Deck 2: Care of the Surgical Patient

Question 1

The anesthesiologist provides ____ anesthesia by inhalation and IV administration routes.

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

Answer 1

general

Question 2

A male patient, age 80, has had a total hip replacement. Anxiety, hypotension, and jarring during transfer from the recovery room to his room can cause a postoperative increase in which of his vital signs?

A) Pulse rate
B) Temperature
C) Blood pressure
D) Pain

Answer 2

Pulse rate

Question 3

Which nursing interventions would be appropriate after a wound evisceration?

A) Place the patient in 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.

Answer 3

Apply a warm, moist normal saline sterile dressing.

Question 4

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 5

Serum potassium levels are usually determined before surgery to

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

Question 6

The patient is 38 years old and is in her second postoperative day after placement of an intramedullary rod in her left femur. She is receiving analgesia via a patient-controlled analgesia (PCA) device. The inappropriate intervention related to caring for a patient with a PCA is:

A) Maintaining the system.
B) Recording activations of the system.
C) Administering the analgesia to the patient.
D) Monitoring the patient's pain.

Question 7

Frequent assessment of a postoperative patient is essential. One of the first signs and symptoms of hemorrhage may be

A) increasing blood pressure.
B) decreasing pulse.
C) restlessness.
D) weakness, apathy.

Question 8

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

A) Only when the patient asks.
B) Regularly every three to four hours before pain gets severe.
C) Only when the physician orders.
D) Only when the patient is in severe pain.

Question 9

A patient, age 65, underwent a right hemicolectomy. On postoperative day 4, her surgical wound dehisced. This means that

A) there is partial or complete wound separation.
B) there has been inadequate wound closure.
C) abdominal viscera protrude through the walls.
D) the wound will not heal well when it is resutured.

Question 10

A 45-year-old patient has had a repair of a cerebral aneurysm and is presenting signs of increased intracranial pressure (ICP). Which postoperative nursing interventions would be contraindicated?

A) Coughing every 2 hours
B) Leg exercises every 2 hours
C) Monitoring intravenous therapy at 50 ml/hr
D) Assessing vital signs every 2 hours

Question 11

Decreased activity in an obese surgical patient predisposes the patient to which complication?

A) Cardiac arrest
B) Pneumonia
C) Incisional hernias
D) Hypoventilation

Question 12

A type of anesthesia that requires a depressed level of consciousness is

A) regional anesthesia.
B) specific anesthesia.
C) optional sedation.
D) conscious sedation.

Question 13

An informed consent was to be obtained from the patient for his scheduled open cholecystectomy. Which circumstance could prevent the patient from signing his informed consent?

A) Pain radiating to the scapula
B) An injection of Demerol, 75 mg IM, 1 hour ago
C) The presence of jaundice and scleral icterus
D) His concern over his insurance company not covering the procedure

Question 14

Frequent monitoring of the postoperative patient's vital signs assesses which body system?

A) Gastrointestinal
B) Endocrine
C) Neurological
D) Cardiovascular

Question 15

What nursing interventions will minimize the effects of venous stasis?

A) Pillows under the knee in a position of comfort
B) Sitting with the feet flat on the floor
C) Early ambulation
D) Gentle leg massage

Question 16

The Patient's Bill of Rights states that a patient must give his or her permission for any specific test or procedure to be performed. What is the legal term for this permission?

A) Verbal consent
B) Medical documentation
C) Informed consent
D) Informed decision

Question 17

The nurse acknowledges that all preoperative nursing interventions have been performed by signing which document?

A) Nurse's notes
B) Anesthesia record
C) Preoperative checklist
D) Physician's order sheet

Question 18

The older adult patient may not respond to surgical treatment as well as a younger adult because of

A) poor skin turgor resulting in dehydration.
B) disturbed body image related to surgical incision.
C) his or her body's response to physiological changes.
D) decreased peristalsis related to general anesthesia.

Question 19

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.
B) Check airway for patency.
C) Check intravenous site.
D) Check vital signs.

Question 20

A patient is on postoperative day 2 after a nephrectomy. The nurse is aware that the most effective way to increase her peristalsis is

A) ambulation.
B) an enema.
C) encouraging hot liquids.
D) administering a laxative.

Question 21

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

Question 22

What is the responsibility of the nurse regarding informed consent?

A) Explain the surgical options.
B) Explain the operative risks.
C) Obtain the patient's signature.
D) Check form for appropriate signatures.

Question 23

Two considerations for the older adult surgical patient include (Select the two that apply.)

A) pre- and postoperative teaching.
B) lower morbidity and mortality.
C) quick assessment skills.
D) surgery causes much physiological stress.

Question 24

Although informed about the proposed surgical procedure, the patient has only vague responses about the postoperative period. A nursing diagnosis at this time would be

A) Impaired verbal communication.
B) Impaired gas exchange.
C) Deficient knowledge, postoperative.
D) Acute pain.

Question 25

Southeast Asian and Native American patients often do not make eye contact when preoperative teaching is being performed because

A) they aren't educated.
B) they aren't paying attention.
C) they believe eye contact is disrespectful.
D) they believe they are superior to the nurse.

Question 26

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

Question 27

A patient and a nurse develop a preoperative teaching plan. In teaching the patient to cough effectively after surgery, the nurse should tell her to practice

A) breathing through her nose, holding her breath, and exhaling slowly.
B) taking three deep breaths and coughing from the chest.
C) inhaling while contracting the abdominal muscles and exhaling while contracting the diaphragm.
D) taking short, frequent panting breaths and coughing from the throat to clear accumulated mucus.

Question 28

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 29

Ideally, preop teaching should be done

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 30

Sudden chest pain combined with dyspnea, cyanosis, and tachycardia is an indication of

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

Question 31

In preparing the patient for abdominal surgery, the Assistive Personnel (AP) can perform which interventions? (Select all that apply.)

A) Vital signs
B) Insertion of N/G tube
C) Enema
D) Height and weight
E) Obtain operative consent
F) Sterile gowning

Question 32

A postoperative patient who had a left inguinal hernia repair is ready for his discharge instructions. Which information should the nurse provide? (Select all that apply.)

A) Care of the wound site and any dressings
B) When he may operate a motor vehicle
C) Signs and symptoms to report to the physician
D) Call the physician's office once he arrives home
E) Report bowel movements to the physician
F) Actions and side effects of any medications

Question 33

Which early postoperative observation is abnormal and should be reported immediately?

A) Emesis that is red
B) Complaint of feeling cold
C) Nausea
D) Complaint of pain

Question 34

Which patients would be at greatest risk during surgery?

A) 78-year-old taking an analgesic agent
B) 43-year-old taking an antihypertensive agent
C) 27-year-old taking an anticoagulant agent
D) 10-year-old taking an antibiotic agent

Question 35

The nurse is assisting with the sponge and instrument count in the operating room. The operative phase in which the nurse is assisting is called the

A) perioperative phase.
B) preoperative phase.
C) intraoperative phase.
D) postoperative phase.

Question 36

An appendectomy during a hysterectomy would be classified as

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

Question 37

What are the high-risk conditions that may affect perioperative procedures? (Select all that apply):

A) Age, health, occupation, mental status
B) Financial income, health, nutritional status
C) Age, mental state, nutritional status, health
D) Occupation, age, nutritional status, health
E) Financial Income, occupation, age, health

Question 38

A patient will have an incision in the lower left abdomen. Which intervention by the nurse will help decrease discomfort in the incisional area when she coughs postoperatively?

A) Apply a splint directly over the lower abdomen.
B) Keep the patient flat with feet flexed.
C) Turn her on her right side.
D) Apply a splint above and below the incision.

Question 39

Which preoperative fear is linked to postoperative behavior?

A) Fear of anesthesia and death
B) Fear of death and malnutrition
C) Fear of unknown and lack of respect
D) Fear of malnutrition and addiction to new medications

Question 40

On the patient's return to the medical-surgical unit, the nurse performs an abdominal assessment. To assess bowel sounds, the nurse auscultates the lower abdomen for

A) 1 minute.
B) 5 to 20 seconds.
C) as long as it takes to hear a bowel sound.
D) one full inspiration and expiration.

Question 41

A patient is transferred from the operating room to the recovery room after undergoing an amputation of his left foot. Place the interventions in the correct order for immediate assessment once the patient enters the PACU. Place a comma between each answer choice (a, b, c, d, etc.).

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