Question 1

In which location are guidelines for ensuring that all nursing interventions on the day of surgery completed and documented?

Accepted Answer

When the nurse signs the preoperative checklist, that nurse assumes responsibility for all areas of care included on the list.

Question 2

The nurse clarifies that serum potassium levels are determined before surgery to:

Accepted Answer

Serum electrolytes are evaluated if extensive surgery is planned or the patient has extenuating problems. One of the essential electrolytes examined is potassium; if potassium is not available in adequate amounts, arrhythmias can occur during anesthesia.

Question 3

The patient who had a nephrectomy yesterday has not used the patient-controlled analgesia (PCA) delivery system but admits to being in pain but fearful of addiction. What is the nurse's best response?

Accepted Answer

Addiction rarely occurs in the short time that it is required after surgery. Postsurgical analgesia, because of its brief application, does not usually produce a physical or a psychological dependence.

Question 4

A patient is transferred from the operating room to the recovery room after undergoing an open reduction and internal fixation (ORIF) of his left ankle. Which is the first assessment to make?

Accepted Answer

Evaluation of the patient follows the ABCs of immediate postoperative observation: airway, breathing, consciousness, and circulation.

Question 5

Which circumstance could prevent the patient from signing his informed consent for a cholecystectomy?

Accepted Answer

Informed consent should not be obtained if the patient is disoriented and under the influence of sedatives. Age, illegibility, and lack of insurance coverage do not prevent signing the consent. Pain into the scapula is a symptom of colitis.

Question 6

Why might the older adult patient not respond to surgical treatment as well as a younger adult patient?

Accepted Answer

Of specific concern in older adults is the body's response to temperature changes, cardiovascular shifts, respiratory needs, and renal function. Fear of the unknown and decreased peristalsis are common to all ages.

Question 7

While turning a patient who had a bowel resection yesterday, the wound eviscerated. What is the initial nursing intervention?

Accepted Answer

Cover the wound with a sterile towel moistened with sterile physiological saline (warm).

Question 8

When should the nurse offer prescribed analgesics to a patient who is 24 hours postoperative?

Accepted Answer

The nurse should assess for pain frequently to medicate at the onset of pain.

Question 9

The nurse acting as a circulating nurse has a responsibility for:

Accepted Answer

The circulating nurse is responsible for observing breaks in sterile technique. The scrub nurse handles the surgical specimens, drapes the patient, and maintains needle and sponge count during surgery, then does a final sponge and needle check with the circulating nurse before closing.

Question 10

A patient is on postoperative day 2 after a nephrectomy. What is the most effective way to increase her peristalsis?

Accepted Answer

Encouraging activity (turning every 2 hours, early ambulation) assists GI activity.

Question 11

In which situation might surgery be delayed?

Accepted Answer

All medications should be cancelled before surgery, except for drugs such as phenytoin (Dilantin). Anticoagulant therapy increases the threat of hemorrhage and may be a cause for delay.

Question 12

The nurse instructing a postsurgical patient in the use of thrombolytic deterrent stockings would include which of the following instructions?

Accepted Answer

Stockings should be washed gently in warm water and mild soap and laid over a surface to dry. They should not be wrung out or hung. Massaging legs may dislodge a clot and the appearance of edema indicates the stockings are too restrictive.

Question 13

The patient is brought into PACU still unconscious. What should the nurse do when the nurse assesses an oral temperature of 94° F?

Accepted Answer

Hypothermia is a frequent assessment postsurgery. A warm blanket or a ventilated cover would be applied to bring up the temperature. Vital signs are checked every 15 minutes until stable.

Question 14

The postoperative nursing intervention that would be contraindicated for a 45-year-old patient who has had a repair of a cerebral aneurysm and is presenting signs of increased intracranial pressure (ICP) would be:

Accepted Answer

Coughing increases ICP.

Question 15

A 73-year-old patient with diabetes was admitted for below-the-knee amputation of his right leg. Removal of his right leg is an example of which type of surgery?

Accepted Answer

Ablative is a type of surgery where an amputation, excision of any part of the body, or removal of a growth and harmful substance is performed.

Question 16

Which statement made by a patient during a preoperative assessment would be significant to report to the charge nurse and surgeon?

Accepted Answer

The herbal remedy of feverfew acts as an anticoagulant and increases the possibility of hemorrhage. The drug should be stopped before surgery, and bleeding and clotting times should be evaluated.

Question 17

What should the nurse do to minimize the potential for venous stasis?

Accepted Answer

Early ambulation has been a significant factor in hastening postoperative recovery and preventing postoperative complications.

Question 18

Frequent assessment of a postoperative patient is essential. What is one of the first signs and symptoms of hemorrhage?

Accepted Answer

A pulse that increases and becomes thready combined with a declining blood pressure, cool and clammy skin, reduced urine output, and restlessness may signal hypovolemic shock.

Question 19

The nurse anticipates that the patient will be given ______________anesthesia because of the extensive tissue manipulation involved in a hysterectomy.

Accepted Answer

An anesthesiologist gives general anesthetics by IV and inhalation routes through four stages of anesthesia when the procedure requires extensive tissue manipulation.

Question 20

The nurse caring for a patient who had an epidural block for a vaginal repair should be alert for:

Accepted Answer

Epidural anesthesia may cause a sudden drop in blood pressure or respiratory difficulty as the anesthetic agent moves up in the spinal cord. Elevating the patient's torso may prevent respiratory paralysis.

Quiz 41: Care of the Surgical Patient