Perioperative

Question 1

After surgery your patient starts to shiver uncontrollably. What nursing intervention would you do FIRST?
A. Apply warm blankets & continue oxygen as prescribed
B. Take the patient’s rectal temperature
C. Page the doctor for further orders
D. Adjust the thermostat in the room

Answer 1

The answer is A. Shivering is an early sign that the patient is starting to experience hypothermia. Immediately, the nurse would need to control the shivering by applying warm blankets and continue oxygen. When the patient starts to experience hypothermia, vital organs are not receiving as much oxygenated blood due to the vasoconstriction. Therefore, oxygen would need to be continued. Then the nurse would take the patient’s temperature.

Question 2

A nurse is developing a care plan for a patient who is at risk for developing pneumonia after surgery. Which of the following is not an appropriate nursing intervention?
A. Encourage patient intake of 3000 ml/day of fluids if not contraindicated
B. Encourage patient to use the incentive spirometer device 10 times every 1-2 hours while awake
C. Encourage early ambulation and patient to eat meals in beside chair
D. Repositioning every 3-4 hours

Answer 2

The answer is D. All options are correct expect for repositioning every 3-4 hours. If the patient is unable to reposition themselves or ambulate, they must be repositioned every 1 to 2 hours minimally.

Question 3

To prevent headaches after spinal anesthesia, the patient should be positioned:
A. semi-fowlers
B. Flat (supine) on bed for 6-8 hours
C. Prone position
D. Modified trandelenburg

Answer 3

Ans: B

rationale:
After spinal anesthesia, you lie flat in bed for a few hours. This is to keep you from getting a headache. You may feel sick to your stomach and be dizzy. You may be tired.

Question 4

What is the primary reason for the gradual change of position of the patient after surgery?
A. to prevent muscle injury
B. to prevent sudden drop in BP
C. to prevent respiratory distress
D. To promote comfort

Answer 4

Ans: B

rationale:
if one were to get up quickly, orthostatic hypotension may occur, causing you to drop BP and feel dizzy. Get up gradually and have your BP monitored while you are lying down, then while on the bed side, and finally while standing up. wait a couple minutes each time you transition.

Question 5

The best time to teach deep breathing, coughing and turning exercise to patient would be:
A. Before giving preoperative medication
B. The afternoon or evening prior to surgery
C. Several days prior to surgery
D. Upon admission of the client in the recovery room

Answer 5

Ans: B

rationale:
Give time for the patient to learn deep breathing so they remember it prior to procedure

Question 6

Which of the following drugs is administered to minimize respiratory secretions?
A. Valium (Diazepam)
B. Nubain (Nalbuphine HCL)
C. Phenergan (Promethazine)
D. Atropine Sulfate

Answer 6

Ans: D

rationale:
Nubaine is used to treat severe pain. Valium is an antianxiety medication. Phenergan is used to treat allergies. Atropine Sulfate treats bradycardia and reduce salivation.

Question 7

Which of the following is experienced by a patient who is under spinal anesthesia?
A. patient is unconscious
B. Patient is awake
C. Patient experiences amnesia
D. Patient experiences total loss of sensation

Answer 7

Ans: B

rationale:
patient is awake when under spinal anesthesia because it is considered a regional anesthesia

Question 8

Which of the following drugs is given to relieve nausea and vomiting?
A. Mepivacaine
B. Aquamephyton
C. Nubain
D. Plasil

Answer 8

Ans: D

Plasil treats N/V. Mepivacaine treats is an anesthetic. Aquamephyton (vitamin K) which helps blood clot better. Nubain treats severe pain.

Question 9

The skin is shaved prior to surgery in order to:
A. facilitate skin incision
B. INdicate the site to be draped
C. TO prevent wound infection
D. reduce postop scarring

Answer 9

Ans: C

rationale:
to eliminate bacteria that cling to the hair

Question 10

Nursing measures to promote the client’s respiratory function during recovery from anesthesia are the following EXCEPT:
A. Encourage deep breathing and coughing
B. Administer humidified air
C. Place in semi-fowlers position
D. Place in supine position with head turned to the side without pillow support

Answer 10

Ans: C

rationale:
Make sure to lie flat to prevent headache from occurring. Semi-fowlers is when the head is slightly elevated, which can cause a headache.

Question 11

Which of the following criteria must be met before the client is released from the recovery room to the unit?
A. Breathe with ease, coughs freely
B. Has regained consciousness
C. Vital signs fluctuate erratically
D. able to move all four extremities

Answer 11

Ans: C

rationale:
vital signs must be stable in order for a patient to be release from the recovery room

Question 12

A client in shock must be placed in:
A. High-fowlers position
B. Sim's position
C. modified trandelenburg
D. Prone position

Answer 12

Ans: C

rationale:
legs elevated to improve BP and CO

Question 13

A patient is admitted to the PACU. Which of the following action is the most important during the patient’s stay in this unit?
A. Monitor urine output
B. Assess LOC
C. Ensure patency of drainage tube
D. Suction mucus form respiratory passages

Answer 13

Ans: D

rationale:
Maintaining a patent airway is always the priority to prevent respiratory distress and hypoxia. This follows ABC’s (airway, breathing, circulation) of patients care.

Question 14

A postoperative patient is transferred back to the surgical unit with an abdominal dressing and Penrose drain. Which is teh most important nursing action associated with caring for a patient with a Penrose drain?
A. remove the external portion until drainage stops
B. Change the soiled dressing carefully
C. Maintain the negative pressure
D. Pinning the drain to the dressing

Answer 14

Ans: B

rationale:
Changing soiled dressing carefully is necessary to prevent to prevent inadvertent removal of the Penrose drain because it is placed between several layers of gauze to absorb drainage.
-A Penrose drain functions by gravity, not negative pressure

Question 15

Which factor places a patient at the greatest risk for postoperative N/V after receiving general anesthesia?
A. Obesity
B. Inactivity
C. hypervolemia
D. unconsciousness

Answer 15

Ans: A

rationale:
Obese people have excess adipose tissue that exerts pressure on the abdominal cavity, which raises intra-abdominal pressure. This Exerts more pressure on the GI tract, increasing the risk of N/V.

Question 16

On the second postoperative day after an above-the-knee surgery, the patient’s elastic dressing accidentally comes off. Which should the nurse do first?
A. Wrap the residual limb with an elastic compression bandage
B. Apply saline dressing to the residual limb
C. Notify HCP
D. place two pillows under the limb

Answer 16

Ans: A

rationale:
Gentle compression is desirable because it prevents bleeding and promotes molding and shrinkage of the residual limb.

-a saline dressing is unsafe because it breaks down the connective tissue which impedes wound healing by primary intention

Question 17

A patient has abdominal surgery for the removal of a gallbladder. Which should  the nurse be most concerned if exhibited by the patient?
A. constipation
B. urinary retention
C. shallow breathing
D. inability to provide self-care

Answer 17

Ans: C

rationale:
After abdominal surgery patients frequently have shallow respirations becuase when the diaphragm contracts with a deep breath, it increases intra-abdominal pressure, which causes pain at the operative site. Shallow breathing may result in atelectasis and/ or hypostatic pneumonia

Question 18

How many days does the nurse expect the patient to exhibit S/S of wound infection if it should occur?
A. day 5
B. day 3
C. day 9
d. day 7

Answer 18

Ans: B

rationale:
microorganisms introduced to asurgical site take 72 hours to multiply and present local adaptations of painswelling, erythema, warmth and purulent discharge and systematic adaptations of fever and tachcardia

Question 19

A nurse is assessing a patient who had spinal anesthesia. For which common response should the nurse assess the patient?
A. headache
B. neuropathy
C. Lower back discomfort
D. increased BP

Answer 19

Ans: A

rationale:
leakage of spinal fluid from needle insertion site reduces cerebrospinal fluid pressure, which causes headaches.

Question 20

Which is the most dietary order the nurse can anticipate after a patient who had abdominal surgery exhibits a return of intestinal peristalsis?
A. clear liquid
B. full liquid
C. low fiber
D. regular

Answer 20

Ans: A

rationale:
They started as NPO and when peristalsis starts, they are prescribed clear liquid because they are easier to digest and process

Question 21

A postoperative patient experiences tachycardia, sudden chest pain, and low BP. Which complication associated with the postoperative period should the nurse conclude that the patient most likely experienced?
A. pulmonary embolus
B. hemorrhage
C. heart attack
D. pneumonia

Answer 21

Ans: A

rationale:
classic symptoms of pulmonary embolus. S/S include chest pain resulting from hypoxia, tachycardia, and hypotension from decreased Cardiac output

-embolus lodges (block) a vessel impeding pulmonoary circulation

Question 22

A nurse is caring for two patients. One of the patients has a Jackson-Pratt drain and the other patient has a Hemovac drain.Which does the nurse understand is the difference between these two drains?
A. The size of the collection container
B. How the pressure within the collection container is reestablished
C. The type of pressure that promotes drainage to the collection container
D. Where the collection container should be placed in relation to the insertion site.

Answer 22

Ans: A

rationale:
The size of the collection container. Hemovac is designed to store 100, 400, or even 800 ml. A Jackson-Pratt stores less than 100 ml of drainage.

Question 23

A nurse in the operating room is to position a patient for surgery. Which factor is most important for the nurse to consider?
A. Allow for skeletal deformities
B. Prevent pressure on bony prominence
C. Provide for adequate thoracic expansion
D. Avoid stretching of neuromuscular tissue

Answer 23

Ans: C

rationale:
Facilitating respiratory is always the priority because permanent brain damage can result from cerebral hypoxia in as little as 4-6 hours.

Question 24

One hour after the reduction of a compound fracture of the ulna and radius and application of the cast, the nurse observes a centimeter circle of drainage on the patient’s cast. Which should the nurse do first?
A. inform surgeon immediately
B. Reinforce the cast with gauze dressing
C. Monitor the area frequently for expansion
D. Circle the spot with a pen and date, time and initial area.

Answer 24

Ans: D

rationale:
locate the area and see if the drainage grows. This is also used to indicate how long the patient would be bleeding and the extent of it.

Question 25

A nurse is caring for a patient with an NG tube attached to suction. What is teh most important nursing action in relation to the nasogastric tube?
A. use sterile technizue when irrigating the tube
B. record intake and output every 2 hours
C. provide oral hygiene every 4 hours
D. Setting suction at the ordered level

Answer 25

Ans: D

rationale:
suction must be maintained continuously to prevent reflux of gastric secretions into the vent lumen which can result in mucosa damage

Question 26

A nurse is considering the commonalities and differences of equipment used for gastric depression. Which is the major advantage to using a double-lumen tube?
A. minimize risk of bowel obstruction
B. Ensure drainage of the intestines
C. Prevents gastric mucosal drainage
D. Promotes gastric rest

Answer 26

Ans: C

rationale:
one allows the secretions to be removed and the other allows the air to be drawn into the stomach. this makes the outside pressure equal to the inside pressure preventing the tip from attaching to the gastric mucosa when the drainage lumen is attached to the suction, limiting mucosal damage

Question 27

A patient has negative pressure wound therapy(vacuum assisted closure) (aka VAC) after the amputation of a toe. The tubing is connected to the intermittent negative pressure. What should the nurse do when the film over the wound collapses when the negative pressure is exerted?
A. notify HCP
B. decrease extent of negative pressure
C. Apply a new transparent film over the wound
D. Continue to observe the function of the device.

Answer 27

Ans: D

rationale:
The device is functioning appropriately. The transparent film will collapse or wrinkle as negative pressure is applied to the wound. This indicates that there are no leaks in the dressing and the negative pressure is functioning