Chapter 17: Surgical Care
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A postoperative patient is complaining of incisional pain. An order has been given for
morphine every 4 to 6 hours as needed (PRN). What should the nurse assess first?
a.
Assess for the presence of bowel sounds.
b.
Assess pupillary reaction.
c.
Ask the patient’s family if she is having pain.
d.
Determine when the patient last received pain medication.
2. A nurse is caring for a postoperative patient. What should the nurse ask when assessing for the
complication of malignant hyperthermia?
a.
“Do you think you might have a fever?”
b.
“Do you currently have an infection?”
c.
“Has anyone in your family ever had problems with general anesthesia?”
d.
“Have you ever had any type of malignancy?”
3. A patient who had a hysterectomy yesterday has not been allowed food or drink by mouth
(NPO). The physician has now ordered the patient’s diet to be clear liquids. What should the
nurse assess prior to providing this patient with clear liquids?
a.
Feelings of hunger
b.
Bowel sounds
c.
Positive Homans sign
d.
Gag reflex
4. Which technique should a nurse implement when changing a postoperative dressing?
a.
Enteric isolation
b.
Aseptic technique
c.
Clean technique
d.
Respiratory isolation
5. A nurse is caring for a postoperative patient who has had spinal anesthesia. Which assessment
is a priority for this patient?
a.
Complaints of a headache
b.
Pulse rate of 78 beats/min
c.
Voided 300 mL
d.
Blood pressure of 126/78 mm Hg
6. What should a nurse ensure that a postoperative patient implement to best prevent deep vein
thrombosis (DVT)?
a.
Splint the incision.
b.
Cough and deep breathe every 2 hours.
c.
Regularly remove antiembolism stockings.
d.
Ambulate frequently.
7. During a nurse’s preoperative assessment, the nurse notices that a patient is extremely
anxious. The patient’s blood pressure is 142/92 mm Hg, the heart rate is 104 beats/min, and
respirations are 32 breaths/min. What nursing action should be implemented?
a.
Give the preoperative medicine early to help calm the patient.
b.
Call the surgical department and cancel the surgery.
c.
Notify the anesthesiologist or surgeon.
d.
Instruct the patient on possible postoperative complications.
8. A nurse is performing a postoperative assessment on a patient who has just returned from a
hernia repair. The patient’s blood pressure is 90/60 mm Hg, and the apical pulse is 108
beats/min. What should be the nurse’s first action?
a.
Check the dressing for bleeding.
b.
Notify the registered nurse (RN).
c.
Document the vital signs.
d.
Increase the rate of infusion of intravenous fluids.
9. A postoperative patient who has no previous medical conditions is difficult to arouse when
transferred to the surgical unit from the postanesthesia care unit. A nurse monitors the pulse
oximeter and gets a reading of 85%. What should be the nurse’s next action?
a.
Assess the pulse oximeter reading again in 1 hour.
b.
Arouse the patient, have him cough, and encourage deep breathing.
c.
Administer a dose of pain medication.
d.
Suction fluid from the oral cavity.
10. A nurse has completed giving discharge instructions to a patient after a hernia repair. What
verbalization by the patient should lead the nurse to determine that the patient understands the
instructions?
a.
Go back to work tomorrow.
b.
Do not change the dressing until he sees his physician in 2 weeks.
c.
Ignore changes in the size of his abdomen.
d.
Report fever, redness, swelling, or increased pain at the incision site.
11. A nurse should include the proper use of an incentive spirometer in teaching a preoperative
patient. What postoperative assessment of this patient would reveal that the incentive
spirometry teaching has been effective?
a.
Adventitious breath sounds
b.
Expiratory wheezing
c.
Thick, green respiratory secretions
d.
Clear breath sounds
12. The suprapubic area of a postoperative patient is distended. The patient states that he has not
voided since surgery approximately 9 hours ago. What should be the nurse’s first action?
a.
Notify the head nurse or physician.
b.
Insert a catheter and document insertion.
c.
Seat the patient on the side of the bed to try to void.
d.
Prepare the patient to return to surgery.
13. Which modification should the nurse implement when caring for a postoperative patient after
cataract surgery?
a.
Early ambulation is not necessary.
b.
Remove the dressing immediately.
c.
Omit instructions relative to coughing.
d.
Omit use of an incentive spirometer for deep breathing.
14. When obtaining a patient’s signature on the surgical consent form, the patient seems confused
about the procedure to be performed. What is the most appropriate response by the nurse?
a.
Tell the patient to talk to the physician after he or she gets to the surgical
department.
b.
Ask the patient to go ahead and sign the consent.
c.
Ask the patient what the physician told him and then call the physician if
necessary.
d.
Encourage the patient to ask his family what the physician told them.
15. A nurse is doing an assessment of a patient who has returned from a cardiac catheterization
and had conscious sedation. Which finding should the nurse report?
a.
Difficulty arousing the patient
b.
Blood pressure of 124/72 mm Hg
c.
Oxygen saturation of 96%
d.
Patient complaints of the need to void
16. What is the goal of palliative surgery?
a.
Remove and study tissue to make a diagnosis.
b.
Relieve symptoms or improve function without correcting the basic problem.
c.
Remove diseased tissue or correct defects.
d.
Correct serious defects that only affect appearance.
17. What information should a nurse ask a patient during the preoperative assessment?
a.
Current address and telephone number
b.
Food preferences
c.
Allergies, medications, and past medical conditions
d.
Bathing and sleep patterns
18. Which member of the surgical team administers anesthetics and monitors the patient’s status
throughout the procedure?
a.
Surgeon
b.
Circulating nurse
c.
Perfusionist
d.
Anesthesiologist
19. A nurse is assisting in the transfer of a postoperative patient from the postanesthesia care unit
to the surgical nursing unit. What action should the nurse implement to ensure the safety of
the patient?
a.
Put the side rails up after moving the patient from the stretcher to the bed.
b.
Ask the patient to move from the stretcher to the bed.
c.
Move the patient rapidly from the stretcher to the bed.
d.
Uncover the patient before transferring from the stretcher to the bed.
20. A patient who has just undergone a colon resection complains to a nurse that he felt
something pop under his dressing while trying to get out of bed. The nurse removes the
dressing and finds that dehiscence of the wound has occurred. What nursing action should be
implemented first?
a.
Replace the dressing; dehiscence is normal.
b.
Call the physician.
c.
Pull the wound edges together and replace the dressing.
d.
Cover the wound with sterile dressings saturated with normal saline.
21. A patient has just returned to the surgical unit after varicose vein stripping and ligation. What
is the best technique for a nurse to evaluate pain relief?
a.
Check the patient’s record for the last dose of pain medication administered.
b.
Ask the patient to rate the severity of the pain on a scale of 1 to 10.
c.
Ask the family if they think that the patient is having pain.
d.
Tell the patient to ask for pain medicine when it is needed.
22. A patient scheduled for a liver biopsy has given a nurse a list of medications routinely taken at
home. Which medication should the nurse question?
a.
Aspirin
b.
Multivitamin
c.
Furosemide
d.
Acetaminophen
23. A patient scheduled for a bronchoscopy is placed on an NPO status after midnight before the
procedure. The patient is complaining of being thirsty and requests some water on the
morning of the procedure. What action should the nurse implement?
a.
Deny any oral fluid per order.
b.
Allow 8 oz of tap water.
c.
Offer limited ice chips.
d.
Administer only carbonated drinks.
24. What should a nurse suggest to a patient to prevent the effects of postoperative immobility on
the gastrointestinal system?
a.
Avoid taking antibiotics.
b.
Increase her fluid intake.
c.
Avoid high-fiber foods.
d.
Limit her activity for the first 3 to 4 days.
25. A postanesthesia care nurse is evaluating a patient for possible transfer to the surgical unit.
Which assessment should prevent the patient’s transfer?
a.
Blood pressure of 126/78 mm Hg
b.
Pulse rate of 82 beats/min
c.
Pulse oximeter reading of 85%
d.
Respirations of 22 breaths/min
26. Why should a nurse assess a patient’s limbs and position the limbs frequently after a regional
anesthesia?
a.
Pain is not perceived, although motion is possible.
b.
Rashes and skin eruptions would indicate an allergy.
c.
Permanent paralysis is a concern.
d.
Contracture deformities may occur.
27. A patient who received Penthrane as an inhaled anesthesia complains of a sore throat and a
raspy voice. What should the nurse explain as the probable cause of these discomforts?
a.
Drying effect of the anesthesia
b.
Insertion of an endotracheal tube
c.
Postsurgical dehydration
d.
Possible upper respiratory infection
MULTIPLE RESPONSE
28. Patients with preoperative disorders put them at risk during recovery. What disorders should a
nurse be aware may pose this hazard? (Select all that apply.)
a.
Diabetes
b.
Warfarin therapy
c.
Fungal skin infection
d.
Hepatitis C
e.
Chronic obstructive pulmonary disease (COPD)
29. A patient has an extensive bowel preparation of oral laxatives and enemas for a colon
resection. What rationales should the nurse list when asked about the rigorous preparation?
(Select all that apply.)
a.
Reduces possibility of fecal contamination of the operative site
b.
Flattens the colon
c.
Decreases postoperative distention
d.
Avoids postoperative constipation
e.
Decreases straining at stool
30. A nurse carefully monitors an obese patient after a hysterectomy for the peculiar postoperative
complications. Which postoperative complications are associated with obesity? (Select all that
apply.)
a.
Nausea
b.
Wound infection
c.
Hypertension
d.
Hemorrhage
e.
Respiratory difficulties
31. What are the responsibilities of a circulating nurse? (Select all that apply.)
a.
Assisting the surgeon with the procedure
b.
Setting up the surgical room
c.
Scrubbing in to handle instruments
d.
Maintaining patient safety
e.
Documenting nursing care
COMPLETION
32. A nurse discovers on the preoperative assessment that a patient has a condition that would
require increased amounts of general anesthesia. The condition is _____.