Perioperative Nursing Practice Questions

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1. How does palliative surgery differ from any other type of surgery? A. The main purpose is cosmetic in nature rather than functional repair or comfort. B. There are fewer risks associated with palliative surgery than with any other type of surgery. C. The outcomes of palliative surgery cannot be ensured to produce the desired effect or restoration of functional ability. D. Palliative surgery is performed to provide temporary relief of distressing symptoms rather than to cure a problem or condition.
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ANS: D The purpose of palliative surgery is to improve the client’s quality of life by reducing or eliminating distressing symptoms. It does not cure a health problem and, often, does not prolong life. Although the exact outcomes of palliative surgery cannot be ensured, neither can the outcomes of any other type of surgery.
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2. The client tells the nurse during the preoperative history that he is a three-pack a day cigarette smoker. This information alerts the nurse to which potential complication during the intraoperative and postoperative periods? A. A decreased tolerance to pain B. A decreased clotting ability C. An increased risk for atelectasis and hypoxia D. An increased risk for excessive scar tissue formation
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ANS: C Smoking increases the level of circulating carboxyhemoglobin, which decreases oxygen delivery to the tissues. In addition, cigarette smoking damages the cilia of mucous membranes, decreasing transport of secretions and increasing the risk of pulmonary infection and atelectasis.
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3. The client receiving preoperative medication tells the nurse that all of the following medications (drugs or herbs) were ingested yesterday. Which one should the nurse report to the surgical team? A. Acetaminophen (Tylenol) B. Vitamin C C. Motherwort D. Diphenhydramine (Benadryl)
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ANS: C Motherwort interferes with coagulation, increasing the client’s risk for bleeding during and after the surgical procedure.
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4. When the nurse brings the preoperative medication to the client about to have abdominal surgery, she tells the nurse that she does not need the injection because she had a good night’s sleep last night. What is the nurse’s best first action? A. Tell the client that her surgeon has ordered the medication; therefore, she should go ahead and take the medication because the surgeon knows what is best. B. Tell the client that the preoperative medication is ordered to reduce the risk of some problems during surgery rather than to ensure adequate rest. C. Appropriately discard the preoperative medication and notify the surgeon. D. Document the client’s statement and notify the charge nurse.
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ANS: B The preoperative medication is prescribed to prevent a vagal response during intubation and surgery, reduce the amount of anesthetic needed during induction, and reduce anxiety.
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5. The client who is scheduled to have surgery cannot read or write. The surgeon obtaining the consent wants to have the client’s spouse sign the consent instead. What is the nurse’s best action? A. Nothing; a signed informed consent statement does not need to be obtained from this client. B. Locate the spouse, because the informed consent statement must be signed by the client’s closest relative. C. Inform the surgeon that the client may sign the informed consent statement with an X in front of two witnesses. D. Notify the administration because the court must appoint a legal guardian to represent the client’s best interests and give consent for all surgical procedures.
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ANS: C The lack of ability to read or write does not constitute incapacity to give legal consent. If the client meets all other legal and clinical aspects of competence, he or she may use an X to demonstrate consent if the act is witnessed by two persons.
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6. Twenty minutes after the client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. What is the nurse’s best first action? A. Document the findings as the only action. B. Check the client’s pulse and blood pressure. C. Prepare to administer epinephrine and diphenhydramine (Benadryl). D. Explain to the client that these symptoms are normal responses to the medication.
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ANS: B Although these are the expected physiologic responses to the preoperative medication, any time the client states that he or she can feel a change in normal cardiac function, the system should be assessed. If the client’s pulse and blood pressure are within normal limits, the nurse should
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7. Which nursing action or statement is most likely to reduce anxiety in a client being brought to the surgical suite? A. Asking the client if he or she has talked with the hospital chaplain B. Asking the client what specific surgery he or she is having done today C. Asking the client if he or she wants family members to be with them in the holding area D. Explaining to the client that the surgical area is the most technologically advanced in the city
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ANS: C Most anxious clients would feel some relief by having one or more familiar persons waiting with them until surgery begins. In addition, asking the client what he or she wants allows the client to have more control over the situation. Asking the client if he or she has visited with the hospital chaplain and telling the client about the advanced technology can imply to the client that the procedure is dangerous. Although the client must be asked what procedure he or she is having (to ascertain that the client does know what is to be done), this question may make the client worry about the competency of the staff.
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8. All of the members of the surgical team must perform a “surgical scrub” except which of the following? A. Anesthetist/anesthesiologist B. Surgical technologist C. Scrub nurse D. Surgeon
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ANS: A The anesthetist or anesthesiologist does not enter the sterile field. Caps, masks, scrub clothing, and scrub jackets are worn to prevent shedding of microorganisms, but sterile gloves and surgical scrubbing are not needed.
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9. In the operating room, the client tells the circulating nurse that he is going to have the cataract in his left eye removed. The nurse notes that the consent form indicates that surgery is to be performed on the right eye. What is the nurse’s best first action? A. Assume that the client is a little confused because he is older and has received midazolam intramuscularly. B. Check to see if the client has received any preoperative medications. C. Notify the surgeon and anesthesiologist. D. Ask the client his name.
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ANS: D Ensuring proper identification of the client is a responsibility of all members of the surgical team. Especially in a specialty surgical setting, where many people undergo the same type of surgery each day, such as cataract removal, it is possible that the client and the record do not match. The nurse identifies the client and the client’s consent form before the physicians are notified.
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10. The anesthetized client with an open abdomen suddenly develops malignant hyperthermia. What intervention should the nurse be prepared to initiate or assist with? A. Discontinue mechanical ventilation. B. Administer intravenous potassium chloride. C. Administer intravenous calcium chloride. D. Administer intravenous dantrolene (Dantrium).
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ANS: D Dantrolene is a skeletal muscle relaxant and can help lower body temperature by reducing metabolic heat production by the muscles. Clients become hyperkalemic and hypercalcemic; therefore, neither of these electrolytes should be administered. The client’s gas exchange is severely compromised. If the client is not already receiving mechanical ventilation, it is initiated.
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11. What is the priority nursing diagnosis for the client under general anesthesia during surgery? A. Acute Pain related to surgical procedure B. Risk for Infection related to surgical wound C. Risk for Impaired Skin Integrity related to prolonged static position D. Disturbed Body Image related to presence of surgical wound or scar
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ANS: C The problem that nursing is most responsible for with this client is ensuring maintenance of skin integrity.
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12. The client who has received ketamine hydrochloride during a surgical procedure has all of the following manifestations and behaviors. Which one alerts the nurse to a dissociative reaction? A. Hypoventilation and decreased oxygen saturation B. Presence of hives on the skin around the IV site C. Crying because the pain at the surgical site has increased D. Pulling out the IV because he sees bugs in the solution bag
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ANS: D Ketamine hydrochloride induces dissociative reactions such as hallucinations, distorted images, and irrational behavior during emergence from the anesthesia.
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13. Who is responsible for accompanying the surgical client to the postanesthesia recovery area after surgery and for giving a report of the client’s intraoperative experience to the PACU nurse? A. The surgeon and scrub nurse B. The surgeon and circulating nurse C. The anesthesiologist and scrub nurse D. The anesthesiologist and circulating nurse
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ANS: D The anesthesiologist (or certified registered nurse anesthetist) and the circulating nurse are responsible for accompanying the client to the postoperative recovery area and giving a report of the client’s intraoperative experience.
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14. The client is admitted to the postanesthesia care unit (PACU) after surgery that took place with the client in the lithotomy position. Which change in assessment findings alerts the nurse to a possible complication of this surgical position? A. The electrocardiogram (ECG) shows tall, peaked T waves and wide QRS complexes. B. The client only arouses in response to light shaking. C. The pulse pressure has increased from 28 to 40 mm Hg. D. The dorsalis pedis pulses are not palpable bilaterally.
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ANS: D The lithotomy position can compromise the client’s peripheral circulation in the lower extremities.
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15. Which client is at greatest risk for respiratory complications after surgery under general anesthesia? A. 65-year-old woman taking a calcium channel blocker for hypertension B. 55-year-old man with chronic allergic rhinitis C. 45-year-old woman with diabetes mellitus type 1 D. 35-year-old man who smokes two packs of cigarettes daily
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ANS: D Cigarette smoking greatly increases the risk for pulmonary problems following general anesthesia because the cilia of the mucous membranes may be absent or hypoactive, the lining of the airways may be hypertrophied, and the alveoli may be less compliant. Age and gender are not significant in this case.
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16. Two hours after abdominal surgery, the nurse auscultates the client’s abdomen. No bowel sounds are present. What is the nurse’s best first action? A. Position the client on the right side with the bed flat. B. Check the dressing and apply an abdominal binder. C. Palpate the bladder and measure abdominal girth. D. Document the finding as the only action.
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ANS: D Absence of bowel sounds 2 hours after abdominal surgery is an expected finding that should be documented. No intervention specific to this finding is needed at this time.
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17. Calculate the actual amount of nasogastric (NG) tube drainage during an 8-hour shift (3 PM to 11 PM) from the client who has a drainage container with 200 mL marked at 3 PM and 840 mL at 11 PM, and who received NG irrigations (flushings) of 60 mL three times during the 8-hour shift. A. 840 mL B. 660 mL C. 460 mL D. 420 mL
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ANS: C The initial volume of 200 mL is subtracted from the 840 mL, leaving 640 mL. The irrigation fluid is not drainage and also must be subtracted (60 3 = 180 mL). The total drainage from this client’s NG tube during the 8-hour shift was 460 mL (640 180 = 460 mL).
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18. The client who is 24 hours postoperative from abdominal surgery has light brown fluid with small particles that look like coffee grounds in the NG tube drainage. What is the nurse’s best action? A. Notify the physician. B. Irrigate the tube with normal saline. C. Clamp the tube and advance it 1 to 2 inches. D. Document the finding as the only action.
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ANS: A This type of drainage indicates possible gastrointestinal bleeding and should be explored further as soon as possible.
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19. The nurse empties 80 mL of sanguineous drainage from the Jackson-Pratt drain in the client’s hip after hip surgery. What other actions regarding the drain should the nurse take? A. Flush the tubing with urokinase to ensure patency. B. Compress and close the drain to ensure suction. C. Advance the tubing ½ inch from the insertion site. D. Clamp the drain for 2 hours and release the clamp for 2 hours.
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ANS: B The Jackson-Pratt drain removes fluid from the wound through closed suction. The drain must be compressed and closed to create suction as it slowly re-expands.
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20. The client is postoperative from surgery performed to determine whether a growth in her colon is cancerous. She asks the nurse what the pathology report shows. The pathology report indicates that the growth is benign. What is the nurse’s best response? A. “Congratulations! The growth was not cancerous.” B. “You will have to wait for your doctor to tell you the results.” C. “You shouldn’t worry. Most tumors of this sort are benign.” D. “I will call your doctor to let her know you are awake and are concerned about the results.”
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ANS: D Unless there are specific orders to tell the client the pathology results, the surgeon is the person to explain them to the client.

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