PRELIM QUIZ 1 - PERIOPERATIVE NURSING (NICE)

Multiple Choice: Identify the choice that best completes the statement or answers the question.

1. The preoperative phase encompasses which period of time?

A. Entry to the operating suite until admission to postanesthesia care
B. Entry into the operating suite until discharge from the hospital
C. The decision to have surgery until admission to postanesthesia care
D. The decision to have surgery until entry to the operating suite

2. A 2-year-old child is scheduled for a tonsillectomy. When determining the plan of care, the nurse
should:
A. Include the parents or caregivers in the plan of care.
B. Explain to the child that she will have a sore throat after surgery.
C. Tell the child that she can have her favorite foods for the first 24 hours after surgery.
D. Prepare the child for discharge from the hospital as soon as she is alert.

3. The focus of nursing activities in the preoperative phase is to:

A. Admit the patient to the surgical suite.
B. Prepare the patient mentally and physically for surgery.
C. Set up the sterile field in the operating room.
D. Perform the primary surgical scrub to the surgical site.

4. A patient is scheduled for abdominal surgery tomorrow. While gathering preoperative data, the
nurse learns that the patient takes the following medications daily: an anticoagulant, a
multivitamin, and vitamin E 1,500 IU. The patient reports that he stopped taking the
anticoagulant 4 days ago as instructed by the surgeon. He has continued to take the
multivitamin and vitamin E. Based on the information given, the nurse telephones the surgeon
because she:
A. Needs an order to restart the anticoagulant.
B. Iis concerned about continued use of the multivitamin.
C. Is concerned about the vitamin E dosage.
D. Thinks the surgery should be delayed until further notice.

5. A patient is admitted for hip surgery. The patient usually takes the following medications daily:
an anticoagulant, a multivitamin, and vitamin E 1,500 IU. He stopped taking his anticoagulant 4
days ago as instructed by his surgeon, but has continued to take the multivitamin and vitamin E.
An important collaborative problem or nursing diagnosis for this patient is which of the
following?
A. Potential complication: anemia
B. Risk for infection related to inadequate anticoagulant dosage
C. Risk for noncompliance related to inability to follow instructions
D. Potential complication: increased bleeding

6. A patient is admitted from a local skilled nursing facility to the outpatient surgery center for
surgical débridement of a stage IV sacral pressure ulcer. The perioperative nurse discovers that
the patient does not have a signed consent form for the surgery on the chart or in the surgery
center. The patient says that she has not talked to the surgeon and that she has many questions
regarding her surgery. When informed of this, the surgeon tells the nurse to have the patient
sign the informed consent form, and he will review it prior to the surgery. What should the nurse
do?
A. Follow the surgeon’s orders, and ask the patient to sign the surgical consent form.
B. Inform the surgeon that she will have the patient sign after he discusses the surgery with
the patient.
C. Ensure that the signed surgical consent is witnessed by two nurses, because the surgeon is
not available.
 D. Cancel the surgery and transfer the patient back to the long-term care facility.

7. Identify the type of surgery a terminally ill patient will undergo if the purpose is removal of tissue
to relieve pain.
A. Procurement C. Palliative
B. Ablative D. Diagnostic

8. A patient had a hiatal hernia repair earlier today and is now in the postanesthesia care unit
(PACU). The family asks the nurse why the patient is in the PACU rather than back in his room on
the postsurgical unit. The nurse should inform the family that:
A. Patients who have had surgical complications are observed in the PACU until they are
stable enough to return to the floor.
B. Patients recover from the effects of anesthesia in the PACU and then return to the
postsurgical unit for further care.
C. The PACU is a holding area for patients awaiting a surgical unit bed or awaiting adequate
staff to provide care on the postsurgical unit.
D. The nurse will ask the surgeon explain to them why the patient is not on the postsurgical
unit, as is the usual procedure.

9. The focus of nursing care in the intraoperative phase is to:

A. Prepare the patient for surgery.
B. Maintain the sterile field.
C. Ensure patient safety during the surgery.
D. Obtain a signed informed consent.

10. The nurse has a prescription to give a series of medications on an “on call” basis. The nurse
realizes that these medications will be given:
A. In the postanesthesia recovery unit.
B. At the time specified in the order.
C. On the patient’s arrival in the surgery suite.
D. When the OR staff notify the nurse to do so.

11. A patient has chronic confusion secondary to dementia. As a result, he is unable to sign an
informed consent for surgery. In this situation:
A. An informed consent is not needed.
B. Two nurses may sign the informed consent for the patient.
C. The surgeon must sign the informed consent.
D. A family member will be asked to sign the informed consent.

12. Surgeries are commonly classified by which of the following? Choose all that apply.
A. Acuity C. Length of surgery
B. Level of urgency D. Organ involved

13. The nurse is caring for a patient who had abdominal surgery 3 days ago and will be discharged
home later today. The nurse will know that teaching is effective if the patient does which of the
following? Choose all that apply.
A. Describes clinical findings associated with infection
B. Performs the dressing change as prescribed
C. Demonstrates freedom from surgical incision pain
D. Completes the regimen of prescribed antibiotics

14. Which of the following members of the operative team use sterile technique during the surgical
procedure? Choose all that apply.
A. Surgeon
B. Anesthetist
C. Scrub nurse
D. Registered nurse first assistant
15. Which of the following are potential complications of anesthesia? Choose all that apply.
A. Hypothermia C. Cardiovascular compromise
B. Respiratory depression D. Aspiration

16. A young adult woman is scheduled for a bilateral breast reduction under general anesthesia. She
is normally healthy and takes no daily medications. Identify the preoperative screening tests
appropriate for this patient. Choose all that apply.
A. Urinalysis C. Creatinine clearance
B. EKG D. CBC

17. Identify the desired effects of general anesthesia. Choose all that apply.
A. Reduction of risk C. Amnesia
B. Analgesia D. Muscle relaxation

18. The preoperative nurse is preparing a patient for surgery. Identify the interventions the nurse
will perform. Choose all that apply.
A. Inform the family to wait in the surgical waiting room.
B. Prepare the surgical suite for the operation.
C. Remove the patient’s dentures and contact lenses.
D. Assist the patient to complete a living will.

19. A patient had a colon resection for removal of a cancerous tumor. Postoperatively, on the
surgical floor which of the following activities would the nurse perform for the purpose of
decreasing the risk of postoperative complications? Choose all that apply.
A. Assist the patient to turn, breathe deeply, and cough every 2 hours.
B. Teach the patient about the type of tumor removed.
C. Assess the drainage from the surgical site.
D. Monitor vital signs on a regular basis.

20. A patient returns from surgery with a nasogastric tube and intermittent gastric suction to
provide abdominal decompression. Which of the following are correct nursing activities for
managing the equipment and drainage? Choose all that apply.
A. Wear nonsterile procedure gloves when emptying the drainage container.
B. When irrigating the nasogastric tube, use sterile water.
C. Wear sterile gloves when irrigating the nasogastric tube.
D. Apply water-soluble lubricant if the patient’s lips are dry.

21. There are discharge criteria for clients in the post anesthesia care unit (PACU) regardless of the
type of anesthesia used and additional criteria for specific types of anesthesia. Which is the
criterion specific for the client who has received spinal anesthesia?
A. Oxygen saturation reaches the presurgical baseline.
B. Motor and sensory function returns.
C. Nausea and vomiting are minimal.
D. Headache is reported as tolerable.

22. A client is admitted to the postanesthesia care unit. Which nursing action is most important
during the client’s stay in this unit?
A. Monitoring urinary output
B. Assessing level of consciousness
C. Ensuring patency of drainage tubes
D. Suctioning mucus from respiratory passages

23. A postoperative client is transferred back to the surgical unit with an abdominal dressing and a
Penrose drain. Which is the most important nursing action associated with caring for a client
with a Penrose drain?
A. Removing the excess external portion until drainage stops
 B. Changing the soiled dressing carefully
C. Maintaining the negative pressure
D. Pinning the drain to the dressing

24. A client has abdominal surgery. Which should the nurse do to best assess for a sign of
postoperative ileus in this client after surgery?
A. Identify the time of the first bowel movement.
B. Monitor the tolerance of a clear liquid diet.
C. Palpate for abdominal distention.
D. Auscultate for bowel sounds.

25. Four days after abdominal surgery, while being transferred from a bed to a chair, a client says to
a nurse, “My incision feels funny all of a sudden.” Which should the nurse do first?
A. Take the vital signs.
B. Apply an abdominal binder immediately.
C. Place the client in the low-Fowler position.
D. Encourage slow deep breathing by the client.

26. Which factor places a client at the highest risk for postoperative nausea and vomiting after
receiving general anesthesia.
A. Obesity C. Hypervolemia
B. Inactivity D. Unconsciousness

27. On the second postoperative day after an above-the-knee amputation, the client’s elastic
dressing accidentally comes off. Which should the nurse do first?
A. Wrap the residual limb with an elastic compression bandage.
B. Apply a saline dressing to the residual limb.
C. Notify the primary health-care provider.
D. Place two pillows under the limb.

28. A nurse is caring for a postoperative client. Which action is effective in preventing postoperative
urinary tract infections?
A. Eating foods with roughage
B. Taking sitz baths twice a day
C. Drinking an adequate amount of fluid
D. Increasing the intake of citrus fruit juices

29. A client received conscious sedation during a colonoscopy. Which should the nurse expect
regarding the client’s experience with this procedure?
A. Client will be unresponsive and pain free.
B. Client will be at risk for malignant hyperthermia.
C. Client will be sleepy but able to follow verbal commands.
D. Client will be positioned in the supine position to prevent headache.

30. Which client having emergency surgery should the nurse anticipate to be at the highest risk for
postoperative mortality?
A. Individual who has alcoholism C. Middle-age adult
B. Person who has epilepsy D. Infant

31. A nurse is caring for a client who had an abdominal hysterectomy. Which intervention best
prevents postoperative thrombophlebitis?
A. Utilization of compression stockings at night
B. Deep breathing and coughing exercises daily
C. Leg exercises 10 times per hour when awake
D. Elevation of the legs on 2 pillows
32. An obese client has abdominal surgery for removal of the gallbladder. Which should the nurse be
most concerned about if exhibited by the client?
A. Constipation C. Shallow breathing
B. Urinary retention D. Inability to provide self-care

33. A client arrives in the postanesthesia care unit. Which is the most important information that
the nurse needs to know?
A. Anxiety level before surgery
B. Type and extent of the surgery
C. Type of intravenous fluids administered
D. Special requests that were expressed by the client

34. Which client responses best support the decision to discharge the client from the postanesthesia
care unit?
A. Sao2 of 95%, vital signs stable for 30 minutes, active gag reflex
B. Tolerable pain, ability to move extremities, dry intact dressing
C. Urinary output of 30 mL/hr, awake, turning from side to side
D. Afebrile, adventitious breath sounds, ability to cough

35. How many days after surgery should the nurse anticipate that a postoperative client will begin to
exhibit signs and symptoms of a wound infection if it should occur?
A. Fifth day C. Ninth day
B. Third day D. Seventh day

36. A nurse is assessing a client who had spinal anesthesia. For which common response should the
nurse assess the client?
A. Headache C. Lower back discomfort
B. Neuropathy D. Increased blood pressure

37. A hospitalized client who has been receiving medications via a variety of routes for several days
is scheduled for surgery at 10 a.m. Which should the nurse plan to do on the day of surgery?
A. Use an alternative route for the oral medications.
B. Withhold all the previously prescribed medications.
C. Withhold the oral medications and administer the other drugs.
D. Obtain directions from the primary health-care provider regarding the
E. medications.

38. Which is the most common dietary prescription the nurse can anticipate after a client who had
abdominal surgery exhibits a return of intestinal peristalsis.
A. Clear liquids C. Low fiber
B. Full liquids D. Regular

39. A nurse compares the advantages and disadvantages of a central venous catheter inserted into a
peripheral vein and a central venous catheter inserted into a subclavian vein. Which of the
following does the nurse conclude is the reason why a peripheral catheter is more desirable?
A. Because it will not be in the superior vena cava
B. Because it will not cause a tension pneumothorax
C. Because it will not prevent the development of an infection
D. Because it will not allow large volumes of fluid to be administered

40. A nurse is caring for a client who had abdominal surgery. Which type of incisional drainage
should the nurse expect 4 hours after surgery?
A. Serous wound drainage C. Sanguineous wound drainage
B. Purulent wound drainage D. Serosanguineous wound drainage

41. A nurse is assessing a postoperative client. Which client response identified by the nurse
indicates altered renal perfusion.
 A. Oliguria C. Yellow sclera
B. Cachexia D. Suprapubic distention

42. A nurse is evaluating the effectiveness of nursing interventions for meeting the nutrient needs
of clients during the first 2 days after abdominal surgery. Which outcome is most important?
A. Nausea and vomiting have not occurred.
B. Fluid and electrolytes are balanced.
C. Wound healing is progressing.
D. Oral intake is reestablished.

43. Which is the next most important assessment made by the nurse after ensuring a postoperative
client has a patent airway?
A. Condition of drains C. Stability of the vital signs
B. Level of consciousness D. Location of the surgical dressing

44. A client’s perineal area must be examined by the primary health-care provider prior to surgery.
In which position should the nurse place the client for this physical assessment?
A. Sims C. Lithotomy
B. Supine D. Trendelenburg

45. A nurse is caring for two clients. One of the clients has a Jackson-Pratt drain and the another
client has a Hemovac drain. Which does the nurse understand is the difference between these
two drains?
A. The size of the collection container
B. How the pressure within the collection container is reestablished
C. The type of pressure that promotes drainage to the collection container
D. Where the collection container should be placed in relation to the insertion site

46. A nurse is caring for several clients who received general anesthesia. A client with which
concurrent health problem poses the highest risk for the development of a postoperative
complication?
A. Gastroesophageal reflux disease C. Hypothyroidism
B. Reduced reflexes D. Emphysema

47. A postoperative client experiences tachycardia, sudden chest pain, and low blood pressure.
Which complication associated with the postoperative period should the nurse conclude that the
client most likely experienced?
A. Pulmonary embolus C. Heart attack
B. Hemorrhage D. Pneumonia

48. A client spikes a fever during the first postoperative day after major abdominal surgery. The
nurse suspects that the fever indicates an infection. Which site does the nurse conclude most
likely is the source of the infection?
A. Intestines C. Wound
B. Bladder D. Lungs

49. A nurse is to apply a transparent wound barrier over a client’s incision. Which nursing action is
appropriate?
A. Stretch the transparent dressing snugly over the entire wound.
B. Clean the skin with normal saline before applying the dressing.
C. Cover the transparent wound barrier with a gauze dressing and secure with paper tape.
D. Ensure the reinforcing tape extends several inches beyond the edges of the transparent
wound barrier.

50. A nurse is to position a client in the postanesthesia care unit. Which factor is most important for
the nurse to consider?
A. Allow for skeletal deformities.
 B. Prevent pressure on bony prominences.
C. Provide for adequate thoracic expansion.
D. Avoid stretching of neuromuscular tissue.

51. When should the nurse initiate planned interventions regarding a client’s perioperative
management?
A. When the consent form is signed
B. When the decision for surgery is made
C. When the client is admitted for surgery
D. When the client is transferred to the operating room

52. One hour after the reduction of a compound fracture of the ulna and radius and application of a
cast, the nurse observes a centimeter circle of drainage on the client’s cast. Which should the
nurse do first?
A. Inform the surgeon immediately.
B. Reinforce the cast with a gauze dressing.
C. Monitor the area frequently for expansion.
D. Circle the spot with a pen and date, time, and initial the area.

53. A nurse is caring for a client with a nasogastric tube attached to suction. What is the most
important nursing action in relation to the nasogastric tube?
A. Using sterile technique when irrigating the tube
B. Recording intake and output every 2 hours
C. Providing oral hygiene every 4 hours
D. Setting suction at the prescribed level

54. A nurse is considering the commonalities and differences of equipment used for gastric
decompression. Which is the major advantage to using a double-lumen tube?
A. Minimizes the risk of bowel obstruction
B. Ensures drainage of the intestines
C. Prevents gastric mucosal damage
D. Promotes gastric rest

55. A nurse is performing preoperative teaching a week before surgery. The client is taking 650 mg
of aspirin twice a day for arthritis. Which instruction should the nurse expect the surgeon to
have the nurse include in the preoperative teaching?
A. Continue to take the aspirin indefinitely.
B. Stop taking the aspirin 5 days before surgery.
C. Withhold the dose of aspirin on the morning of surgery.
D. Reduce the dose of aspirin to 81 mg a day until after surgery.

56. A client has negative pressure wound therapy (vacuum-assisted closure [VAC]) after the
amputation of a toe. The tubing is connected to intermittent negative pressure. What should the
nurse do when the film over the wound collapses when negative pressure is exert?
A. Notify the primary health-care provider.
B. Decrease the extent of negative pressure.
C. Apply a new transparent film over the wound.
D. Continue to observe the functioning of the device.

57. A client had a tonsillectomy and is on a soft diet. Which of the following should the nurse
encourage this client to have during the first 24 hours after surgery? Select all that apply.
A. _____ Warm pudding
B. _____ Milk shakes
C. _____ Apple juice
D. _____ Ice pops
E. _____ Gelatin
58. A nurse in the postanesthesia care unit at 3 p.m. receives report from the nurse who is
completing the day shift. The following information about a 65-year-old man who was admitted
to the unit at 1:30 p.m. after repair of a double inguinal hernia is reported. Which information
does not meet the standard criteria for discharge from the unit?
A. Stability of vital signs C. Absence of bowel sounds
B. Level of consciousness D. Presence of a urinary catheter

59. A client has a right abdominal incision. Which should the nurse teach the client to do when
getting out of bed? Select all that apply.
A. _____ Exit from the left side of the bed.
B. _____ Ask the nurse to apply an abdominal binder.
C. _____ Hold a pillow against the abdomen with both hands.
D. _____ Use the left arm to push up to a sitting position on the side of the bed.
E. _____ Sit on the side of the bed for a few minutes before moving to a standing position.

60. A nurse is caring for a client with the following type of portable wound drainage device. Which
should the nurse do when caring for a client with this type of drainage system? Select all that
apply.
A. _____ Empty the container and then compress the collection container, close the port, and
release hand compression.
B. _____ Wear sterile gloves when emptying the collection container.
C. _____ Keep the collection container below the insertion site.
D. _____ Shorten the length of the tubing by one inch daily.
E. _____ Empty the collection container when full.
F. _____ Attach tubing to clothing.

61. A nurse is caring for a postoperative client who had abdominal surgery. The client states, “The
incision just felt like it gave way.” The nurse identifies that the client had a dehiscence with slight
evisceration. Which of the following should the nurse implement? Select all that apply.
A. _____ Instruct the client to avoid coughing or bearing down.
B. _____ Notify the primary health-care provider immediately.
C. _____ Position the client in the low-Fowler position.
D. _____ Cover the incision with a sterile dressing.
E. _____ Prepare the client for surgery.

62. Which of the following independent and dependent nursing interventions help prevent
thrombophlebitis during the postoperative period? Select all that apply.
A. _____ Applying lower-extremity sequential compression devices when in bed
B. _____ Wearing antiembolism stockings when out of bed
C. _____ Walking in the hall several times a day
D. _____ Using an incentive spirometer
E. _____ Coughing and deep breathing
F. _____ Keeping the legs uncrossed

63. Which of the following types of anesthesia is administered by injecting a local anesthetic around
a nerve trunk supplying the area of surgery.
A. Nerve block C. Surface anesthesia
B. Subdural block D. Local infiltration with lidocaine

64. When obtaining a consent form from a patient scheduled to undergo surgery, the nurse should
consider which of the following facts?
A. A consent form is legal, even if the patient is confused or sedated.
B. The form that is signed is not a legal document and would not hold up in court.
C. In emergency situations, the doctor may obtain consent over the telephone.
D. The responsibility for securing informed consent from the patient lies with the nurse.
65. A 9-month-old baby is scheduled for heart surgery. When preparing this patient for surgery, the
nurse should consider which of the following surgical risks associated with infants?
A. Prolonged wound healing
B. Potential for hypothermia or hyperthermia
C. Congestive heart failure
D. Gastrointestinal upset

66. Mr. Lemke, age 42, is scheduled for elective hernia surgery. While taking a medical history for
Mr. Lemke, you find out he is taking antibiotics for an infection. To which of the following
surgical risks would Mr. Lemke be predisposed because of his use of antibiotics?
A. Hemorrhage C. Cardiovascular collapse
B. Electrolyte imbalances D. Respiratory paralysis

67. When preparing a patient who has diabetes mellitus for surgery, the nurse should be aware of
which of the following potential surgical risks associated with this disease?
A. Fluid and electrolyte imbalance
B. Slow wound healing
C. Respiratory depression from anesthesia
D. Altered metabolism and excretion of drugs

68. Mr. Pete is an obese 62-year-old man scheduled for heart surgery. Which of the following
surgical risks related to obesity should be considered when performing an assessment for this
patient?
A. Delayed wound healing and wound C. Respiratory distress
infection D. Hemorrhage
B. Alterations in fluid and electrolyte
balance

69. When teaching a postoperative patient about pain control, the nurse should consider which of
the following statements?
A. When giving pain medication p.r.n., the patient should ask for the medication when the
pain becomes severe.
B. The nurse is responsible for ordering and administering pain medications.
C. Medications for pain usually are given by injection for the first few days or as long as the
patient is NPO.
D. Alternate pain control methods, such as TENS and PCA, should not be used after surgery.

70. To prevent postoperative complications, which of the following measures should be taken after
surgery?
A. The patient should be instructed to avoid coughing if possible, to minimize damage to the
incision.
B. The patient should take shallow breaths to prevent collapse of the alveoli.
C. The patient should be instructed to do leg exercises to increase venous return.
D. The patient should not be turned in bed until the incision is no longer painful.

71. Which of the following is the most common postanesthesia recovery emergency?
A. Respiratory obstruction C. Wound infection
B. Cardiac distress D. Dehydration

72. Mr. Fischer has returned to your unit after cardiac surgery. Which of the following interventions
would be appropriate to prevent cardiovascular complications for him?
A. Position him in bed with pillows placed under his knees to hasten venous return.
B. Keep him from ambulating until the day after surgery.
C. Implement leg exercises and turn him in bed every 2 hours.
D. Keep him cool and uncovered to prevent elevated temperature.
73. Which of the following interventions should be carried out by the nurse when a postoperative
patient is in shock?
A. Remove extra coverings on the patient to keep temperature down.
B. Place the patient in a flat position with legs elevated 45 degrees.
C. Do not administer any further medication.
D. Place the patient in the Trendelenburg or “shock” position.

74. Which of the following is a recommended physical preparation for a patient undergoing surgery?
A. Shave the area of the incision with a razor.
B. Empty the patient’s bowel of feces.
C. Do not allow the patient to eat or drink anything for 8 to 12 hours before surgery.
D. Be sure the patient is well nourished and hydrated.

75. Which of the following preoperative medications would be prescribed to decrease pulmonary
and oral secretions and prevent laryngospasm?
A. Narcotic analgesics C. Neuroleptanalgesia agents
B. Anticholinergics D. Histamine-receptor antihistaminic

76. Which of the following positions would be used in minimally invasive surgery of the lower
abdomen or pelvis?
A. Trendelenburg position C. Lithotomy position
B. Sims’ position D. Prone position

77. Which of the following would be an appropriate reaction to a patient experiencing pulmonary
embolus?
A. Try to overhydrate the patient with fluids.
B. Instruct the patient to perform Valsalva’s maneuver.
C. Place the patient in semi-Fowler’s position.
D. Assist the patient to ambulate every 2 to 3 hours.

78. Your postsurgical patient is experiencing decreased lung sounds, dyspnea, cyanosis, crackles,
restlessness, and apprehension. Which of the following conditions would you diagnose?
A. Atelectasis C. Pulmonary embolus
B. Pneumonia D. Thrombophlebitis

79. Which of the following actions would be performed in the postoperative phase of the
perioperative period? (Select all that apply.)
A. The nurse prepares the patient for home care.
B. The physician informs the patient that surgical intervention is necessary.
C. The patient is transferred to the recovery room.
D. The patient is admitted to the recovery area.
E. The patient begins to emerge from anesthesia.
F. The patient participates in a rehabilitation program after surgery.

80. Which of the following examples of surgery would be classified as surgical procedures based on
purpose? (Select all that apply.)
A. Control of hemorrhage D. Colostomy
B. Breast biopsy E. Tracheostomy
C. Cleft palate repair F. Breast reconstruction

81. Regional anesthesia may be accomplished through which of the following methods? (Select all
that apply.)
A. Inhalation D. Oral route
B. Spinal block E. Nerve block
C. Intravenous F. Epidural block
82. Which of the following pieces of information must be provided to a patient to obtain informed
consent? (Select all that apply.)
A. A description of the procedure or treatment, along with potential alternative therapies
B. The name and qualifications of the nurse providing perioperative care
C. The underlying disease process and its natural course
D. Explanation of the risks involved and how often they occur
E. Explanation that a signed consent form is binding and cannot be withdrawn
F. Customary insurance coverage for the procedure

83. Which of the following statements accurately describe the surgical risks related to the
developmental stage of the patient? (Select all that apply.)
A. Infants are at a greater risk from surgery than are middle-aged adults.
B. Infants experience a slower metabolism of drugs that require renal biotransformation.
C. Muscle relaxants and narcotics have a shorter duration of action in infants.
D. Older adults have decreased renal blood flow and a reduced bladder capacity, necessitating
careful monitoring of fluid and electrolyte status and input and output.
E. Older adults have an increased gastric pH and require monitoring of nutritional status
during the perioperative period.
F. Older adults have an increased hepatic blood flow, liver mass, and enzyme function that
prolongs the duration of medication effects.

84. Which of the following statements accurately describe how preexisting disease states affect
surgical risk? (Select all that apply.)
A. Cardiovascular diseases increase the risk for dehydration after surgery.
B. Patients with respiratory disease may experience alterations in acid–base balance after
surgery.
C. Kidney and liver diseases influence the patient’s response to anesthesia.
D. Endocrine diseases increase the risk for hyperglycemia after surgery.
E. Endocrine diseases increase the risk for slow surgical wound healing.
F. Pulmonary disorders increase the risk for hemorrhage and hypovolemic shock after surgery.

85. Which of the following statements accurately describe the effects the patient’s medications may
have on surgical risk? (Select all that apply.)
A. Diuretics may precipitate hemorrhage.
B. Anticoagulants may cause electrolyte imbalances.
C. Diuretics may cause respiratory depression from anesthesia.
D. Tranquilizers may increase the hypotensive effect of anesthetic agents.
E. Adrenal steroids may cause respiratory paralysis.
F. Abrupt withdrawal from adrenal steroids may cause cardiovascular collapse in long-term
users.

86. Which of the following are significant abnormal findings related to presurgical screening tests?
(Select all that apply.)
A. An elevated white blood cell count, indicating an infection
B. Decreased hematocrit and hemoglobin level, indicating bleeding or anemia
C. Increased hyperkalemia or hypokalemia, indicating possible renal failure
D. Elevated blood urea nitrogen or creatinine levels, indicating an increased risk for cardiac
problems
E. Abnormal urine constituents, indicating infection or fluid imbalances
F. Increased hemoglobin level, indicating infection

87. Which of the following nursing interventions would be appropriate for a patient recovering from
a surgical procedure? (Select all that apply.)
A. Teach the patient to suppress urges to cough in order to protect the incision.
B. Encourage the patient to take frequent shallow breaths to improve lung expansion and
volume.
 C. Place the patient in a semi-Fowler’s position to perform deep breathing exercises every 1 to
2 hours for the first 24 to 48 hours after surgery and as necessary thereafter.
D. Encourage the patient to lie still in bed with the incision facing upward to prevent putting
pressure on the stitches.
E. Teach the patient the appropriate leg exercises to increase venous blood return from the
legs.
F. Encourage the patient to use incentive spirometry 10 times each waking hour for the first 5
days after surgery.

88. A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as
the result of an automobile crash. For what type of surgery would the nurse prepare this
patient?
A. Minor, diagnostic C. Major, emergency
B. Minor, elective D. Major, palliative

89. A nurse has been asked to witness a patient signature on an informed consent form for surgery.
What information should be included on the form? Select all that apply.
A. The option of nontreatment
B. The underlying disease process and its natural course
C. Notice that once the form is signed, the patient cannot withdraw the consent
D. Explanation of the guaranteed outcome of the procedure or treatment
E. Name and qualifications of the provider of the procedure or treatment
F. Explanation of the risks and benefits of the procedure or treatment

90. A 72-year-old woman who is scheduled for a hip replacement is taking several medications on a
regular basis. Which drug category might create a surgical risk for this patient?
A. Anticoagulants C. Laxatives
B. Antacids D. Sedatives

91. A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for
what postoperative complication?
A. Anesthetic agent interactions C. Hemorrhage
B. Impaired wound healing D. Gas pains

92. A responsibility of the nurse is the administration of preoperative medications to patients.

Which statements describe the action of these medications? Select all that apply.
A. Diazepam is given to alleviate anxiety.
B. Ranitidine is given to facilitate patient sedation.
C. Atropine is given to decrease oral secretions.
D. Morphine is given to depress respiratory function.
E. Cimetidine is given to prevent laryngospasm.
F. Fentanyl citrate–droperidol is given to facilitate a sense of calm.

93. A nurse is providing teaching for a patient scheduled to have same-day surgery. Which teaching
method would be most effective in preoperative teaching for ambulatory surgery?
A. Lecture C. Audiovisuals
B. Discussion D. Written instructions

94. A 70-year-old male is scheduled for surgery. He says to the nurse, “I am so frightened —what if I
don’t wake up?” What would be the nurse’s best response?
A. “You have a wonderful doctor.”
B. “Let’s talk about how you are feeling.”
C. “Everyone wakes up from surgery!”
D. “Don’t worry, you will be just fine.”
95. A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates
that the patient will have a higher risk for postoperative complications involving which body
system?
A. Respiratory system C. Digestive system
B. Circulatory system D. Nervous system

96. While assessing a patient in the PACU, a nurse notes increased wound drainage, restlessness, a
decreasing blood pressure, and an increase in the pulse rate. The nurse interprets these findings
as most likely indicating:
A. Thrombophlebitis C. Infection
B. Atelectasis D. Hemorrhage

97. A patient tells the nurse she is having pain in her right lower leg. How does the nurse determine
if the patient has developed a deep vein thrombosis (DVT)?
A. By palpating the skin over the tibia and fibula
B. By documenting daily calf circumference measurements
C. By recording vital signs obtained four times a day
D. By noting difficulty with ambulation

98. A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient
responsibilities of the scrub nurse? Select all that apply.
A. Maintaining sterile technique
B. Draping and handling instruments and supplies
C. Identifying and assessing the patient on admission
D. Integrating case management
E. Preparing the skin at the surgical site
F. Providing exposure of the operative area

99. Older adults often have reduced vital capacity as a result of normal physiologic changes. Which
nursing intervention would be most important for the postoperative care of an older surgical
patient specific to this change?
A. Take and record vital signs every shift
B. Turn, cough, and deep breathe every 4 hours
C. Encourage increased intake of oral fluids
D. Assess bowel sounds daily

100. A nurse is explaining the rationale for performing leg exercises after surgery. Which reason
would the nurse include in the explanation?
A. Promote respiratory function C. Provide diversional activities
B. Maintain functional abilities D. Increase venous return