Deck 33: Care of the Surgical Patient

Question 1

Before placing antiembolism stockings on a patient for the first time, a nurse should

A) Obtain baseline vital signs.
B) Have the patient lie supine for 15 minutes.
C) Ask the patient to sit at the side of the bed.
D) Instruct the patient to apply lotion to his or her legs.

Answer 1

Have the patient lie supine for 15 minutes.

Question 2

The wife of a patient who recently returned from a radical neck dissection asks a nurse why her husband was given scopolamine. The best response by the nurse is:

A) "It is important to dry secretions to reduce the bacteria in his saliva."
B) "Swallowing is painful for him right now. Scopolamine helps keep him from drooling."
C) "This medication will reduce the swelling in his lips and tongue by reducing the amount of saliva that his body makes."
D) "The scopolamine will help dry oral secretions to reduce his chances of aspirating saliva into his lungs."

Answer 2

"The scopolamine will help dry oral secretions to reduce his chances of aspirating saliva into his lungs."

Question 3

A nurse recognizes that which of the following patients may receive spinal anesthesia?

A) A 45-year-old scheduled for a pulmonary wedge resection
B) A 29-year-old scheduled for repair of a torn rotator cuff
C) A 48-year-old scheduled for a hemorrhoidectomy
D) A 66-year-old scheduled for a bone marrow biopsy

Answer 3

A 48-year-old scheduled for a hemorrhoidectomy

Question 4

A nurse is providing care to a 32-year-old who returned from a thyroidectomy 6 hours ago. The nurse notes that the patient's temperature is 99.5°F and that the patient has been taking sips of clear liquids, reports mild nausea, and is using patient-controlled anesthesia to manage pain, which is 3/10. The nurse should

A) Order a low-salt diet.
B) Document the findings.
C) Contact the physician.
D) Assess the back of the patient's throat.

Question 5

Which of the following members of the surgical team is responsible for monitoring a patient's vital signs during surgery?

A) The surgeon
B) The circulating nurse
C) The first surgical assistant
D) The anesthesiologist

Question 6

A nurse who is caring for a male patient after a left-side total hip replacement recognizes that further teaching is required when

A) The patient alternately flexes and extends the toes of both feet.
B) The patient circles both ankles clockwise and counterclockwise.
C) The patient bends the knees slightly and helps pull himself up in bed using the trapeze.
D) The patient turns on his right side and lifts the left leg with his toes pointed and then returns the leg to the midline.

Question 7

A nurse is providing care for a patient who is wearing antiembolism hose following a colectomy. The patient's plan of care should include:

A) Turning the stockings off 4 hours each day.
B) Removing the stockings at bedtime and replacing them in the morning.
C) Rolling the stockings down 2 inches to create a band at the top.
D) Removing the stockings twice daily to wash and dry the legs.

Question 8

When determining the appropriate size of thigh-high antiembolism hose, a nurse would obtain which of the following measurements?

A) Length from gluteal fold to the bottom of the heel
B) Length from midthigh to the tip of the toe
C) Circumference of the knee
D) Amount of edema noted in the ankles

Question 9

Which of the following is most commonly taught to help prevent postsurgical respiratory complications?

A) Turning, coughing, and deep breathing
B) Splinting incisions
C) The use of postsurgical compression stockings
D) Measuring intake and output

Question 10

A nurse is caring for a patient who received spinal anesthesia. The patient reports having a bad headache later that day. The nurse's best response is:

A) "You may have an allergy to the anesthetic used. Have you ever had spinal anesthesia before?"
B) "That sometimes happens due to loss of spinal fluid during anesthesia."
C) "I will need to call the physician immediately."
D) "Do you have a history of migraines?"

Question 11

A nurse who is working in the post-anesthesia care unit (PACU) recognizes that a patient is most likely to experience which of the following complications while in the unit?

A) Hypoventilation
B) Deep vein thrombosis
C) Atelectasis
D) Pneumonia

Question 12

A nurse is caring for a female patient who is scheduled for an abdominal hysterectomy. The nurse obtains the patient's signature on the consent form and then signs the form himself. The nurse's signature indicates that

A) The patient does not have any questions about the surgery.
B) The nurse verified that it was the patient who signed the form.
C) The patient understands the risks of the procedure.
D) The nurse has provided verbal and written information about the surgical procedure.

Question 13

A nurse is caring for a patient who returned from abdominal surgery 6 hours ago. The nurse notes that the abdominal dressing is nearly saturated with serosanguineous drainage and that a small amount of drainage is leaking from the lower edge of the dressing. The nurse's best action is to

A) Reinforce the dressing with additional gauze pads.
B) Remove the surgical dressing to assess the site directly.
C) Replace the surgical dressing with fresh dressings.
D) Reinforce the tape edges of the dressing.

Question 14

After assisting with the transfer of a patient from the post-anesthesia care unit into a bed on the unit, a nurse should first

A) Review the physician's orders.
B) Determine the type and amount of intravenous fluid hanging.
C) Perform a physical assessment.
D) Reassure the patient that he or she will receive excellent care on the unit.

Question 15

A nursing instructor teaches a group of students the differences between conscious sedation and general anesthesia. According to the instructor, which of the following is a primary benefit of conscious sedation?

A) The patient will remember the procedure.
B) The patient will not require airway support.
C) It will block reflexes such as coughing and gagging.
D) It can be used for procedures that take long periods of time.

Question 16

A nurse would expect an International Normalized Ratio (INR) to be ordered for which of the following patients?

A) A 32-year-old with a history of asthma
B) A 29-year-old who takes digoxin (Lanoxin), a cardiac drug
C) A 53-year-old with a history of cirrhosis of the liver
D) A 71-year-old with a history of benign prostatic hypertrophy (BPH)

Question 17

A nurse who is providing care for a patient with a large abdominal wound removes the dressing and notes that the wound has dehisced. The nurse should

A) Cover the wound with a large sterile dressing.
B) Pour sterile saline into the wound bed.
C) Notify the supervisor.
D) Ask the patient, "Did you feel anything pop open?"

Question 18

A nurse is caring for a 28-year-old man who returned from the repair of a broken jaw 3 hours earlier. The patient reports an urge to urinate and tried to use the urinal in the bed without success. The best action by the nurse is to

A) Call to obtain an order to catheterize the patient.
B) Perform a digital rectal examination.
C) Assist the patient in standing and using the urinal.
D) Use the bladder scanner to determine the degree of distention.

Question 19

A nurse who is caring for patients on a surgical unit recognizes that the individual having corrective surgery is the

A) 39-year-old scheduled for breast reduction.
B) 14-year-old scheduled for tumor debulking.
C) 4-month-old scheduled for cleft lip repair.
D) 55-year-old scheduled for an exploratory laparotomy.

Question 20

A nurse is providing care for a patient with a nasogastric (NG) tube in place 10 hours after removal of a portion of the stomach. The patient's plan of care would include

A) Providing mouth care every 4 hours.
B) Keeping NG to continuous high suction.
C) Draping NG tubing over the patient's shoulder.
D) Providing tube feeding every 3 hours.

Question 21

Anticholinergics such as atropine, scopolamine, and glycopyrrolate may be given to a patient preoperatively to decrease the risk for

A) Aspiration.
B) Infection.
C) Nausea and vomiting.
D) All of the above.

Question 22

A nurse is working in a post-anesthesia care unit (PACU) when a patient arrives from the operating room. The nurse should provide assessments and documentation for this patient every

A) 5 minutes.
B) 10 minutes.
C) 15 minutes.
D) 30 minutes.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 23

While caring for a patient in the surgical center, which of the following preoperative laboratory values would a nurse expect to be included in the orders?

A) White blood cell (WBC) count
B) Hemoglobin (Hgb)
C) Alkaline phosphatase (Alk Phos)
D) Platelet count (PLT)
E) Urinalysis (UA)

Question 24

An instructor observes a nurse conducting preoperative teaching to help reduce a patient's anxiety before surgery. The instructor should intervene if the nurse includes

A) Actions the patient can take to help prevent complications, decrease discomfort, and shorten recovery time.
B) Information regarding preoperative preparations.
C) Details of the surgical procedure.
D) A description of the general roles of the various operating room (OR) team members.

Question 25

A nurse is caring for a patient with a history of congenital heart disease. To decrease the risk for infection and prevent bacterial endocarditis during surgery, the nurse identifies a need to administer preoperative

A) Anticholinergics.
B) Antiemetics.
C) Anticoagulants.
D) Antibiotics.

Question 26

Before beginning surgery, a circulating nurse suspects that the wrong patient may be on the operating table. The first thing the nurse should do is

A) Check that the proper surgical site is marked with a permanent marker.
B) Check the signed consent form in the patient's chart.
C) Call a time-out.
D) Confirm the patient's identity and date of birth.

Question 27

Most facilities require that several basic tests be performed on all patients before surgery. A nurse identifies that these tests include all of the following except

A) Electrocardiogram (EKG).
B) Complete blood cell count (CBC).
C) Blood urea nitrogen (BUN).
D) Urinalysis (UA).

Question 28

During standard preoperative testing, a nurse notices that a patient's urine has an elevated specific gravity. This finding is an indication that this patient is at risk for

A) Dehydration.
B) Anemia.
C) Ischemia.
D) Impaired renal function.

Question 29

A nurse recognizes that which of the following would be classified as elective surgeries?

A) A tonsillectomy for a 10-year-old with a history of frequent pharyngitis
B) An appendectomy for a 12-year-old with acute appendicitis
C) A colectomy with colostomy for an 18-year-old with Crohn disease
D) A mastectomy for a 56-year-old with recently diagnosed breast cancer
E) A total hip replacement for an 87-year-old with a fractured femur

Question 30

A nurse understands that a preoperative checklist is used to

A) Confirm that all preoperative tasks have been completed.
B) Provide instructions for the surgical assistant.
C) Provide documentation.
D) Both 1 and 3

Question 31

To prepare the surgical environment and begin setting up sterile supplies, the first staff member to perform a surgical scrub is the

A) Circulating nurse.
B) Scrub nurse.
C) Anesthesia provider.
D) Registered nurse first assistant (RNFA).

Question 32

A nurse is assisting a surgeon who will be performing a tonsillectomy. The nurse is able to identify from the descriptor ectomy that the procedure involves

A) Removal.
B) Separation.
C) Creating an opening.
D) Uprooting and replanting.

Question 33

After sending a patient to have a bowel resection, a nurse prepares the room for the patient's return. Preparations would include which of the following?

A) Obtaining any necessary supplies
B) Placing the bed in the lowest position
C) Placing a lift sheet on the bed
D) Moving bedside tables away from the bedside
E) Putting the bed in high Fowler position

Question 34

Once a patient enters the post-anesthesia care unit (PACU), a nurse's priority is the immediate application and observation of a(n)

A) Pulse oximeter.
B) Electrocardiogram (EKG) monitor.
C) Blood pressure monitor.
D) All of the above.

Question 35

Preoperative teaching provides a patient and family with the information, skills, and instructions that will

A) Support optimal healing.
B) Be conducive to the shortest recovery period.
C) Prevent or reduce postoperative complications.
D) All of the above.

Question 36

A nurse would include which of the following questions in a presurgical assessment?

A) "Have you had any prior surgeries?"
B) "Is there a possibility you may be pregnant?"
C) "Are you taking any medications at this time?"
D) "Do you smoke or use tobacco in any form?"
E) "What surgery is planned? Why are you having surgery?"

Question 37

The plan of care for a patient at risk for cardiac complications during the immediate postoperative period would include which of the following?

A) Monitoring the patient's heart rate continuously
B) Administering intravenous fluids as ordered
C) Assessing the patient's skin color and capillary refill frequently
D) Assessing the patient's peripheral pulses bilaterally
E) Evaluating for bowel sounds hourly