Ch. 30 Perioperative Nursing NCLEX Questions

A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. The nurse knows that this type of surgery belongs in what category?

a. Minor, diagnostic

b. Minor, elective

c. Major, emergency

d. Major, palliative

c. This surgery would involve a major body organ, has the potential for postoperative complications, requires hospitalization, and must be done immediately to save the patient's life. Elective surgery is a procedure that is preplanned by essentially healthy people. Diagnostic surgery is performed to confirm a diagnosis. Palliative surgery is not curative, rather it is done to relieve or reduce the intensity of an illness.

A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply.

a. Loss of consciousness

b. Relaxation of skeletal muscles

c. Reduction or loss of reflex action

d. Localized loss of sensation

e. Prolonged pain relief after other anesthesia wears off

f. Infiltrates the underlying tissues in an operative area

c, d. A localized loss of sensation and possible loss of reflexes occurs with a regional anesthetic. Loss of consciousness and relaxation of skeletal muscles occurs with general anesthesia. Prolonged pain relief after other anesthesia wears off and infiltration of the underlying tissues in an operative area occur with topical anesthesia.

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 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

a, b, e, f

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

b. Antacids

c. Laxatives

d. Sedatives

a. Anticoagulant drug therapy would increase the risk for hemorrhage during surgery.

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

b. Impaired wound healing

c. Hemorrhage

d. Gas pains

b. Fatty tissue is less vascular and, therefore, less resistant to infection and more prone to delayed wound healing.

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.

a, c, f.

Sedatives, such as diazepam (Valium), midazolam (Versed), or lorazepam (Ativan) are given to alleviate anxiety and decrease recall of events related to surgery. Anticholinergics, such as atropine and glycopyrrolate (Robinul) are given to decrease pulmonary and oral secretions and to prevent laryngospasm. Neuroleptanalgesic agents, such as fentanyl citrate-droperidol (Innovar) are given to cause a general state of calm and sleepiness. Histamine-2 receptor blockers, such as cimetidine (Tagamet) and ranitidine (Zantac) are given to decrease gastric acidity and volume. Narcotic analgesics, such as morphine, are given to facilitate patient sedation and relaxation and to decrease the amount of anesthetic agent needed.

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery?

a. Lecture

b. Discussion

c. Audiovisuals

d. Written instructions

d. Written instructions are most effective in providing information for same-day surgery

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."

b. This answer allows the patient to talk about his feelings and fears, and is therapeutic.

A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's correct response?

a. "The pump allows the patient to be completely free of pain during the postoperative period."

b. "The pump allows the patient to take unlimited amounts of medication as needed."

c. "The pump allows the patient to choose the type of medication given postoperatively."

d. "The pump allows the patient to self-administer limited doses of pain medication."

d. PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within physician-prescribed time and dose limits. Patients activate the delivery of the medication by pressing a button on a cord connected to the pump or a button directly on the pump.

A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates that he will have a higher risk for postoperative complications involving which body system?

a. Respiratory system

b. Circulatory system

c. Digestive system

d. Nervous system

a. A thoracic incision makes it more painful for the patient to take deep breaths or cough. Shallow respirations and ineffective coughing increase the risk for respiratory complications.

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

b. Atelectasis

c. Infection

d. Hemorrhage

d. Increased wound drainage, restlessness, decreasing blood pressure, and increasing pulse rate are assessment findings that indicate hemorrhage. Manifestations of thrombophlebitis are pain and cramping in the calf or thigh of the involved extremity, redness and swelling in the affected area, elevated temperature, and an increase in the diameter of the involved extremity. Manifestations of atelectasis include decreased lung sounds over the affected area, dyspnea, cyanosis, crackles, restlessness, and apprehension. Signs of infection include elevated white blood count and fever.

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 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

b. Inflammation from thrombophlebitis increases the size of the affected extremity and can be assessed by measuring circumference on a regular basis.

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

a, b. The scrub nurse is a member of the sterile team who maintains sterile technique while draping and handling instruments and supplies. Two duties of the circulating nurse are to identify and assess the patient on admission to the operating room and prepare the skin at the surgical site. The RNFA actively assists the surgeon by providing exposure of the operative area. The APRN coordinates care activities, collaborates with physicians and nurses in all phases of perioperative and postanesthesia care, and integrates case management, critical paths, and research into care of the surgical patient.

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.

b. Reduced vital capacity in older adults increases the risk for respiratory complications, including pneumonia and atelectasis. Having the patient turn, cough, and deep breathe every 4 hours maintains respiratory function and helps to prevent complications.

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

b. Maintain functional abilities

c. Provide diversional activities

d. Increase venous return

d. Leg exercises in the postoperative period increase venous return. As a result, the patient has a decreased risk for thrombophlebitis and emboli.