Deck 33: Surgery

Question 1

Modern operating rooms are designed to prevent wound infections.Which of these characteristics contributes MOST to achieving that goal?

A)a cool temperature between 66 and 68 degrees Fahrenheit
B)a limit on the supplies and furniture allowed in the room
C)overhead ceiling lights
D)stainless steel furniture

Answer 1

a cool temperature between 66 and 68 degrees Fahrenheit

Question 2

Infants who undergo surgery are at greater risk than adults for which of these possible complications?

A)hyperthermia
B)cardiac arrest
C)fluid overload
D)prolonged wound healing

Answer 2

fluid overload

Question 3

A client who has a history of angina is scheduled for a hernia repair tomorrow.Which of these nursing interventions is MOST likely to prevent postoperative complications for this client?

A)forcing fluids by mouth
B)careful monitoring of intravenous (IV)infusions
C)resuming food intake as soon as possible
D)maintaining a high Fowler's position

Answer 3

careful monitoring of intravenous (IV)infusions

Question 4

When discussing an upcoming surgery with a client,the nurse is aware that which of these statements about the perioperative experience is TRUE?

A)To a client,there is no such thing as minor surgery.
B)Major surgery creates as much body stress as minor surgery.
C)Surgery is performed primarily for curative reasons.
D)Surgeons play the major role in the perioperative experience.

Question 5

Which member of the surgical team monitors the client's oxygenation and gas exchange during surgery?

A)anesthesiologist or anesthetist
B)circulating nurse
C)scrub nurse
D)surgeon

Question 6

Clients who have diabetes mellitus are prone to what postoperative complications?

A)atelectasis
B)hemorrhage
C)infection
D)pressure sores

Question 7

When a nurse conducts preoperative teaching for a client,which of these educational principles is MOST important?

A)Focus on correct medical terminology.
B)Begin the sessions the day before surgery.
C)Give the client and family a test following the sessions.
D)Use more than one teaching medium.

Question 8

What is the primary reason that electrocardiograms (EKGs)are routinely performed in middle-aged and older adult clients undergoing surgery?

A)Most insurance coverage dictates that they be performed.
B)The client's cardiac health must be evaluated because of the physical stress of surgery.
C)Ischemic heart disease is prevalent in these age groups.
D)A baseline study for comparison is needed should subsequent EKGs be needed.

Question 9

Preoperative client teaching should include the purpose of the surgical site skin preparation,which is to:

A)lower the number of microorganisms on or near the operative site
B)prevent any wound infection
C)remove soil around the operative site
D)sterilize the skin

Question 10

The nurse is caring for a client about to undergo surgery.A major nursing role related to preoperative physiologic assessment and diagnostic tests is to:

A)ensure the tests ordered by the health care provider have been performed
B)inform the client and family of test results
C)notify the surgeon that tests have been completed
D)make the client's family comfortable while tests are performed

Question 11

Which of these postoperative complications is MORE likely to occur in older adult clients?

A)deep vein thrombosis
B)dehydration
C)pneumonia
D)unpredictable responses to medications and anesthetics

Question 12

Preoperative teaching should include how to perform postoperative leg exercises,which are done to prevent which complication of surgery?

A)ankylosis of the joints
B)atrophy of the muscles
C)thrombosis formation
D)pneumonia

Question 13

Which member of the surgical team assists all other team members,coordinates the team's efforts,and is held responsible for all activities during the surgical procedure?

A)anesthesiologist or anesthetist
B)circulating nurse
C)scrub nurse
D)surgeon

Question 14

A nurse is assessing a client admitted to the ambulatory surgery unit.The client has diaphoresis with rapid pulse and respirations,elevated blood pressure,and dilated pupils.When the nurse attempts to reinforce preoperative teaching,the client cannot remember anything about previous instructions.Which of these nursing actions is MOST appropriate?

A)Administer the prescribed preoperative medication now.
B)Ask the client to describe what is wrong.
C)Slowly repeat all preoperative instructions.
D)Notify the surgeon of the client's emotional status.

Question 15

A client who is scheduled for surgery tells the nurse about an allergy to Demerol.Which of these actions should the nurse take NEXT?

A)Apply an allergies alert wristband.
B)Ask the client to describe the symptoms experienced when given Demerol.
C)Label the client record accordingly.
D)Notify the pharmacy and the health care provider.

Question 16

Surgical clients who have chronic respiratory diseases are MOST likely to develop which postoperative complication?

A)atelectasis
B)stroke
C)hypovolemic shock
D)myocardial infarction

Question 17

A client who has diabetes mellitus is scheduled for surgery tomorrow.Which of the following accommodations will be made?

A)The dose of insulin for the morning of the surgery will be reduced.
B)IV fluids will be omitted.
C)Surgery will be scheduled as early in the morning as possible.
D)Serum glucose will be carefully monitored immediately after surgery.

Question 18

Clients who have nutritional deficiencies before surgery are MORE prone to have which of the following postoperative complications?

A)atelectasis
B)delayed wound healing
C)renal failure
D)hepatitis B

Question 19

Of the common fears that clients have related to surgery,which fear is MOST prevalent and most easily addressed by nurses?

A)anesthesia
B)disruption of life patterns
C)pain and discomfort
D)the unknown

Question 20

Before beginning to implement preoperative medical orders for a surgical client,it is MOST important that the nurse:

A)ask the visitors to leave the client's room
B)be sure that the surgical consent form has been signed
C)complete the preoperative checklist
D)verify the identity of the client verbally and by viewing the name band

Question 21

The entire surgical team is responsible for prevention of infection,and maintaining the sterile field in the operating room in the area that includes:

A)all members of the sterile team
B)all members of the surgical team
C)the client and the surgical site itself
D)the entire operating room

Question 22

Postoperative nursing measures to prevent the development of deep vein thrombosis,thrombophlebitis,and pulmonary embolism include which of the following?

A)using an alternating pressure pad on the bed
B)administering antibiotics every 12 hours as ordered
C)massaging the calves of the legs for complaints of "cramping"
D)performing postoperative leg exercises each hour

Question 23

Which of the following assessments of a client transferred to the post-anesthesia care unit (PACU)from the operating room would NOT necessarily indicate a postoperative complication to the nurse?

A)acute inspiratory stridor with sternal retractions
B)labored chest movement
C)snoring
D)peripheral cyanosis

Question 24

Nursing care of a client for the first 48 hours after surgery includes all of the following interventions.Which action would enable the client to better participate in the other activities?

A)Assist the client to sit up and ambulate as soon and as often as possible.
B)Encourage coughing and deep breathing every 2 hours.
C)Monitor use of the incentive spirometry every waking hour.
D)Provide adequate pain-relief measures.

Question 25

Upon admission to the post-anasthetic care unit (PACU),a client's Aldrete score (post-anesthetic recovery score)is 4.Within 30 minutes,it has become 8.The nurse recognizes this score means that the client:

A)may be dismissed from the PACU
B)must be admitted to a critical care unit
C)needs oxygen
D)needs to remain in the PACU for further evaluation and care

Question 26

A client who had surgery 4 hours ago has not yet voided.Of the following nursing measures to facilitate voiding,which one would be done LAST?

A)asking visitors to wait in the lounge area for a few minutes
B)assisting the client to ambulate to the bathroom
C)catheterizing the client
D)pouring warm water over the perineum

Question 27

Which of the following concepts are part of current trends in surgical health care?

A)The majority of clients are admitted through the ambulatory surgery unit on the morning of surgery.
B)The invasiveness of many surgeries has increased.
C)Clients may stay up to 48 hours in the short-stay surgery unit.
D)Clients must assume all responsibility for postoperative care at home.

Question 28

A client who is 24 hours postoperative has an oral temperature of 101.8 degrees Fahrenheit.Which of these actions is indicated FIRST?

A)administering antipyretics as ordered
B)lowering the room temperature and providing cool washcloths
C)notifying the surgeon
D)providing light covers and clothing

Question 29

For a client who had a craniotomy,postoperative nursing care would give priority to which of these actions?

A)assessing respiratory function on a regular schedule
B)checking pupillary reactions
C)observing for changes in vital signs
D)using the Trendelenburg position immediately if shock develops

Question 30

A client experiences dyspnea,chest pain,cyanosis,cough,hemoptysis,and tachycardia on the second postoperative day.Vital signs confirm the client is in shock.The nurse should recognize that the client has MOST likely developed which of these complications?

A)atelectasis
B)myocardial infarction
C)pneumothorax
D)pulmonary embolism

Question 31

The endotracheal tube of a postoperative client transferred to the post-anesthesia care unit (PACU)was removed for 5 minutes.The client develops acute inspiratory stridor with sternal retractions.Which of these actions should the nurse take immediately?

A)Reinsert the endotracheal tube.
B)Reassure the client.
C)Prepare to initiate cardiopulmonary resuscitation.
D)Start oxygen via mask.

Question 32

Assessing the postoperative client's level of consciousness is a priority because a change in the level of consciousness may be the first indication that which of these complications has occurred?

A)a stroke or increased intracranial pressure
B)an adverse reaction to anesthetic agents or postoperative medications
C)fluid and electrolyte imbalances or hypoxia
D)sleep deprivation or sensory input overload

Question 33

A nurse is caring for a client who has just returned from the post-anesthetic care unit (PACU).Which of the following should the nurse include in her initial assessment upon the client's return? (Select all that apply. )

A)color of skin
B)time of client's surgery
C)time of last meal
D)assessment of dressings
E)vital signs
F)patency of airway

Question 34

Criteria for discharge of the postoperative client from the post-anesthetic care unit (PACU)includes which of the following?

A)The client has been in the PACU at least 30 minutes.
B)The client's dressing is in place.
C)The client is fully awake.
D)The client is able to stand up.

Question 35

An older adult client had a colon resection 8 days ago.The client experiences a gush of serosanguinous drainage from the wound,feels the abdominal incision "give," and calls the nurse.Viscera are protruding from the wound.Which of these actions must the nurse take FIRST?

A)Cover the viscera with sterile saline dressings.
B)Notify the surgeon of the situation.
C)Place the client on NPO,and begin preparation for emergency surgery.
D)Place the client in the semi-Fowler's position.

Question 36

A scrub nurse thinks aseptic technique may have been broken while setting up the instrument stand in the operating room.Which of these actions should the scrub nurse take NEXT?

A)Ask the circulating nurse to remove and replace the instrument setup,rescrub,and set up the area again.
B)No action is necessary,because the client is already on preoperative antibiotics.
C)Report the possible compromise in private to the anesthesiologist.
D)Request a replacement setup and proceed to prepare for the surgery.

Question 37

A client complains of a warm,tender,reddened,hardened area in the right calf on the second postoperative day and has a positive Homans' sign.Which of these actions should the nurse take NEXT?

A)Assist the client to ambulate.
B)Recheck for Homans' sign and chart the results.
C)Massage the calf vigorously to relieve the pain.
D)Report finding to the client's surgeon.

Question 38

To minimize microorganisms being introduced into the surgical wound,a scrub nurse would be permitted to wear:

A)artificial nails
B)bracelets
C)unchipped nail polish
D)rings and watches

Question 39

A client is returned to the unit from the post-anesthetic care unit (PACU).The client is crying and begging for "something for the pain." Which of these actions should the nurse take NEXT?

A)Check the PACU record to see what medications were administered and when.
B)Notify the surgeon of the client's complaints of extreme pain.
C)Prepare and administer the prescribed postoperative analgesic PRN medication.
D)Use comfort measures,and withhold analgesics in the first 3 hours of the postoperative period to allow adequate recovery from the anesthesia.

Question 40

The nurse should give which of these postoperative instructions to a client who had a cataract removal?

A)Drink plenty of fluids.
B)Do not cough.
C)Avoid head movement.
D)Apply ice to the operative area.

Question 41

The nurse is preparing the client for surgery and assisting the client to put on a hospital gown and hair cap.Which of the following articles does the nurse remove? (Select all that apply. )

A)hair piece
B)glasses
C)jewelry
D)dentures
E)hearing aid
F)nail polish

Question 42

The physiologic nursing assessment is completed before surgery.Which of the following are the focus of this assessment? (Select all that apply. )

A)living arrangements
B)insurance
C)nutritional status
D)fluid and electrolyte balance
E)respiratory status
F)family status
G)age
H)medications