ATI Perioperative

Question 1

Pt recovering from spinal anesthesia, sensations return in what order?

Answer 1

touch first
pain second
warmth third
cold fourth

Question 2

Preop med history. Med that interacts with anesthetics?

Answer 2

Captopril (Capoten)- antihypertensives can cause hypotensive crisis when given with anesthetics.

Question 3

Most critical pt?

Answer 3

pt post thoracotomy with 150 mL bright red blood in collection chamber in the past hour- could indicate hemorrhage.

Question 4

Postop pt has calf that is red, swollen, warm what to do?

Answer 4

DVT. elevate extremity- promote venous return

Question 5

Tongue swollen, obstructing airway-

Answer 5

insert nasal airway

Question 6

Conscious Sedation-

Answer 6

expect to feel sleepy several hours after procedure. avoid activities requiring concentration.
Meds used for moderate sedation are given IV which results in quick onset/recovery.
NPO 6-8 hours before bronchoscopy.

Question 7

Pt vomiting past 24h, small bowel obstruction, pain 8/10, hard distended abdomen, absent bowel sounds. tell dr then?

Answer 7

insert NG tube- greatest risk to pt is F&E imbalance due to accumulated fluid and gas in GI tract. put down NG tube to begin decompression of the bowel.

Other actions, not priority- draw blood for electrolytes, administer pain meds, initiate intake and output.

Question 8

Qualifications for DC from PACU:

Answer 8

move all 4 extremities on command.
BP cant drop 25% or greater.
Maintain o2 sat of at least 92% on RA

Question 9

Surgical Asepsis

Answer 9

Finger and wrist jewelry must be removed.
You should open dressing packages before applying sterile gloves because the outside wrapping of dressing packages is non sterile.
Hold hands above the waist.
Gown the surgeon first, then assist with the surgeons gloves.

Question 10

Penrose Drain

Answer 10

change dressing with sterile technique.
Drain sponge should be used. Gauze pad should never be cut and used around drain due to risk of dressing fibers being embedded in the wound.
Never clamp.
Open system, drains by gravity.

Question 11

Surgery rooms are maintained at a cool temp with low humididy b/c it reduces

Answer 11

risk of fire secondary to volatile anesthetic agents used.

Question 12

Reaction to anesthetic

Answer 12

malignant hyperthermia

Question 13

PCA pump

Answer 13

Dont let family push button when sleeping to prevent excessive dosing.
It is still possible to overdose b/c tolerance levels of opioids vary.
Pin pca button to pts gown for easy access to prevent it from falling out of reach.
Dont wait until pain is severe.

Question 14

Post Mastectomy

Answer 14

Start hand exercises (squeezing ball) the first day after surgery.
Wait 3-4 weeks to do water aerobics.
Avoid having blood drawn & BP from arm.
You can shower after the drain is removed.

Question 15

Prevent thrombi formation-

Answer 15

dorsal/plantar flexion of the feet q hr- help prevent venous stasis in the lower legs and decrease likelihood of thrombophlebitis.
Change position q2.
Dont put pillow under calves- pressure on popliteal is bad.

Question 16

Pt nervous about gastrectomy

Answer 16

provide concise factual information- allows for open communication

Question 17

Jackson Pratt drain

Answer 17

Empty and compress the drain reservoir as needed.Compressing the reservoir produces the suction necessary for the drain to fx properly.
Dont clamp drain- continuous drainage is required.
Secure the drain to the pts gown or clothes to prevent dislodgement.
Drain should be kept lower than the incision to facilitate drainage.

Question 18

Pt is recieving succinylcholine (Anectine) during surgery, what should nurse do if pt develops malignant hyperthermia?

Answer 18

administer dantrolene (Dantrium)p IV 2-3 mg/kg to reverse malignant hyperthermia.

Question 19

Status post total hip, risk factor for infection?

Answer 19

long term use corticosteroids- inhibit leukocyte response, increasing risk of infection.

Question 20

Med to DC 48 hours before surgery

Answer 20

warfarin (Coumadin)- increases bleeding risk

furosemide, digoxin, and prednisone dont need to be DC before sx

Question 21

Pt recieving moderate sedation with versed and fentanyl. RR goes from 16 to 6, o2sat goes from 92 to 85. what to do?

Answer 21

administer reversal agents- this will increase the respiratory rate. greatest risk is respiratory arrest.

(May be necessary but Not priority- assist with intubation, obtain equipment necessary for CPR, obtain stat ABGs)

Question 22

Pt has NG tube set to continuous low suction after gastrectomy. what should nurse report to PCP?

Answer 22

gastric distention- sign that ngt may not be patent. Report to dr to prevent complications at the anastomosis.

(absent bowel sounds are normal after abdominal surgery, incisional pain is normal- treat with prescribed analgesics, small amount of bloody drainage in NG tube is common)

Question 23

During surgery help prevent neuromuscular complications by…

Answer 23

Support bony prominences with foam padding to help prevent pressure on nerves and blood vessels and reduce the potential for neuromuscular complications.
Joints should be slightly flexed.

Question 24

Post abdominal surgery DC teaching?

Answer 24

Encourage ambulation and activity- dont encourage bed rest.
Return to work in 6 weeks.
Eat foods high in protein and vitamin C during recovery- essential for healing.
Call dr if increased temp or wound drainage- may indicate infection.

Question 25

Post total knee arthroplasty, in pacu, had spinal anesthesia. notify pcp if?

Answer 25

Reports of chest pain and SOB- risk for pulmonary embolism.

(recovery score of 8 indicates recovery is in progress, spinal anesthesia will prob still be in effect in pacu, elevated hr and bP are signs of acute pain- needs medication dont need to call dr)

Question 26

Open transverse colectomy 5 days ago. wound eviscerated. nurse covers with sterile saline soaked dressing. what to do now?

Answer 26

Obtain vital signs to assess for shock.
Place pt in supine position with hips and knees bent.
Dont try to reinsert organs.
Dont leave pt alone. press call light to seek assistance.

Question 27

Pt is apprehensive and asks many questions about risks of procedure. what to do before witnessing consent?

Answer 27

ask surgeon to speak to pt for clarification. nurse cannot explain risk and benefits- surgeon has to.
Dont reassure. Dont document lack of preop teaching.

Question 28

Unexpected finding postop-

Answer 28

urine output 20 mL/hr. should be 30.