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NRSG 327 Exam Questions with Complete Solutions: Post-Operative Care and Complications, Exams of Nursing

Montana State UniversityNursing

A comprehensive set of questions and answers related to post-operative care and complications in nursing. It covers various aspects, including pain management, wound care, fever management, electrolyte imbalances, and common post-operative complications like dvt and wound dehiscence. Valuable for nursing students preparing for exams or those seeking to deepen their understanding of post-operative care.

Typology: Exams

2024/2025

Available from 03/18/2025

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NRSG 327 EXAM QUESTIONS WITH COMPLETE SOLUTIONS
A fast acting analgesic should be given for post-op pain __min before activities that will
cause pain -- Answer ✔✔ 30
what can be given for SEVERE pain (if ordered) -- Answer ✔✔ combination of:
- acetaminophen
- NSAID
- Narcotic
What analgesic should be used:
- for mild pain -- Answer ✔✔ Non-Opioid analgesics: Acetaminophen
- in combination with narcotics, helps relieve moderate to severe pain
What is the recommended and max dose for Non-Opioid analgesics (acetaminophen) --
Answer ✔✔ 650mg PO Q4H or
1000mg PO Q6H
650 - 1300mg PO Q8H
MAX = 4g/day
What analgesic should be used:
- for mild to moderate pain -- Answer ✔✔ NSAIDs: Ketorolac, Ibuprofen, Diclofenac
- in combo with narcotics helps relieve moderate to severe pain
what analgesics often cause stomach upset? -- Answer ✔✔ NSAIDs
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Download NRSG 327 Exam Questions with Complete Solutions: Post-Operative Care and Complications and more Exams Nursing in PDF only on Docsity!

NRSG 327 EXAM QUESTIONS WITH COMPLETE SOLUTIONS

A fast acting analgesic should be given for post-op pain __min before activities that will cause pain -- Answer ✔✔ 30 what can be given for SEVERE pain (if ordered) -- Answer ✔✔ combination of:

  • acetaminophen
  • NSAID
  • Narcotic What analgesic should be used:
  • for mild pain -- Answer ✔✔ Non-Opioid analgesics: Acetaminophen
  • in combination with narcotics, helps relieve moderate to severe pain What is the recommended and max dose for Non-Opioid analgesics (acetaminophen) -- Answer ✔✔ 650mg PO Q4H or 1000mg PO Q6H 650 - 1300mg PO Q8H MAX = 4g/day What analgesic should be used:
  • for mild to moderate pain -- Answer ✔✔ NSAIDs: Ketorolac, Ibuprofen, Diclofenac
  • in combo with narcotics helps relieve moderate to severe pain what analgesics often cause stomach upset? -- Answer ✔✔ NSAIDs
  • regardless of route
  • should be given with food or milk
  • monitor for GI bleed RANITIDINE (Zantac) may be ordered - anti ulcer agent What organ metabolizes: Non-opioid analgesics (acetaminophen) -- Answer ✔✔ Liver What organ metabolizes: NSAIDs (Ibuprofen, Ketorolac) -- Answer ✔✔ Kidneys
  • NSAIDs may slow bone healing What analgesic should be used:
  • for moderate to severe pain
  • not useful for mild pain due to side effects -- Answer ✔✔ Narcotics:
  • morphine
  • codeine
  • oxycodone
  • Demerol
  • hydromorphone Post-Op bleeding is a concern if a dressing needs to be changed more than - times per shift -- Answer ✔✔ 2 - 3 How much drainage:
  • open abdominal surgeries -- Answer ✔✔ - moderate amount of serosanguinous fluid How much drainage:
  • may need to be taken back into OR
  • transfusion or bolus IV fluids
  • monitor vitals Post-Op complication causes: Fever (wind) -- Answer ✔✔ atelectasis (collapsing of the small airways at the bottom of the lungs)
  • most common postop day 1 - 2
  • treated by encouraging use of incentive spirometer Q1H and mobilizing Post-Op complication causes: Fever (water) -- Answer ✔✔ UTI (urinary tract infection)
  • common postop day 3 - 5
  • obtain sterile urine specimen for c&s Post-Op complication causes: Fever (walking) -- Answer ✔✔ DVT (deep vein thrombosis)
  • common after postop day 4 - 6
  • may cause low grade fever
  • should ambulate at least 3 times per day to prevent
  • anticoagulants Post-Op complication causes: Fever (wound) -- Answer ✔✔ Infection
  • most infections do not cause fever until postop day 5 - 7
  • teach to watch for signs of infection (redness, swelling, pain, purulent drainage)
  • take wound culture if suspected Post-Op complication causes: Fever (wonder drugs) -- Answer ✔✔ Fever caused by adverse drug rxn
  • may not occur until 7+ days of taking drug
  • check MAR for new meds Post-Op complication causes: Fever (other causes) -- Answer ✔✔ - septicemia/septic shock Sepsis
  • increased HR
  • increased RR
  • drop in BP
  • SOFA (sepsis related organ failure assessment)
  • hypotonic IV fluids
  • retention of fluids after surgery (usually due to increased ADH secretion) S&S of ___? Lab value: <3.5 mEq/L
  • weakness
  • decreased GI motility
  • weak, irregular pulse -- Answer ✔✔ hypokalemia How to treat Hypokalemia -- Answer ✔✔ - IV containing potassium (ex. KCl) (NEVER given bolus - can cause cardiac arrest)
  • cardiac monitoring
  • potassium supplement S&S of ___: Lab value: < 135 mEq/L
  • often asymptomatic until very low -- Answer ✔✔ hyponatremia Post-Op complication: Wound -- Answer ✔✔ - wound to abdomen and evisceration (internal organ outside), dehisce
  • cover with sterile moist gauze
  • diabetic pt. don't heal very will increased risk for dehisces what is a vasovagal episode -- Answer ✔✔ - peripheral blood vessels are dilated so when standing up all blood rushes from brain to feet
  • when vagus nerve is stimulated, it slows down heart (decreasing cardiac output)
  • may be caused by certain activities (ex. bearing down, insuring rectal suppository, inserting IV catheter) (hyper/hypo)volemia
  • increased volume
  • full and bounding pulse
  • distended veins
  • increased HR
  • 3rd spacing
  • fluid in lungs, crackles --> chest x-ray would show "white out" spaces
  • pulmonary edema (SOB, crackles, tachypnea, frothy pink sputum)
  • edema depending on position:
  • ambulatory = feet and legs
  • in bed = sacrum and buttocks -- Answer ✔✔ hypervolemia causes:
  • too much fluid given
  • result from surgery treatment
  • diuretics Lab values with Hypervolemia:
  • weak, thready pulse
  • cool extremities
  • decreased BP
  • urine output <30mL/hr
  • more than 40% loss of blood leads to shock -- Answer ✔✔ hypovolemia Causes of: hypovolemia -- Answer ✔✔ - blood loss due to surgery
  • GI loss (vomiting, diarrhea, NG suctioning)
  • diuretics
  • polyuria in hyperglycemia (diabetics at higher risk)
  • excessive sweating
  • fluid shifts (3rd shifting) Lab values with Hypovolemia:
  • Hematocrit (decrease/normal/increase)
  • Serum sodium (decrease/normal/increase) -- Answer ✔✔ Hematocrit
  • close to normal Serum Sodium
  • close to normal Treatment of: Hypovolemia -- Answer ✔✔ - replace fluids (oral electrolyte solution, IV fluid isotonic or colloid volume expanders)
  • blood transfusion
  • oxygen therapy
  • vasopressors
  • lower HOB
  • monitor mental status, vitals, urine output for shock DVT Virchow's Triad -- Answer ✔✔ Venous Stasis vascular wall Coagulation what is:
  • decreased platelets
  • usually occurs to pt. on heparin for more than 5 days
  • LMWH decreases chance for this compared to other anti-coagulants
  • immune response -- Answer ✔✔ HIT
  • Heparin induced thrombocytopenia What is the reversal agent for heparin? -- Answer ✔✔ protamine sulfate anyone who complains of chest pain over the age of __ gets a EKG -- Answer ✔✔ 17 what is? group of risk factors that increases risk of heart disease, stroke, and diabetes -- Answer ✔✔ metabolic syndrome Include
  • high blood cholesterol
  • high BP
  • obesity
  • high blood sugar
  • low HDL
  • 2/3 of people have severe atherosclerosis in at least one major coronary artery -- Answer ✔✔ Variant angina what type of angina:
  • causes chest pain that is unexpected and may happen when at rest or without stimulating activity
  • if new, worsening or constant --> at greater risk of having a heart attack, irregular heartbeat (arrhythmia), and even suffer death -- Answer ✔✔ Unstable angina
  • see doctor as soon as possible what type of angina:
  • causes chest pain but without any apparent blockage in a coronary artery
  • pain caused by improper functioning of the tiny blood vessels that feed your heart
  • may be referred to as cardiac syndrome X -- Answer ✔✔ microvascular angina what type of angina:
  • not experiencing typical symptoms of angina but instead may feel a vague chest discomfort, SOB, fatigue, nausea, back or neck pain, burning indigestion
  • women more likely to experience -- Answer ✔✔ atypical angina what are some triggers for angina -- Answer ✔✔ - Exertion (increased MvO2)
  • Cold (vasoconstriction)
  • Eating (bld is in the gut decreased supply)
  • Stress catecholamine's increase MvO2c (myocardial volume oxygen consumption) ACS (acute coronary syndrome) is an umbrella term for? -- Answer ✔✔ - angina
  • MI (NSTEMI, STEMI)
  • results in an imbalance in O2 supply and demand to the myocardium
  • damage to the myocardium can impact CO and can decrease O2 supply to rest of body AMI: (NSTEMI/STEMI)
  • decreased myocardial perfusion secondary to narrowing caused by a non-occlusive thrombus (ruptured atherosclerotic plaque) -- Answer ✔✔ Non ST elevation MI
  • won't show up on EKG
  • not total occlusion of vessel AMI: (NSTEMI/STEMI)
  • decreased myocardial perfusion secondary to narrowing caused by an occlusive thrombus (ruptured atherosclerotic plaque) -- Answer ✔✔ ST elevation MI
  • vessel has been occluded
  • can see on EKG
  • death of cells Chest pain most common symptoms: -- Answer ✔✔ - Central substernal
  • Radiates up to neck, down left arm
  • Throat pain

people with CAD or high risk <2.13mmol/L (Cardiogenic Shock/Heart Failure)

  • low BP
  • weak and irregular pulse
  • rapid onset
  • quiet heart sounds
  • murmur - diastolic
  • crackles in lungs -- Answer ✔✔ Cardiogenic shock what is the #1 risk factor for Cardiogenic shock -- Answer ✔✔ - heart attack
  • people over 80 (Cardiogenic Shock/Heart Failure)
  • high BP
  • Strong bounding pulse -- Answer ✔✔ Heart Failure 3 problems that cause cariogenic shock -- Answer ✔✔ - primary ventricular ischemia
  • structural problems (arterial septic defect, aortic stenosis
  • young people often can have undiagnosed --> can lead to sudden death
  • dysrhythmia Top areas in which life threatening hemorrhage can occur -- Answer ✔✔ - chest
  • thighs
  • abdomen/pelvis
  • outside body Approximate total blood volume
  • chest
  • thigh
  • abdomen/pelvis -- Answer ✔✔ total: 5 - 6L chest: 3-4L Thigh: 1L Abdomen/Pelvis: 3L (blood loss >30 --> compensatory mechanisms begin to fail) Which crystalloid?
  • watch for hypervolemia -- Answer ✔✔ Isotonic
  • osmolality matches plasma ex. 0.9%NS, RL Which crystalloid?
  • watch for intravascular overload, pulmonary edema -- Answer ✔✔ Hypertonic
  • higher [ ] of electrolytes ex. 3% NaCl, D1OW, D5O which crystalloid?

Definition of: Sepsis -- Answer ✔✔ life-threatening condition that arises when the body's response to infection injures its own tissue these may be manifestations of what type of shock? hypotension, elevated lactate, decreased urine output -- Answer ✔✔ Distributive shock

  • Severe sepsis ___ and ___ are considered the earliest signs of shock -- Answer ✔✔ Narrow pulse pressure, tachycardia goal in shock is to keep hematocrit >__% and hemoglobin [ ] >__g/dL -- Answer ✔✔ 30, 10 normal daily lactate production is ___mmol/L -- Answer ✔✔ 1500
  • metabolized by kidney and liver Tissue perfusion during septic shock is predominantly achieved by aggressive administration of IV Fluids typically (crystalloids/colloids) -- Answer ✔✔ crystalloids
  • 30ml/Kg within first 3 hours septic shock treatment as much as 6 - 10L of isotonic crystalloids and 2 - 4 L of colloids needed in first 6 hours to reach target CVP of - -- Answer ✔✔ 8 - 12 septic shock treatment:

once CVP =>8mmHg __ may be added -- Answer ✔✔ vasopressors

  • norepinephrine
  • dopamine what antibody is usually responsible for allergic reaction -- Answer ✔✔ IgE Anaphylactic shock S&S: (increased/decreased) BP (increased/decreased) HR (increased/decreased) RR -- Answer ✔✔ Decreased BP Increased HR Increased RR 1st line of drug for Anaphylaxis -- Answer ✔✔ epinephrine 15 - year-old male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylactic shock and develops: a. bradycardia, decreased arterial pressure, and oliguria. b. bronchoconstriction, hives or edema, and hypotension. c. hypertension, anxiety, and tachycardia. d. fever, hypotension, and erythematous rash. -- Answer ✔✔ b. bronchoconstriction, hives or edema, and hypotension Which of the following is one of the most important goals of the preoperative assessment by the nurse?