PRETEST:

1. The best time to provide preoperative teaching on deep breathing, coughing and turning exercises is:

a. Before the administration of preoperative medicatiosb. The afternoon or evening prior to surgeryc. Several days prior to surgeryd. Upon admission of the client in the recovery room

2. Which of the following is the primary purpose of maintaining NPO for 6-8 hours before surgery?

a. To prevent malnutritionb. To prevent electrolyte imbalancec. To prevent aspiration pneumoniad. To prevent intestinal obstruction

3. Regarding the surgical patient, which of the following terms refers to the period of time that constitutes the surgical experience?

a. Preoperative phaseb. Intraoperative phasec. Postoperative phased. Perioperative phase

4. When the indication for surgery is “without delay”, the nurse recognizes that the surgery will be classified as:

a. Emergencyb. Urgentc. Requiredd. elective

5. When a person with history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period?

a. Immediately, upon admissionb. Up to 72 hours after alcohol withdrawalc. Upon awakening in the PACUd. Up to 24 hours after alcohol withdrawal

6. Which of the following categories of medications may result in seizure activity if withdrawn suddenly?

a. Adrenal corticosteroidsb. Anti-depressantsc. Tranquilizersd. diuretics

7. When the patient is encouraged to concentrate on a pleasant experience or restful scene, the cognitive coping strategy employed by the nurse is

a. optimistic self recitationb. progressive muscular relaxationc. distractiond. imagery

8. According to the American Society of Anesthesiology Physical Status Classification System, a patient with a severe systemic disease that is not incapacitating would be assigned which Classification number?

a. I c.IIIb. II d.IV

9. Which stage of anesthesia is termed as “surgical anesthesia”?a. I c.IIIb. II d.IV

10. How frequent should the nurse monitor the VS of the patient in the recovery room?a. Every 15 minutesb. Every 30 minutesc. Every 45 minutesd. Every 60 minutes

11. Which of the following manifestations is often the earliest sign of malignant hyperthermia?

a. Hypotensionb. Elevated temperaturec. Tachycardia(heart rate above 150 bpm)d. oliguria

12. Which of the following terms refer to protrusion of abdominal organs through the surgical incision?

a. Hernia c. erythemab. Dehiscence d. evisceration

13. What method of wound healing is describe when wound edges are not surgically approximated and integumentary continuity is restored by granulations.

a. Primary intention healingb. Second intention healingc. First intention healingd. Third intention healing

14. When the surgeon performs an appendectomy, the nurse recognizes that the surgical category will be identified as:

a. Cleanb. Contaminatedc. Dirtyd. Clean contaminated

15. The nurse knows that there are ways of sterilizing surgical equipments. Which of the following is not a form of sterilization?

A. High pressure steam C. Dry heat

B. Cold chemical D. Alcohol

16. What is the responsibility of the nurse regarding informed consent?

A. To explain surgical options C. To explain surgical procedure to be done

B. To explain operative risks D. To witness the patient’s signature

17. In order to maintain pulmonary ventilation post operative period, a skillful nurse positions the client in:

A. side lying C. Semi-prone position

B. flat on bed D. prone position

18. What is the prime reason why indwelling catheter is in place after surgery?

A. Epidural anesthesia blocks the innervations of the bladder leading to inability to void.B. To measure accurately the intake and output of the patient.C. To ensure that the client voids after operation.D. To reduce risk for fluid volume overload.

19. Which of the following conditions indicates that a sterile field has been contaminated?

A. Wetness on the sterile cloth on top of the nonsterile table. B. Sterile objects are held above the waist of the scrub nurseC. Sterile packages are opened with the first edge away from the nurseD. the outer inch of the sterile towel hangs over the side of the table

20. If spinal anesthesia rises to high in her spinal cord, the nurse should be prepared to:

a. Elevate the foot of the bed

b. administer artificial respiration

c. Elevate head of the bed above the extremities

D. begin external cardiac massage

21. Hypotension may occur as a complication following induction of spinal anesthesia, which may be due to:

A. Traction of various structures within the abdomenB. Loss of cerebrospinal fluid to cushion the brainC. Paralysis of the vasomotor nerve

D. Depression of the respiratory system22. The final skin preparation is done in the operating room during:

A. First stage of anesthesia C. Third Stage of anesthesia B. Second stage of anesthesia D. Fourth stage of anesthesia

23. The preoperative teaching of a nurse is directed towards:

A. Instruction of post op exercises C. encouragement of verbalize feelings

B. Acceptance of grief D. Discussion of surgical procedure

24 . After a patient has been given his preoperative medication, the nurse should:

A. Raise side rails C. encourage him to void

B. Remove his head pillow D. apply extra blanket

25. The patient is receiving intravenous fluids intraoperatively with the main reason to:

A. Maintain circulatory volume C. restore serum electrolyte levelsB. Replace fluid being lost from the body D. increase urinary output

26 . Status post tonsillectomy patient is in the PACU, early manifestation of bleeding is:

A. inflammation C. frequent swallowing

B. decrease blood pressure D. distended abdomen

27 . A wound dehiscence can be prevented by:

A. suturing the wound with steel wire C.bed rest for at least two days

Instead of silk post operatively

B. postponing surgery of patients D. applying good support like

with persistent cough abdominal binder

28. Which of the following nursing measures will be most helpful in the prevention of pulmonary atelectasis post operatively?

A. having client cough every 1-2 hours C. placing client on supine position

B. wearing of elasticized stocking D. increase oral fluid at least 1.5 liter

29 . A patient fear her impending operation is an expected problem encountered by the perioperative nurse because it is natural to equate anesthesia with:

A. amnesia C. intoxication

B. insanity D. death

30. A chemical agent used to inhibit the growth of microorganisms on skin and mucus membranes is called as:

A. Sporicide C. Antihistamine

B. Disinfectant D. Antiseptic

31. Which of the following categories of surgery that is done at the client’s life-threatening situation?

A. Elective Surgery C. Required Surgery

B. Emergency Surgery D. Elective Surgery

32. Which sign alerts the nurse to wound evisceration?

A. acute bleeding C. purple drainage

B. pink serous drainage D. severe pain

33. A client has been admitted to the recovery room following surgery, upon initial assessment, the recovery room nurse notes the client is restless, has a rapid thread pulse, intercostals retractions and noisy respirations. Which term describes what should be suspected by the nurse?

A. Shock C. Respiratory obstruction

B. Hemorrhage D. Pain

34. Which statement describes the technique of choice for removing sutures?

A. Sterile technique is used when removing suture.

B. each suture is clipped as far away from the skin as possible.

C. tweezers are necessary only for removal of the continuous stitch sutures.

D. the suture is clipped close to the skin and pulled through from the other side.

35. Which factor in the client’s history adversely affects wound healing?

A. weight C. Age

B. occupation D. Smoking

36. Three days after surgery, client states: “something popped and gushed when I coughed.” What action should be taken by the nurse?

A. Cover the area with dry, sterile abdominal binder C. Leave the area open to air

B. Cover the area with sterile towels soaked in saline D. Apply an abdominal binder

37. What is the purpose of a penrose drain protruding from a post operative surgical incision site?

A. provide an entry for wound irrigation C. promote healing of underlying tissues by obliterating dead space

B. prevent the entry of microorganisms D. promote hemostasis of the wound

Into the wound

38. Preoperatively, a patient is given Atropine sulfate. Which of these findings would indicate that the desired effects of the medication have been achieved?

A. increase in heart rate C. onset of drowsiness

B. dryness of the lips D. relief of nausea

39. What is the method and practices that prevent cross-contamination in the surgery?

A. Surgical scrubbing C. Contamination

B. Sterilization D. Aseptic technique

40. What do you call the process of destroying tissue by using chemical corrosion, electricity or heat. It is done by using a small probe, which has an electrical current running through it, to burn or destroy the tissue.

A. Laser surgery C. General surgery

B. Cryosurgery D. Cauterization

41. Which of the following would be the nurse’s best response to a female client scheduled for an emergency surgery that is crying and voicing that she is afraid of being put to sleep?

A. Squeeze her hand and tell her “there’s nothing to be afraid of.”

B. Check her name band and ask the anesthesiologist to give her a sedative.

C. Stand by her side and quietly ask her to describe what she is feeling.

D. Let her cry and tell others to leave her alone until she is anesthetized.

42. What do you call the maneuver use to displace the esophagus by applying pressure in the cricoids cartilage; it is usually done prior to insertion of the endotracheal tube?

A. Leopold’s maneuver C. Shellick’s maneuver

B. Sellick’s maneuver D. Ritgen’s maneuver

43. The nurse is caring for a client with a chest tube. On the second post operative day, the chest tube accidentally disconnects from the drainage tube. The first action the nurse should take is:

A. Clamp the chest tube C. Call the physician

B. Raise the collection chamber D. Reconnect the tube

above the patient’s chest

44. Which of the following is the primary purpose of maintaining NPO for 6-8 hours before surgery?

A. prevent malnutrition C. prevent aspiration pneumonia

B. prevent electrolyte imbalance D. prevent intestinal obstruction

45. The nurse is assessing a client’s nutritional status preoperatively. Which of the following observations would indicate poor nutrition in a 5-foot 7-inch female client who is 21 years of age?

A. poor posture C. dull expression

B. brittle nails D. weight of 128lbs.

46. A client scheduled for outpatient surgery will receive IV Midazolam hydrochloride for premedication. The nurse should prepare a teaching plan for the client that indicates that the medication is intended to produce which of the following effects?

A. amnesia C. Nausea

B. mild agitation D. blurred vision

47. Which of the following clients is most at risk for potential hazards from the surgical expeience?

A. a 68-year-old client C. a 50-year-old client

B. a 30-year-old client D. a 13-year-old client

48. The nurse should keep in mind while helping to prepare the patient for surgery that the most common problem of the elderly is:

A presence of various diseases C. hypersensitivity to variety of drugs

B. dehydration and malnourishment D. mental confusion.

49. The nurse understands that the client who has epidural pain management post operatively can ambulate:

A. because the epidural catheter is in place for occasional use only

B. because a low concentration of local anesthesia is used

C. because only analgesia is used

D. because of a low pain threshold

50. Which of the following interventions should the nurse implement to help prevent post operative pulmonary embolism?

A. have the client perform leg exercises every hour while awake

B. encourage the client to cough and deep-breathe

C. massage the calves of the client’s legs

D. have the client wear antiembolic stockings when out of bed

51. Which is the best explanation for the nurse to give a child about general anesthesia induction?

A.”Your premedication will put you to sleep

B. “You will breathe oxygen through a facial mask and receive IV medication to

make you sleepy”

C. “You will breathe in medication through a facial mask and make you sleepy”

D. “You will receive IV medications to make you sleepy”

52. The nurse explains to the family that they cannot go with the client past the doors that separate the public from the restricted area of the OR suite because traffic control measures are designed to:

A. protect the privacy of clients

B. separate the family from the surgical team while they are working on the client

C. prevent any electrical sparks that could ignite the anesthetic gases

D. provide an antiseptic environment to prevent infection

53. Which of the following client statements indicates that the client understands the nurse's teaching about postoperative wounds?

A. “I should expect a slight odor from the surgical dressing.”

B. “I should call my doctor if my wound is intact and has no drainage.”

C. “I should not clean my surgical wound until i go back to my doctor in 2 weeks.”

D. “I should call my healthcare provider if i have a temperature of 102 degrees

54. Which of the following nursing actions help the patient decrease anxiety during preoperative period?

A. explaining all procedures thoroughly in chronological order

B. spending time listening to the patient and answering questions

C. encouraging sleep and limiting interruptions

D. reassuring the patient that the surgical staff are competent professionals

55. A wound dehiscence or wound disruption can be prevented by:

A. suturing the wound with steel wire instead of silk

B. postponing surgery of patients with persistent cough

C. bed rest for at least two days post op

D. applying a good support abdominal binder

56. The position of choice for administering the above anesthesia is to have the patient on

A. sides with legs well flexed

B. sides with legs well extended

C. abdomen with her arms on her sides

D. abdomen with her arms folded under her head

57. When receiving drugs from the circulator, the scrub nurse should:

A. clean the top of the vial before inserting the needle

B. ask the circulator to read the label before withdrawing the solution

C. keep the medication vial on the back table until the procedure is over

D. read aloud the name of the drug,strength and/or amount of drug and the expiration date

58. What is the proper attire for the semirestricted area in the operating room suite?

1. Street clothes

2. Scrubsuit and cap and OR shoes

3. OR shoes/slippers and masks

4. Eye shields and sterile gloves

A. 1 only B. 2 only

C. 3 and 4 D. 1 and 2

59. Who is responsible for the patient's safety inside the operating room?

A. surgeon B anesthesiologist

C. nurse D. entire surgical team

60. What is the safest and most practical means for sterilizing heat and moist- stable items?

A. saturated steam under pressure

B. ethylene oxide gas

C.activated glutaraldehyde

D. boiling water

61. Which of the following sutures is absorbable?

a. Vicryl b. Prolene c. Silk d. Mersilk

62. The perioperative nurse is teaching the client about patient-controlled analgesia (PCA_ planned for post operative care. Which statement would indicate further teaching is needed?

a. “I will be receiving continuos doses of medication

b. I should call the nurse before I take additional doses

c. I will call for assistance

63. A client undergoes a traditional cholecystectomy and choledochotomy and returns from surgery with a T-tube. To evaluate the effectiveness of the T0tube, the nurse should understand that the primary reason for the T-tube is to accomplish which of the following goals?

a. Promote drainageb. Provide a way to irrigate the biliary tractc. Minimize the passage of bile into the duodenumd. Prevent the bile from entering the peritoneal cavity

64. How much bile would the nurse expect the T-tube to drain during the first 24 hours aftr choledocholithotomy?

a. 50-100 mlb. 150-250 mlc. 300-500mld. 550-700 ml

65. The nurse measures the amount of bile drainage from a T-tube and records it by which one of the following methods?

a. Adding it the client’s urine output?b. Charting it separately on the output recordc. Adding it to the amount of wound drainaged. Subtracting it from the total intake of the day

66. A client with cholecystitis is complaining of severe right upper quadrant pain. Which of the following medications would the nurse anticipate administering to relieve the client’s pain?

a. Meperidine (Demerol)b. Acetaminophen with codeinec. Promethazine (Phenergan)d. Morphine sulfate

67. Which of the following serum enzymes is most accurate in assessing liver function?a. AST c.ALTb. LDH d. ALP

68. The client will undergo cholecystectomy. Which of the following drugs would you expect to be given during the preop period?

a. Vit A c. Vit Eb. Vit D d. Vit K

69. The client is for cholecystectomy and choledochotomy. The procedure involves removal of the gall bladder and

a. Drainage of the gall bladderb. Opening of the common bile ductc. Removal of CBDd. Insertion of a drainage tube into the cystic duct

70. Because of the high abdominal incision in cholecytectomy, a major post op complication is:

a. Hemorrhage c. pneumoniab. Atelectasis d. infection

71. A client undergoes transurethral resection of the prostate (TURP) under spinal anesthesia. He eturns to his room with continuous bladder irrigation (CBI). Which of the following statements best explains the reason for the CBI?

a. To decrease bladder atonyb. To remove blood clots from the bladderc. To maintain patency of the urethral catheterd. To dilute the concentrated urine

72. If effective traction must be maintained, the following must be maintained, the following nursing measures must be implemented EXCEPT:

a. Provision of adequate countertractionb. Weights should hang freelyc. Remove weights intermittentlyd. Line of pull should be in line with the deformity

73. Which of the following is inappropriate nursing action when caring for the client with cast?

a. Support newly casted extremity with the palms of the handb. Keep the casted extremity dependent on the mattressc. Promote dryness of the cast by exposing the casted extremityd. Do neurovascular assessment on the affected extremity

74. When caring for the patient in traction, the nurse is guided by which of the following principles?

a. Skeletal traction is never interruptedb. Weights should rest on the bedc. Knots in the ropes should touch the pulleyd. Weights are removed routinely

75. An 84-year old man has just returned to the nursing unit after a TURP. He has a 3-way Foley catheter for continuous bladder irrigation connected to straight drainage. Immediately after surgery, the nurse would expect his urine to be:

A. Clear C. Pink or dark red

B. Light yellow D. Bright red

76. Nursing actions help the patient decrease anxiety during preoperative period?a. Explaining all procedures thoroughly in chronological orderb. Spending time listening to the patient and answering questionsc. Encouraging sleep and limiting interruptions

d. Reassuring the patient that the surgical staff are competent professional77. Which of the following is the most dangerous complication during induction of spinal

anesthesia?

a. Tachycardiab. Hypotension

c. Hyperthermiad. bradypnea

78. The preoperative teaching of a nurse is direcred towardsa. Instructing in post op exercisesb. Learning to grievec. Encouragement to verbalized. Discussing his medications and treatments

79. When assisting patient to cugh post operatively, which of this objectives should the nurse have?

a. To prevent hemorrhage and promote wound healingb. To constrict the abdomen and prevent ileal retractionc. To lessen pain d. To promote pulmonary ventilation

80. Following abdominal surgey, Mrs Bautista says that she does not like to tae a deep breath or cough due to:

a. Trauma of tissue incurred during surgeryb. Psychological action commonly experience by surgical patients.c. Proximity of the diaphragm to the incisiond. The sutures which act as the invading foreign bodies

81. If the patient develops thrombophlebitis post operativey, the nurse should be prepared to give care that will prevent:

a. Arteriole collapseb. Cerebrovascular aneurysmc. Pulmonary embolid. Contractive deformities of the legs

82. When patient develops a wound infection, the nurse studies a laboratory analysis od the patient’s blood findings. Most indicative of patient having a wound infection present when he has

a. Low platelet countb. Elevated RBCc. Low hemoglobin countd. Elevated WBC

83. If the patient administered with regional anesthesia develops a postoperative bladder infection, the factor most likely predisposed her to infection is having

a. Limited ambulationb. Urinary incontinences

c. Low fluid intaked. Bladder catheterization

84. Mrs .Kaingin has not responded to conservative management and was scheduled for gastric and duodenal resection with anastomosis to the jejunum. This surgery is called:

a. Billroth 1 c. Mile’s Surgeryb. Billroth II d. Gastrorrhaphy

85. The best position for the client following thyroid surgery isa. Lateral c. semi- Fowler’sb. Supine d. prone

86. For post operative subtotal thyroidectomy, the nurse asks the client to state her name as soon as she regains consciousness. The PACU nurse does this primarily to monitor for which of the following complication?

A. Intestinal hemorrhage C. Laryngeal nerve damage

B. Upper airway obstruction D. Lower airway obstruction

87. The following are appropriate nursing interventions for a client with appendicitis EXCEPT

a. Maintain NPOb. Apply ice cap over the RLQ of the abdomenc. Promote bed restd. Administer laxative

88. An adolescent male client scheduled for an emergency appendectomy is to be transferred directly from the emergency room to the operating room. Which of the following statements by the client would the nurse interpret as most significant?

A. “All of the sudden it doesn’t hurt at all.” C. “I feel like I’m going to throw up”

B. The pain is centered around my navel” D. “It hurts when you press on my stomach”

89. During the shock phase of burns, the following are manifested by the client EXCEPT:a. Hypovolemia, increased hctb. Dieresisc. Hyperkalemia, hyponatremiad. Fluid shifts from IVC to ISC

90. . The primary cause of dehydration during the first 48 hours of burn is:a. Increased insensible lossesb. Shifting of plasmac. Fluid loss through blister formation

d. Actual fluid destruction by the burning91. Which of the following should be given highest priority in client with burns:

a. Initiation of fluid replacementb. Securing an airwayc. Initiation of total parenteral nutritiond. Prevention of infection

92. The drug of choice for burn clients because it penetrates eschar isa. Silver nitrate c. mafenide acetateb. Silver sulfadiazine d. povidone iodine

93. Which of the following chemical agents may not cause pain?a. P-substanceb. Histaminec. Endorphinsd. bradykinin

94. The pain center that functions in the interpretation of pain is:a. Cerebral cortexb. Thalamusc. Skind. Medulla oblongata

95. To perform mechanical debridement, which of the following method is done?a. Dry to dry dressingb. Wet to dry dressingc. Wet to wet dressingd. Dry to wet dressing

96. What is the percentage of burns of an adult client who had experienced burns in the entire right arm and entire right lower extremity?

a. 9% c. 27%b. 18% d. 36%

97. A major goal in the discharge teaching is:a. Prevention of fluid-electrolyte imbalancesb. Prevention of systemic infectionc. Prevention of stress ulcerd. Prevention of excessive scar formation

98. When the emergency nurse learns that the patient suffered injury from a flash flame, the nurse anticipates which depth of burn?

a. Deep Partial thicknessb. Superficial partial thicknessc. Full thicknessd. Superficial

99. Which of the following is experienced by the patient who is under spinal anesthesia?a. The patient is unconscious

b. The patient is awakec. The patient experiences amnesiad. The patient experiences total loss of sensation

100.Which of the following nursing actions should be given highest priority when admitting the patient into the operating room?

a. Level of consciousnessb. Vital signsc. Patient identification and correct operative consentd. Positioning and skin preparation