Deck 41: Care of the Surgical Patient

Question 1

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

Answer 1

In the preoperative checklist

Question 2

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.

Answer 2

prevent arrhythmias related to 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?

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."

Answer 3

"Addiction rarely occurs in the brief time postsurgical analgesia is required."

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?

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

Question 5

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 6

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 physiological changes
D) Decreased peristalsis related to anesthesia

Question 7

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 8

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.

Question 9

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

A) observing for 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.

Question 10

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 11

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.

Question 12

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) Wash stockings in warm water and mild soap

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?

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 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:

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 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?

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

Question 16

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 eyedrops every day."

Question 17

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 18

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 19

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 20

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 21

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 22

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 23

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 24

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 25

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 26

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 27

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 28

Which interventions in preparing the patient for abdominal surgery may be delegated to unlicensed assistive personnel (UAP)?

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

Question 29

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

Question 30

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 31

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

Question 32

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 33

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 34

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 35

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 36

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 37

The type of anesthesia that uses a combination of drugs to reduce the level of consciousness and provides amnesia is _________________ __________.

Question 38

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 39

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 40

The nurse would include the nursing diagnosis 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 41

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

Question 42

Place the instructions for controlled coughing in the correct sequence. (Separate letters by a comma and space as follows: A, B, C, D)

A) Inhale deeply and hold breath for a count of three
B) Document exercise and patient reaction
C) Cough 2 or 3 times without inhaling then relax
D) Take several deep breaths
E) Inhale through nose
F) Exhale through pursed lips

Question 43

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

Question 44

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.

Question 45

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. (Separate letters by a comma and space as follows: A, B, C, D)

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