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Pre-Op, Intra-Op, & Post-Op Study Questions

1. A 65 year old man has been admitted to the hospital for spinal stenosis surgery. When does discharge training and planning begin for this patient? a. Following surgery b. Upon admit c. Within 48 hours of discharge d. Preoperative discussion 2. Prior to the operation, the nurse checks the client receiving warfarin sodium, an anticoagulant, has a prothrombin time of 22 and a partial thromboplastin time of 39. The control values are PT 12.9 and PTT 37. The International Normalized Ratio (INR) is 2.8. Which nursing intervention would be most appropriate? a. Notifying the health care provider b. Preparing to administer protamine sulfate c. Holding the medication and assessing for bleeding d. Administering the medication as ordered 3. Open glove method is preferred to use except a. Changing a glove during an operation b. When donning gloves for procedures requiring gown c. In the emergency department when donning sterile gloves for suturing lacerations d. Intravenous cutdown or administering of spinal anesthesia 4. Following a thyroidectomy, the client experiences hemorrhage. The nurse would prepare for which emergency intervention? a. IV administration of thyroid hormone b. Creation of a tracheostomy c. Insertion of an oral airway d. IV administration of calcium 5. Following a bee sting a client who develops shortness of breath and hives on his face and neck receives an epinephrine injection. Which assessment data would indicate that the epinephrine is effective?

a. Reduced pain at the sting site b. Drowsiness c. Easier breathing d. Increased itching 6. After obtaining 3 liters of fluid from a client via parecentesis, the nurse would be alert for which complication? a. Bleeding from the site b. Vascular collapse c. Respiratory distress d. Encephalopathy 7. Which statement best explains the scientific rationale for performing urinary catheterization on a client following an abdominal hysterectomy if she is unable to void within 8 hours? a. The bladder is removed along with the uterus b. Temporary atony may result from surgical manipulation in the area c. Infection from surgery interferes with the clients ability to void d. Surgically induced menopause impairs the client urinary function 8. Which intervention should the nurse implement first when beginning preoperative teaching? a. Using a standardized preoperative teaching plan for consistency b. Assessing the clients knowledge base related to the surgical procedure c. Describing the possible risks of the surgical procedure d. Having the client read the printed instructional booklet 9. A client is 4 hours postoperative abdomino-peritoneal resection with sigmoid colostomy. He is complaining of rectal pain that ranks 8 on a scale of 0 to 10. Which interventions should the nurse implement? Select all that apply. a. Notifying the health care provider that the stoma is pink b. Assessing the clients blood pressure and pulse c. Medication the client as ordered d. Assisting the client with distraction to help the pain e. Assessing the abdominal incision 10. A nurse at an outpatient clinic is returning phone calls that have been made to the clinic. Which of the following calls should have the highest priority for medical intervention?

a. A home health patient reports, I am starting to have breakdown of my heels. b. A patient that received an upper extremity cast yesterday reports, I cant feel my fingers in my right hand today. c. A young female reports, I think I sprained my ankle about 2 weeks ago. d. A middle-aged patient reports, My knee is still hurting from the TKR. 11. A nurse working the surgical unit notices a patient is experiencing SOB, calf pain, and warmth over the posterior calf. All of these may indicate which of the following medical conditions? a. Patient may have a DVT b. Patient may be exhibiting signs of dementia c. Patient may be in the late phases of CHF d. Patient may be experiencing anxiety after surgery 12. A nurse has just started on the 7 pm surgical unit shift. Which of the following patients should the nurse check on first? a. A 75 year-old female who is scheduled for an EGD in 10 hours b. A 34 year-old male who is complaining of low back pain following back surgery and has an onset of urinary incontinence in the last hour c. A 21 year-old male who had a lower extremity BKA yesterday, following an MVA and has phantom pain d. A 27 year-old female who has received 1.5 units of RBCs via transfusion the previous day 13. An adult who has had general anesthesia for major surgery is in the PACU. One of the signs that may indicate that his artificial airway should be removed is a. Gagging b. Restlessness c. An increase in pain d. Clear lungs on auscultation 14. An adult is 6 days post abdominal surgery. Which sign alerts the nurse to wound evisceration? a. Acute bleeding b. Pink serous drainage c. Purple drainage d. Severe pain

15. A 26 year-old has acute leukemia and is scheduled for a Hickman catheter insertion under local anesthesia. A major advantage of regional anesthesia is that the client a. Retains all reflexes b. Remains conscious c. Has retroactive amnesia d. Is in the OR for a short period of time 16. Which of the following is the most dangerous complication during induction of spinal anesthesia? a. Tachycardia b. Hypotension c. Hyperthermia d. Bradypnea 17. Which type of surgery is most likely to predispose a patient to postop atelectasis, pneumonia, or respiratory failure? a. Upper abdominal surgery on an obese patient with a long history of smoking b. Upper abdominal surgery on a patient with normal pulmonary function c. Lower abdominal surgery on a young patient with diabetes mellitus d. Surgery on the extremities of a nonsmoking football player 18. Which of the following characterizes excitement stage of anesthesia? a. Occurs from the administration of anesthesia to the loss of consciousness b. Extends from the loss of consciousness to the loss of lid reflex, characterized by struggling and talking c. From the loss of lid reflex to the loss of most reflexes d. From the loss of most reflexes to respiratory and circulatory failure 19. To prevent a headache after spinal anesthesia, the patient should be positioned a. Semi-Fowlers b. Flat on the bed for 6 to 8 hours c. Prone position d. Modified trendelenburg 20. Which of the following nursing actions should be given the highest priority when admitting the patient into the operating room? a. Level of consciousness

b. Vital signs c. Patient identification and correct operative consent d. Positioning and skin preparation 21. Which of the following postop findings should the nurse report to the MD? a. The patient pushes out the oral airway with his tongue b. Urine output is 20 ml/hr for the past 2 hours c. Vital signs: B/P 110/70, P-95, R-19, T-36.8C d. Wound drainage is serosanguinous 22. If wound eviscerations occur, the immediate nursing action is a. Cover the wound with sterile gauze moistened with sterile NSS b. Cover the wound with sterile dry gauze c. Cover the wound with water-soaked gauze d. Leave the wound uncovered and pull the skin edges together 23. An appendectomy is classified as a. Ablative b. Constructive c. Reconstructive d. Palliative 24. The following are the appropriate nursing actions before administration of preoperative medications except a. Ascertain the consent has been signed b. Ensure that NPO has been maintained c. Instruct patient to empty his bladder d. Shave the skin at the site of surgery 25. Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery? a. To prevent malnutrition b. To prevent electrolyte imbalance c. To prevent aspiration pneumonia d. To prevent intestinal obstruction 26. The following ensure validity of informed written consent except a. The patient is of legal age with proper mental disposition b. The consent has been secured within 24 hours before surgery c. If the patient is unable to write secure the consent from a relative

d. The consent is secured before the administration of any medication that alter the level of consciousness 27. Which of the following drugs is administered to minimize respiratory secretions preop? a. Valium (Diazepam) b. Nubain (Nalbuphine HCl) c. Phenergan (Promethazine) d. Atropine Sulfate 28. Which of the following primarily prevents postop complications? a. Adequate fluid intake b. Early ambulation c. Well-balanced diet d. Administration of antimicrobials 29. The most important factor in the prevention of postop infection is a. Proper administration of antibiotics b. Fluid intake of 2-3 L/day c. Practice of strict aseptic techniques d. Frequent change of wound dressings 30. Postoperatively, a patient is expected to void after a. 6-8 hours b. 2-4 hours c. 12-24 hours d. 10-12 hours 31. Nursing measure for postop thrombophlebitis include the following except a. Maintain bedrest b. Elevate the affected leg with pillow support c. Massage the painful extremities d. Apply antiembolic stockings 32. Prior to having a subtotal gastrectomy, a client is told about the dumping syndrome. The nurse explains that it is a. The bodys absorption of toxins produced by liquefaction of dead tissue b. Formation of an ulcer at the margin of the gastrojejunal anastomosis c. Obstruction of venous flow from the stomach into the portal system d. Rapid emptying of food and fluid from the stomach into the jejunum

33. A 40 year old female client has arrived in the post anesthesia room following a cholecystectomy and a common bile duct exploration. She is semi-conscious. Her vital signs are within normal limits. Which of the following nursing actions would be inappropriate? a. Apply a warm blanket to her body b. Place her in a semi-fowlers position c. Attach her T-tube to gravity drainage d. Set up low, intermittent suctioning for her NGT 34. A client in shock must be placed in a. High-fowlers position b. Sims position c. Modified trendelenburg d. Prone position