. Avoiding any type of injury to the patient
b. Maintaining a clean environment for the patient
c. Providing for patient comfort and sense of well-being
d. Preventing breaks in aseptic technique by the sterile members of the
team
5. Goals for patient safety in the OR include the Universal Protocol. What
is included in this protocol?
All surgical centers of any type must submit reports on patient
safety infractions to the accreditation agencies.
b. Members of the surgical team stop whatever they are doing to
check that all sterile items have been prepared properly.
c. Members of the surgical team pause right before surgery to
meditate for 1 minute to decrease stress and possible errors.
d. A surgical timeout is performed just before the procedure is started
to verify patient identity, surgical procedure, and surgical site.
6. A break in sterile technique occurs during surgery when the scrub nurse
touches
a. the mask with sterile gloved hands.
b. sterile gloved hands to the gown at chest level.
c. the drape at the incision site with sterile gloved hands.
d. the lower arm to the instruments on the instrument tray.
7. During surgery, a patient is at risk for perioperative positioning injury.
What is a common risk factor for this problem?
a. Skin lesions
b. Break in sterile technique
c. Musculoskeletal deformities
d. Electrical or mechanical equipment failure
8. Which short-acting barbiturate is most often used for induction of
general anesthesia?
a. Nitrous oxide
b. Propofol (Diprivan)
c. Isoflurane (Forane)
d. Methohexital (Brevital)
9. Because of the rapid elimination of volatile liquids used for general
anesthesia, what should the nurse anticipate the patient will need early in
the anesthesia recovery period?
a. Warm blankets
b. Analgesic medication
c. Observation for respiratory depression
d. Airway protection in anticipation of vomiting
10. What is the primary advantage of the use of midazolam as an adjunct
to general anesthesia?
a. Amnestic effect
b. Analgesic effect
c. Prolonged action
d. Antiemetic effect
15. What condition should the nurse anticipate that may occur during
epidural and spinal anesthesia?
a. Spinal headache
b. Hypotension and bradycardia
c. Loss of consciousness and seizures
d. Downward extension of nerve block
16. A patient scheduled for a procedure is expected to receive ketamine
(Ketalar). What would be included in patient teaching regarding
ketamine?
a. Hallucinations may occur, so the patient will receive midazolam.
b. An indwelling catheter may be needed if urinary retention occurs.
c. Antiemetics will be given beforehand to reduce nausea and
vomiting.
d. Using ketamine will allow the patient to be fully awake during the
procedure.
17. A preoperative patient reveals that an uncle died during surgery
because of a fever and cardiac arrest. Knowing the patient is at risk for
malignant hyperthermia, the perioperative nurse alerts the surgical team.
What is likely to happen next?
a. The surgery will have to be canceled.
b. Specific precautions can be taken to safely anesthetize the patient.
c. Dantrolene (Dantrium) must be given to prevent hyperthermia
during surgery.
d. The patient should be placed on a cooling blanket during the
surgical procedure.
18. It is most important to monitor the patient for malignant hyperthermia
if the patient received which anesthetic agent?
a. ketamine
b. pancuronium
c. succinylcholine
d. dexmedetomidine

Postoperative Care
1. What does progression of patients through various phases of care in a postanesthesia
care unit (PACU) primarily depend on?
a. Condition of patient
b. Type of anesthesia used
c. Preference of surgeon
d. Type of surgical procedure
2. Priority Decision: Upon admission of a patient to the PACU, the nurse’s priority
assessment is
a. vital signs.
b. surgical site.
c. respiratory adequacy.
d. level of consciousness.
3. How is the initial information given to the PACU nurses about the surgical patient?
a. A copy of the written operative report
b. A verbal report from the circulating nurse
c. A verbal report from the anesthesia care provider (ACP)
d. An explanation of the surgical procedure from the surgeon
4. To prevent agitation during the patient’s recovery from anesthesia, when should the
nurse begin orientation explanations?
a. When the patient is awake
b. When the patient first arrives in the PACU
c. When the patient becomes agitated or frightened
d. When the patient can be aroused and recognizes where he or she is
5. What is included in the routine assessment of the patient’s cardiovascular function on
admission to the PACU?
a. Monitoring arterial blood gases
b. Electrocardiographic (ECG) monitoring
c. Determining fluid and electrolyte status
d. Direct arterial blood pressure monitoring
6. With what are the postoperative respiratory complications of atelectasis and aspiration
of gastric contents associated?
a. Hypoxemia
b. Hypercapnia
c. Hypoventilation
d. Airway obstruction
7. To prevent airway obstruction in the postoperative patient who is unconscious or
semiconscious, what will the nurse do?
a. Encourage deep breathing.
b. Elevate the head of the bed.
c. Administer oxygen per mask.
d. Position the patient in a side-lying position.
8. Priority Decision: To promote effective coughing, deep breathing, and ambulation in
the postoperative patient, what is most important for the nurse to do?
a. Teach the patient controlled breathing.
b. Explain the rationale for these activities.
c. Provide adequate and regular pain medication.
d. Use an incentive spirometer to motivate the patient.
9. While assessing a patient in the PACU, the nurse finds that the patient’s blood
pressure (BP) is below the preoperative baseline. The nurse determines that the patient
has residual vasodilating effects of anesthesia when what is assessed?
a. A urinary output > 30 mL/hr
b. An oxygen saturation of 88%
c. A normal pulse with warm, dry, pink skin
d. A narrowing pulse pressure with normal pulse
10. Priority Decision: A patient in the PACU has emergence delirium manifested by
agitation and thrashing. What should the nurse assess the patient for first?
a. Hypoxemia
b. Neurologic injury
c. Distended bladder
d. Cardiac dysrhythmias
11. The PACU nurse applies warm blankets to a postoperative patient who is shivering
and has a body temperature of 96.0° F (35.6° C). What treatment may also be used to
treat the patient?
a. Oxygen therapy
b. Vasodilating drugs
c. Antidysrhythmic drugs
d. Analgesics or sedatives
12. Which patient is ready for discharge from Phase I PACU care to the clinical unit?
a. Arouses easily, pulse is 112 bpm, respiratory rate is 24 breaths/min,
dressing is saturated, arterial oxygen saturation by pulse oximetry (SpO2)
is 88%
b. Awake, vital signs stable, dressing is dry and intact, no respiratory
depression, SpO2 is 92%
c. Difficult to arouse, pulse is 52 bpm, respiratory respiratory rate is 22 breaths/min,
dressing is dry and intact, SpO2 is 91%
d. Arouses, BP higher than preoperative and respiratory rate is 10
breaths/min, no excess bleeding, SpO2 is 92%
13. For which nursing diagnoses or collaborative problems common in postoperative
patients has ambulation been found to be an appropriate intervention (select all that
apply)?
a. Surgical wound; Etiology: incision
b. Risk for aspiration; Etiology: decreased level of consciousness
c. Impaired physical mobility; Etiology: decreased muscle strength
d. Impaired airway clearance; Etiology: decreased respiratory excursion
e. Constipation; Etiology: decreased physical activity and impaired
gastrointestinal (GI) motility
f. Risk for ineffective tissue perfusion; Etiology: venous thromboembolism;
Supporting data: dehydration, immobility, vascular manipulation, or injury
14. A patient who had major surgery is experiencing emotional stress as well as
physiologic stress from the effects of surgery. What can this stress cause?
a. Diuresis
b. Hyperkalemia
c. Fluid retention
d. Impaired blood coagulation
15. In addition to ambulation, which nursing intervention could be implemented to
prevent or treat the postoperative complication of syncope?
a. Monitor vital signs after ambulation.
b. Do not allow the patient to eat before ambulation.
c. Slowly progress to ambulation with slow changes in position.
d. Have the patient deep breathe and cough before getting out of bed.
16. Which tubes drain gastric contents (select all that apply)?
a. T-tube
b. Penrose
c. Nasogastric tube
d. Indwelling catheter
e. GI tube
17. Which drainage is drained with a Hemovac?
a. Bile
b. Urine
c. Gastric contents
d. Wound drainage
18. Priority Decision: The nurse notes drainage on the surgical dressing when the patient
is transferred from the PACU to the clinical unit. In what order of priority should the
nurse perform the following actions? Number the options with 1 for the first action
and 5 for the last action.
a. Reinforce the surgical dressing.
b. Change the dressing and assess the wound as ordered.
c. Notify the surgeon of excessive drainage type and amount.
d. Recall the report from PACU for the number and type of drains in use.
e. Note and record the type, amount, and color and odor of the drainage.
19. Thirty-six hours postoperatively, a patient has a temperature of 100° F (37.8° C). What
is the most likely cause of this temperature elevation?
a. Dehydration
b. Wound infection
c. Lung congestion and atelectasis
d. Normal surgical stress response
20. The health care provider has ordered IV morphine q2-4hr as needed for a patient
following major abdominal surgery. When should the nurse plan to administer the
morphine?
a. Before all planned painful activities
b. Every 2 to 4 hours during the first 48 hours
c. Every 4 hours as the patient requests the medication
d. After assessing the nature and intensity of the patient’s pain
21. What should be included in the instructions given to the postoperative patient before
discharge?
a. Need for follow-up care with home care nurses
b. Directions for maintaining routine postoperative diet
c. Written information about self-care during recuperation
d. Need to restrict all activity until surgical healing is complete
ANSWER KEY INTRA OP
1. b.
2. b.
3. a, c, e.
4. a.
5. d.
6. a.
7. c.
8. d.
9. b.
10. a.
12. d.
13. a. 3; b. 5; c. 1; d. 4; e. 2
14. d.
15. b.
16. a.
17. b.
18. c.