Question of the Week

Question 1

A potential negative side effect of positive end-expiratory pressure (PEEP) is:

1. alveolar collapse
2. decreased intrapulmonary shunting
3. increase cardiac output
4. hypertension

Answer 1

2. Decreased intrapulmonary shunting.

Question 2

A patient complains of dyspnea and chest pain after the insertion of a central line catheter. The patient’s breath sounds are diminished. After a physician notification, the priority nursing action is to:

1. prepare for the insertion of a chest tube.
2. obtain an order for analgesic
3. apply a positive pressure airway ventilator
4. prepare for immediate removal of the central line.

Answer 2

1. prepare for the insertion of a chest tube.

Question 3

The dissociative state attributed to ketamine anesthesia can be modified by the administration of a/an:

1. antiarrhythmic
2. benzodiazepine
3. antagonist
4. anticonvulsant

Answer 3

2. benzodiazepine

Question 4

A patient has met discharge criteria, but has no one to drive him home or to stay with him. The perianesthesia nurse’s next action should be to:

1. Call the surgeon to admit the patient.
2. keep the patient 3 more hours then send home
3. follow facility policies and procedures
4. notifiy risk management.

Answer 4

1. Call the surgeon to admit the patient.

Question 5

Patient discharge education for post operative nausea and vomiting includes:

1. turning head to the side
2. taking several quick breaths.
3. awareness of future risk
4. avoiding essential oils.

Answer 5

3. awareness of future risk

Question 6

During the assessment of a geriatric patient, the PACU nurse is aware that during the aging process, there is a decline in :

1. delirium
2. short term memory
3. intelligence
4. confabulation

Answer 6

2. short term memory

Question 7

The recommended dose of ketorolac for postoperative pain is :

1. 30mg IV q6 hours for healthy patients less than 65
2. 60 mg IV q6 hours for healthy patients less than 65
3. 15 mg IV q 12 hours for patients with renal failure
4. 30 mg IV or IM q4h for patients with body weight over 50 kg.

Answer 7

1. 30mg IV q6hr for healthy paitents less than 65.

Question 8

During an interscalene block, the patient becomes apneic and unresponsive. The most likely cause is:

1. vagus nerve stimulation
2. carotid artery infiltration
3. high spinal anesthesia
4. traumatic pneumothorax

Answer 8

3. high spinal anesthesia.

Question 9

The primary effect of steroid therapy for multisystemic organ failure shock is to:

1. decrease lysosomal membrane stability
2. increase pulmonary vascular resistance
3. increase alveocapillary permeability
4. increase gluconeogenic activity.

Answer 9

4. Increase gluconeogenic activity.

Question 10

Upon a patient’s admission to PACU, the anesthesiologist reports that the patient received anesthesia with thiopental, atracurium, morphine sulfate and sevoflurane. The patient was reversed with neostigmine, atropine and naloxone 5 min prior to admission to the PACU. The PACU nurse will observe for repiratory depression because:

1. thiopental is potentiated by the naloxone.
2. atracurium causes irreversible muscle relaxation
3. morphine sulfate may last longer than noloxone’s reversal action
4. The combination of neostigmine and atropine increases respiratory depression.

Answer 10

3. morphine sulfate may last longer than naloxone’s reversal action.

Question 11

A patient who had received an interscalene block for shoulder surgery reports a numb mouth and tongue, tinnitus, no pain, and full range of motion of fingers. The perianesthesia nurse suspects:

1. appropriate blockade
2. toxicity
3. ischemia
4. possible infection

Answer 11

2. toxicity

Question 12

Anxious parents are at the bedside of a toddler who is crying, kicking, and thrashing following bilateral myringotomy with insertion of typanostomy. The perianesthesia nurse informs the parents that this behavior is:

1. the emergence excitement phase after anesthesia
2. a temper tantrum often seen in toddlers
3. associated with the surgical procedure
4. uncommon in children this age

Answer 12

1. the emergence excitement phase after anesthesia.

Question 13

Which of the following is an indicator of readiness for extubation in a post anesthesia patient weighing 60kg

1. Respiratory rate of 30 bpm
2. Tidal volume of 300ml and vital capacity of 900ml
3. Ability to open eyes and move extremities on command
4. Ability to sustain a head life for 3 seconds

Answer 13

3. Ability to open eyes and move extremities on command.

Question 14

The perianesthesia nurse is aware that a dramatic decrease in the serum calcium level may be cause by the removal of the:

1. Parathyroid glands
2. Pineal gland
3. adrenal glands
4. pituitary gland

Answer 14

1. Parathyroid glands

Question 15

The perianesthesia nurse recognizes that upon a patient’s arrival to PACU, a side effect of ketamine anesthesia is:

1. decreased muscle tone
2. hypotension
3. marked salivation
4. nausea and vomiting

Answer 15

3. marked salivation

Question 16

Slippage of an endotrachial tube into the right mainstem bronchus can result in:

1. atelectasis of the right lung
2. laryngeal or subglottic edema
3. erosion of the bronchial tissue
4. atelectasis of the left lung

Answer 16

4. atelectasis of the left lung

Question 17

Following a pediatric otoplsty, the perianesthesia nurse should advise the patient’s parents to notifiy the surgeon of post-op pain that exceeds:

1. 4 hours
2. 6 hours
3. 10 hours
4. 12 hours

Answer 17

4. 12 hours

Question 18

During the preop interview, a patient complains about the frightening previous anesthesia experience. The most appropriate immediate intervention is to:

1. allow the patient to discuss the event.
2. arrange for the family to stay with the patient
3. notifiy the supervisor of the patient’s concerns
4. refer the patient to social services

Answer 18

1. allow the patient to discuss the event.

Question 19

The perianesthesia nurse’s best approach to minimizing anxiety in a child who has autism is to:

1. Initiate the admission process quickly
2. provide a quiet environment
3. offer several choices
4. reduce parental contact as much as possible

Answer 19

2. provide a quiet environment

Question 20

Parents of a child who has undergone a tonsillectomy should be instructed to expect:

1. that the child will stay in bed for the next week
2. slight ear pain for a few days
3. that the child will return to school in 4 days
4. some bleeding in 14 to 18 days

Answer 20

2. slight ear pain for a few days

Question 21

Following a shoulder arthroscopy with regional block the patient denies any discomfort. The nursing care priority is to:

1. monitor for post-dural puncture headache
2. check for bladder distention
3. check sixth cranial nerve involvement
4. protect the affected arm

Answer 21

4. protect the affected arm

Question 22

Because the stomach of a fasting patient often contains clear acidic fluids, which of the following is correct?

1. ingestion of fats and solids improves gastric emptying.
2. ingestion of 150ml of water improves gastric emptying.
3. fasting for 12 hours preoperativiely is recommended
4. fluids in children are withheld for at least 6 hours

Answer 22

2. Ingestion of 150ml of water improves gastric emptying