Question 1

A patient is admitted for surgery with a BMI of 30. In what way does obesity cause potential complications during the surgical process?

Accepted Answer

The obese patient is more likely to develop an infection. Increased numbers of fat cells associated with obesity are more vulnerable to infection during the surgical process. Added weight also makes the obese patient more difficult to move and turn, increasing the risk of infection due to inactivity.

Question 2

The nurse is performing a preoperative assessment on a patient before a colon resection and notes the patient's blood pressure is elevated to 142/90 mmHg. What should the nurse do next?

Accepted Answer

When checking a preoperative blood pressure and determining the level is elevated at 142/90 mmHg, the nurse should record the vital sign in the chart, allow the patient to rest quietly in a room, and recheck in 30 minutes. The patient could be anxious about the upcoming surgery or could have another condition manifesting as elevated blood pressure. The nurse should notify the physician but the surgery does not necessarily need to be rescheduled.

Question 3

Which types of precautions must the nurse consider when weighing a patient who needs to use a sling scale?

Accepted Answer

When using a sling scale to weigh a patient, the nurse should weigh the patient while wearing the same types of clothing each time and ensure the bed rails are up when rolling the patient onto the sling. Wearing the same types of clothing reduces the chance for significant weight differences related to clothing; a patient may wear a hospital gown for most weights. Ensuring the bed rails are up prevents the patient from rolling out of bed and becoming injured while being moved onto the sling.

Question 4

Which of the following is a type of intervention the nurse can employ with a patient who is suffering from memory problems during the teaching portion of the preoperative period?

Accepted Answer

When providing teaching for a patient with memory loss, the nurse can reduce outside distractions by closing the door and turning off the television. This intervention may help the patient to concentrate more closely on what the nurse is saying. Involving family members and presenting concepts in a concrete manner are important to help the patient better understand the procedure. The nurse should correct misinformation right away instead of allowing the patient to be misinformed; they can address this by writing down facts about the surgery for the patient to remember.

Question 5

Which of the following actions should the nurse perform when trying to interview a patient with a language barrier when there is no interpreter available?

Accepted Answer

If an interpreter is not available and the nurse must speak to a patient with a language barrier, they should act out some words while saying them to facilitate better understanding. The nurse may be unaware of how much English the patient actually knows. Pantomiming while speaking gives a visual cue to the patient about what information the nurse is trying to convey.

Question 6

The nurse is preparing to insert a nasogastric tube into a patient as part of a preoperative procedure. Which of the following is a true statement regarding placement of a nasogastric tube?

Accepted Answer

During placement of a nasogastric tube, the patient may need to sip water during the procedure to help advance the tube. As the tube is being placed, it may reach a slight obstruction at the back of the throat, and sipping water helps to facilitate passage of the tube. Swallowing while sipping water may also help to reduce the patient's urge to gag or vomit during the procedure.

Question 7

As part of a preoperative examination, the nurse depresses the patient's tongue with a tongue depressor and moves it from side to side. This test is an example of examining which cranial nerve?

Accepted Answer

Depressing the patient's tongue with a tongue depressor and moving it from side to side is an example of examining cranial nerve XII, the hypoglossal nerve. This nerve controls tongue movement and has an impact on the movement of saliva through swallowing. If the patient is going to be intubated for the surgical procedure, damage to the tongue may affect swallowing and speech.

Question 8

Which of the following must the nurse ask about when preparing to use Hypaque for arteriography?

Accepted Answer

The nurse should ask if the patient is allergic to shellfish. An allergy to shellfish may indicate sensitivity to iodine, which is one of the components of Hypaque. This solution is used as a contrast medium for exams such as arteriography. The nurse should assess for iodine sensitivity before administering the contrast to avoid any allergic reactions.

Question 9

The patient is being extubated at the end of the surgical procedure. The cuff has been deflated and the mouth and tube have been suctioned. What is the next step in this process?

Accepted Answer

The next step of the extubation process is to insert a suction catheter into the tube and apply suction while pulling the tube out. This process helps to remove secretions in the trachea while simultaneously removing the tube. The nurse should have oxygen nearby to administer after the tube has been removed in case the patient does not tolerate the procedure right away.

Question 10

Which of the following is a purpose of invasive hemodynamic monitoring during the surgical procedure?

Accepted Answer

The purpose of invasive hemodynamic monitoring during the surgical procedure is to measure the effectiveness of the heart muscle. Hemodynamic monitoring gives the nurse a clinical picture of the heart's function. Often, this type of monitoring also shows the nurse potential cardiac changes before the patient starts to show changes in clinical status.

Question 11

Which of the following interventions must the nurse consider when giving a patient furosemide?

Accepted Answer

When giving furosemide, the nurse should administer the drug slowly, over approximately two minutes, and check and document the patient's potassium levels after administration. Furosemide is an example of a diuretic, which will cause the patient to excrete more urine. Increased urine excretion leads to the possibility of increased potassium excretion as well, and hypokalemia may develop.

Question 12

In what position would the perioperative nurse most likely position a patient for a temporal craniectomy?

Accepted Answer

The patient undergoing a temporal craniectomy would most likely be in a sitting position. This position gives the surgeon clear access to the temporal bone of the skull. The patient's hands rest on their lap and they are secured to the table. Repositioning and moving after the procedure must be done gradually to prevent changes in blood pressure if the patient is moved from this position to that of a lower level, such as semi-Fowler or supine.

Question 13

Which of the following actions must the nurse consider when setting up or using a laser unit for surgery?

Accepted Answer

The nurse must move laser equipment carefully to avoid running into objects and damaging internal components. Depending on the type of equipment, laser units may be difficult to move, or transporting may not be the responsibility of the perioperative nurse. However, movement of this equipment involves careful consideration for the route of choice to avoid bumping the equipment or causing damage. This could lead to equipment malfunctioning, which can be very dangerous when trying to use the laser in future surgeries.

Question 14

What is the purpose of having a case cart with operating supplies sent from central processing for a surgical procedure?

Accepted Answer

The purpose of having a case cart sent from central processing for a surgical procedure is that it reduces the amount of supplies and materials in the operating room, allowing more room for the procedure. Some supplies can remain stored in the operating room, while central processing can distribute case carts, which should carry most of what the surgical team needs for a procedure. The cart can be sent back for sterilizing of materials when the procedure is done, and this clears the room for the next surgery.

Question 15

When working around a sterile field, which of the following measures will result in contamination?

Accepted Answer

Adjusting the patient's drape after placement will result in contamination of the field. Drapes are placed on a patient to maintain the sterile field and are usually secured in place with clips. Once they are in place, they should not be moved or adjusted, as this can contaminate the area near the incision. Drapes should remain in place throughout the procedure unless they become torn.

Question 16

A patient is transferred to the PACU and presents with snoring respirations and little chest expansion while breathing. The nurse notes that their oxygen saturations are at 94% and starting to decrease. What is the nurse's first action?

Accepted Answer

The nurse should stimulate the patient to take deeper breaths. The patient may be in a relaxed state following anesthesia and the tongue muscle may slip backward, partially occluding the airway. By stimulating the patient, they may awaken slightly and take several deep breaths, reducing snoring and increasing respiratory effort and oxygen saturations. If depressed respirations continue, the nurse should consider repositioning the patient and administering oxygen.

Question 17

Which of the following nursing diagnoses is the patient most likely to have during the recovery period after surgery?

Accepted Answer

The patient is most likely to have a nursing diagnosis of ineffective thermoregulation. Anesthesia may have an effect on the patient's ability to control their temperature; additionally, the patient may have been exposed on the operating room table for several hours. Although each patient is an individual and may have many different types of nursing diagnoses after transfer, ineffective thermoregulation may be more common. The nurse should assess temperature frequently and keep the patient covered with blankets to preserve heat.

Question 18

What aspects of the PACU may help the psychological wellbeing of the patient recovering from surgery?

Accepted Answer

The PACU often has low lighting so the patient is not exposed to harsh glare during recovery. The atmosphere of the PACU is often conducive to rest and quiet, to facilitate a smooth transition through the recovery process. Some patients wake up from anesthesia in combative states and extra noise, people or monitors may only further promote anxiety.

Question 19

The patient arrives in the recovery room with a blood pressure of 148/100 mmHg. Upon report from the anesthesiologist, the patient has no cardiac history and is currently asymptomatic. What is the nurse's next action?

Accepted Answer

The nurse should assess the patient for increased pain and anxiety and listen to the patient's heart and lung sounds. If the patient does not have a cardiac history and has an elevated blood pressure, they may be suffering from anxiety or may have pain that is causing their blood pressure to rise. Additionally, the nurse should listen to cardiac and respiratory sounds to detect abnormalities. Increased blood volume or pulmonary edema may also cause hypertension.

Question 20

A patient is transferred to the post-surgical unit and the nurse receives a report on their status. During the report, they are notified that the patient has a history of thrombocytopenia. Which of the following measures should the nurse perform to reduce the risk of this patient developing a blood clot?

Accepted Answer

In order to reduce the risk of a blood clot, the nurse should provide prophylactic aspirin as ordered to reduce clot formation and tell the patient to avoid crossing their legs. Aspirin works as an anticoagulant to prevent platelets from sticking together. The patient should refrain from crossing their legs, which can occlude the vessels in the lower legs and promote clotting.

Quiz 1: Essential Nursing Considerations During the Perioperative Period