Pre-op

1.An overweight patient (BMI 28.1 kg/m2) 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 preparation because of obesity.

2. The patient tells the nurse in the preoperative setting that she has
noticed she has a reaction when wearing rubber gloves. What is the
most appropriate intervention?

a. Notify the surgeon so the case can be cancelled.

b. Ask additional questions to assess for a possible latex allergy.
c. Notify the OR sta immediately so that latex-free supplies can
be used.
d. No intervention is needed because the patients rubber sensitivity has no bearing on surgery.

3. A 59-year-old man is scheduled for a herniorrhaphy in 2 days.

During the preoperative evaluation he reports that he takes ginkgo
daily. What is the priority intervention?

a. Inform the surgeon, since the procedure may need to be

rescheduled.
b. Notify the anesthesia care provider, since this herb interferes
with anesthetics.
c. Ask the patient if he has noticed any side eects from taking this
herbal supplement.
d. Tell the patient to continue to take the herbal supplement up to
the day before surgery.

4. A 17yearold patient with a leg fracture is scheduled for surgery.

She reports that she is living with a friend and 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 states nurse practice act related to emancipated
minors and informed consent.

5. A priority nursing intervention to assist a preoperative patient in

coping with fear of postoperative 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 patients particular
surgery.
d. explain the pain management plan, including the use of a pain
rating scale.

6. A patient is scheduled for surgery requiring general anesthesia at

an ambulatory surgical center. The nurse asks him when he ate last.
He replies that he had a light breakfast a couple of hours before
coming to the surgery center. What should the nurse do first?

a. Tell the patient to come back tomorrow, since he ate a meal.

b. Proceed with the preoperative checklist, including site
identifcation.
c. Notify the anesthesia care provider of when and what the patient
last ate.
d. Have the patient void before administering any preoperative
medications.

7. A patient who normally takes 40 units of glargine insulin (long

 acting) at bedtime asks the nurse what to do about her dose the
night before surgery. The best response would be to have her

a. skip her insulin altogether the night before surgery.

b. take her usual dose at bedtime and eat a light breakfast in the
morning.
c. eat a moderate meal before bedtime and then take half her usual
insulin dose.
d. get instructions from her surgeon or health care provider on any
insulin adjustments.

8. Preoperative considerations for older adults include (select all that

apply)

a. only using large print educational materials.

b. speaking louder for patients with hearing aids.
c. recognizing that sensory deficits may be present.
d. providing warm blankets to prevent hypothermia.
e. teaching important information early in the morning.

Intra-op

1.Proper attire for the semirestricted 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.

2. 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 operating room.
e. maintaining accurate counts of sponges, needles, and
instruments.

3. The nurse is caring for a patient undergoing surgery for a knee

replacement. What is critical to the patients 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 circulating nurse is a registered nurse.
e. The patients allergies are conveyed to the surgical team.

4. The nurses primary responsibility for the care of the patient undergoing surgery is

a. developing an individualized plan of nursing care for the patient.

b. carrying out specific tasks related to surgical policies and
procedures.
c. ensuring that the patient has been assessed for safe administration of anesthesia.
d. performing a preoperative history and physical assessment to
identify patient needs

5. When scrubbing at the scrub sink, the nurse should

a. scrub from elbows to hands.

b. scrub without mechanical friction.
c. scrub for a minimum of 10 minutes.
d. hold the hands higher than the elbows.
6. When positioning a patient in preparation for surgery, the nurse
understands that injury to the patient is most likely to occur as a
result of

a. incorrect musculoskeletal alignment.

b. loss of perception of pain or pressure.
c. pooling of blood in peripheral vessels.
d. disregarding the patients need for modesty.

7. Intravenous 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.

Post-op

1. 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.
d. Review results of intraoperative laboratory values and medications received.

2. 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 would be to

a. increase the rate of the IV uids.

b. obtain vital signs, including O2 saturation.
c. position patient in lateral recovery position.
d. administer antiemetic medication as ordered.

3. After admission of the postoperative patient to the clinical unit,

which assessment data require the most immediate attention?

a. Oxygen saturation of 85%

b. Respiratory rate of 13/min
c. Temperature of 100.4 F (38 C)
d. Blood pressure of 90/60 mm Hg

4. A 70-kg postoperative patient has an average urine output of

25 mL/hr during the frst 8 hours. Te priority nursing intervention(s) given this assessment would be to

a. perform a straight catheterization 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 fnding
during this time period.
d. evaluate the patients uid volume status since surgery and
obtain a bladder ultrasound.

5. 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 respiratory depression.
d. written discharge instructions understood.
e. opioid pain medication given 45 minutes ago
 NCLEX perioperative

66. The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical
unit. The nurse plans to monitor which parameter most carefully during the next hour?

1. Urinary output of 20 mL/hour

2. Temperature of 37.6 C (99.6 F)
3. Blood pressure of 100/70 mm Hg
4. Serous drainage on the surgical dressing

167. A postoperative client asks the nurse why it is so important to deep-breathe and cough after surgery. When
formulating a response, the nurse incorporates the understanding that retained pulmonary secretions in a postoperative
client can lead to which condition?

1. Pneumonia
2. Hypoxemia
3. Fluid imbalance
4. Pulmonary embolism

168. The nurse is developing a plan of care for a client scheduled for surgery. The nurse should include which activity in
the nursing care plan for the client on the day of surgery?

1. Avoid oral hygiene and rinsing with mouthwash.

2. Verify that the client has not eaten for the last 24 hours.
3. Have the client void immediately before going into surgery.
4. Report immediately any slight increase in blood pressure or pulse.

169. A client with a perforated gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form
because of sedation from opioid analgesics that have been administered. The nurse should take which most appropriate
action in the care of this client?

1. Obtain a court order for the surgery.

2. Have the charge nurse sign the informed consent immediately.
3. Send the client to surgery without the consent form being signed.
4. Obtain a telephone consent from a family member, following agency policy

170. A preoperative client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most
likely to stimulate further discussion between the client and the nurse?

1. If its any help, everyone is nervous before surgery.

2. I will be happy to explain the entire surgical procedure to you.
3. Can you share with me what youve been told about your surgery?
4. Let me tell you about the care youll receive after surgery and the amount of pain you can anticipate.

171. The nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse
should include which piece of information in discussions with the client?

1. Inhale as rapidly as possible.

2. Keep a loose seal between the lips and the mouthpiece.
3. After maximum inspiration, hold the breath for 15 seconds and exhale.
4. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees.

172. The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a
history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs
additional teaching if the client makes which statement?

1. Aspirin can cause bleeding after surgery.

2. Aspirin can cause my ability to clot blood to be abnormal.
3. I need to continue to take the aspirin until the day of surgery.
4. I need to check with my health care provider about the need to stop the aspirin before the scheduled
surgery.
 173. The nurse assesses a clients surgical incision for signs of infection. Which finding by the nurse would be
interpreted as a normal finding at the surgical site?

1. Red, hard skin

2. Serous drainage
3. Purulent drainage
4. Warm, tender skin

174. The nurse is monitoring the status of a postoperative client. The nurse would become most concerned with which
sign that could indicate an evolving complication?

1. Increasing restlessness
2. A pulse of 86 beats/minute
3. Blood pressure of 110/70 mm Hg
4. Hypoactive bowel sounds in all four quadrants

175. A client who has had abdominal surgery complains of feeling as though something gave way in the incisional site.
The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing
interventions should the nurse take? Select all that apply.

1. Contact the surgeon.

2. Instruct the client to remain quiet.
3. Prepare the client for wound closure.
4. Document the findings and actions taken
5. Place a sterile saline dressing and ice packs over the wound.
6. Place the client in a supine position without a pillow under the head.

176. A client who has undergone preadmission testing has had blood drawn for serum laboratory studies, including a
complete blood count, coagulation studies, and electrolytes and creatinine levels. Which laboratory result should be
reported to the surgeons office by the nurse, knowing that it could cause surgery to be postponed?

1. Sodium, 141 mEq/L

2. Hemoglobin, 8.0 g/dL
3. Platelets, 210,000/mm3
4. Serum creatinine, 0.8 mg/dL

177. The nurse receives a telephone call from the postanesthesia care unit stating that a client is being transferred to
the surgical unit. The nurse plans to take which action first on arrival of the client?

1. Assess the patency of the airway.

2. Check tubes or drains for patency.
3. Check the dressing to assess for bleeding.
4. Assess the vital signs to compare with preoperative measurements.

178. The nurse is reviewing a health care providers (HCPs) prescription sheet for a preoperative client that states that
the client must be NPO after midnight. The nurse would telephone the HCP to clarify that which medication should be
given to the client and not withheld?

1. Prednisone
2. Ferrous sulfate
3. Cyclobenzaprine (Flexeril)
4. Conjugated estrogen (Premarin)

Pain
1.Pain is best described as
a. a creation of a persons imagination.
b. an unpleasant, subjective experience.
c. a maladaptive response to a stimulus.
d. a neurologic event resulting from activation of nociceptors.

2. A patient is receiving a PCA infusion after surgery to repair a hip

fracture. She is sleeping soundly but awakens when the nurse
speaks to her in a normal tone of voice. Her respirations are 8
breaths/minute. The most appropriate nursing action in this situation is to
 a. stop the PCA infusion.
b. obtain an oxygen saturation level.
c. continue to closely monitor the patient.
d. administer naloxone and contact the physician.

3. Which words are most likely to be used to describe neuropathic

pain (select all that apply)?
a. Dull
b. Mild
c. Burning
d. Shooting
e. Shock-like

4. Unrelieved pain is
a. expected after major surgery.
b. expected in a person with cancer.
c. dangerous and can lead to many physical and psychologic complications.
d. an annoying sensation, but it is not as important as other physical care needs.

5. A cancer patient who reports ongoing, constant moderate pain

with short periods of severe pain during dressing changes is
a. probably exaggerating his pain.
b. best treated by referral for surgical treatment of his pain.
c. best treated by receiving both a long-acting and a short-acting
opioid.
d. best treated by regularly scheduled short-acting opioids plus
acetaminophen.

6. An example of distraction to provide pain relief is

a. TENS.
b. music.
c. exercise.
d. biofeedback.

7. Appropriate nonopioid analgesics for mild pain include (select all

that apply)
a. oxycodone.
b. ibuprofen (Advil).
c. lorazepam (Ativan).
d. acetaminophen (Tylenol).
e. codeine with acetaminophen (Tylenol #3).

8. An important nursing responsibility related to pain is to

a. leave the patient alone to rest.
b. help the patient appear to not be in pain.
c. believe what the patient says about the pain.
d. assume responsibility for eliminating the patients pain.

9. Providing opioids to a dying patient who is experiencing moderate

to severe pain
a. may cause addiction.
b. will probably be ineective.
c. is an appropriate nursing action.
d. will likely hasten the persons death.

10. A nurse believes that patients with the same type of tissue injury
should have the same amount of pain. Tis statement reects
a. a belief that will contribute to appropriate pain management.
b. an accurate statement about pain mechanisms and an expected
goal of pain therapy.
c. a belief that will have no eect on the type of care provided to
people in pain.
 d. a lack of knowledge about pain mechanisms, which is likely to
contribute to poor pain management.

Chronic Illness & Older Adults

1.Examples of primary prevention strategies include
a. colonoscopy at age 50.
b. avoidance of tobacco products.
c. intake of a diet low in saturated fat in a patient with high cholesterol.
d. teaching the importance of exercise to a patient with hypertension.

2. A characteristic of a chronic illness is that it (select all that apply)

a. has reversible pathologic changes.
b. has a consistent, predictable clinical course.
c. results in permanent deviation from normal.
d. is associated with many stable and unstable phases.
e. always starts with an acute illness and then progresses slowly.

3. Ageism is characterized by
a. denial of negative stereotypes regarding aging.
b. positive attitudes toward the elderly based on age.
c. negative attitudes toward the elderly based on age.
d. negative attitudes toward the elderly based on physical disability.

4. An ethnic older adult may feel a loss of self-worth when the nurse
a. informs the patient about ethnic support services.
b. allows a patient to rely on ethnic health beliefs and practices.
c. has to use an interpreter to provide explanations and teaching.
d. emphasizes that a therapeutic diet does not allow ethnic foods.

5. An important nursing action to help a chronically ill older adult

is to
a. avoid discussing future lifestyle changes.
b. assure the patient that the condition is stable.
c. treat the patient as a competent manager of the disease.
d. encourage the patient to fght the disease as long as possible.

6. Older adults who become ill are more likely than younger adults to
a. complain about the symptoms of their problems.
b. refuse to carry out lifestyle changes to promote recovery.
c. seek medical attention because of limitations on their lifestyle.
d. alter their daily living activities to accommodate new symptoms.

7. An appropriate care choice for an older adult who lives with an

employed daughter but requires help with activities of daily living
is
a. adult day care.
b. long-term care.
c. a retirement center.
d. an assisted living facility.

8. Nursing interventions directed at health promotion in the older

adult are primarily focused on
a. disease management.
b. controlling symptoms of illness.
c. teaching positive health behaviors.
d. teaching regarding nutrition to enhance longevity

Patient Teaching
1.What would be the priority teaching goal for a middle-aged
Hispanic woman regarding methods to relieve symptoms of menopause?

a. Prevent the development of future disease.

b. Maintain the patients current state of health.
 c. Change the patients cultural belief regarding the use of herbs.
d. Provide information for selection and use of treatment options.

2. When planning teaching with consideration of the diverse learning

needs of adults, the nurses best approach would include

a. presenting material in an efficient lecture format.

b. recognizing that adults enjoy learning regardless of the relevance
to their personal lives.
c. providing opportunities for the patient to learn from other
adults with similar experiences.
d. postponing practice of new skills until the patient can independently practice the skill at home.

3. Which is the priority patient teaching strategy when limited time

is available?

a. Setting realistic goals that have high priority for the patient
b. Referring the patient to a nurse educator in private practice for
teaching
c. Observing more experienced nurse-teachers to learn how to
teach faster and more efficiently
d. Providing reading materials for the patient instead of discussing
information the patient needs to learn

4. The nurse needs to include caregivers in patient teaching primarily

because (select all that apply)

a. they provide most of the care for patients after discharge.

b. they might feel rejected if they are not included in the teaching.
c. patients have better outcomes when their caregivers are involved.
d. the patient may be too ill or too stressed to fully understand the
teaching.
e. caregivers are responsible for the overall management of the
patients care.

5. Which technique is most appropriate when using motivational

interviewing with a patient who tells you that he is ready to start a
weight loss program?

a. Confirm that the patient is serious about losing weight.

b. Insist that the patient consider an organized group weight loss
program.
c. Focus on the patients strengths to support his optimism that he
can successfully lose weight.
d. Ask a prescribed set of questions to increase the patients awareness of his dietary behaviors

6. Which patient characteristic enhances the teaching-learning

process?
a. Moderate anxiety
b. High self-efficacy
c. Being in the precontemplative stage of change
d. Being able to laugh about the current health problem

7. A patient tells the nurse that she enjoys talking with others and
sharing experiences, but easily falls asleep when reading. Which
teaching strategy would be most eective with this patient?
a. Role play
b. Group teaching
c. Lecture-discussion
d. Discussion supplemented with computer programs
8. The nurse has taught a patients caregiver how to administer insulin
to her husband. Evaluation of the nurses teaching eectiveness
before discharge would include
a. arranging for follow-up with a home care nurse.
b. monitoring the patients glucose readings before discharge.
c. asking the caregiver to show back her ability to administer
insulin.
d. asking the caregiver what she found helpful about the teaching
experience.