Deck 95: Care of Surgical Patients

Question 1

The nurse is completing a medication history for the surgical patient in preadmission testing.Which of the following medications should the nurse instruct the patient to hold in preparation for surgery?

A) Ibuprofen
B) Acetaminophen
C) Vitamin C
D) Miconazole

Answer 1

A
Nonsteroidal anti-inflammatory drugs (NSAIDs)such as ibuprofen inhibit platelet aggregation and prolong bleeding time,increasing susceptibility to postoperative bleeding.Acetaminophen is a pain reliever that has no special implications for surgery.Vitamin C actually assists in wound healing and has no special implications for surgery.Miconazole is an antifungal and has no special implications for surgery.

Question 2

The nurse and the nursing assistant are caring for a group of postoperative patients who need turning,coughing,deep breathing,incentive spirometer,and leg exercises.The nurse directs the nursing assistant to

A) Teach and demonstrate postoperative exercises.
B) Inform the nurse if the patient is unwilling to perform exercises.
C) Document in the medical record when exercises are completed.
D) Do nothing associated with postoperative exercises.

Answer 2

B
The nurse may delegate activities to individuals who are competent,within their scope of practice,and willing to be legally responsible-all while maintaining responsibility for follow-up and outcome.The nurse can delegate to a nursing assistant to encourage patients to practice postoperative exercises regularly after instruction,and to inform the nurse if the patient is unwilling to perform these exercises.The skills of demonstrating and teaching postoperative exercises and documenting are not within the scope of practice for the nursing assistant.Doing nothing is not appropriate.

Question 3

The nurse is caring for a postoperative patient with an abdominal incision.A pillow is used during coughing to provide

A) Pain relief.
B) Splinting.
C) Distraction.
D) Anxiety reduction.

Answer 3

B
Surgical incisions cut through muscles,tissues,and nerve endings.Deep breathing and coughing exercises place additional stress on the suture line and cause discomfort.Splinting incisions with hands and a pillow provides firm support and reduces incisional pull.Providing a pillow during coughing does not provide distraction or reduce anxiety.Providing a pillow does not provide pain relief.Coughing can increase anxiety because it can cause pain.

Question 4

The nurse is preparing a patient for surgery.Aims of assessment before surgery include

A) Establishing a patient's baseline of normal function.
B) Planning for care after the procedure.
C) Educating the patient and family about the procedure.
D) Gathering appropriate equipment for the patient's needs.

Question 5

The nurse is caring for a postoperative patient on the medical-surgical floor.To prevent venous stasis and the formation of thrombus after general anesthesia,the nurse encourages

A) Coughing.
B) Diaphragmatic breathing.
C) Incentive spirometry.
D) Leg exercises.

Question 6

The nurse is encouraging the postoperative patient to utilize diaphragmatic breathing.Reasons for this intervention include

A) Management of pain.
B) Decreased healing time.
C) Prevention of atelectasis.
D) Decreased thrombus formation.

Question 7

Which nursing assessment would indicate that the patient is performing diaphragmatic breathing correctly?

A) Hands placed on border of rib cage with fingers extended will touch as chest wall contracts.
B) Hands placed on chest wall with fingers extended will separate as chest wall contracts.
C) The patient will feel upward movement of the diaphragm during inspiration.
D) The patient will feel downward movement of the diaphragm during expiration.

Question 8

The nurse and the nursing assistant are assisting a postoperative patient to turn in the bed.To assist in minimizing discomfort,which instruction should the nurse provide to the patient?

A) "Close your eyes and think about something pleasant."
B) "Hold your breath and count to three."
C) "Hold my shoulders with your hands."
D) "Place your hand over your incision."

Question 9

The patient has presented to the ambulatory surgery center to have a colonoscopy.The patient is scheduled to receive moderate sedation (conscious sedation)during the procedure.Moderate sedation is used routinely for procedures that require

A) Performance on an outpatient basis.
B) A depressed level of consciousness.
C) Loss of sensation in an area of the body.
D) The patient to be immobile.

Question 10

The nurse is preparing to assist the patient in using the incentive spirometer.Which nursing intervention should the nurse provide first?

A) Perform hand hygiene.
B) Place in reverse Trendelenburg position.
C) Explain use of the mouthpiece.
D) Instruct the patient to inhale slowly.

Question 11

The nurse is caring for a patient in the postanesthesia care unit who has undergone a left total knee arthroplasty.The anesthesia provider has indicated that the patient received a left femoral peripheral nerve block.Which assessment would be an expected finding for a patient with this type of regional block?

A) Decreased pulse at the left posterior tibia
B) Left toes cool to touch and slightly cyanotic
C) Sensation decreased in the left leg
D) Patient report of pain in the left foot

Question 12

The nurse is caring for a patient in preadmission testing.The patient has been assigned a physical status classification by the American Society of Anesthesiologist of P3.Which of the following assessments would support this classification?

A) Denial of any major illnesses or conditions
B) Normal, healthy patient
C) History of hypertension, 80 pounds overweight, history of asthma
D) History of myocardial infarction that limits activity

Question 13

The nurse is precepting a student nurse and explains that perioperative nursing care occurs

A) Before, during, and after surgery.
B) In preadmission testing.
C) During the surgical procedure.
D) In the postanesthesia care unit.

Question 14

The nurse is caring for a patient in the postanesthesia care unit.The patient has developed profuse bleeding from the surgical site,and the surgeon has determined the need to return to the operative area.This procedure would be classified as

A) Elective.
B) Urgent.
C) Emergency.
D) Major.

Question 15

The nurse is caring for a potential surgical patient in the preadmission testing unit.The medication history indicates that the patient is currently taking warfarin (Coumadin).Which of the following actions should the nurse take?

A) Consult with the physician regarding a radiological examination of the chest.
B) Consult with the physician regarding an international normalized ratio (INR).
C) Consult with the physician regarding blood urea nitrogen (BUN).
D) Consult with the physician regarding a complete blood count (CBC).

Question 16

The nurse is caring for a preoperative patient.The nurse teaches the principles and demonstrates leg exercises for the patient.The patient is unable to perform leg exercises correctly.What is the nurse's best next step?

A) Assess for the presence of anxiety, pain, or fatigue.
B) Ask the patient why he does not want to do the exercises.
C) Encourage the patient to practice at a later date.
D) Assess the educational methods used to educate the patient.

Question 17

The nurse is providing preoperative teaching for the ambulatory surgery patient who will be having a cyst removed from the right arm.Which would be the best explanation for diet progression after surgery?

A) "Start with clear liquids, soup, and crackers. Advance to a normal diet as you tolerate."
B) "There is no limitation on your diet. You can have whatever you want."
C) "Stay on clear liquids for 24 hours. Then you can progress to a normal diet."
D) "Start with clear liquids for 2 hours, then full liquids for 2 hours. Then progress to a normal diet."

Question 18

The nurse is encouraging a reluctant postoperative patient to deep breathe and cough.What explanation can the nurse provide that may encourage the patient to cough more effectively?

A) "If you don't deep breathe and cough, you will get pneumonia."
B) "Deep breathing and coughing will clear out the anesthesia."
C) "Coughing will not harm the incision if done correctly."
D) "You will need to cough only a few times during this shift."

Question 19

The nurse explains the pain relief measures available after surgery during preoperative teaching for a surgical patient.Which of the following comments from the patient indicates the need for additional education on this topic?

A) "I will take the pain medication as the physician prescribes it."
B) "I will be asked to rate my pain on a pain scale."
C) "I will have minimal pain because of the anesthesia."
D) "I will take my pain medications before doing postoperative exercises."

Question 20

The nurse is caring for a patient who is scheduled to undergo a surgical procedure.The nurse is completing an assessment and reviews the patient's laboratory tests and allergies.In which perioperative nursing phase would this work be completed?

A) Perioperative
B) Preoperative
C) Intraoperative
D) Postoperative

Question 21

The nurse is caring for a patient in the operating suite.Which of the following outcomes would be most appropriate for this patient?

A) At the end of the intraoperative phase, the patient will be free of burns at the grounding pad.
B) At the end of the intraoperative phase, the patient will be free of infection.
C) At the end of the intraoperative phase, the patient will be free of nausea and vomiting.
D) At the end of the intraoperative phase, the patient will be free of pain.

Question 22

The ambulatory surgical nurse calls to check on the patient at home the morning after surgery.The patient is reporting continued nausea and vomiting.Which of the following discharge education points should be reviewed with the patient?

A) Instruct the patient to take deep breaths.
B) Instruct the patient to drink ginger ale and eat crackers.
C) Instruct and attempt to connect the patient with the physician.
D) Instruct the patient to go to the emergency department.

Question 23

The nurse has administered an anxiolytic as a preoperative medication to the patient going to surgery.Which of the following is the best next step?

A) Waste any unused medication according to policy.
B) Notify the operating suite that the medication has been given.
C) Instruct the patient to call for help to go to the restroom.
D) Ask the patient to sign the consent for surgery.

Question 24

The postanesthesia care unit (PACU)nurse transports the inpatient surgical patient to the medical-surgical floor.Before leaving the floor,the medical-surgical nurse obtains a complete set of vital signs.What is the rationale for this nursing action?

A) The first action in a head-to-toe assessment is vital signs.
B) This is done to compare and monitor for vital sign variation during transport.
C) This is done to ensure that the medical-surgical nurse checks on the postoperative patient.
D) This is done to follow hospital policy and procedure for care of the surgical patient.

Question 25

The nurse is caring for a patient in the preoperative holding area of an ambulatory surgery center.Which nursing action would be most appropriate for this area?

A) Monitor vital signs every 15 minutes.
B) Empty the urinary drainage bag.
C) Apply a warm blanket.
D) Check the surgical dressing.

Question 26

The nurse is caring for a patient in the operating suite who is experiencing hypercarbia,tachypnea,tachycardia,premature ventricular contractions,and muscle rigidity.The nurse suspects that this patient may be experiencing

A) Hypoxia.
B) Malignant hyperthermia.
C) Fluid imbalance.
D) Hemorrhage.

Question 27

The nurse is caring for a patient intraoperatively.Primary roles of the circulating nurse include

A) Establishing and implementing the plan of care.
B) Maintaining a sterile field.
C) Assisting with applying sterile drapes.
D) Handing sterile instruments and supplies to the surgeon.

Question 28

The nurse is monitoring a patient in the postanesthesia care unit (PACU)for postoperative fluid and electrolyte imbalance.Which of the following actions would be most appropriate for this patient?

A) Encourage copious amounts of water.
B) Weigh the patient and compare with preoperative weight.
C) Measure and record all intake and output.
D) Start an additional intravenous (IV) line.

Question 29

The nurse is concerned about the skin integrity of the patient in the intraoperative phase of surgery.Which of the following actions helps to minimize skin breakdown?

A) Encouraging the patient to bathe before surgery
B) Securing attachments to the operating table with foam padding
C) Periodically adjusting the patient during the surgical procedure
D) Measuring the time a patient is in one position during surgery

Question 30

The nurse is caring for a postoperative patient who has had a carpel tunnel repair.The patient has a temperature of 97° F and is shivering.Which of the following is the best reason for this condition?

A) The patient is dressed only in a gown.
B) Anesthesia lowers metabolism.
C) The surgical suite has laminar flow.
D) The open body cavity contributed to heat loss.

Question 31

The nurse is caring for a patient in the postanesthesia care unit.The patient asks for a bedpan and states to the nurse,"I feel like I need to go to the bathroom,but I can't." Which of the following nursing interventions would be most appropriate?

A) Encourage the patient to wait a minute and try again.
B) Call the physician and obtain an order for catheterization.
C) Assess the patient's intake and the patient for bladder distention.
D) Inform the patient that everyone feels this way after surgery.

Question 32

The nurse is caring for a patient who will undergo a coronary artery bypass graft procedure.What level of care will the patient require immediately post procedure?

A) Acute care-medical-surgical unit
B) Acute care-intensive care unit
C) Ambulatory surgery
D) Ambulatory surgery-extended stay

Question 33

The nurse is caring for a postoperative patient with a history of obstructive sleep apnea.The nurse monitors for which of the following?

A) Choking and noisy, irregular respirations
B) Shallow respirations
C) Moaning and reports of pain
D) Disorientation

Question 34

The nurse has completed a preoperative assessment for a patient going to surgery and gathers assessment data.Of the following,which would be the most important next step?

A) Notify the operating suite that the patient has a latex allergy.
B) Document that the patient had a bath at home this morning.
C) Ask the nursing assistant to obtain vital signs.
D) Administer the ordered preoperative intravenous antibiotic.

Question 35

The nurse is caring for an ambulatory surgery patient.To be discharged home,what criteria must the patient meet?

A) Able to drink fluids
B) Able to eat crackers
C) Manageable pain
D) Able to void
E) Dry and intact dressing
F) Able to dress self

Question 36

During preoperative assessment for a 7:30 case,the patient indicates to the nurse that he had a cup of coffee this morning.The nurse reports this information to the anesthesia provider anticipating

A) A delay in or cancellation of surgery.
B) Questions regarding components of the coffee.
C) Additional questions about why the patient had coffee.
D) Instructions to determine what education was provided in the preoperative visit.

Question 37

The nurse is precepting a new nurse in the perioperative area.The nurse explains that perioperative nursing is based on certain principles and includes

A) Purchasing the correct equipment.
B) Providing high-quality and patient safety-focused care.
C) Scheduling the right types of patients.
D) Conducting multidisciplinary teamwork.
E) Ensuring effective therapeutic communication.
F) Providing advocacy for the patient.

Question 38

The nurse is preparing a patient for a surgical procedure on the right great toe.Which of the following actions would be most important to include in this patient's preparation?

A) Ascertain that the surgical site has been correctly marked.
B) Ascertain where the family will be located during the procedure.
C) Place the patient in a clean surgical gown.
D) Ask the patient to remove all hairpins and cosmetics.

Question 39

The nurse is making a preoperative education appointment with a patient.The patient asks if he should bring family with him to the appointment.What is the best response by the nurse?

A) "There is no need for an additional person at the appointment."
B) "Your family can come and wait with you in the waiting room."
C) "We recommend including family in this appoint to ease everyone's anxiety."
D) "It is required that you have a family member at this appointment."

Question 40

The nurse is reviewing the surgical consent with the patient during preoperative education.The patient indicates that he does not understand what procedure will be completed.What is the nurse's best next step?

A) Notify the physician about the patient's question.
B) Explain the procedure that will be completed.
C) Ask the patient to sign the form.
D) Continue with preoperative education.

Question 41

The nurse is caring for a patient in the operating suite.The nurse assists in positioning the patient to

A) Gain access to the operative site.
B) Sustain adequate circulatory and respiratory function.
C) Ensure patient safety and skin integrity.
D) Support the use of equipment.
E) Maintain neuromuscular structures.
F) Provide warmth and comfort.

Question 42

The nurse is providing preoperative education and reviews with the patient what it will be like to be in the surgical environment.What points should the nurse include?

A) The surgical area is cold but warm blankets will be provided.
B) The surgical staff will be dressed in special clothing with hats and masks.
C) The operative suite will be very dark.
D) Families are not allowed in the operating suite.
E) The operating table or bed will be comfortable and soft.
F) The nurses will be there to assist you through this process.

Question 43

The nurse is caring for a postoperative patient with an incision.Which of the following nursing interventions have been found to decrease wound infections?

A) Perform hand hygiene before and after contact with the patient.
B) Maintain normoglycemia.
C) Use hair clippers to remove hair.
D) Administer antibiotics within 30 to 60 minutes of incision time.
E) Provide bath and linen change daily.
F) Perform first dressing change 1 week postoperatively.

Question 44

The nurse is preparing for a patient who will be going to surgery.The nurse screens for risk factors that can increase a person's risks in surgery.What risk factors are included in the nurse's screening?

A) Age
B) Nutrition
C) Race
D) Obesity
E) Pregnancy
F) Ambulatory surgery

Question 45

The nurse is using a preoperative checklist to assist in preparing a patient on the day of surgery.What will the checklist include?

A) Vital signs
B) Laboratory data
C) Living will
D) NPO
E) Identification (ID) band on
F) Family location