2) Anticholinergics: to reduce secretions
3) Opioids: to decrease intraoperative anesthetic requirements and pain
4) Additional drugs include antiemetics, antibiotics, eye drops, and regular prescription drugs
Benzodiazepines and barbiturates
Latex, Iodine, and allergies to anesthesia that may result in Malignant Hyperthermia.
A.) Assist patient to bathroom and stay next to door to assist patient back to bed when done.
B. Allow patient to go to the bathroom since the onset of the medication will be more than 5 minutes.
C. Offer the patient to use the urinal/bedpan after explaining the need to maintain safety.
D. Ask patient to hold the urine for a short period of time since a urinary catheter will be placed in the operating room.
The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance.
A. Note the presence of the ring in the nurse’s notes of the chart.
B. Insist the patient remove the ring.
C. Explain that the hospital will not be responsible for the ring.
D. Tape the ring securely to the finger.
It is customary policy to tape a patient’s wedding band to the finger and make a notation on the preoperative checklist that the ring is taped in place.
A. She must be NPO after breakfast.
B. She needs to be NPO after midnight.
C. She can drink clear liquids up to 2 hours before surgery.
D. She can drink clear liquids up until she is taken to the OR.
Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidenced-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.
A. Inform the anesthesiologist of the patient’s ingestion of kava.
B. Tell the patient that using kava to help sleep was a good idea.
C. Tell the patient that the kava should continue to help him relax before surgery.
D. Inform the patient about the dangers of taking herbal medicines without consulting his health care provider.
Kava may prolong the effects of certain anesthetics. Thus the anesthesiologist needs to be informed of recent ingestion of this herbal supplement.
B. Muscle rigidity
C. Decreased body temperature
D. Confusion upon arousal from anesthesia
Malignant hyperthermia is a metabolic disease characterized by hyperthermia with rigidity of skeletal muscles occurring secondary to exposure to certain anesthetic agents in susceptible patients. Hypoxemia, hypercarbia, and dysrhythmias may also be seen with this disorder.
A. A functional status evaluation
B. Renal and liver function tests
C. A physical examination report
D. An electrocardiogram
It is essential to have a physical examination report attached to the chart of a patient going for surgery. This document explains in detail the overall status of the patient for the surgeon and other members of the surgical team.
A. Positioning the patient
B. Observing the operative site
C. Checking the postoperative orders
D. Receiving report from operating room personnel.
A patient is received in the postanesthesia care unit on a bed or stretcher. Proper positioning is necessary to ensure airway patency in a sedated, unconscious, or semiconscious patient. Observation of the operative site, receiving report from operating room personnel, and checking postoperative orders are interventions made after proper positioning of the patient.
B. Hearing aid
C. Engagement ring
D. Well-fitting dentures
If a patient is wearing a hearing aid, the perioperative nurse should be notified. Leaving the hearing aid in place enhances communication in the operating room. The nurse should make certain to record that the appliance is in place. Wigs, engagement rings, and dentures are not necessary items to facilitate quality patient care in the operating room.
A. assessing for respiratory depression.
B. establishing a baseline laboratory profile.
C. inspecting the catheter insertion site hourly.
D. ensuring that the patient remains on strict bed rest.
Possible side effects of epidural opioids are pruritus, urinary retention, and delayed respiratory depression, occurring 4 to 12 hours after a dose. Establishing a baseline laboratory profile is outside the scope of practice for a nurse. Hourly inspection of the catheter insertion site is an unnecessary nursing intervention. In general, the site is assessed once a shift unless unexpected complications occur. Strict bed rest is not necessary for the patient with an epidural catheter; however, assistance with getting out of bed could be necessary related to effects of the opioid analgesic.
A. Confirming that the patient has voided
B. Monitoring vital signs every 15 minutes
C. Placing the patient in bed with the rails up
D. Transporting the patient immediately to the operating room
After administration of preoperative medications, a nurse should instruct a patient not to get up without assistance because medications can cause drowsiness or dizziness. Confirming that the patient has recently voided should be done before preoperative medications are administered. Monitoring vital signs every 15 minutes is not a necessary intervention unless prescribed by the physician. Transporting the patient immediately to the operating room is not necessary unless the patient is called for.
A. Elevating the head of the bed to decrease nausea
B. Elevating the patient’s feet to increase blood pressure
C. Instructing the patient to remain flat in bed for 6 hours
D. Administering oxygen to reduce hypoxia produced by spinal anesthesia
In addition to interventions designed to replace fluids and indirectly replace lost spinal fluid after administration of spinal anesthesia, the patient is instructed to lie flat for 6 to 8 hours. Elevating the head of the bed after spinal anesthesia can precipitate “spinal headache” or nausea related to losses of cerebrospinal fluid or changes in ICP. Elevating the patient’s feet or administering oxygen are not necessary interventions unless the patient becomes hypotensive or hypoxic.
A. Tell the surgeon before an incision is made.
B. Tell the circulating nurse at the end of the surgery.
C. Say nothing because someone else is likely to notice also.
D. Point out the observation immediately to the personnel involved.
Any break in sterile technique in the operating room should be immediately pointed out and remedied.
A. Ask the patient his name.
B. Notify the surgeon and anesthesiologist.
C. Check to see whether the patient has received any preoperative medications.
D. Assume that the patient is a little confused because he is older and has received midazolam intramuscularly.
Ensuring proper identification of a patient is a responsibility of all members of the surgical team. In a specialty surgical setting where many patients undergo the same type of surgery each day, such as cataract removal, it is possible that the patient and the record do not match. Nurses do not assume in the care of their patients. The priority is with the nurse identifying the patient and the patient’s consent form before the physicians are notified.
A. explain that the drug will help prevent clot formation in the legs.
B. check the results of the partial thromboplastin time before administration.
C. administer the dose with meals to prevent GI irritation and bleeding.
D. inform the patient that blood will be drawn every 6 hours to monitor the prothrombin time.
Unfractionated heparin or LMWH is given as a prophylactic measure for venous thrombosis and pulmonary embolism. These anticoagulants work by inhibiting thrombin-mediated conversion of fibrinogen to fibrin. LMWH is injected subcutaneously with no relationship to meals. It has a more predictable dose response and less risk of bleeding complications. It does not require anticoagulant monitoring and dosage adjustments.
A. report the physician for violating surgical asepsis and endangering the patient.
B. not say anything, because the nurse is not sure that the gloves and field were contaminated.
C. ask the physician whether the contaminated glove and the sterile field have been contaminated.
D. point out the possible break in surgical asepsis and provide another set of sterile gloves and fresh sterile field.
It is the responsibility of the nurse to point out any possible break in surgical asepsis when others are unaware that they have contaminated the field. Reporting the physician is not indicated, nor does it protect the patient. Asking the physician may lead to infection if the physician is unaware of the break in technique that the nurse believes may have happened. Saying nothing does not protect the patient and is negligence on the part of the nurse.
A. Serum sodium level of 140 mEq/L
B. Serum potassium level of 3 mEq/L
C. Hb concentration of 13.5 mg/dl
D. Partial thromboplastin time of 25 seconds
Electrolyte imbalances increase operative risk. Preoperative laboratory results should be checked to see whether they are within the normal range. The normal potassium level is 3.5 to 5.0 mEq/L. A low serum potassium level puts the patient at risk for cardiac dysrhythmias. A serum sodium level of 140 mEq/L is considered a normal value. An Hb concentration of 13.5 mg/dl is considered a normal value by most laboratory standards and does not interfere with operative decisions. A partial thromboplastin time of 25 seconds is a normal value and conducive to proceeding with a surgical procedure.
A. Teaching only the patient
B. Teaching the patient and family
C. Using brief verbal instructions
D. Using only written instructions
A nurse should determine learning needs preoperatively and teach both the patient and the family before surgery. Using only written instructions does not provide the opportunity for evaluation for learning. Brief verbal instructions are often forgotten. Teaching only the patient limits learning preoperatively because the patient can be anxious and not receptive to new information.
A. Excessive thirst
B. Gradual weight gain
C. Overwhelming fatigue
D. Recurrent blurred vision
The classic clinical manifestations of diabetes mellitus are increased frequency of urination (polyuria); increased thirst and fluid intake (polydipsia); and as the disease progresses, weight loss despite increased hunger and food intake (polyphagia). Weakness, fatigue, and recurrent blurred vision are associated with diabetes mellitus but are not considered priority manifestations because of the generalization of these complaints being applied to other disease processes. Weight loss is the cardinal sign related to the depletion of water, glycogen, and triglyceride stores.
A. Ask the family whether the patient understands the procedure.
B. Check the chart for a completed and signed consent form.
C. Ask the patient what he or she understands regarding the procedure.
D. Determine from the physician what was discussed with the patient.
Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure, and then gives consent for it to be done. The piece of paper is simply evidence that the informed consent process has been done.
A. Increase oral fluid intake.
B. Perform oral hygiene frequently.
C. Swab the inside of the mouth with petroleum.
D. Increase the rate of IV fluid administration.
Frequent oral hygiene will help alleviate discomfort for a patient who is NPO. IV fluid rate is prescribed by the physician. Petroleum is always inappropriate intraorally. Oral fluid intake is contraindicated in a patient who is NPO.
A. Reassure the patient that the surgery will go as planned.
B. Explain the surgery and possible outcomes to the patient.
C. Complete her first priority, the preoperative teaching plan.
D. Call the physician to return and clarify information for the patient.
Examples of nursing advocacy include questioning doctors’ orders, promoting patient comfort, and supporting patient decisions regarding health care choices.
A. laboratory tests and perioperative medications.
B. preoperative and postoperative teaching by the nurse.
C. psychologic support to alleviate fears of pain and discomfort.
D. preoperative nursing assessment related to possible risks and complications.
Ambulatory surgery is usually less expensive and more convenient, generally involving fewer laboratory tests, fewer preoperative and postoperative medications, less psychological stress, and less susceptibility to hospital-acquired infections. However, the nurse is still responsible for assessing, supporting, and teaching the patient undergoing surgery, regardless of where the surgery is performed.
A. decrease nausea and vomiting during and after surgery.
B. decrease oral and respiratory secretions, thereby drying the mouth.
C. decrease anxiety and produce amnesia of the preoperative period.
D. induce sleep, so the patient will not be aware during transport to the operating room.
Atropine, an anticholinergic medication, is frequently used preoperatively to decrease oral and respiratory secretions during surgery, and the addition of morphine will help to relieve discomfort during the preoperative procedures. Antiemetics decrease nausea and vomiting during and after surgery, and scopolamine and some benzodiazepines induce amnesia. An actual sleep state is rarely induced by preoperative medications unless an anesthetic agent is administered before the patient is transported to the operating room.
A. avoiding any type of injury to the patient.
B. maintaining a clean environment for the patient.
C. providing for patient comfort and sense of well-being.
D. preventing breaks in aseptic technique by the sterile members of the team.
The protection of the patient from injury in the operating room environment is maintained by the circulating nurse by ensuring functioning equipment, preventing falls and injury during transport and transfer, monitoring asepsis, and being with the patient during anesthesia induction.
A. can be administered only by anesthesiologists or nurse anesthetists.
B. enables the patient to respond to commands and accept painful procedures.
C. is so safe that it can be administered by nurses with direction from health care providers.
D. should never be used outside of the OR because of the risk of serious complications.
Conscious sedation is a moderate sedation that allows the patient to manage his or her own airway and respond to commands, and yet the patient can emotionally and physically accept painful procedures. Drugs are used to provide analgesia, relieve anxiety and/or provide amnesia. It can be administered by personnel other than anesthesiologists, but nurses should be specially trained in the techniques of conscious sedation to carry out this procedure because of the high risk of complications resulting in clinical emergencies.
A. encourages deep breathing.
B. elevates the head of the bed.
C. administers oxygen per mask.
D. positions the patient in a side-lying position.
An unconscious or semiconscious patient should be placed in a lateral position to protect the airway from obstruction by the tongue. Deep breathing and elevation of the head of the bed are implemented to facilitate gas exchange when the patient is responsive. Oxygen administration is often used, but the patient must first have a patent airway.
C. fluid overload.
D. impaired blood coagulation.
Secretion and release of aldosterone and cortisol from the adrenal gland and ADH from the posterior pituitary as a result of the stress response cause fluid retention during the first 2 to 5 days postoperatively, and fluid overload is possible during this time. Aldosterone causes renal potassium loss with possible hypokalemia, and blood coagulation is enhanced by cortisol.
Which of the following best describes a consent form?
A. May be signed by an emancipated minor.
B. Protects the health care facility but not the physician
C. Signifies that the patient understands all aspects of the procedure.
D. Signifies that the patient and family have been told about the procedure
E. Must be signed by the patient or responsible party at the health care facility, and that consent may not be obtained by phone or fax
C. Signifies that the patient understands all aspects of the procedure.
A consent form may be signed by an emancipated minor, and consent may be obtained by fax or phone with appropriate witnesses. Only in the cases of underage children or unconscious or mentally incompetent people must a family member be aware of the procedure. The document protects the surgeon and the health care facility in that it indicates that the patient knows and understands all aspects of the procedure.
Advantages of laser surgery include diminished
C. tissue damage.
D. postoperative pain.
E. postoperative infection.
(All of the above)
Laser surgery offers the benefits of diminished bleeding, swelling, tissue damage, and postoperative pain and infection.
A nurse is caring for a surgical patient in the preoperative area. The nurse obtains the patient’s informed consent for the surgical procedure. Which statements are true regarding informed consent?
A. Informed consent must be signed while the patient is free from mind-altering medications.
B. Informed consent must be witnessed.
C. Informed consent may be withdrawn at any time.
D. Informed consent must be signed by patients age 16 and older.
E. Informed consent must be obtained by the physician.
F. Informed consent must be obtained from the family even in a life-threatening emergency.
B. Informed consent must be witnessed.
An informed consent must be signed while the patient is free from mind-altering medications and must be witnessed after it has been determined that the patient has received all of the necessary information needed to make an informed decision. An informed consent may be withdrawn at any time before the procedure and must be signed by patients age 18 and older. A parent or guardian’s signature is required for minors. The informed consent may be obtained by the physician or the nurse and is not required in the event of a life-threatening emergency.
A nurse is caring for patients on a medical-surgical unit. The nurse plans the patients’ care and instructs the nursing assistant to assist in repositioning patients every 2 hours. Which patients are at the greatest risk for complications if not repositioned properly?
A. A 20-year-old unconscious patient
B. A 90-year-old frail patient
C. A 65-year-old patient who is visually impaired
D. A 40-year-old patient who has paraplegia
B. A 90-year-old frail patient (&)
D. A 40-year-old patient who has paraplegia
Patients who are at the greatest risk for complications if not properly repositioned are those who are unconscious, frail, or paralyzed.
Initially position pt in a Lateral recumbant position until arousal from anesthesia, then position pt in Semi or Fowler position to reduce breathing effort.
2. Encourage coughing & deep breathing.
This helps clear anestetics from the body, lowers risk of pulmonary/fat emboli, and hypostatic pneumonia associated with secretion buildup in the airways.
3. Encourage use of Incentive Spirometer.
4. Monitor In’s and Out’s.
Hydration and protein rich nutrition promotes healing and provides energy to meet the needs of the pts increased metabolism associated with surgery.
5. Promote early ambulation.
Early post-op exercise and ambulation significantly reduce the risk of thromboembolism.
Recent general anesthesia, shallow breathing, respiratory muscle weakness and immobility are common risk factors.
A. to be monitored while recovering from anesthesia.
B. to remain near the surgeon immediately after surgery.
C. to allow the medical-surgical unit time to prepare for transfer.
D. to provide time for the pt to cope with the effects of surgery.
Pts are sent to a PACU to be monitored while they’re recovering from anesthesia.
A. Stop taking medication when pts physical appearance improves.
B. Pt should take steroids on an empty stomach.
C. Pt should take the prescribed medication as directed.
The pt should take prescribed medication as directed. Sudden withdrawl of steroids can precipitate adrenal crisis.
A. weakness and fatigue
B. nausea & vomiting
D. sodium & fluid retention
Sodium and fluid retention are characteristics of Cushing’s Syndrome.
Adrenal crisis causes decreased sodium levels and hypotension.
A. Type 2 diabetes commonly occurs in adults <40 yr. old. B. Type 1 diabetes usually occurs before age 30. C. Type 1 diabetes is treatable with exercise, meal planning, and antidiabetic drugs. D. An increasing number of adolescents are being diagnosed with type 2 diabetes.
Type 1 diabetes is treated with insulin and dietary management.
C. Paralytic ileus
D. Gastrocolic reflux
After surgery, pts are clients are at risk for paralytic ileus as a result of anesthesia.
Evidence of bowel function returning to normal includes auscultation of bowel sounds and passing of flatus and stool.
A. Suction the tracheostomy.
B. Readjust the tracheostomy tube and tighten the ties.
C. Preform a complete respiratory assessment.
Noisy, increased respiration & increased pulse are signs that the pt needs immediate suctioning to clear the airway of secretions. A complete respiratory assessment may then be completed.
A. 75ml of bright red drainage in the system.
B. A column of water 20cm high in the suction control chamber.
C. Constant bubbling in the water seal chamber.
Constant bubbling in the water seal chamber is indicative of an air leak. The nurse should assess the entire system to the pt to find the sourse of he leak. The leak may be with in the pts chest or at the insertion site. If it is, notify physician. This could cause the lung to collapse due to a buildup of air pressure within the plural cavity.
A. Transplantation surgery
B. Constructive surgery
C. Palliative surgery
D. Reconstructive surgery
A. Larger doses of anesthetic agents and larger doses of postoperative analgesics.
B. Larger doses of anesthetic agents and lower doses of postoperative analgesics.
C. Lower doses of anesthetic agents and larger doses of postoperative analgesics.
D. Lower doses of anesthetics agents and lower doses of postoperative analgesics.
A. Before the pain becomes severe.
B. When the patient experiences a pain rating of 10 on a 1-to-10 pain scale.
C. After the pain becomes severe and relaxation techniques have failed.
D. When there is no pain, but it is time for the medication to be administered.
A. Inform the physician that is his responsibility to obtain the signature.
B. Obtain the signature and ask another nurse to co-sign the signature.
C. Inform the physician that the nurse manager will need to obtain the signature.
A. Trendelenburg position
B. Prone position
C. Side-lying position
D. Supine position
A. Spinal anesthesia
B. Nerve block
C. Conscious sedation
D. Epidural anesthesia
A. Cardiac problems
B. Bleeding with anemia
C. Fluid imbalances
A. An informed consent
B. An insurance card
C. A Patient’s Bill of Rights
D. An advance directive
A. Hold all medications.
B. Avoid strong smelling foods.
C. Avoid oral hygiene until the nausea subsides.
D. Provide clear liquids with a straw.
A. 34 yr old female
B. 83 yr old female
C. 48 yr old male
D. 8 yr old male
A. Polydipsia, polyuria, and weight loss
B. Weight gain, tiredness, and bradycardia
C. irritability, diaphoresis and tachycardia
D. Diarrhea, abdominal pain and weight loss