Deck 42: Care of the Surgical Patient

Question 1

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

A) observing breaks in sterile technique.
B) identifying and handling surgical specimens correctly.
C) assisting with surgical draping of the patient.
D) maintaining count of sponges,needles,and instruments during surgery.

Answer 1

observing breaks in sterile technique.

Question 2

In which situation might surgery be delayed?

A) The patient has taken Dilantin today.
B) An illegible signature is on the consent form.
C) The patient is still taking anticoagulants.
D) The admission office is unable to confirm insurance coverage.

Answer 2

The patient is still taking anticoagulants.

Question 3

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

A) Only when the patient asks.
B) When the onset of pain is assessed.
C) Sparingly to avoid drug dependence.
D) Only when severe pain is assessed.

Answer 3

When the onset of pain is assessed.

Question 4

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

A) "I have been taking an herbal product of feverfew for my migraines."
B) "I exercise for 3 hours a day."
C) "I drink 2 glasses of wine a day."
D) "I use atropine eye drops every day."

Question 5

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

A) Increasing blood pressure
B) Decreasing pulse
C) Restlessness
D) Weakness,apathy

Question 6

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

A) assess kidney function.
B) determine respiratory insufficiency.
C) prevent arrhythmias related to anesthesia.
D) measure functional liver capability.

Question 7

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?

A) "Modern analgesic drugs do not cause addiction."
B) "Pain relief is worth a short period of addiction."
C) "Addiction rarely occurs in the brief time postsurgical analgesia is required."
D) "Addiction could be a real concern."

Question 8

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?

A) Palliative
B) Diagnostic
C) Reconstructive
D) Ablative

Question 9

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

A) Place the patient in the high Fowler's position.
B) Give the patient fluids to prevent shock.
C) Replace the dressing with sterile fluffy pads.
D) Apply a warm,moist normal saline sterile dressing.

Question 10

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

A) Notify the charge nurse immediately.
B) Offer warm fluids through a straw.
C) Do nothing,this is a normal reaction to anesthesia.
D) Cover with a warm blanket.

Question 11

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

A) Disregard appearance of edema above the stocking.
B) Massage legs to smooth wrinkles out of stockings.
C) Wring stockings thoroughly before hanging to dry.
D) Hand wash stockings in warm water and mild soap.

Question 12

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?

A) Check ankle dressings for hemorrhage.
B) Check airway for patency.
C) Check intravenous site.
D) Check pedal pulse.

Question 13

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

A) Ambulation
B) An enema
C) Encouraging hot liquids
D) Administering a laxative

Question 14

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

A) In the nurse's notes
B) In the anesthesia record
C) In the preoperative checklist
D) In the progress notes

Question 15

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

A) general
B) regional
C) specific
D) preoperative

Question 16

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

A) Poor skin turgor
B) Fear of the unknown
C) Response to physiologic changes
D) Decreased peristalsis related to anesthesia

Question 17

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

A) The patient complains of pain radiating to the scapula.
B) The patient received an injection of Demerol,75 mg IM,1 hour ago.
C) The patient is 85 years of age.
D) The patient is concerned over his lack of insurance coverage.

Question 18

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

A) Place pillows under the knee in a position of comfort.
B) Assist patient to sit with feet flat on the floor.
C) Assist with early ambulation.
D) Perform gentle leg massage.

Question 19

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

A) a flushing of the face and torso.
B) numbness of the perineum.
C) complaint of thirst.
D) a sudden drop in blood pressure.

Question 20

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:

A) coughing every 2 hours.
B) turning every 2 hours.
C) monitoring intravenous therapy at 50 mL/hr.
D) assessing vital signs every 2 hours.

Question 21

Discharge planning for a surgical procedure begins in the preoperative period and continues through the _____________ period.

Question 22

A patient is transferred from the operating room to the recovery room after undergoing an amputation of his left foot.Which intervention is the last step for immediate assessment once the patient enters the PACU?

A) System review
B) Breathing
C) Circulation
D) Airway
E) Level of consciousness

Question 23

Which of the following early postoperative observations should be reported immediately?

A) "Coffee ground" emesis
B) Shivering
C) Scanty urine output
D) Evidence of pain

Question 24

Which of the following are considerations for the older adult surgical patient? (Select all that apply. )

A) The need for specific clear preoperative and postoperative teaching
B) Awareness of lower morbidity and mortality rate
C) Presence of coexisting conditions
D) Increased risk of respiratory complications
E) Expectation of normal recovery time

Question 25

The nurse would include the patient problem of deficient knowledge,postoperative,when the patient scheduled for a bowel resection tomorrow remarks:

A) "I am going to have adequate pain medication after surgery."
B) "I know you all are going to make me cough and walk soon after surgery."
C) "I am glad I will get to go home tomorrow evening."
D) "I will have to put up with dressing changes."

Question 26

When the postoperative patient complains of sudden chest pain combined with dyspnea,cyanosis,and tachycardia,the nurse recognizes the signs of:

A) hypovolemic shock.
B) dehiscence.
C) atelectasis.
D) pulmonary embolus.

Question 27

In preparation for the return of the surgical patient,the patient's bed and equipment should be in what position?

A) Lowest position with side rails elevated with oxygen and suction equipment available
B) Highest position with side rails elevated with IV pole and pump at bedside
C) Lowest position with side rails down on the receiving side
D) Highest position with the side rails down on receiving side and up on opposite side

Question 28

The most appropriate intervention by the nurse to decrease the pain of an abdominal incision while coughing would be to:

A) support the surgical site with a pillow.
B) position patient in a side-lying position.
C) medicate with prescribed narcotic before coughing.
D) ask the patient to cross arms over the chest to increase force of cough.

Question 29

Which of the following are preoperative conditions that may affect the patient's response to surgery? (Select all that apply. )

A) Age
B) Religion
C) Mental status
D) Occupation
E) Nutritional status

Question 30

On the patient's return to the medical-surgical unit,the nurse performing an abdominal assessment can affirm an absence of bowel sounds after listening in each quadrant for at least:

A) 30 seconds.
B) 1 minute.
C) 2 minutes.
D) 3 minutes.

Question 31

The removal of a nondiseased appendix during a hysterectomy is classified as:

A) major,emergency,diagnostic.
B) major,urgent,palliative.
C) minor,elective,ablative.
D) minor,urgent,reconstructive.

Question 32

The nurse is aware that there is a loss of _________ during catabolism after severe tissue injury.

Question 33

______________ therapy is performed to alleviate or decrease uncomfortable symptoms without curing the problem.

Question 34

When the patient asks the nurse to make sure no one sees her with her dentures out,the nurse recognizes the common preoperative fear of:

A) anesthesia.
B) loss of control.
C) fear of separation from family.
D) mutilation.

Question 35

What is the ideal time for preoperative teaching?

A) Immediately before surgery to eliminate fear
B) 2 months in advance so the patient can prepare
C) 1 to 2 days before the surgery when anxiety is not as high
D) In the surgical holding area

Question 36

What instruction should a nurse give when teaching the patient to cough effectively after surgery?

A) Breathe through the nose,hold breath,and exhale slowly.
B) Take three deep breaths and cough from the chest.
C) Inhale while contracting the abdominal muscles and exhale while contracting the diaphragm.
D) Take short,frequent panting breaths and cough from the throat to clear accumulated mucus.

Question 37

What is the responsibility of the nurse as a witness to informed consent?

A) Explain the surgical options.
B) Explain the operative risks.
C) Verify/obtain the patient's signature.
D) Verify the patient's understanding of the procedure.

Question 38

The type of anesthesia that uses a combination of drugs to reduce the level of consciousness and provides amnesia is conscious (or moderate)____________________.

Question 39

In performing the preoperative assessment,the nurse discovers that the patient is allergic to latex.What should the nurse do initially?

A) Notify the diet kitchen to omit peaches from diet tray.
B) Apply a medical alert band to patient's wrist.
C) Tag chart with allergy alert.
D) Place patient in an isolation room.

Question 40

Which medication would cause surgery to be delayed if it had not been discontinued several days before surgery?

A) Analgesic agent
B) Antihypertensive agent
C) Anticoagulant agent
D) Antibiotic agent

Question 41

The nurse caring for a postsurgical patient is aware that the patient should void ____ to 8 hours postsurgery.

Question 42

The nurse explains that to promote deep breathing and improve lung expansion and oxygenation the patient should use the _____________ ______________ at regular intervals during the day.