Perioperative Nursing 001 1.) Which of the following is most dangerous complication during induction of spinal anesthesia? A.

)Tachycardia B.)Hypotension C.)Hyperthermia D.)Bradypnea Ans: B 2.) Which type of surgery is most likely to predispose a patient to postoperative atelectasis, pneumonia or respiratory failure? A.)Upper abdominal surgery on an obese patient with a long history of smoking B.)Upper abdominal surgery on a patient with normal pulmonary function C.)Lower abdominal surgery on a young patient with diabetes mellitus D.)Surgery on the extremities of a nonsmoking football player Ans: A

B.) Vital signs C.) Patient identification and correct operative consent D.) Positioning and skin preparation Ans: C 6.) What is the primary reason for the gradual change of position of the patient after surgery? A.) To prevent muscle injury B.) To prevent sudden drop of BP C.) To prevent respiratory distress D.) To promote comfort Ans: B 7.) Which of the following assessment data is most important to determine when caring for a patient who has received spinal anesthesia? A.) The time of return of motion and sensation in the legs and toes B.) The character of respiration C.) Level of consciousness D.) Amount of wound drainage Ans: A

3.) Which of the following characterizes excitement stage of anesthesia A.) Occurs from the administration of anesthesia to the loss of consciousness B.) Extends from the loss of consciousness to the loss of lid reflex, characterized by struggling and talking C.) From the loss of lid reflex to the loss of most reflexes D.) From the loss of most reflexes to respiratory and circulatory failure Ans: B 4.) To prevent headache after spinal anesthesia the patient should be positioned: A.) Semi-fowlers B.) Flat on bed for 6 to 8 hours C.) Prone position D.) Modified trendelenburg Ans: B

8.) Which of the following postop findings should the nurse report to the M.D.? A.) The patient pushes out the oral airway wit h his tounge B.) Urine output is 20ml/hr for the past two hours C.) VS are as follows: BP=110/70;PR=95;RR=19,Temp=36.8C D.) Wound drainage is serosanguinous Ans: B 9.) Which of the following is the earliest sign of poor respiratory function? A.) Cyanosis B.) Fast thready pulse C.) Restlessness D.) Faintness Ans: C 10.) If wound eviscerations occurs, the immediate nursing action is: A.) Cover the wound with sterile gauze moistened with sterile NSS B.) Cover the wound with water-soaked gauze C.) Cover the wound with sterile dry gauze D.) Leave the wound uncovered and pull the skin edges together

5.) Which of the following nursing actions should be given highest priority when admitting the patient into the operating room? A.) Level of consciousness

Ans: A 11.) Appendectomy is classified as A.) Ablative B.) Constructive C.) Reconstructive D.) Palliative Ans: A

the preoperative period? A.) Explaining all procedures thoroughly in chronological order B.) Spending time listening to the patient and answering questions C.) Encouraging sleep and limiting interruptions D.) Reassuring the patient that the surgical staff are competent professional Ans: B

12.) The worst of all fears among clients undergoing surgery is: A.) Fear of financial burden B.) Fear of death C.) Fear of the unknown D.) Fear of loss of job Ans: C 13.) The best time to provide preoperative teaching on deep breathing, coughing and turning exercises is: A.) Before administration of preoperative medications B.) The afternoon or evening prior to surgery C.) Several days prior to surgery D.) Upon admission of the client in the recovery room Ans: B 14.) The following are the appropriate nursing actions before administration of preoperative medications EXCEPT: A.) Ascertain the consent has been signed B.) Ensure that NPO has been maintained C.) Instruct patient to empty his bladder D.) Shave the skin at the site of surgery Ans: D 15.) The patient has been observed pacing along the hallway, goes to the bathroom frequently and asks questions repeatedly during preoperative assessment. The most likely cause of the behavior is: A.) She is anxious about the surgical procedure B.) She is worried about separation from the family C.) She has urinary tract infection D.) She has an underlying emotional problem Ans: A 16.) Which of the following nursing actions would help the patient decrease anxiety during

17.) Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery? A.) To prevent malnutrition B.) To prevent electrolyte imbalance C.) To prevent aspiration pneumonia D.) To prevent intestinal obstruction Ans: C 18.) The following ensure validity of informed written consent EXCEPT: A.) The patient is of legal age with proper mental disposition B.) The consent has been secured within 24 hours before the surgery C.) If the patient is unable to write, secure the consent from a relative D.) The consent is secured before administration of any medication that alter the level of consciousness Ans: C 19.) Which of the following drugs is administered to minimize respiratory secretions preop? A.) Valium (Diazepam) B.) Nubain ( Nalbuphine HCL) C.) Phenergan (Promethazine) D.) Atropine Sulfate Ans: D 20.) Which of the following is experienced by the patient who is under spinal anesthesia? A.) The patient is unconscious B.) The patient is awake C.) The patient experiences amnesia D.) The patient experiences total loss of sensation Ans: B 21.) The patient who has undergone TAHBSO complains of pain. Which of the following is an

initial nursing action? A.) Administer the PRN analgesics B.) Instruct to do deep breathing exercises C.) Assess the VS D.) Change the patients position Ans: C 22.) How frequent should the nurse monitor the VS of the patient in the recovery room? A.) Every 15 minutes B.) Every 30 mins C.) Every 45 mins D.) Every 60 mins Ans: A 23.) Which of the following drugs is given to relieve nausea and vomiting? A.) Mepivacaine B.) Aquamephyton C.) Nubain D.) Plasil Ans: D 24.) The most important factor in the prevention of postop infection is: A.) Proper administration of antibiotics B.) Fluid intake of 2-3L/day C.) Practice of strict aseptic techniques D.) Frequent change of wound dressings Ans: C 25.) Which of the following primarily prevents postop complications? A.) Adequate fluid intake B.) Early ambulation C.) Well-balanced diet D.) Administration of antimicrobials Ans: B Situation: A female client, 23 y/o was admitted for the first time at the Fatima Hospital with the chief complaint of Right Iliac Pain, accompanied by nausea and vomiting, chills and fever. She was diagnosed to have acute appendicitis. She was scheduled to have emergency appendectomy under spinal anesthesia 26.) Pre-op instructions to the client would include the following EXCEPT: A.) Deep breathing and coughing exercise

B.) Turning to sides C.) Foot and leg exercises D.) reassuring her that narcotics will be given every 4 hours round the clock until she is discharged Ans: D 27.) The client gave her consent for the surgery. To ensure the legality of the consent, the following conditions must be met EXCEPT: A.) She gave her consent freely B.) She must understand the nature of the surgery C.) The consent must be signed by a witness D.) Signing should be done after the administration of pre-anesthesia meds Ans: D 28.) The skin is shaved prior to surgery in order to: A.) Facilitate skin incision B.) Indicate the site to be draped C.) To prevent wound infection D.) Reduce post op scarring Ans: C 29.) The important nursing intervention prior to administration of pre-anesthetic medication is: A.) Ask patient to empty the bladder B.) Do deep breathing and coughing exercises C.) Regulate IVF accurately D.) Shave the skin Ans: A 30.) Immediately following spinal anesthesia, the greatest risk is: A.) Severe hemorrhage B.) Severe Hypotension C.) Severe Hypoglycemia D.) Hypertensive crisis Ans: B 31.) Nursing measures to promote the clients respiratory function during recovery from anesthesia are the following EXCEPT: A.) Encourages deep breathing and coughing exercises B.) Administer Humidified oxygen C.) Place in semi-fowlers position D.) Place in supine position with head turned to the side without pillow support

Ans: C 32.) Which of the following criteria must be met before the client is released from the RR to the unit. A.) Breathes with ease, coughs freely B.) Has regained consciousness C.) Vital signs fluctuates erratically D.) Able to move four extremities Ans: C 33.) Early signs of poor respiratory function include which of the following A.) Cyanosis B.) Hypotension C.) Loss of consciousness D.) Restlessness Ans: D 34.) Post operatively, the client must be encouraged to turn, cough and deep breathe: A.) Every 1-2 hours B.) Every 4 hours C.) Every 30 Mins D.) Every 8 hours Ans: A 35.) A client in shock must be placed in: A.) High-fowlers position B.) Sims position C.) Modified trendelenburg D.) Prone position Ans: C

38.) Post operatively, a patient is expected to void after: A.) 6-8 hours B.) 2-4 hours C.) 12-24 hours D.) 10-12 hours Ans: A 39.) Headache after spinal anesthesia is due to: A.) Paralysis of vasomotor nerves B.) Traction placed on structures within abdomen C.) Loss of CSF through dural hole D.) Administration of large amounts and heavy concentration of anesthetic agents Ans: C 40.) Nursing measures for post-op thrombophlebitis include the following EXCEPT: A.) Maintain bedrest B.) Elevate affected leg with pillow support C.) Massage the painful extremities D.) Apply antiembolic stockings Ans: C 41.) Nursing measures to relieve hiccups include the following EXCEPT: A.) Exhale and inhale through a paper bag B.) Apply pressure over the eyeball through closed eye lids C.) Hold breath while taking a large pulp of water D.) Administer high concentration of oxygen Ans: D

36.) The most important factor in the prevention of post op wound infection is: A.) Adequate fluid intake B.) Proper administration of antibiotics C.) Practice of strict aseptic technique D.) Frequent cleaning of the wound Ans: C 37.) When the patient vomits, the most important nursing objective is to prevent: A.) Dehydration B.) Aspiration C.) Rupture of suture line D.) Met. Alkalosis Ans: B

42.) Modified radical mastectomy involves: A.) Removal of the entire breast, axillary lymph nodes, pectoralis muscle B.) Removal of the lump of the breast C.) Removal of the entire breast, axillary and neck lymph nodes, including pectoralis muscles D.) Removal of the entire breast but nipple remains intact Ans: A 43.) Which of the following is not appropriate nursing intervention after modified radical mastectomy? A.) Place in semi fowlers position and elevate arm on the affected side with pillow support

B.) Check behind the client for bleeding C.) Monitor output from wound suction drainage D.) Immobilize the arm on affected side in adduction Ans: D 44.) A fluid challenge is begun with a post-op gastric surgery client. Which assessment will give the best indication of client response to this treatment? A.) CVP readings and hourly urine output B.) Blood pressure and apical rate checks C.) Lung sounds and arterial blood gases D.) Electrolytes, BUN, creatinine results Ans: A

D.) Deep-breathing will prevent post op vomiting and intestinal distention Ans: B 48.) Prior to having a subtotal gastrectomy, a client is told about the dumping syndrome. The nurse explains that it is: A.) The bodys absorption of toxins produced by liquefaction of dead tissue B.) Formation of an ulcer at the margin of the gastrojejunal anastomosis C.) Obstruction of venous flow from the stomach into the portal system D.) Rapid emptying of food and fluid from the stomach into the jejunum Ans: D

45.) A client is scheduled for a subtotal gastrectomy. In anticipation of clarifying information for client education, the nurse knows that vagotomy is done as part of the surgical treatment for peptic ulcers in order to A.) Decrease secretion of hydrochloric acid B.) Improve the tone of the GI muscles C.) Increase blood supply to the jejunum D.) Prevent the transmission of pain impulses Ans: A 46.) Which of the following facts best explains why the duodenum is not removed during a subtotal gastrectomy? A.) The head of the pancreas is adherent to the duodenal wall B.) The common bile duct empties into the duodenal lumen C.) The wall of the jejunum contains no intestinal villi D.) The jejunum receives its blood supply through the duodenum Ans: B 47.) During the immediate postoperative period following gastric surgery, why must the nurse be particularly conscientious about encouraging a client to cough and deep-breathe at regular intervals? A.) Marked changes in intrathoracic pressure will stimulate gastric drainage B.) The high abdominal incision will lead to shallow breathing to avoid pain C.) The phrenic nerve will have been permanently damaged during the surgical procedure

49.) Which of the following statements by a client recovering from a subtotal gastrectomy would indicate a need for additional teaching about the diet protocol for dumping syndrome? A.) I plan to eat a diet low in carbohydrates and high in protein and fat B.) I plan to eat a diet high in CHO and low in CHON and fat C.) I will eat slowly and avoid drinking fluids during meals D.) I will try to assume a recumbent position after meals for 30 mins to 1 hour to enhance digestion and relieve symptoms Ans: B 50.) A 40 y/o female client has arrived in the post anesthesia room following a cholecystectomy and a common bile duct exploration. She is semi conscious. Her vital signs are within normal limits. Which of the following nursing actions would be inappropriate? A.) Apply a warm blanket to her body B.) Place her in a semi-fowlers position C.) Attached her T-tube to gravity drainage D.) Set up low, intermittent suction for her NGT Ans: B