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NURS 334 MEDICAL SURGICAL NURSING EXAM
1|ACTUAL 150Qs&As|ALREADY GRADED A+|NEW
An overweight patient (BMI 28.1) is scheduled for a laparoscopic cholecystectomy at an outpatient surgery setting. The nurse knows that: a. surgery will involve multiple small incisions b. this setting is not appropriate for this procedure c. surgery will involve removing a portion of the liver d. the patient will need special prep because of obesity a The patient tells the nurse in the preop setting that she has noticed she has a reaction when wearing rubber gloves. What is the most appropriate intervention? a. Notify the surgeon so that the case can be cancelled b. ask additional questions to assess for a possible latex allergy c. notify the OR staff immediately so that latex-free supplies can be used d. no interventions is needed because the patients rubber sensitivity has no bearing on surgery b A 59- year old man scheduled for a herniorrhaphy in 2 days reports that he takes ginkgo daily. What is the primary intervention? a. Inform the surgeon, since the procedure may have to be rescheduled
b. notify the anesthesia care provider, since this herb interferes with anesthetics c. Ask the patient if he ahs noticed any side effects from taking this herbal supplement d. tell the patient to continue to take the herbal supplement up to the day before the surgery a A 17-year-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which intervention is most appropriate? a. witness the permit after consent is obtained by the surgeon b. call a parent or legal guardian to sign the permit, since the patient is under 18 c. obtain verbal consent, since written consent is not necessary for emancipated minors d. investigate your state's nurse practice act related to emancipated minors and informed consent a A priority nursing intervention to assist a preop patient in coping with fear of postop pain would be to a. inform the patient that pain medication will be available b. teach the patient to use guided imagery to help manage pain c. describe the type of pain expected with the patient's particular surgery d. explain the pain management plan, including the use of a pain rating scale d
e. teaching important information early in the morning c d When a patient is admitted to the PACU, what are the priority interventions the nurse performs? a. assess the surgical site, noting presence and character of drainage b. assess the amount of urine output and the presence of bladder distention c. assess for airway patency and quality of respirations and obtain vital signs dd. review results of intraop lab values and medications recieved c A patient is admitted to the PACU after major abdominal surgery. During the initial assessment the patient tells the nurse he thinks he is going to "throw up". a priority nursing intervention is to a. increase rate of the IV fluids b. obtain VS, including O2 SATS c. position patient in lateral recovery position d. administer antiemetic medication as ordered c After admission of the postop patient to the clinical unit, which assessment data require the most immediate attention a. O2 SAT of 85% b. resp rate of 13/min c. temp of 100.4 F
d. BP of 90/60 mmHg a A 70 kg postop patient has an average urine output of 25 mL/hr during the first 8 hours. The priority nursing intervention(s) given this assessment would be too a. perform a straight cath to measure the amount of urine in the bladder b. notify the physician and anticipate obtaining blood work to evaluate renal function c. continue to monitor the patient because this is a normal finding during this time period d. evaluate the patient's fluid volume status since surgery and obtain a bladder ultrasound d Discharge criteria for the phase II patient include (select all that apply) a. no nausea or vomiting b. ability to drive self home c. no rep depression d. written discharge instruction understood e. opioid pain medication given 45 minutes ago c d e
What are common fears contributed with surgery?
- death
- pain
- anesthesia
- mutilation
- disruption of life What medications do nurses need to know about prior to surgery?
- Prescriptions
- OTCs
- Herbs
- Vitamins
- Rec drugs How much of the US is overweight or obese? 2/ A BMI of what is considered obese?
How many adults 20 and older are obese? 1/ A BMI of what is considered obese?
What risks are associated with obesity and surgery?
- stress on cardiac and pulmonary systems
- Increase risk of postop complications
- predisposition of wound dehiscence and infection
- slower recovery What does adipose do to anesthesia? Absorbs and stores it What should be included in the legal prep before surgery?
What can override consent? A true medical emergency such as to preserve life or limb but the patient is unable to give concent In a medical emergency where the patient is unable to give consent, who is appointed to make decisions? Next of kin or HCP If written consent is not obtained, what needs to be completed? An event report Should you encourage a patient to void before surgery? Yes What type of drug is used that has a sedative and amnesic affect? Benzodiazepines What type of drug decreased secretions in the mouth? Anticholinergics
What type of drugs decrease pain? Opioids What type of medications decrease nausea and vomitting Antiemetics What type of medications decrease infection rates Antibiotics Should patients on BP meds recieve their medication before surgery? Yes; with small sips of water Should patients with DM receive their insulin prior to surgery? Yes What helps maintain a sterile environment in the OR?
- Long term anesthesia
- When a patient is not a good candidate for other anesthesias What kind of onset does IV anesthesia have? Rapid How do inhalation anesthetics enter the body? Through the alveoli What does local anesthesia do? Loss of sensation without loss of consciousness What is a benefit of monitored anesthesia care? Maintains own airway How does regional anesthesia work? Agent is injected into/around specific nerve or group of nerves
Where is spinal anesthesia injected into? CSF of subarachnoid space usually below L What can spinal anesthesia cause? Spinal headaches What may happen due to spinal anesthesia? Hypotension from vasodilation Where is an epidural block injected into? Epidural space Which type of anesthesia would be most appropriate for a client with severe COPD who has a hip fracture? a. General b. Epidural/spinal c. Local d. Conscious sedation b
Where is the PACU located? Adjacent to the OR What is the nurses biggest concern in the PACU? Maintaining patient's airway What are some cares needed in the postop?
- Airway
- VS
- Assessment
- Initiation of postop orders
- Early ambulation Proper attire for the semi restricted area of the surgery department is: a. street clothing b. surgical attire and head cover c. surgical attire, head cover, and mask. d. street clothing with the addition of shoe covers b
Activities that the nurse might perform in the role of a scrub nurse during surgery include (select all that apply) a. checking electrical equipment b. preparing the instrument table c. passing instruments to the surgeon and assistants d. coordinating activities occurring in the OR e. maintaining accurate counts of sponges, needles, and instruments b, c, e The nurse is caring for a patient undergoing surgery for a knee replacement. What is critical to the patient's safety during the procedure (select all that apply) a. universal protocol is followed b. the ACP is an anesthesiologist c. the patient has adequate health insurance d. the patient is in the surgery waiting area e. the patient's allergies are conveyed to the surgical team a, e
IV induction for general anesthesia is the method of choice for most patients because a. the patient is not intubated. b. the agents are nonexplosive. c. induction is rapid and pleasant. d. emergence is longer but with fewer complications. c What are some common respiratory complications postop?
- Atelectasis
- Pneumonia
- Airway obstuction What are some common circulatory complications?
- Hypovolemic shock
- Fluid overload
- DTV
- Pulmonary embolus What are some common integumentary complications?
- Breakdown
- Infection What are some respiratory interventions?
- Deep breathing/cough
- Incentive spirometry
- Ambulation
- Splinting incision What are the parameters for BP when you need to notify a HCP? <90 or > What are the parameters for HR when you need to notify a HCP? <60 or >
