chapter 42

Question 1

The patient who had a nephrectomy yesterday has not used the patient-controlled analgesia
(PCA) delivery system but admits to being in pain but fearful of addiction. Which is the
nurse’s response?
a. “Modern analgesic drugs do not cause addiction.”
b. “Pain relief is worth a short period of addiction.”
c. “Addiction rarely occurs in the brief time postsurgical analgesia is required.”
d. “Addiction could be a real concern.”

Answer 1

c. “Addiction rarely occurs in the brief time postsurgical analgesia is required.”

Question 2

A 73-year-old patient with diabetes was admitted for below the knee amputation of his right
leg. Removal of his right leg is an example of which type of surgery?
a. Palliative
b. Diagnostic
c. Reconstructive
d. Ablative

Answer 2

c. Reconstructive

Question 3

A patient is in need of appendix removal surgery. In which situation might surgery be
delayed?
a. The patient has taken antiseizure medication today.
b. An illegible signature is on the consent form.
c. The patient is still taking anticoagulants.
d. The admission office is unable to confirm insurance coverage.

Answer 3

c. The patient is still taking anticoagulants.

Question 4

Which circumstance could prevent the patient from signing an informed consent form for a cholecystectomy?
a. The patient complains of pain radiating to the scapula.
b. The patient received an injection of antianxiety medication 1 hour ago.
c. The patient is 85 years of age.
d. The patient is concerned over his lack of insurance coverage.

Answer 4

b. The patient received an injection of antianxiety medication 1 hour ago.

Question 5

The nurse anticipates that the patient will be given which type of anesthesia because of the
extensive tissue manipulation involved in a hysterectomy?
a. general
b. regional
c. specific
d. preoperative

Answer 5

a. general

Question 6

The nurse caring for a patient who had spinal anesthesia for a vaginal repair should be alert
for which sign of a serious complication?
a. a flushing of the face and torso.
b. numbness of the perineum.
c. complaint of thirst.
d. a sudden drop in blood pressure.

Answer 6

d. a sudden drop in blood pressure.

Question 7

Why might the older adult patient not respond to surgical treatment as well as a younger
adult patient?
a. Poor skin turgor
b. Fear of the unknown
c. Response to physiologic changes
d. Decreased peristalsis related to anesthesia

Answer 7

c. Response to physiologic changes

Question 8

Which postoperative nursing intervention is contraindicated for a 45-year-old patient who has had a repair of a cerebral aneurysm?
a. coughing every 2 hours.
b. turning every 2 hours.
c. monitoring intravenous therapy at 50 mL/hr.
d. assessing vital signs every 2 hours.

Answer 8

a. coughing every 2 hours.

Question 9

The nurse acting as a circulating nurse has a responsibility for which activity?
a. Observing for breaks in sterile technique.
b. Performing surgical hand scrub
c. assisting with surgical draping of the patient.
d. maintaining count of sponges, needles, and instruments during surgery.

Answer 9

a. Observing for breaks in sterile technique.

Question 10

Which statement made by a patient during a preoperative assessment would be significant to
report to the charge nurse and surgeon?
a. “I have been taking an herbal product of feverfew for my migraines.”
b. “I exercise for 3 hours a day.”
c. “I drink 2 cups of coffee a day.”
d. “I use eye drops for redness every day.”

Answer 10

a. “I have been taking an herbal product of feverfew for my migraines.”

Question 11

A patient is on postoperative day 2 after a nephrectomy. Which intervention is an effective
way to increase peristalsis?
a. Ambulation
b. An enema
c. Encouraging hot liquids
d. Administering a laxative

Answer 11

a. Ambulation

Question 12

A patient is transferred from the operating room to the recovery room after undergoing an
open reduction and internal fixation (ORIF) of his left ankle. Which is the first assessment
to make?
a. Check ankle dressings for hemorrhage.
b. Check airway for patency.
c. Check intravenous site.
d. Check pedal pulse.

Answer 12

b. Check airway for patency.

Question 13

Frequent assessment of a postoperative patient is essential. Which are the first signs and
symptoms of hemorrhage?
a. Increasing blood pressure
b. Decreasing pulse
c. Restlessness
d. Weakness, apathy

Answer 13

c. Restlessness

Question 14

The nurse instructing a postsurgical patient in the use of thrombolytic deterrentstockings
will include which instruction?
a. Disregard appearance of edema above the stocking.
b. Massage legs to smooth wrinkles out of stockings.
c. Wring stockings thoroughly before hanging to dry.
d. Hand wash stockings in warm water and mild soap.

Answer 14

d. Hand wash stockings in warm water and mild soap.

Question 15

The patient is brought into PACU still unconscious. Which action will the nurse take FIRST when the nurse assesses a temperature of 94°F?
a. Notify the charge nurse immediately.
b. Offer warm fluids through a straw.
c. Do nothing, this is a normal reaction to anesthesia.
d. Cover with a warm blanket.

Answer 15

d. Cover with a warm blanket.

Question 16

In which location are guidelines for ensuring that all nursing interventions on the day of surgery completed and documented?
a. In the nurse’s notes
b. In the anesthesia record
c. In the preoperative checklist
d. In the progress notes

Answer 16

c. In the preoperative checklist

Question 17

While turning a patient who had a bowel resection yesterday, the wound eviscerated. Which
is the initial nursing intervention?
a. Place the patient in the high Fowler’s position.
b. Give the patient fluids to prevent shock.
c. Replace the dressing with sterile fluffy pads.
d. Apply a warm, moist normal saline sterile dressing.

Answer 17

d. Apply a warm, moist normal saline sterile dressing.

Question 18

When will the nurse offer prescribed analgesics to a patient who is 24 hours postoperative?
a. Only when the patient asks.
b. When the onset of pain is assessed.
c. Sparingly to avoid drug dependence.
d. Only when severe pain is assessed.

Answer 18

b. When the onset of pain is assessed.

Question 19

Which action will the nurse take to minimize the potential for venous stasis?
a. Place pillows under the knee in a position of comfort.
b. Assist patient to sit with feet flat on the floor.
c. Assist with early ambulation.
d. Perform gentle leg massage.

Answer 19

c. Assist with early ambulation.

Question 20

The nurse clarifies that serum potassium levels are determined before surgery for which
reason?
a. Assessing kidney function.
b. Determining respiratory insufficiency.
c. Preventing arrhythmias related to anesthesia.
d. Measuring functional liver capability.

Answer 20

c. Preventing arrhythmias related to anesthesia.

Question 21

In performing the preoperative assessment, the nurse discovers that the patient is allergic to
latex. What should the nurse do initially?
a. Notify the diet kitchen to omit bananas from diet tray.
b. Apply a medical alert band to patient’s wrist.
c. Tag chart with allergy alert.
d. Place patient in an isolation room.

Answer 21

d. Place patient in an isolation room.

Question 22

Which early postoperative observation should be reported immediately?
a. “Coffee ground” emesis
b. Shivering
c. Scanty urine output
d. Evidence of pain

Answer 22

a. “Coffee ground” emesis

Question 23

When the postoperative patient complains of sudden chest pain combined with dyspnea,
cyanosis, and tachycardia, the nurse recognizes the signs of which complication?
a. hypovolemic shock.
b. dehiscence.
c. atelectasis.
d. pulmonary embolus.

Answer 23

d. pulmonary embolus.

Question 24

The removal of a nondiseased appendix during a hysterectomy is classified in which way?
a. major, emergency, diagnostic.
b. major, urgent, palliative.
c. minor, elective, ablative.
d. minor, urgent, reconstructive.

Answer 24

c. minor, elective, ablative.

Question 25

Which medication would cause surgery to be delayed if it had not been discontinued several
days before surgery?
a. Analgesic agent
b. Antihypertensive agent
c. Anticoagulant agent
d. Antibiotic agent

Answer 25

c. Anticoagulant agent

Question 26

Which intervention by the nurse will decrease the pain of an abdominal incision while
coughing?
a. support the surgical site with a pillow.
b. position patient in a side-lying position.
c. medicate with prescribed narcotic three hours before coughing.
d. ask the patient to cross arms over the chest to increase force of cough.

Answer 26

a. support the surgical site with a pillow.

Question 27

Which patient statement indicates the patient needs further education regarding tomorrow’s
scheduled bowel resection surgery?
a. “I am going to have adequate pain medication after surgery.”
b. “I know you all are going to make me cough and walk soon aftersurgery.”
c. “I am glad I will get to go home tomorrow evening.”
d. “I will have to put up with dressing changes.”

Answer 27

c. “I am glad I will get to go home tomorrow evening.”

Question 28

Which instruction will the nurse give when teaching the patient to cough effectively after
surgery?
a. Breathe through the nose, hold breath, and exhale slowly.
b. Take three deep breaths and cough from the chest.
c. Inhale while contracting the abdominal muscles and exhale while contracting the
diaphragm.
d. Take short, frequent panting breaths and cough from the throat to clear
accumulated mucus.

Answer 28

b. Take three deep breaths and cough from the chest.

Question 29

Which is the responsibility of the nurse as a witness to informed consent?
a. Explain the surgical options.
b. Explain the operative risks.
c. Verify/obtain the patient’s signature.
d. Verify the patient’s understanding of the procedure.

Answer 29

c. Verify/obtain the patient’s signature.

Question 30

On the patient’s return to the medical-surgical unit, the nurse performing an abdominal
assessment can affirm an absence of bowel sounds after listening in each quadrant for which
length of time?
a. 30 seconds.
b. 1 minute.
c. 2 minutes.
d. 3 minutes.

Answer 30

d. 3 minutes.

Question 31

When the patient asks the nurse ”please make sure no one sees me with my dentures out”,
the nurse recognizes which common preoperative fear?
a. anesthesia.
b. loss of control.
c. fear of separation from family.
d. mutilation.

Answer 31

b. loss of control.

Question 32

Which is the ideal time for preoperative teaching?
a. Immediately before surgery to eliminate fear
b. 2 months in advance so the patient can prepare
c. 1 to 2 days before the surgery when anxiety is not as high
d. In the surgical holding area

Answer 32

c. 1 to 2 days before the surgery when anxiety is not as high

Question 33

In preparation for the return of the patient following surgery, the patient’s bed and
equipment should be in which position?
a. Lowest position with side rails elevated with oxygen and suction equipment
available
b. Highest position with side rails elevated with IV pole and pump at bedside
c. Lowest position with side rails down on the receiving side
d. Highest position with the side rails down on receiving side and up on opposite side

Answer 33

d. Highest position with the side rails down on receiving side and up on opposite side

Question 34

A patient is transferred from the operating room to the recovery room after undergoing an
amputation of his left foot. Which intervention is the last step for immediate assessment
once the patient enters the PACU?
a. System review
b. Breathing
c. Circulation
d. Airway
e. Level of consciousness

Answer 34

a. System review

Question 35

Which is the first step a patient should take to control coughing?
a. Inhale deeply and hold breath for a count of three.
b. Document exercise and patient reaction.
c. Cough two or three times without inhaling then relax.
d. Take several deep breaths, inhaling through the nose.

Answer 35

d. Take several deep breaths, inhaling through the nose.