Deck 1: Essential Nursing Considerations During the Perioperative Period

Question 1

A patient is admitted for surgery with a BMI of 30. In what way does obesity cause potential complications during the surgical process?

A)The patient is more likely to become anemic.
B)The patient is more likely to develop an infection.
C)The patient is more likely to have postoperative bleeding.
D)The patient is more likely to develop diarrhea.

Answer 1

The patient is more likely to develop an infection.

Question 2

The nurse is performing a preoperative assessment on a patient before a colon resection and notes the patient's blood pressure is elevated to 142/90 mmHg. What should the nurse do next?

A)Record the vital sign in the chart, allow the patient to rest quietly in a room, and recheck in 30 minutes.
B)Lower the head of the bed and tell the patient they need to lie flat for the next hour.
C)Notify the physician of the blood pressure result and consider rescheduling the surgery.
D)Obtain an order for antihypertensive medications to keep the blood pressure under control.

Answer 2

Record the vital sign in the chart, allow the patient to rest quietly in a room, and recheck in 30 minutes.

Question 3

Which types of precautions must the nurse consider when weighing a patient who needs to use a sling scale?

A)Weigh the patient while wearing the same types of clothing each time.
B)To avoid weighing drains or tubing, allow them to dangle over the side of the sling.
C)Ensure the bed rails are up when rolling the patient onto the sling.
D)Both A and C

Answer 3

Both A and C

Question 4

Which of the following is a type of intervention the nurse can employ with a patient who is suffering from memory problems during the teaching portion of the preoperative period?

A)Request to speak with the patient privately to eliminate outside influences from family
B)Reduce outside distractions by closing the door and turning off the television
C)Do not correct misinformation to avoid upsetting the patient
D)None of the above

Question 5

Which of the following actions should the nurse perform when trying to interview a patient with a language barrier when there is no interpreter available?

A)Speak in a loud, slow voice to ensure the patient can hear the information.
B)Avoid using known words in the patient's own language, in case they are spoken incorrectly.
C)Act out some words while saying them to facilitate better understanding.
D)Avoid attempting to interview the patient at all until an interpreter arrives.

Question 6

The nurse is preparing to insert a nasogastric tube into a patient as part of a preoperative procedure. Which of the following is a true statement regarding placement of a nasogastric tube?

A)The patient is placed in the reverse-Trendelenburg position during placement.
B)The patient may need to sip water during the procedure to help advance the tube.
C)Placement of the nasogastric tube is confirmed through a CT scan.
D)Both B and C

Question 7

As part of a preoperative examination, the nurse depresses the patient's tongue with a tongue depressor and moves it from side to side. This test is an example of examining which cranial nerve?

A)V (trigeminal)
B)VII (facial)
C)X (vagus)
D)XII (hypoglossal)

Question 8

Which of the following must the nurse ask about when preparing to use Hypaque for arteriography?

A)Does the patient have high blood pressure?
B)Is the patient allergic to shellfish?
C)Does the patient have anxiety?
D)What is the patient's ethnic background?

Question 9

The patient is being extubated at the end of the surgical procedure. The cuff has been deflated and the mouth and tube have been suctioned. What is the next step in this process?

A)Provide ten more minutes of assisted ventilation using a bag connected to the ET tube.
B)Flex the patient's head down with the chin toward the chest to ease removal of the tube.
C)Insert a suction catheter into the tube and apply suction while pulling the tube out.
D)Using the thumb and forefinger, apply cricoid pressure to the neck while slowly pulling out the tube.

Question 10

Which of the following is a purpose of invasive hemodynamic monitoring during the surgical procedure?

A)To assess for depletion or restoration of electrolytes.
B)To measure effectiveness of the heart muscle.
C)To confirm changes in the patient's clinical status.
D)Both A and C

Question 11

Which of the following interventions must the nurse consider when giving a patient furosemide?

A)Administer the drug slowly, over approximately two minutes.
B)Monitor the patient for signs of facial flushing and tachypnea.
C)Check and document the patient's potassium levels after administration.
D)Both A and C

Question 12

In what position would the perioperative nurse most likely position a patient for a temporal craniectomy?

A)Supine
B)Prone
C)Lateral recumbent
D)Sitting

Question 13

Which of the following actions must the nurse consider when setting up or using a laser unit for surgery?

A)Place the foot control device near all other foot pedals below the table so the surgeon has easy access to the device.
B)Leave liquids and solutions placed next to the laser device instead of placing them directly on top of the equipment.
C)Move laser equipment carefully to avoid running into objects and damaging internal components.
D)Only allow the physician to remove the outside component of the laser equipment if the machine malfunctions.

Question 14

What is the purpose of having a case cart with operating supplies sent from central processing for a surgical procedure?

A)It allows the central processing unit to determine what supplies are necessary for each individual procedure.
B)It saves time for the nursing staff to pick and choose what supplies are needed.
C)It reduces the amount of supplies and materials in the operating room, allowing more room for the procedure.
D)It gives personnel in central processing extra work to perform.

Question 15

When working around a sterile field, which of the following measures will result in contamination?

A)Dropping items onto the sterile field.
B)Reaching around the outside of a sterile area.
C)Adjusting the patient's drape after placement.
D)Keeping gloved hands in front of the body, above the level of the waist.

Question 16

A patient is transferred to the PACU and presents with snoring respirations and little chest expansion while breathing. The nurse notes that their oxygen saturations are at 94% and starting to decrease. What is the nurse's first action?

A)Perform a jaw thrust to open the airway.
B)Notify the physician immediately.
C)Stimulate the patient to take deeper breaths.
D)Turn the patient prone.

Question 17

Which of the following nursing diagnoses is the patient most likely to have during the recovery period after surgery?

A)Dysfunctional grieving
B)Altered nutrition, less than bodily requirements
C)Disorientation and confusion
D)Ineffective thermoregulation

Question 18

What aspects of the PACU may help the psychological wellbeing of the patient recovering from surgery?

A)The presence of many monitors so the patient knows the PACU has advanced technology to help them.
B)Many nurses and technicians, which gives the patient confidence in the abilities of the nursing staff.
C)A large, open room so the patient is aware that others are also recovering from surgery.
D)Low lighting so the patient is not exposed to harsh glare during recovery.

Question 19

The patient arrives in the recovery room with a blood pressure of 148/100 mmHg. Upon report from the anesthesiologist, the patient has no cardiac history and is currently asymptomatic. What is the nurse's next action?

A)Assess the patient for increased pain and anxiety.
B)Listen to the patient's heart and lung sounds.
C)Ask the patient to sit up and raise the head of the bed.
D)Both A and B

Question 20

A patient is transferred to the post-surgical unit and the nurse receives a report on their status. During the report, they are notified that the patient has a history of thrombocytopenia. Which of the following measures should the nurse perform to reduce the risk of this patient developing a blood clot?

A)Provide prophylactic aspirin to reduce clot formation.
B)Tell the patient to avoid crossing their legs.
C)Have the patient remain in bed with a pillow under the knees.
D)Both A and B

Question 21

Which of the following interventions can the nurse perform to reduce the risk of infection after the patient has been transferred to the surgical unit?

A)Remove the indwelling catheter as soon as possible.
B)Administer anti-inflammatory medications, such as steroids, to reduce swelling.
C)Encourage the patient to sleep on their stomach to facilitate adequate lung expansion.
D)Tell the patient they should increase their intake of water and carbohydrate-based foods.

Question 22

The patient is transferred from the operating room to the PACU and upon initial assessment, tells the nurse, "I feel like I'm going to throw up." Which of the following is the most appropriate response from the nurse?

A)"Take some deep breaths and close your eyes."
B)"I'm going to turn you on your side now."
C)"Here is an emesis basin if you need one."
D)"That is a common feeling. It will go away soon."

Question 23

Which of the following is important for the nurse to teach the patient prior to having a fiberoptic colonoscopy?

A)The patient should limit fluid intake for one week prior to the procedure.
B)The patient may continue to take normal medications except anticoagulants after instillation of the lavage solution.
C)The patient must refrain from eating anything for at least 12 hours before the procedure.
D)The lavage solution may be ingested orally or through a nasogastric tube.

Question 24

When starting an intravenous line, the nurse holds the needle with the bevel up before penetrating the skin. What is the rationale for this practice?

A)It reduces the risk of the needle going through the vein.
B)It produces less pain for the patient.
C)It is less traumatic to the skin.
D)It reduces the risk of infection.

Question 25

Which of the following is not a nursing intervention for a patient with a diagnosis of anxiety related to the surgical procedure?

A)Teach the patient techniques that will help them to relax.
B)Call a social worker to come and stay with the patient.
C)Help the patient to verbalize why they are feeling anxious.
D)Remove outside factors that may be overstimulating.

Question 26

What type of appearance should the nurse expect to see in a patient with polycythemia who presents for surgery?

A)Pale appearance and flushed skin
B)Yellow appearance of the skin and sclera
C)A bronze appearance on the chest and perineum
D)A ruddy-blue appearance in the face, hands and feet

Question 27

What is the purpose of administering an enema to a patient prior to some types of surgical procedures?

A)It prevents the patient from defecating during the surgical procedure.
B)It reduces the risk for gas pain that may occur after surgery.
C)It prevents constipation that can occur related to anesthesia.
D)It reduces patient discomfort due to withholding food and fluids before surgery.

Question 28

Which of the following tests measures coagulation by assessing fibrinogen and clotting factors V, VII, and X?

A)Partial thromboplastin time
B)Platelet aggregation
C)Prothrombin time
D)Reticulocyte count

Question 29

The nurse is performing a preoperative assessment on a patient and notes that they have a heart murmur. When assessing intensity of a cardiac murmur, what question should the nurse ask themself?

A)Does the murmur occur during systole or diastole?
B)How loud is the murmur?
C)In what area of the chest is the murmur heard?
D)Does the murmur produce any additional sounds?

Question 30

Which of the following is a benefit of using depilatory cream as part of skin preparation before a surgical procedure?

A)The skin at the surgical site remains intact.
B)The process of applying the cream is cleaner than hair removal through shaving.
C)In some situations, the patient may apply the cream to themself.
D)Both A and C

Question 31

The term used to describe anesthesia that includes a mixture of a hypnotic-sedative, a narcotic, a muscle relaxant and inhalation medication is called:

A)General anesthesia
B)Balanced anesthesia
C)Local anesthesia
D)Regional anesthesia

Question 32

Which of the following actions should be performed with instruments that are difficult to clean and have been used on a patient with Creutzfeldt-Jakob disease?

A)Immerse the instruments in formaldehyde for approximately 30 minutes before starting the disinfection process.
B)Begin decontamination by using a steam autoclave.
C)Immerse the instruments in a covered container of sodium oxalate for 90 minutes.
D)Clean and sterilize the instruments according to instructions, but store them separately from other instruments.

Question 33

Which of the following practices disrupts the integrity of the sterile field?

A)Always standing and facing the sterile field.
B)Setting up supplies as close to the time of the surgical procedure as possible.
C)Setting up supplies ahead of time and covering them with sterile towels for protection.
D)Staying within the sterile field for the duration of the procedure when scrubbed in as sterile.

Question 34

Which type of complication occurs most commonly with a vertical midline incision of the abdomen?

A)Accidental ligation of the inferior epigastric artery
B)Decreased blood supply to the rectus muscle
C)Wound dehiscence and evisceration
D)Damage to the ilioinguinal nerve

Question 35

What conditions are considered indications for a surgical vitrectomy?

A)Diabetic retinopathy
B)Foreign object in the eye
C)Glaucoma
D)Both A and B

Question 36

Which of the following are potential outcomes of hypothermia in a patient during a surgical procedure? Choose all that apply.

A)Increased bleeding during surgery
B)Slow wound healing
C)Numbness and tingling in the extremities
D)None of the above

Question 37

Halothane and enflurane are examples of what types of anesthetic agents?

A)Intravenous
B)Inhalation
C)Subcutaneous
D)Nerve block

Question 38

Which of the following practices can the nurse perform to reduce air contamination during the perioperative setting?

A)Keep doors closed while in the operating suite and avoid excessive movement between rooms.
B)Perform a room disinfection using a fog technique after the procedure is complete.
C)Spray an air neutralizer in the room immediately before, during and after the surgery.
D)Both A and C

Question 39

When performing a sponge count during a surgical procedure, which aspects should be included in the documentation?

A)Who performed the count
B)The types of sponges counted
C)The results of the count
D)Both A and C

Question 40

At what points should medications be checked before being administered to a patient?

A)When the drug comes from pharmacy, when the drug is drawn up, and when the drug is administered
B)When the drug is drawn up, when the drug is administered, and after the patient receives it
C)When the drug is brought out for use, when the drug is drawn up, and when the drug is administered
D)When the drug is packaged, when the drug is administered, and when the empty vial is thrown away

Question 41

Which of the following are important components of developing an educational program for a patient and their family? Choose all that apply.

A)The patient's reading abilities
B)The nurse's schedule to allow enough time for teaching
C)The patient's relationship with their family members
D)None of the above

Question 42

Which of the following types of mechanical cleaners uses a process called cavitation to rid the instruments of debris?

A)Washer-disinfector
B)Ultrasonic washer
C)Resonant washer
D)Washer-sterilizer

Question 43

What is the purpose of a steam integrator strip that is kept with a tray of instruments?

A)To indicate that the items need to be sterilized.
B)To indicate that the items are disposable and do not need to be sterilized.
C)To indicate that the items went through the flash sterilization process.
D)To indicate that the items have been damaged through sterilization.

Question 44

What is the purpose of covering reconstituted disinfectant solutions when not in use?

A)The solutions may otherwise become contaminated.
B)The solutions may emit noxious fumes or odors.
C)The solutions may otherwise lose levels of concentration.
D)The solutions may expire more quickly.

Question 45

Which of the following steps is part of the terminal process of cleaning instruments used in surgery?

A)Disinfection
B)Neutralization
C)Sterilization
D)Both A and C

Question 46

What items must the perioperative nurse check to ensure safety during a surgery that uses electrocautery?

A)The electrosurgical unit is set at the highest setting necessary for the procedure.
B)The footpad should be located just next to the suction canister for ease of use.
C)The ground pad is in an appropriate location, such as on the back of the elbow.
D)The alarm is turned on and can be heard by those in the room.

Question 47

Which of the following factors may have an effect on a patient's risk of developing an infection after a surgical procedure?

A)The patient's condition before surgery
B)The state of the surgical wound at closure
C)The route the antibiotics were administered preoperatively
D)Both A and B

Question 48

A nurse in the operating room helps the surgeon by using surgical instruments, providing suturing and handling tissue specimens. The most likely title of this nurse would be:

A)Scrub nurse
B)RN first assistant
C)Circulating nurse
D)Nurse anesthetist

Question 49

While administering blood products during a surgical procedure, the nurse notes that the patient has spiked a fever to 101 degrees, their skin is flushing and their heart rate has increased. What is the nurse's first reaction?

A)Administer oxygen by non-rebreather mask at 10L/min.
B)Call the Blood Bank to verify labeling of the blood products.
C)Check the patient's chart to ensure the orders are correct.
D)Stop the transfusion and notify the physician.

Question 50

Which of the following is a potential complication associated with spinal anesthetic?

A)Hypertension
B)Post-dural puncture headache
C)Intraspinal bleeding
D)Paralysis

Question 51

Which of the following procedures most likely requires the patient to be placed in the Kraske position?

A)Splenectomy
B)Hip arthroscopy
C)Coccygectomy
D)Craniotomy

Question 52

During surgery, a patient's respiratory rate drops and they begin to have heart arrhythmias. The physician orders a blood gas panel, and the results show pH 7.20, PCO₂ 62, P02 86, and HCO323. Which of the following conditions is the patient most likely to have?

A)Metabolic acidosis
B)Metabolic alkalosis
C)Respiratory acidosis
D)Respiratory alkalosis

Question 53

Upon arrival in the operating room, the nurse is reviewing some information about the procedure with the patient before anesthesia is given. Which of the following questions or statements is most appropriate for the nurse to say in this situation?

A)"Are you ready for this?"
B)"Tell me about what concerns you have."
C)"We're going to give you something that will make you sleepy."
D)"Is your family going to be here when you are finished?"

Question 54

The surgeon is planning to perform insufflation for an abdominal surgery. What information should the nurse give to the patient regarding this procedure?

A)The patient may have bruising on the abdomen after the surgeon takes hold of the tissue.
B)Insufflation will be done laparoscopically, and the surgeon will be able to visualize where he is instilling the gas.
C)The surgeon will use nitrous oxide gas for insufflation, which is very safe.
D)The process will put the patient at risk of constipation following the procedure.

Question 55

Which of the following is a true statement regarding sponge counts in the operating room?

A)If a pack of sponges arrives that is numbered incorrectly, the nurse should write the actual number of sponges included on the outside of the package.
B)During surgery, the circulating nurse should hand the sponges to the scrub nurse to keep in a pan for later counts.
C)Sponges should be kept separated from towels to avoid confusion and miscounting.
D)The nurse should bag the sponges and then perform a quick count in the room after the procedure is complete.

Question 56

When preparing a frozen section for laboratory analysis, what must the nurse do to prepare a specimen?

A)Place the frozen section in a sterile bowl of saline.
B)Keep the frozen section in a container of formaldehyde.
C)Place the frozen section on a damp towel.
D)Carry the frozen section by hand to pathology.

Question 57

What is the meaning of the term 'contact precautions' during infection control measures?

A)The patient can transmit disease if he sneezes or coughs.
B)The patient can transmit disease if the nurse touches equipment used for their care.
C)The patient can transmit disease when others breathe in the air around them.
D)The patient can transmit disease when the surgeon opens their body cavity.

Question 58

Which of the following patients is at highest risk of developing intraoperatively acquired neuropathy?

A)A patient with type 1 diabetes mellitus
B)A patient who is morbidly obese
C)A patient with hypercholesterolemia
D)Both A and B

Question 59

Which of the following symptoms is a potential outcome of botulism contamination?

A)Fever, abdominal pain, and shock
B)Blurred vision, muscle weakness, and paralysis
C)Nausea, vomiting, and diarrhea
D)Chills, joint pain, and cough

Question 60

All of the following are essential guidelines for a nurse who is scrubbing in for a procedure EXCEPT:

A)Wash hands and arms before starting the surgical hand scrub.
B)Rinse thoroughly, keeping the hands lower than the elbows.
C)Hold the hands and the arms away from the body.
D)Use knee or foot controls to turn off the water.