COMPREHENSIVE PHASE

POST TEST
PERIOP
Prepared by: Mr. Jules Arceo, RN
NOV 24 Philippine Nurse Licensure Examination Review
1. Patient Adolf, 36 weeks age of gestation, was born with symptoms of transplant rejection. Which set of
transposition of the great arteries. The surgeon symptoms will you include as part of your care plan?
recommended a procedure called “arterial switch.” What A. Photophobia, redness, blurred vision, and pain
type of surgery is this? B. Malaise, fever, rapid weight gain, oliguria, increased
A. Curative surgery BUN and creatinine
B. Palliative surgery C. Arrhythmia, tachycardia, hypotension, and ankle
C. Cosmetic surgery edema
D. Constructive surgery D. Fever, jaundice, fatigue, increased AST and ALT,
2. Patient Keith is 23 years old and is to undergo nausea, vomiting, and diarrhea
circumcision. He asks you what type of surgery he will 6. What statements made by your patient who underwent
undergo. You will answer that circumcision is liver transplant indicate that they have a good
A. Cosmetic surgery understanding of your discharge teaching?
B. Constructive surgery A. I must avoid activities such as rock climbing,
C. Curative surgery gardening, and pottery
D. Exploratory surgery B. It is okay for me to attend concerts for as long as I
3. Your patient is a 75-year-old woman who has been wear my mask
diagnosed with stage IV lung cancer. She is terminally-ill C. I can eat caesar salad for as long as it is washed
and has been experiencing easy fatigability and dyspnea thoroughly
on exertion because of a tumor that is blocking her D. If I develop symptoms of fever and malaise, I should
bronchi. You have been reading her charts and she is drink paracetamol and more fluids.
expected to undergo an endoscopy-guided surgery to 7. That same patient post-liver transplant asked you why
remove such a tumor. What type of surgery is this? he should drink his medications faithfully. Your response
A. Urgent surgery is based on the knowledge that:
B. Emergent surgery A. Since he just underwent a transplant surgery, his
C. Required surgery body is experiencing general inflammatory processes.
D. Elective surgery Immunosuppressants are taken to bring down such
4. You are the ER nurse and you received a call regarding a inflammatory processes.
patient who is on the way after a car accident. The B. The patient is at risk for infection due to just
emergency sponse team relayed the following patient undergoing a surgery. Immunosuppressants will
details: GCS 8, BP: 180/120 mmHg, HR: 40 bpm, RR: 10 protect them from being at risk for infection.
cpm, and T: 39 C. Given this situation, you expect what C. Transplanted organs are treated as foreign objects by
type of surgery will this patient go through? the patient’s body. Immunosuppressants will inhibit
A. Emergent, palliative surgery transplant rejection by suppressing the
B. Urgent, reconstructive surgery hypersensitivity reactions of the body.
C. Emergent, reconstructive surgery D. Immunosuppressants are mostly glucocorticoids. The
D. Urgent, palliative surgery patient needs cortisol because their body is
5. Your patient underwent liver transplant 5 days ago for experiencing a huge amount of stress and it will help
end-stage liver failure. Part of your discharge teaching is them cope with the surgery.
that the patient should watch out for signs and

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 8. Who among the following patients can give informed D. Enoxaparin
consent? 13. You reviewed your patient’s laboratory results the day
A. A patient who is a magna cum laude and is currently before the surgery. You have discovered that their
admitted because of coma HbA1C is 10%. What implications do this result indicate
B. A lawyer who is admitted due to alcohol intoxication that you must relay to the healthcare team?
C. A sari-sari store vendor who cannot read or write A. The patient is at risk for bleeding
D. A 17-year old who just graduated from senior high B. The patient’s high blood glucose indicate that they are
school tolerating the NPO well
9. Your patient’s surgery is scheduled for 16:00. At 15:00, C. The patient is at risk for medication toxicity because
you have discovered that the patient has not signed an they will not be able to eliminate the medications
informed consent even after verbally agreeing to given for the surgery.
undergo the surgery after the surgeon has explained the D. The patient who has a high blood glucose will
surgery and other options thoroughly. You decided to go experience a delayed wound healing and is at risk for
to the patient and asked them to sign the consent. What infection
are the legal implications of your actions? 14. Maria, a 37-year-old female, is scheduled to undergo
A. The nurse can be charged with malpractice as they total abdominal hysterectomy with bilateral salpingo
cannot obtain informed consents. oophorectomy. Her pre-surgery complete blood count is
B. The nurse can be charged with malpractice because it as follows: Hgb of 11.5 g/dL, WBC of 7000 u/L, and
is outside their scope of practice. platelets of 400,000. Given these findings, what
C. The nurse should have called the surgeon to be preoperative nursing intervention should you emphasize
present during the signing. to the team?
D. The nurse was acting within their scope as all they did A. The surgery should be delayed because the patient
was to get the patient’s signature. has increased WBCs indicating that they have an
10. Your patient who was just admitted to the ER and is infection
unconscious cannot sign an informed consent. The B. There should be at least two blood products secured
attending physician, surgeon, and the healthcare team to the OR suite in anticipation of blood loss
have all agreed that surgery must be done to this C. The patient should take iron supplements to outset
patient. As the primary nurse, you know that your the decreased RBCs
responsibility is this situation is: D. The patient is at a high risk of bleeding due to the
A. You must look for all possible persons who are related decreased platelets
to this patient in order to obtain an informed consent 15. You are beginning your immediate preoperative nursing
from them. responsibilities for 4 of your patients. Which of the
B. It is the surgeon who will sign the consent, under the following actions made by a patient indicate that that
ethical concept of paternalism patient understood your health teachings?
C. The surgery cannot proceed as the patient is unable A. Your patient who is scheduled for cesarian surgery
to give consent shaved her pubic hair.
D. It is the nurse who will sign the consent, under the B. Your patient scheduled for amputation used
ethical concept of paternalism chlorhexidine for showering
11. A patient who mentions to the nurse that they are C. Your patient scheduled for prostatic surgery is in a
anxious should be initially intervened by the nurse by hospital gown and is wearing a bouffant
saying which appropriate statement? D. Your patient scheduled for abdominal surgery ate a
A. “I’m here to listen. Let’s talk about what you are full meal 1 hour ago
feeling.” 16. In an effort to promote safety during surgery and
B. “I will administer a calming medication to help you” decrease medical errors and adverse events, the WHO
C. “Everyone gets anxious before surgery” made a surgical safety checklist. What are the three
D. “Have you talked to your family about your anxieties components of the surgical safety checklist?
and fear? A. Sign in, time out, sign out
12. A 65-year-old patient who is scheduled for cholelithiasis B. Time in, sign out, time out
is taking several maintenance medications. Which drug C. Log in, time out, log out
category may create an intraoperative risk for this D. Sign in, time off, sign off
patient? 17. Which are the responsibilities of the surgical team during
A. Bisacodyl sign out?
B. Lactulose
C. Ibuprofen

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 A. The patient confirms their identity, the site, their C. IV, V, and VI
consent, while the surgical team confirms the D. I, III, and IV
procedure and that the site is marked. 21. This member of the surgical team is in-charge of
B. The nurse verbally confirms the name of the instrument sterility. They gather all supplies and prepare
procedure, specimens are labeled, instrument counts all instruments using sterile technique. They are
are complete, and whether there are any equipment in-charge of keeping accurate counts of sponges, sharps,
problems that need to be addressed. and instruments during surgery and performs aftercare
C. The nurse confirms whether the patient has allergies, of such at the end.
aspiration risk, and a risk for blood loss. A. Circulating nurse
D. All team members introduce themselves by name and B. Scrub nurse
by role and confirm the patient’s name, procedure, C. The assistant surgeon
and where the incision will be made. D. The anesthesiologist
18. Which are the responsibilities of the surgical team during 22. This member of the surgical team coordinates all
sign in? personnel in the operating room. They assist in
A. The surgical team confirms whether an antibiotic positioning the patient, ensure all equipment are
prophylaxis has been given within the last 60 working properly, handles all specimen, and documents
minutes, the surgeon confirms the critical or care provided.
non-routine steps, and whether essential imaging is A. The assistant surgeon
displayed. B. Scrub nurse
B. The surgeon, anesthetist, and the nurse shares to the C. The anesthesiologist
team the key concerns for recovery and management D. Circulating nurse
for the patient. 23. Which of the following actions is considered to be
C. The surgical team checks the completeness of the following the principles of asepsis?
anesthesia machine and medications given and A. A nurse who changes their surgical scrubs because of
whether the pulse oximeter on the patient have been blood spillage
functioning B. A surgeon who is wearing scrubs one size larger
D. The anesthetist shares any patient-specific concerns. C. A medical technologist who wears shoe caps in the
19. Which are the responsibilities of the surgical team during semi-restricted zone
time out? D. An assistant surgeon who wears their surgical scrubs
A. The nurse confirms whether the patient has allergies, in the unrestricted zone
aspiration risk, and a risk for blood loss. 24. You are conducting a quality improvement class in the
B. The nurse verbally confirms the name of the surgery department regarding the proper use of face
procedure, specimens are labeled, instrument counts masks as part of the new protocol after the COVID-19
are complete, and whether there are any equipment pandemic. Which of the following will you include in your
problems that need to be addressed. slides?
C. The surgeon, anesthetist, and the nurse shares to the A. Face masks worn must not interfere with breathing,
team the key concerns for recovery and management speech, and vision.
for the patient. B. In between surgeries, mask clips or mask laces must
D. The nursing team confirms the sterility of the be used aside from hanging masks in the elbow or
procedure and instruments and any equipment issues putting masks in pockets when not in use.
or any concerns. C. It is better to have masks that are one size smaller
20. A responsibility of the nurse is the administration of than a mask that is one size bigger to avoid tenting
preoperative medications to patients. Which statements D. The recommended face mask for all surgeries must
describe the action of these medications? Select all that be at least N95 or better.
apply.’ 25. Which of the following actions, if made by any member
I. Diazepam is given to alleviate anxiety. of the surgical team, must not alert you as the
II. Ranitidine is given to facilitate patient sedation. circulating nurse as something that follows aseptic
III. Atropine is given to decrease oral secretions. technique?
IV. Morphine is given to depress respiratory function. A. The scrub nurse that puts surgical instruments at the
V. Cimetidine is given to prevent laryngospasm. edge of the mayo table
VI. Fentanyl citrate-droperidol is given to facilitate a B. The scrub nurse who puts their hand at or above
sense of calm. waist level
A. I, III, and V
B. II, IV, and V

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 C. The assistant surgeon who turned their back against C. Administer a dose of dantrolene sodium
the surgeon when moving towards the other side of D. Document the findings and monitor vital signs more
the room frequently next time
D. The surgeon who adjusted the operating room light 31. In preparing a patient who will undergo a pulmonary
26. Your patient is presenting with an increased heart rate, angiography test, which laboratory parameters will you
irregular respirations, and is beginning to lose gag and take note of considering that an iodine dye will be used
cough reflex. What stage of anesthesia is your patient during the procedure?
under? A. Aspartate aminotransferase and alanine
A. Onset stage aminotransferase
B. Excitement stage B. C-reactive protein and erythrocyte sedimentation rate
C. Surgical anesthesia stage C. Red blood cell count, white blood cell count, and
D. Medullary stage platelet count
27. Once the patient has regular respirations, they move on D. Blood urea nitrogen and creatinine
to the next stage of anesthesia. What does this stage 32. What action by the nurse is part of their responsibilities
implicate? to the family of the patient post-surgery?
A. There is too much anesthesia that has been induced A. To give updates to the patient’s family regarding the
B. The patient has just received anesthesia surgery during the operation
C. The patient is at risk for seizures B. To explain the surgical findings and the prognosis of
D. The patient is adequately anesthetized and surgery the patient
can begin C. To monitor the patient every 15 minutes for the first
28. After spinal anesthesia, a parent of a 6-year-old patient hour, every 30 minutes for the next hour, and every
of yours presses the call button and you hear a loud hour thereafter
scream. Upon going to the patient’s room, you see them D. To provide the family an orientation of the frequent
whining and moaning in pain. They mentioned a observations to be made and the equipment that the
headache pain score of 10/10. What is your immediate patient is in after surgery.
nursing action? 33. Delirium is a common complication during the
A. This indicates brain herniation and the surgeon must postoperative period wherein the patient manifests
be immediately informed. confusion, agitation, and aggressiveness. Which of the
B. Prepare to administer paracetamol intravenously. following is not a nursing intervention to prevent this
C. Provide reassurance to the patient and their parents occurrence?
that this is expected. A. Obtain a PRN order of diazepam or any sedative from
D. Reassure the patient and practice deep breathing as the physician
non-pharmacological interventions for pain. B. Provide adequate nutrition and hydration
29. As a PACU nurse, you know that your priority C. Administer pain medications on time
intervention will be based on which of the following D. Reorient the patient to time, place, and person
manifestations of your patient? regardless of level of consciousness
A. Patient who has crackles upon auscultation and is 34. A patient admitted for thyroid surgery is distressed
drooling sputum upon expiration. because they developed hospital-acquired pneumonia.
B. Patient who has increased respiratory rate and an Which among the following statements in the history of
SpO2 of 94% the patient indicates that strongly supports that their
C. Patient presenting with a bloody surgical wound infection has been acquired nosocomially?
D. Patient who is GCS3 and is still under the effect of A. The patient has confirmed pseudomonas aeruginosa
general anesthesia in their sputum culture and sensitivity
30. In the PACU 8 hours after their surgery, patient LHS B. The patient developed fever, purulent sputum, and
presents with a heart rate of 150 beats per minute, malaise 2 days after being admitted
muscle rigidity in the upper chest and jaw, and a C. The patient has no history of respiratory disorders
temperature of 41 C. The surgeon believes the patient is upon admission
experiencing a rare hypersensitivity reaction to D. The patient has an increased WBC count in their
anesthesia, you, as a nurse, anticipate to do which of complete blood count
the following interventions first? 35. Your patient is clarifying to you what is the rationale of
A. Prepare items for tepid sponge bath to lower the practicing deep breathing exercises after surgery. What
patient’s temperature will be your most appropriate nursing action?
B. Obtain cooled IV fluids to address their internal A. Deep breathing exercises are recommended to reduce
hyperthermia the risk of pneumonia.

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 B. Deep breathing exercises are done to promote lung 2 seconds. You check their abdominal dressing and you
expansion before surgery. determine that it is soaked with blood. What is your
C. Deep breathing exercises increase blood circulation to immediate nursing responsibility?
the lungs, hastening post-operative recovery. A. Leave the room immediately to call the surgeon.
D. Deep breathing exercises reduce pain associated with B. Administer O2 1 to 2 LPM via nasal cannula.
coughing which will promote adherence to coughing C. Place the patient in a modified Trendelenburg
exercises. position.
36. Three days after their surgery, a patient of yours, PSH, D. Apply a sterile gauze pad and pressure dressing.
who underwent exploratory laparotomy reported to you 40. Your patient is currently on a mechanical ventilator
that he feels that too much fluid has gone out of his which has been alarming with “low pressure” indicated.
wound. Upon assessment, you noticed that After assessing your patient, you acquired the following
serosanguineous drainage and that his documented flat data: RR of 18 cpm, O2 of 100%, and no signs of
wound is now bulging and painful. What is your priority distress and no adventitious breath sounds. You checked
nursing action? the tubings and all are patent and connected. Lastly, you
A. This may indicate evisceration and the patient must rechecked all settings and determined that all are
lie flat on their back while holding a splint. according to the orders of the attending physician. What
B. This may indicate evisceration and the patient must is your next nursing action?
lie on their side and a gauze soaked in warm saline A. Check the tubes for kinking or obstruction.
must be put. B. Your patient needs more pressure so you increase the
C. This may indicate evisceration and the nurse must prescribed PEEP.
assess further to ensure that what is underneath the C. Refer to the attending physician using proper and
gauze are exteriorized organs. complete ISBAR.
D. This may indicate evisceration and the surgeon must D. Document this finding and refer to the respiratory
be alerted immediately as this is an emergency therapist.
situation. 41. Which of the following complications of spinal anesthesia
37. After your patient underwent cervical surgery, you know is considered the most dangerous?
that they are at an increased risk for development of A. Lower muscle paralysis
deep vein thromboembolism. With this, you plan to B. Hyperthermia
include the following in your nursing care plan C. Spinal headache
post-operatively, except? D. Hypotension
A. Activities that will increase pressure to the popliteal 42. Which activity should the nurse plan for the patient who
artery must be avoided such as dangling of legs at has not yet recovered from anesthesia to prevent
the edge of the bed. complications from immobility?
B. As much as possible, the patient must initiate early A. Provide passive range of motion exercises three times
ambulation. Usually, this is done once complete a day
recovery from anesthesia has been established. B. Ask the patient to perform deep breathing exercises
C. Ensure that the client will be able to drink fluids of at C. Assist the client in early ambulation
least 2000 to 2500 mL per day D. The risk for immobility complications is considered
D. Teach leg exercises for the client to do in bed. low on the first postoperative day
38. A patient being monitored post-cardiac surgery in the 43. The nurse taking care of a patient in the postoperative
telemetry unit suddenly became unconscious while you room that suddenly presents with bluing of the lips,
are talking to them. After determining that they have no gums, and the palate should immediately do which of
pulse nor breathing, what is your immediate nursing the following?
responsibility? A. Call the patient’s surgeon
A. Administer 2 rescue breaths via mouth-to-mouth B. Insert an oral airway and suction the nasopharynx
resuscitation C. Start administration of O2 1 to 2 LPM
B. Acquire the emergency cart, apply the nodes of the D. Reposition the head and determine airway patency
AED, and wait for the rhythm to determine the 44. In helping the client to eat after surgery, the nurse must
appropriate move. anticipate which dietary progression? Arrange the
C. Call for a code and start chest compressions. following diet in the correct sequence
D. Call the attending physician immediately. I. Diet, as tolerated
39. 8 hours after surgery, you go to your patient’s room and II. Nil per orem
assess that they are generally weak, confused, have III. Clear liquid diet
circumoral pallor, and a capillary refill time of more than IV. Soft diet

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 A. 2, 3, 1, 4 IV. No pain in the surgical wound
B. 4, 3, 2, 1 V. (+) bowel sounds
C. 2, 1, 4, 3 VI. No bleeding in the wound
D. 1, 2, 3, 4 A. I, II, IV, V
45. The nurse should expect which most appropriate set of B. II, IV, V, VI
food in the tray of a client who is ordered to be on a full C. I, II, VI
liquid diet? D. I, III, V
A. Gelatin, pudding, and vanilla ice cream
B. Rice, cream soup, and pudding “We spend almost the whole day studying how to take care of
C. Water and black coffee other people. Apply those
D. No diet restrictions principles and do not forget to take care of yourself. You
46. Which of the following patient is the most at risk for deserve it.”
postoperative respiratory complications?
A. A football player who had undergone knee
replacement surgery
B. The patient with a normal pulmonary function who
had undergone upper abdominal surgery
C. An adolescent patient with diabetes mellitus who had
undergone diabetes mellitus
D. The patient with COPD who underwent general
anesthesia surgery
47. The nurse is caring for a 75-kg patient who had
undergone exploratory laparotomy. Which postoperative
assessment should be reported to the physician?
A. The patient’s wound drainage is clear
B. The patient’s vital signs are as follows: BP = 100/70
mmHg, PR = 95 bpm, RR = 12 per minute, T = 36.8
C
C. The patient’s urine output is less than 75 mL/hr for
the past 2 hours
D. The patient pushes out their oral airway with their
tongue
48. The patient who underwent external fixation surgery
complains of pain in their leg. Which of the following is
the most appropriate initial nursing action?
A. Prepare and administer orders of PRN pain medication
B. Instruct the patient to perform deep breathing
exercises, meditation, and guided imagery
C. Assess the patient’s pain level and its characteristics
D. Change the patient’s position
49. When must a nurse begin to plan for a patient’s
discharge?
A. When the patient can ambulate on their own
B. When the surgeon gives a may-go-home order
C. When the patient is admitted for surgery
D. When the patient verbalizes that they wish to go
home
50. In applying the principles of C-SMART, which of the
following are the criteria that a nurse may assess to a
patient who can be deemed safe to go home and be
discharged post-operation?
I. Stable vital signs and full consciousness
II. (+) bladder distention
III. (+) gag and cough reflex

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