Exam #1

Question 1

Behavioral Response to Pain (acute)

Answer 1

Grimacing, moaning, flinching, guarding​

Question 2

Physiologic Response to Pain (Chronic)

Answer 2

Depression, fatigue, decreased functioning, disability​

Question 3

Physiologic Response to Pain (Acute)

Answer 3

Tachycardia, Hypertension, diaphoresis, anxiety, and muscle tension

Question 4

Most reliable report of pain

Answer 4

The Clients report

Question 5

OPQRST-AAA​

Answer 5

-Onset- When did it start?
-Provocation- What makes it worse?
-Quality- Sharp, stabbing, dull, burning, crushing, and tearing
-Region/Radiation- Where is it/where does it go?
-Severity- pain scale and comparison
-Time/Duration- How long, happened before, change since it started?
-Aggravating/ Alleviating/ Associated- Anything makes it better or worse? taken or done anything for the pain? Any other symptoms?

Question 6

Most common pain tool

Answer 6

The pain scale

Question 7

Nonpharmacological pain management

Answer 7

• Positioning
  -Heat/cold
• ROM/exercise
  -Massage
  -Relaxation (meditation/yoga)
  -Imagery
• Distraction
  -TENS unit
  -RICE

Question 8

Pain presentation in older adults

Answer 8

• Scale ratings can be inaccurate
  -Some adults may be reluctant to report
  -Pain may manifest as behavioral changes

Question 9

Risk factors (operative)

Answer 9

• Obstructive sleep apnea: airway obstruction, oxygen desaturation​
• Pregnancy: fetal risk with anesthesia​
• Resp disease: COPD, pneumonia, asthma​
• CVD: heart failure, MI, HTN, dysrhythmias​
• DM: altered blood glucose, delayed healing, infection​
• Liver disease: altered med metabolism, increased risk for bleeding​
• Kidney disease: altered elimination and medication excretion​
• Immune system disorder: immunocompromised​
• Coag defect: increased risk of bleeding​
• Malnutrition: delayed healing​
• Obesity: pulmonary complications​

Question 10

Preoperative Nurse education

Answer 10

• Post op instructions (Splints, drains, dietary restrictions, medications to take, Medications not to take)

Question 11

What is included in an informed consent

Answer 11

• Name of surgeon completing surgery
• Benefits, alternatives, risks
• Consent for anesthesia and blood products

Question 12

Who is responsible to obtain informed consent

Answer 12

Only the provider

Question 13

The role of the nurse in informed consent

Answer 13

• Nurse can clarify but cannot provide new information (Nurse can correct common misconceptions)
• Nurse Signs as a witness after client acknowledges understanding
  -Nurse determines if client is capable (18 years of age capable, mentally capable of understanding risk/benefits/alternatives/procedure, free from influence of medications that affect decision making)

Question 14

Preoperative time out

Answer 14

• Correct patient
  -Correct procedure
  -Correct surgical site

Question 15

Preoperative Assessment

Answer 15

-Medical surgical history
-Anesthesia tolerance
-med uses includes complementary and alternative
- Allergies (medications, latex, contrast agents, and food)
-Baseline data: Full set of vitals and head to toe assessment
-Venous thromboembolism risk

Question 16

Weird allergies

Answer 16

• Banna/Kiwi allergy- Risk for reaction to latex
  -Eggs/soybean oil- propofol is contraindicated
• Shellfish allergy- Reaction to povidone-iodine

Question 17

Intraoperative time out

Answer 17

• Correct patient
• Correct procedure
• Correct surgeon
• Correct position
• Correct equipment
• Correct imaging studies

Question 18

Intraoperative nurse actions

Answer 18

-perform equipment safety check
-utilize sterile technique
- Assist anesthesia provider during intubation
-Properly ground the patient as indicated
-Keep patient safety belt in place
-Apply support hose and sequential compression devices ​
-Keep patient warm
-accurately record number of sponges and sharps
- Accurately measure irrigation fluid
-Keep OR doors closed

Question 19

priority assessments (postoperative)- Airway/Breathing

Answer 19

-Artificial airway left in place until patient can maintain their own airway
-Auscultate/monitor breath sounds (snoring/stridor = poor air exchange)
- Oxygen saturation (compare preop >95)
-Suction secretions PRN
-Cough/ deep breathe/ incentive spirometer ASAP

Question 20

Priority assessments (Postoperative)- circulation

Answer 20

• Observe for bleeding/hypovolemia
  -Apply support hose and sequential compression devices ​
  -Peripheral pulses – impaired circulation, DVT​