STUDY FOR FINAL surgery and endo

Question 1

1. A patient with obesity (BMI 42.1 kg/m2) is scheduled for a laparoscopic cholecystectomy in an outpatient surgery setting. Which information would the nurse include in the plan of care?

a. The patient will be in the hospital for several days.

b. Surgery will involve removing a part of the liver.

c. The setting is not appropriate for the planned procedure.

d. Special equipment may be needed for the patient’s care.

Answer 1

d. Special equipment may be needed for the patient’s care.

Question 2

2. The patient reports that she has noticed a skin reaction when wearing disposable gloves. Which action would the nurse take?

a. Notify the surgeon so that the surgery can be canceled.

b. Ask further questions to assess for a possible latex allergy.

c. Notify the OR staff at once so they can use latex-free supplies.

d. No action is needed because the patient’s reaction has no bearing on surgery.

Answer 2

b. Ask further questions to assess for a possible latex allergy.

Question 3

3. A 59-year-old man scheduled for a herniorrhaphy in 2 days reports that he takes an anticoagulant agent daily. Which action would the nurse take?

a. Inform the surgeon since the procedure may have to be rescheduled.

b. Tell the patient to continue to take the drug up to the day before surgery.

c. Ask the patient if he has any side effects from taking this drug supplement.

d. Notify the anesthesia care provider since this drug may interfere with anesthetics.

Answer 3

a. Inform the surgeon since the procedure may have to be rescheduled.

Question 4

5. Which intervention would the nurse prioritize to aid a preoperative patient in coping with the fear of postoperative pain?

a. Inform the patient that pain medication will be available.

b. Teach the patient to use guided imagery to help manage pain.

c. Describe the type of pain expected after the patient’s surgery.

d. Explain the pain management plan and the use of a pain rating scale.

Answer 4

d. Explain the pain management plan and the use of a pain rating scale.

Question 5

4. A 17-year-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which action would the nurse take?

a. Witness the patient signing the permit after the surgeon obtains consent.

b. Call a parent or legal guardian to sign the permit since the patient is under 18.

c. Notify the hospital attorney that an emancipated minor is consenting for surgery.

d. Obtain verbal consent since written consent is not necessary for emancipated minors.

Answer 5

a. Witness the patient signing the permit after the surgeon obtains consent.

Question 6

6. A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. Which action would the nurse take?

a. Tell the patient to come back tomorrow since he ate a meal.

b. Have the patient void before giving any preoperative medication.

c. Proceed with the preoperative checklist, including site identification.

d. Notify the anesthesia care provider of when and what the patient last ate

Answer 6

d. Notify the anesthesia care provider of when and what the patient last ate

Question 7

7. A patient who takes metformin 500 mg every morning for control of type 2 diabetes asks if she should take her medication the day of surgery. Which recommendation would the nurse make?

a. Skip her medication the day of surgery.

b. Get instructions from the surgeon about medication adjustments.

c. Take her usual morning dose at bedtime the night before surgery.

d. Take her medication as usual with a sip of water in the morning.

Answer 7

b. Get instructions from the surgeon about medication adjustments.

Question 8

8. Which preoperative considerations would the nurse plan for the care of an older adult? (Select all that apply.)

a. Using only large-print educational materials.

b. Speaking louder for patients with hearing aids.

c. Recognizing that sensory deficits may be present.

d. Providing warm blankets to prevent hypothermia.

e. Teaching important information early in the morning.

Answer 8

c. Recognizing that sensory deficits may be present.

d. Providing warm blankets to prevent hypothermia.

Question 9

1. Which items would the nurse wear for proper attire in the semirestricted area of the surgery department?

a. Street clothing

b. Surgical attire and head cover

c. Street clothing and shoe covers

d. Surgical attire, head cover, shoe covers

Answer 9

d. Surgical attire, head cover, shoe covers

Question 10

2. Which activities might the nurse perform in the role of a scrub nurse during surgery? (select all that apply)

a. Checking electrical equipment

b. Preparing the instrument table

c. Assisting with draping the patient

d. Passing instruments to the surgeon and assistants

e. Documenting activities occurring in the operating room

Answer 10

b. Preparing the instrument table

c. Assisting with draping the patient

d. Passing instruments to the surgeon and assistants

Question 11

3. The nurse is caring for a patient undergoing surgery for a knee replacement. Which factors are critical to the patient’s safety during the procedure? (select all that apply)

a. Universal protocol is followed.

b. The ACP is an anesthesiologist.

c. The patient has adequate health insurance.

d. The patient’s family is in the surgery waiting area.

e. The patient’s allergies are conveyed to the surgical team.

Answer 11

a. Universal protocol is followed.
e. The patient’s allergies are conveyed to the surgical team.

Question 12

4. Which action is the nurse’s primary responsibility for the care of the patient undergoing surgery?

a. Developing a patient-centered plan of nursing care

b. Carrying out tasks related to surgical policies and procedure

c. Ensuring that the patient has been assessed for safe administration of anesthesia

d. Performing a preoperative history and physical assessment to identify patient needs

Answer 12

a. Developing a patient-centered plan of nursing care

Question 13

5. Which action would the nurse take when scrubbing at the scrub sink?

a. Scrub from elbows to hands

b. Scrub without mechanical friction

c. Scrub for a minimum of 10 minutes

d. Hold the hands higher than the elbows

Answer 13

d. Hold the hands higher than the elbows

Question 14

6. Which factors in positioning a patient for surgery increase the risk of patient injury? (select all that apply)

a. Loss of pain perception

b. Incorrect musculoskeletal alignment

c. Vasoconstriction of the peripheral vessels

d. Hypovolemia contributing to decreased perfusion

e. Inability to sense pressure over bony prominences

Answer 14

a. Loss of pain perception

b. Incorrect musculoskeletal alignment

d. Hypovolemia contributing to decreased perfusion

e. Inability to sense pressure over bony prominences

Question 15

7. Why is IV induction for general anesthesia the method of choice for most patients?

a. The patient is not intubated.

b. The agents are nonexplosive.

c. Induction is rapid and controlled.

d. Emergence is longer but with fewer complications.

Answer 15

c. Induction is rapid and controlled.

Question 16

3. After admitting a postoperative patient to the clinical unit, which assessment data require attention first?

a. O2 saturation of 85%

b. Respiratory rate of 13/min

c. Temperature of 100.4°F (38°C)

d. Blood pressure of 90/60 mm Hg

Answer 16

a. O2 saturation of 85%

Question 16

1. Which actions would the nurse prioritize when admitting a patient to the PACU?

a. Assess the surgical site, noting presence and character of drainage.

b. Assess the amount of urine output and the presence of bladder distention.

c. Assess for airway patency and quality of respirations and obtain vital signs.

d. Review results of intraoperative laboratory values and medications received.

Answer 16

c. Assess for airway patency and quality of respirations and obtain vital signs.

Question 17

2. A patient is admitted to the PACU after major abdominal surgery. During the initial assessment the patient tells the nurse, “I think I am going to throw up.” Which is the priority intervention?

a. Increase the rate of the IV fluids.

b. Give antiemetic medication as ordered.

c. Obtain vital signs, including O2 saturation.

d. Position patient in lateral recovery position.

Answer 17

d. Position patient in lateral recovery position.

Question 18

5. Which factors would the nurse include in discharge criteria for a Phase II patient? (select all that apply)

a. Nausea and vomiting controlled.

b. Ability to drive themselves home.

c. No respiratory depression present.

d. Written discharge instructions understood.

e. Opioid pain medication given 45 minutes ago.

Answer 18

a. Nausea and vomiting controlled.

c. No respiratory depression present.

d. Written discharge instructions understood.

e. Opioid pain medication given 45 minutes ago.

Question 18

4. A 70-kg postoperative patient has an average urine output of 25 mL/hr during the first 8 hours. Which interventions would the nurse prioritize? (Select all that apply.)

a. Obtain a bladder ultrasound scan.

b. Perform a straight catheterization.

c. Continue to monitor this normal finding.

d. Evaluate the patient’s fluid volume status.

Answer 18

a. Obtain a bladder ultrasound scan.
d. Evaluate the patient’s fluid volume status.

Question 19

1. A characteristic common to all hormones is that they

a. circulate in the blood bound to plasma proteins.

b. influence cellular activity of specific target tissues.

c. accelerate the metabolic processes of all body cells.

d. enter a cell and change the cell’s metabolism or gene expression.

Answer 19

b. influence cellular activity of specific target tissues.

Question 20

2. A patient is receiving radiation therapy for renal cancer. The nurse monitors the patient for signs and symptoms of damage to the

a. pancreas.

b. thyroid gland.

c. adrenal glands.

d. posterior pituitary gland.

Answer 20

c. adrenal glands.

Question 21

4. When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about

a. energy level.

b. intake of vitamin C.

c. employment history.

d. frequency of sexual intercourse.

Answer 21

a. energy level.

Question 22

3. A patient has a serum sodium level of 152 mEq/L (152 mmol/L). The normal hormonal response to this situation is

a. release of ADH.

b. release of ACTH.

c. secretion of aldosterone.

d. secretion of corticotropin-releasing hormone.

Answer 22

a. release of ADH.

Question 23

5. An appropriate technique to use during physical assessment of the thyroid gland is

a. asking the patient to hyperextend the neck during palpation.

b. percussing the neck for dullness to define the size of the thyroid.

c. having the patient swallow water during inspection and palpation of the gland.

d. using deep palpation to determine the extent of a visibly enlarged thyroid gland.

Answer 23

c. having the patient swallow water during inspection and palpation of the gland.

Question 24

1. The nurse is assessing a patient newly diagnosed with type 1 diabetes. Which symptom reported by the patient correlates with the diagnosis?

a. Excessive thirst

b. Gradual weight gain

c. Overwhelming fatigue

d. Recurrent blurred vision

Answer 24

a. Excessive thirst

Question 24

6. Endocrine problems often go unrecognized in the older adult because

a. symptoms are often attributed to aging.

b. older adults rarely have identifiable symptoms.

c. endocrine problems are uncommon in an older adult.

d. older adults usually have endocrine problems with lesser symptoms.

Answer 24

a. symptoms are often attributed to aging.

Question 24

7. Abnormal findings during an endocrine assessment include (select all that apply)

a. excess facial hair on a woman.

b. blood pressure of 100/70 mm Hg.

c. soft, formed stool every other day.

d. 3-lb weight gain over last 6 months.

e. hyperpigmented coloration in lower legs.

Answer 24

a. excess facial hair on a woman.

e. hyperpigmented coloration in lower legs.

Question 25

8. A patient has a total serum calcium level of 3 mg/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse expects further diagnostic testing to reveal

a. decreased serum PTH.

b. increased serum ACTH.

c. increased serum glucose.

d. decreased serum cortisol levels.

Answer 25

a. decreased serum PTH.

Question 26

7. A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of

a. polyuria.

b. severe dehydration.

c. rapid, deep respirations.

d. decreased serum potassium.

Answer 26

c. rapid, deep respirations.

Question 26

2. When distinguishing between persons with type 1 diabetes from type 2 diabetes, the nurse is aware that

a. persons with type 1 diabetes require insulin therapy.

b. autoantibodies to pancreatic β-cells are found in type 2 diabetes.

c. persons with type 1 diabetes may be managed with metformin alone.

d. hyperosmolar hyperglycemia syndrome is more common in type 1 diabetes.

Answer 26

a. persons with type 1 diabetes require insulin therapy.

Question 27

3. Goals of managing the patient with diabetes include (select all that apply)

a. keeping the target A1C greater than 9%.

b. teaching self-monitoring of glucose levels.

c. preventing complications of hypoglycemia.

d. monitoring for ophthalmologic complications.

e. maintaining the LDL cholesterol greater than 100 mg/dL (2.6 mmol/L).

Answer 27

b. teaching self-monitoring of glucose levels.

c. preventing complications of hypoglycemia.

d. monitoring for ophthalmologic complications.

Question 28

5. You are caring for a patient with newly diagnosed type 2 diabetes who was started on metformin. What information should you include in discharge teaching? (Select all that apply.)

a. Need to reduce physical activity

b. Eliminate all forms of sugar from diet

c. Use of a portable blood glucose meter

d. Hypoglycemia prevention, symptoms, and treatment

e. Procedures that require IV contrast media are contraindicated

Answer 28

c. Use of a portable blood glucose meter

d. Hypoglycemia prevention, symptoms, and treatment

Question 29

6. What is the priority action for the nurse to take if the patient with type 2 diabetes reports headache, nervousness, and dizziness?

a. Administer glucagon.

b. Give insulin as ordered.

c. Check the patient’s glucose level.

d. Assess for other signs of neurologic stroke.

Answer 29

c. Check the patient’s glucose level.

Question 29

4. Which patient statement demonstrates an understanding of the role of exercise in managing diabetes?

a. “I cannot exercise if I am taking insulin and metformin.”

b. “Exercise increases insulin resistance, so I will need a higher dose of insulin.”

c. “It is better to exercise before a meal if I take medication that causes hypoglycemia.”

d. “My insulin dose may need to be changed if I have low glucose levels after exercising.”

Answer 29

d. “My insulin dose may need to be changed if I have low glucose levels after exercising.”

Question 30

8. Which are appropriate therapies for patients with diabetes? (Select all that apply.)

a. Use of statins to reduce CVD risk

b. Use of diuretics to treat nephropathy

c. Use of β-blockers to treat retinopathy

d. Use of serotonin agonists to decrease appetite

e. Use of ACE or ARB inhibitors to treat nephropathy

Answer 30

a. Use of statins to reduce CVD risk
e. Use of ACE or ARB inhibitors to treat nephropathy

Question 31

7. To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to

a. limit calcium intake.

b. perform glucose monitoring for hyperglycemia.

c. avoid immunizations due to high risk for infections.

d. stop steroids immediately if the patient gains weight.

Answer 31

b. perform glucose monitoring for hyperglycemia.

Question 32

6. A nursing priority for a patient who underwent removal of a pheochromocytoma includes

a. assessing for weight gain.

b. administering IV calcium.

c. close monitoring of blood pressure.

d. restricting fluid and sodium intake.

Answer 32

c. close monitoring of blood pressure.

Question 33

5. The nurse teaching the patient with Addison disease determines additional teaching is needed when the patient states

a. “I should take my prednisone twice a day.”

b. “I should call my HCP if I develop vomiting or diarrhea.”

c. “If I get influenza, I should decrease my prednisone dose.”

d. “I will pick up my emergency hydrocortisone from the pharmacy.”

Answer 33

c. “If I get influenza, I should decrease my prednisone dose.”

Question 34

4. After thyroid surgery, the nurse suspects damage of the parathyroid glands when the patient develops

a. hyperthermia and severe tachycardia.

b. hypercalcemia and shortness of breath.

c. laryngospasms and tingling in the hands and feet

d. hypophosphatemia, hypertension, vomiting, and chest pain.

Answer 34

c. laryngospasms and tingling in the hands and feet

Question 35

1. Which interventions would the nurse include in the care for a patient who underwent transsphenoidal excision of the pituitary gland? (select all that apply)

a. Frequent monitoring of serum and urine osmolarity

b. Assessment of visual acuity and extraocular movement

c. Keeping the patient in a recumbent position at all times

d. Teaching the patient about the need for lifelong hormone therapy

e. Instructing the patient to blow their nose frequently to relieve cerebral pressure

Answer 35

a. Frequent monitoring of serum and urine osmolarity

b. Assessment of visual acuity and extraocular movement

d. Teaching the patient about the need for lifelong hormone therapy

Question 35

3. The nurse reviews the laboratory results of a patient with primary hypothyroidism. The nurse would expect to find

a. a low TSH.

b. an elevated TSH.

c. an elevated free T4.

d. decreased low-density lipoproteins (LDLs).

Answer 35

b. an elevated TSH.

Question 36

2. A patient with lung cancer develops SIADH. Which are anticipated findings?

a. Hypernatremia and hyperkalemia

b. Thirst, muscle cramping, and headache

c. High urine output, weight gain, and vomiting

d. Weight gain and decreased glomerular filtration rate

Answer 36

b. Thirst, muscle cramping, and headache