PRE-OPERATIVE 9. A patient with diabetes is scheduled for a surgical procedure.

Which blood glucose level goal demonstrates strict glycemic

1. The on call perioperative team is called for an emergent control?
surgery to be performed as soon as they arrive. Which surgical
procedure is considered urgent? a. 80 to 110 mg/dl.
b. 150 to 240 mg/dL
a. An appendectomy c. 250 to 300 mg/dL
b. An exploratory laparotomy d. 300 to 350 mg/dL
c. A repair of multiple stab wounds
d. A face-lift 10. The nurse is monitoring a presurgical patient for electrolyte
imbalance. Which classification of medication may cause
2. A patient is scheduled for a reduction mammoplasty: Which electrolyte imbalance?
classification of surgery does the nurse document on the
perioperative document? a. Corticosteroids
b. Diuretics
a. Urgent c. Phenothiazines
b. Optional d. Insulin
c. Required
d. Reconstructive 11. The nurse assesses an older adult patient who reports
dimmed vision. Which will the nurse include in the plan of care
3. A patient is scheduled with surgical procedure. For which to meet this patient's immediate needs?
surgical procedure will the nurse prepare for an Informed
consent form for the surgeon to sign? a. A safe environment
b. Restrictions of the patient's unassisted mobility
a. An open reduction of a fracture activities
b. An insertion of an intravenous catheter c. Preparation for probable cataract extractions
c. Irrigation of the external ear canal d. Referral to an ophthalmologist
d. Urethral catheterization
12. The nurse is caring for a patient with obesity prior to a
4. The nurse is caring for a patient with alcoholism. When will surgical procedure. Which surgical complications that
the nurse assess for symptoms of alcoholic withdrawal? correlate with obesity would the nurse monitor for? (Select all
that apply)
a. Within the first 12 hours
b. About 24 hours postoperatively a. Cardiovascular system
c. On the second or third day b. gastrointestinal system
d. Four days after a surgical procedure c. pulmonary system
d. renal system
5. the health care provider schedules an elective surgical e. nervous system
procedure for a patient who smokes cigarettes. When will the
nurse recommend that the patient cease smoking before the 13. A patient informs the nurse that they are experiencing some
surgical procedure to minimize risks associated with cigarette anxiety about their scheduled procedure. Which cognitive
smoking? strategy could the nurse implement to assist with alleviating the
anxiety?
a. 4 to 8 weeks
b. 3 to 4 months a. Administer antianxiety medication
c. 2 weeks b. Cancel the scheduled procedure
d. 3 weeks c. Inform the patient that there is nothing to be nervous
about
6. the nurse is caring for a patient with cirrhosis of the liver who d. Have the patient inhale aromatic essential oils
has undergone a surgical procedure. Which laboratory results
should immediately be reported to the HC provider? 14. The patient asks the nurse why food is withheld before
surgery. Which is the best response by the nurse?
a. When the patient’s blood ammonia concentration
reaches 180 mg/dL a. “aspiration is a concern and can be a complication if
b. When a lactate dehydrogenase concentration is 300 food or fluid is taken close to the surgery time”
units b. “distention is a severe complication if food or fluid is
c. When a serum albumin concentration is 5.0 g/dL taken close to the surgery time”
d. When a serum globulin concentration reaches 2.8 c. “infection may occur if food or fluid is taken prior to
g/dL surgery”
d. “obstruction may occur if food or fluid is taken prior
to surgery”
7. a patient with kidney injury is scheduled for a surgical 15. A patient is scheduled for a surgical procedure. Which
procedure. Which laboratory results reported to the HC indication does the nurse have that the patient understands the
provider may result in cancellation of the procedure? impending procedure?
a. A blood urea nitrogen level of 42 mg/dL a. The patient participates willingly in the preoperative
b. A creatine kinase level of 120 U/L preparation
c. A serum creatinine level of 0.9 mg/dL b. The patient discusses stress factors causing the
d. A urine creatinine level of 1.2 mg/dL patient to feel depressed
c. The patient expresses concern about postoperative
8. a patient with uncontrolled diabetes is scheduled for a pain
surgical procedure. Which chief life-threatening hazard will d. The patient verbalizes fears to family
the nurse monitor for?
16. which behaviors exhibited by a patient scheduled for
a. Dehydration surgery demonstrate hidden fears regarding the procedure?
b. Hypertension (SATA)
c. Hypoglycemia
d. Glucosuria a. The patient tells the nurse of concerns with the
outcome of the procedure
b. The patient informs the nurse of problems with
postoperative nausea in the past and that is was a bad
experience
 c. The patient avoids communication with the nurse e. The elasticity of skin increases and decreases the risk
d. The patient repeatedly asks questions that have of shearing.
previously been answered
e. The patient talks incessantly 5. The nurse identifies that, postoperatively, a general
anesthetic is primarily eliminated via what organ(s)?
17. a patient is preparing for a surgical procedure and states to
the nurse, “I’m so nervous about my surgery.” Which is the best a. The kidneys
response? b. The lungs
c. The skin
a. “Relax. Your recovery period will be shorter if you’re d. The liver
less nervous.”
b. “stop worrying.” It only makes you more nervous." 6. The anesthesiologist is administering a stable and safe
c. ”You needn’t worry. Your surgeon has done this nondepolarizing muscle relaxant. Which medication does the
surgery many times before.” nurse identify will be given?
d. Would you life to discuss the concerns that you have?”
a. Succinylcholine chloride
18. Why is assessment of dentition important in the patient b. Vecuronium bromide
preparing to have a surgical procedure with general c. Pancuronium bromide
anesthesia? d. Decamethonium
a. The patient may require referral to the dentist. 7. Which intravenous anesthetic given by the anesthesiologist
b. Oral hygiene is important for all patient has a powerful respiratory depressant effect sufficient to
c. Decayed teeth or dental prosthesis can become cause apnea and cardiovascular depression?
dislodged during intubation,
d. The patient can sue if a tooth falls out during surgery. a. Etomidate
b. Ketamine
19. A patient preparing for a surgical procedure is taking c. Sodium thiopental
corticosteroids for Crohn’s disease. Which will the patient be d. Midazolam
monitored for?
8. The nurse is completing a postoperative assessment for a
a. Obstruction patient who has received a depolarizing neuromuscular
b. Infection blocking agent. The nursing assessment includes careful
c. Hypoglycemia monitoring of which body system?
d. Adrenal insufficiency
a. Cardiovascular system
20. A patient having a surgical procedure takes aspirin 325 mg b. Endocrine system
daily for prevention of platelet aggregation. When will the c. gastrointestinal system
patient stop taking the aspirin before the surgery? d. genitourinary system
a. 2 weeks 9. a patient reports a headache after receiving spinal
b. 4 weeks anesthesia. Which does the nurse determine is the cause of the
c. 7 to 10 days headache related to the spinal anesthesia? (SATA
d. 2 to 3 days
a. The patient lying in the supine position
INTRA-OPERATIVE b. Leakage of spinal fluid from the subarachnoid space
c. Size of the spinal needle used
1. Which are the circulating nurse's responsibilities, in contrast d. Degree of patient hydration
to the scrub nurse's responsibilities? e. An allergic reaction to the medication used
a. Assisting the surgeon 10. the surgeon requests lidocaine 2% with epinephrine for use
b. Coordinating the surgical team in local infiltration anesthesia. Which does the nurse identify is
c. Setting up the sterile tables the purpose of adding epinephrine to the lidocaine? (SATA)
d. Passing instruments
a. The epinephrine causes vasoconstriction
2. The circulating nurse is preparing a patient for a surgical b. The epinephrine prevents rapid absorption of the
procedure. Which primary responsibility does the circulating anesthetic drug
nurse have in the perioperative experience? c. The epinephrine prolongs the local action of the
anesthetic agent
a. Discussing the complications of the surgical d. The lidocaine will not anesthetize the area locally
procedure with the patient without the epinephrine
b. Coordinating the efforts of the surgical team e. The epinephrine will prevent the patient from having
c. Marking the operative site an allergic reaction to the lidocaine
d. Passing Instruments during the intraoperative phase
11. The patient asks the nurse how long the local infiltration
3. An unconscious patient with normal pulse and respirations anesthetic will last. Which is the nurse’s best response?
would be considered to be in what stage of general anesthesia?
a. The anesthetic may last for 1 hour
a. Beginning anesthesia b. The anesthetic may last for 3 hours
b. Excitement c. The anesthetic may last for 5 hours
c. Surgical anesthesia d. The anesthetic may last for 7 hours
d. Medullary depression
12. A patient is scheduled to have a heart valve replacement with
4. Why will the nurse be vigilant with assessment of a porcine valve. Which patient does the nurse understand may
perioperative risks on the older adult patient? (Select all that refuse the use of any porcine-based products?
apply.)
a. A patient of Catholic faith
a. Ciliary action decreases, reducing the cough reflex. b. A patient of Jewsih faith
b. Fatty tissue increases, prolonging the effects of c. A patient of Baptist faith
anesthesia. d. A patient of Lutheran faith
c. Liver size decreases, reducing the metabolism of
anesthetics.
d. Peristalsis increases.
13. The nurse is caring for a patient who is at risk for malignant POSTOPERATIVE
hyperthermia subsequent to general anesthesia. Which is the
most common early sign that the nurse will assess for? 1. The nurse is caring for a patient in the immediate
postoperative period. Which complication requiring early
a. Hypertension intervention will the nurse carefully monitor for?
b. Muscle rigidity
c. Oliguria a. Laryngospasm
d. Tachycardia b. Hyperventilation
c. Hypoxemia and hypercapnia
14. The nurse is placing a patient in the Trendelenburg position d. Pulmonary edema and embolism
for a surgical procedure. Which is the best way for the nurse to
perform the proper positioning for the patient? 2. A patient arrives in the PACU unconscious. Which position
will the nurse place the patient in unless otherwise
a. Flat on the back with arms next to the sides contraindicated?
b. On the back with head lowered so that the plane of the
body meets the horizontal on an angle a. Flat on the back, without elevation of the head, to
c. On the back with legs and thighs flexed at right angles facilitate frequent turning and minimize pulmonary
d. On the side with uppermost leg adducted and flexed at complications
the knee b. In semi-Fowler position, to promote respiratory
function and reduce the incidence of orthostatic
15. The patient received ketamine during a surgical procedure. hypotension when the patient can eventually stand
Which intervention by the nurse will assist with an optimal c. In Fowler position, which most closely stimulates a
recovery period? sitting position, thus facilitating respiratory as well as
gastrointestinal functioning
a. Make sure that the patient is stimulated frequently d. On the side with a pillow at the patient’s back and the
b. Place the patient in a darkened, quiet part of the chin extended, to minimize the dangers of aspiration
recovery area
c. The patient does not require a recover period and may 3. The nurse Is monitoring cardiovascular function in a
go back to the hospital room postoperative patient. Which method will the nurse use to
d. Speak to the patient in a loud, clear voice. measure cardiovascular function?
16. A patient is having a surgical procedure that requires the a. Complete blood count
patient to be in the prone position. Which is an expected patient b. Central venous pressure
outcome? c. Upper endoscopy
d. Chest X-ray
a. The patient will not experience anxiety during the
preoperative phase 4: The nurse is monitoring a patient immediately after a surgical
b. The patient will not experience signs of an allergic procedure. Which measurement will the nurse Immediately
reaction report to the surgeon?
c. The patient remains free of perioperative positioning
injury a. A systolic blood pressure lower than 90mmHg
d. The patient will not experience signs and symptoms of b. A temperature reading between 97° and 98°F.
infection c. Respirations between 20 and 25 breaths/min
d. A hemoglobin of 13.6
17. The circulating nurse is performing a skin preparation for a
patient who is unconscious from general anesthesia when the 5. The nurse is preparing a patient for discharge from the post
scrub nurse states, “I know her, she sure has gotten fat!.” Which anesthesia care unit (PACU). Which evidence indicates that the
is the best response by the circulating nurse? patient is ready for discharge from PACU? (SATA)
a. “it is inappropriate to make comments even when a. The patient has been extubated but still has an
patients appear to be unconscious from anesthesia.” oropharyngeal airway inside
b. “She sure has gained weight. I hope that she will heal b. The patient is arousable but falls back to sleep rapidly
after the surgery” c. The patient has sonorous respirations and
c. Be sure you don’t say anything like that when she is occasionally requires chin lift
coming out of the anesthesia in case she hears you” d. The patient rates pain a 9 out of 10 on a 0 to 10 scale
d. “If you say anything like that again, I will report you to after receiving morphine sulfate
the nurse manager.”
6. the nurse is preparing to discharge a patient from the PACU
18 . The patient is having a repair of a vaginal prolapse. Which using the Aldrete scoring system. With which score can the
position will the nurse place the patient in? patient be transferred out of recovery room?
a. Left lateral Sims a. 2
b. Prone position b. 4
c. Lithotomy c. 6
d. Trendelenburg d. 7
19. the anesthesiologist informs the circulating nurse that the 7. Using the Aldrete score, a nurse would give a patient an
patient is experiencing malignant hyperthermia. Which admission cardiovascular score of 2 if the patient's blood
medication will the nurse administer? pressure is which percentage of their preanesthetic level?
a. Dantrolene sodium a. 20%
b. Fentanyl citrate b. 30% to 40%
c. Naloxone a. 40% to 50%
d. Sodium thiopental c. Greater than 50%
8. A patient is experiencing postoperative vomiting. Which is 16. the nurse is concerned that a postoperative patient may
the priority nursing action? have a paralytic ileus. Which assessment data correlates with
the nurse’s suspicion?
a. Measure the amount of vomitus to estimate fluid loss,
In order to accurately monitor fluid balance. a. Abdominal tightness
b. Offer tepid water and juices to replace lost fluids and b. Abdominal distention
electrolytes. c. Absence of bowel sounds
c. Support the wound area so that unnecessary strain d. Increased abdominal girth
will not disrupt the integrity of the incision.
d. Turn the patient's head completely to one side to 17. The nurse determines that a patient is at risk for the
prevent aspiration of vomitus into the lungs. development of thrombophlebitis. Which preventative actions
will the nurse take? (SATA)
9. the nurse measures the postoperative urinary output for a
patient. Which results will the nurse report to the surgeon for a a. Assisting the patient with leg exercises
2 hour period? b. Encouraging early ambulation
c. Massaging the legs every 4 hours
a. <30mL d. Avoiding placement of pillows or blanket rolls under
b. Between 75 and 100 the patient’s knees
c. Between 100 and 200 ml e. Applying compression stockings only at night
d. >200ml
18. A patient has developed a DVT. Which complication related
10. When will the nurse encourage the postoperative patient to to DVT will the nurse closely monitor for?
get out of bed?
a. Pulmonary embolism
a. Within 6 to 8 hour after surgery b. Immobility because of calf pain
b. Between 10 and 12 hours after surgery c. Marked tenderness over the anteromedial surface of
c. As soon as it is indicated the thigh
d. On the second postoperative day d. Swelling of the entire leg owing to edema
11. The nurse is caring for an older adult patient after a surgical 19. Which intervention by the nurse is most effective for
procedure. Which common postoperative complication will the reducing hospital-acquired infections?
nurse monitor the patient for?
a. Administration of prophylactic antibiotics
a. Pleurisy b. Aseptic wound care
b. Pneumonia c. Control of upper respiratory tract infection
c. Hypoxemia d. Proper handwashing techniques
d. Pulmonary edema
20. The nurse is assessing a postop patient’s abdominal wound
12. The nurse documents the presence of granulation tissue in a and observes a portion of intestines protruding through the
healing wound. Which is the best way for the nurse to describe wound. Which is the priority action by the nurse?
the tissue?
a. Apply an abdominal binder snugly so that the
a. Necrotic and hard intestines can be slowly pushed back into the
b. Pale yet able to blanch with digital pressure abdominal cavity
c. Pink to red and soft, bleeding easily b. Approximate the wound edges with adhesive tape so
d. White with long, thin areas of scar tissue that the intestines can be gently pushed back into the
abdomen
13. A health care provider’s admitting note lists a wound as c. Carefully push the exposed intestines back into the
healing by second intention. Which condition of the wound abdominal cavity
does the nurse expect to find? d. Cover the protruding coils of intestines with sterile
dressings moistened with sterile saline solution
a. A deep, open wound that was previously sutured
b. A sutured incision with a little tissue reaction
c. A wound with a deep, wide scar that was previously
resutured
d. A wound in which the edges were not approximated
14. A patient has a wound that has hemorrhage. Which does the
nurse identify is the cause of the patient’s increased risk of
infection?
a. Reduced amount of oxygen and nutrients are available
b. The tissue becomes less resilient
c. Retrograde bacterial contamination may occur
d. Dead space and dead cells provide a culture medium
15. the nurse assess postoperative abdominal distention in a
patient. Which does the nurse determine that the distention
may be directly related to?
a. A temporary loss of peristalsis and gas accumulation
in the intestines
b. Beginning food intake in the immediate postoperative
period
c. Improper body positioning during the recovery period
d. The type of anesthetic administered