OUR LADY OF FATIMA UNIVERSITY Perioperative Nursing

Situation1Inthehospitalwhereyouwerehired,allnewlyhirednursesarefirsttrainedtoworkin eachwardofthehospitalforafewweeks.Youwerefirstassignedtothefemalesurgicalwardina tertiaryhospital. 1. Thesurgicalexperiencehasthreestages,eachreflectingdifferentbutrelatednursingconcernsand responsibilities.Whichofthefollowingstatementsaboutthepreoperativephaseistrue? A. Thepreoperativephasebeginswhenthedecisiontoproceedwithsurgicalinterventionismade andendswiththetransferofthepatientontotheoperatingroomtable. B. Thepreoperativephasebeginswiththeonsetoftheconditionthatrequiressurgical interventionandendswiththetransferofthepatientontotheoperatingroomtable. C. Thepreoperativephasebeginsaftersigningtheinformedconsentandendswiththetransferof thepatientontotheoperatingroomtable. D. Thepreoperativephasebeginswhenthedecisiontoproceedwithsurgicalinterventionis madeandendswiththeinductionoftheanestheticagent. 2. Whatisthefirstnursingresponsibilityduringthepreoperativephase? A. Assesstheclientforphysiologicfactorsthatmayaffectthepatientsperioperativeexperience. B. Assesstheclientforpsychological,emotionalandculturalfactorsthatmayaffectthepatients perioperativeexperience C. Managepain D. AandB 3. Whichisnotaprimarygoaltobeachievedbyahealthyclientundergoingnonemergentsurgery duringthepreoperativephase? A. Togainadequateknowledgeregardingtheprocedure B. Tomaintainorimproveoptimumhealthpriortothesurgery C. Togaincopingskillstofacethedemandsandchangesthatwillbebroughtaboutbythesurgery D. Noneoftheabove Situation2Amajorconsiderationinprovidingcareandaddressingneedsistheclientsage.Age groupswhoaremoreatriskforperioperativeproblemsincludeinfants,childrenandtheelderly. 4. Whichofthefollowingcharacteristicsisnotaconcernforinfantswhowillbeundergoingsurgery? A. Smallbloodvolumeandlimitedfluidreserves B. Largebodysurfaceandimmaturetemperatureregulatorymechanisms C. Fearofseparationfromparents D. Immatureorgansandorgansystems(kidney,liver,immunesystem) 5. Thecharacteristicdescribedin4a,smallbloodvolumeandlimitedfluidreserves,supportswhichof thefollowingnursingdiagnosis? A. Highriskforfluidvolumedeficit B. Highriskforalteredthermoregulation C. Fluidvolumedeficit D. Alteredthermoregulation 6. Whichofthefollowingteachingandlearningstrategiesistheleastappropriateforchildrenwhowill undergosurgery? A. Useofpuppetsanddolls B. Lecturingusingtechnicaltermsandthoroughdiscussionofthetopics

C. Roleplaying D. Includingtheparentsintheteachinglearningactivities 7. Whichofthefollowingcharacteristicsoftheelderlyclientisnotrelatedtotheirneedforfewer anestheticagentstoproduceanesthesia? A. Thepercentageofleanbodytissuedecreasesandfattytissuesteadilyincreases B. Reducedliversize C. Decreasedkidneyfunction D. Noneoftheabove 8. Anotherconcernfortheelderlypatientisthedeclineinsensoryfunction.Whileteachinga70year oldfemaleclienthowtoperformpostoperativeexercises,shekeptonasking,Ineng,anoang sinasabimo?Hindikomarinig.Duringassessment,youfoundoutthatshepassedthementalstatus exam.Whatisyournursingdiagnosis? A. Knowledgedeficit B. Alteredsensoryperception:Auditory C. ChronicConfusion D. Riskforinjury Situation3Voluntaryandwritteninformedconsentfromthepatientisnecessarybeforenon emergentsurgerycanbeperformed 9. Inwhichofthefollowingsituationsistheinformedconsentvalid? A. Theclientsignedtheinformedconsentafterreceivingadoseofsedative. B. Thenurseaskedtheclienttosigntheconsentformaftersheexplainedwhatwillhappentothe clientduringthesurgery. C. Thenursewitnessedthepatientssignatureafterensuringthattheclientunderstoodthe informationprovidedbythesurgeonandtheanesthetist. D. Theconsentwassignedbeforeprovidingtheclientwithappropriateinformation. 10. Whoamongthefollowingisnotlegallyallowedtowitnessthesigningofaconsentformtoasurgical procedure? A. Theparentsofapatient B. Thepatientssurgeon C. Thenurseinchargeofthepatient D. Theheadnurse 11. Whoamongthefollowingpatientsisnotlegallyallowedtogivetheirconsenttoasurgery? A. Asixteenyearoldmarriedmalewhoisemancipated B. Afifteenyearoldfemalewhoisemancipatedfromherparentsandisindependentlyearningher ownliving C. Theparentsofasevenyearoldfemale D. Asedated25yearoldmale Situation4Maria,a35yearoldfemalediagnosedwithbreastcancer,wasadmittedtoyourward.She willbeundergoingmastectomy. 12. Duringadmission,Mariawasaskingyouwhatthereasonforthesurgicalprocedureisandwhatwill happenduringtheadmission.Whatisyournursingdiagnosis? A. Anticipatorygrieving D. IneffectiveCoping B. KnowledgeDeficit(mastectomy) C. Fear

 13. Whatwillbeyourinterventionfortheidentifiednursingproblem? A. Reassuretheclientthatthesurgeonknowswhathewillbedoing. B. Answertheclientsquestionsfactually. C. Telltheclientthatyouwillinformthesurgeonthatshehassomequestionsandthatyouwillask thesurgeontoscheduleameetingwithherforconsultation. D. TellMariatogobackhomeandconsultwiththesurgeonbeforeplanningtobeadmitted. Situation5Manycomplicationscanarisepostoperativelyduetotheeffectsofanesthesiaand immobility.Topreventthesecomplications,patientsneedtobeinstructedtoperformpostoperative exercises 14. Whatisthebesttimetoteachtheclienthowtoperformpostoperativeexercises? A. Whiletheclientisrecoveringfromtheanesthesiaandsurgeryinthepostanesthesiacareunit. B. Threedaysafterthesurgeryorwhenthepainfromthesurgeryisalreadytolerable. C. Onthedayofthesurgery. D. Afewdaysbeforethesurgery. 15. Oneofthepostoperativeskillsthatyouneedtoteachtheclientishowtogetoutofthebed.Ifthe clientsincisionwillbeontheleftsideofthechestorabdomen,onwhichsideofthebedwillyou tellhim/hertoturntoandgetoutof? A. Leftsideofthebed B. Rightsideofthebed C. Footofthebed D. Itdoesntmatter 16. Movingandturninginbedcanaddstraintothesuture.Whatskillorexercisewillyouteachthe clienttopreventtheadditionalstrainonthesuturewhenmoving? A. Movinginslowmotion B. Deepbreathingexercises C. Splinting D. Legexercises 17. Whichofthefollowingpotentialpostoperativeproblemsduetounduestrainonthesuturesite pertainstotheextrusionofinternalorgansandtissuesthroughtheincision? A. WoundDehiscence B. WoundEvisceration C. WoundInfection D. Postoperativeileus 18. Whicharmshouldtheclientinno.17usetosplintthewound? A. Leftarmandhand B. Rightarmandhand C. Apillow D. Anyofthetwoarmsandapillow 19. Whenmovingtothesittingpositionbeforegettingoutofbed,whicharmshouldtheclientinno.17 usetopushdownagainstthemattress? A. Leftarmandhand B. Rightarmandhand C. Apillow D. Anyofthetwoarmsandapillow

20. Legexercisesarealsoskillsthattheclientneedstoperformafterthesurgery.Whatistherationale fortheperformanceoflegexercisesafterthesurgery? A. Topromotecirculationandpreventthrombusformation B. Topromotelungexpansionandtopromoteairwayclearance C. Topreventinfection D. Topreventcontractures 21. Afterthesurgery,theclientneedstoperformdeepbreathingandcoughingexercises.Whichofthe followingisthebestpositionwhenperformingdeepbreathingandcoughingexercises? A. Sidelyingposition B. Sittingposition C. Dorsalrecumbent D. SemiFowlersposition 22. Toprovidetheclientandthenursefeedbackregardingthedepthoftherespiration,what instructionshouldbegiventotheclientwhenperformingdeepbreathingexercises? A. Splinttheincision. B. Inhaleslowly. C. Placethehandspalmdownontheborderoftheribcage. D. Holdthebreathtwotothreesecondsafterinhalation. 23. Whatistheproperorderofthestepsinperformingcoughingexercises? i. Coughdeeplytwice ii. Beforecoughing,inhaledeeplyandholdthebreathforafewseconds iii. Taketwotothreedeepbreaths iv. Performlegexercises v. Splinttheincision vi. Repeatthreetofivetimesatleastevery2hours A. v>iv>iii>ii>i>vi B. v>iii>ii>i>vi C. v>ii>i>vi D. v>ii>i>iii>vi 24. Coughingcancauseadditionalpressureandpainontheincisionsite.Onewaytopreventthisis throughsplinting.Intheabsenceofabinder,whatistheleastadvisablewaytosplintaleft abdominalincision? A. Useonlytherightarmandhand B. Placethepalmsofbothhandsoneithersideoftheincisionsite C. Holdingthepalmofonehandovertheotherdirectlyovertheincisionsite D. Allareadvisable Situation6IthasbeenatraditiontoplacetheclientonNPOaftermidnightbeforethedayofthe surgery.However,theAmericanSocietyofAnesthesiologyhasreviseditsguidelinesforpreoperative fastingforhealthyclientsundergoingelectiveprocedures. 25. WhichofthefollowingisnotareasonfortheNPOorder? A. Thereisadangerforvomitingandaspirating B. Thesurgicalareamaybecontaminatedbyfeces C. Thebladdermaybeinjuredduringtheprocedure. D. Noneoftheabove 26. Therevisionsintheguidelineswerebasedonreevaluationandresearches.Whatistheleast probabletypeofresearchusedindeterminingthenecessaryrevisionsintheguidelines?

A. Descriptive B. Correlational C. Quasiexperimental D. Experimental 27. Whichofthefollowingisnotallowedinrevisedguidelinesforpreoperativefasting? A. Eatingalightbreakfast6hoursbeforetheprocedure B. Consumptionofclearliquidsupto2hoursbeforeelectivesurgeryrequiringgeneralanesthesia. C. Aheaviermeal8hoursbeforesurgery D. Noneoftheabove 28. Oneofyourresponsibilitiesduringthepreoperativephaseistoensurethatthenailsaretrimmed andfreefrompolish.Whatisthemainreasonforthis? A. Chipsinnailpolisharegoodbreedingsitesofmicroorganisms B. Longnailsarebreedingsitesofmicroorganisms C. Nailbedswillbevisibleforassessingcirculation D. Topreventinfection 29. Jewelriesshouldberemovedfromtheclientbeforethesurgery.However,evenafterexplainingwhy jewelriesshouldberemoved,theclientwishedtonothaveherweddingbandremoved.Whichof thefollowingshouldyoudo? A. Insistonremovingtheweddingband. B. Allowtheclienttokeeptheweddingbandinherhand. C. Consultthesurgeonregardingtemporarilycuttingtheringfingersothattheweddingbandwill bekeptattachedtothefingerandsurgicallyreattachingthefingertothehandafterthesurgery. D. Tapetheweddingbandinplace. 30. Inwhichofthefollowingsituationswillyounotallowaclienttokeepaweddingband? A. Mastectomyofbothbreasts B. Cholecystectomy C. Anysurgeryinthearms D. AllexceptB Situation7Adaybeforehersurgery,Mariaavoidedinitiatingconversationswithanybodyand answeredwithonlyafewwordswhenaskedquestions.Thisseemedveryunlikeher.Whilemakingyour rounds,yougreetedandaskedherhowsheis.Sheanswered,Mababawasannaangpagkababaeko.Di akotakotsasakitokayasamangyayarisaakin.Ayawkolangmawalaangpagkababaeko. 31. Whatisyournursingdiagnosis? A. AnticipatoryGrieving B. Knowledgedeficit C. Fear D. IneffectiveCoping 32. Whatisthebestresponsetoherstatement? A. Anoka?Virgin? B. HindinamanmagmumutateangDNAmopoathindipomagbabagoangsexchromosomemo. XXparinnamanpoyanafterthesurgery. C. Ah,okpo.Angsusomopoangbasehanmopongpagkababaemo. D. Anopoangibigmongsabihinsasinabimopongmawawalanapoangpagkababaemo? Situation8Inthesurgicalwardwhereyouwereassigned,allpatientsarerequiredtowearantiemboli stockings.

 33. Whatis/arethereasonsforusingantiembolistockings? A. Tocompresstheveinsandtherebyfacilitatevenousreturn B. Toimprovearterialcirculation C. Topreventorreduceedema D. Alloftheabove 34. Whatisthebesttimetoapplyantiembolismstockings? A. Inthemorning,beforetheclientarises. B. Lateevening,beforetheclientsleeps C. Middleoftheday,rightaftertheclientperformsaverystrenuousactivity. D. Anytime 35. Whenapplyingtheantiembolismstockingsonaclient,whatisthebestpositionofthefoot? A. Paralleltotheground B. Toesarepointedawayfromthehead(plantarflexion) C. Toesarepointedtowardsthehead(dorsiflexion) D. Withthefootexternallyrotated Situation9Afterworkinginthefemalesurgerywardforthreeweeks,youwerereassignedtothe operatingroomsofthehospital. 36. Beforetransferringtheclienttotheoperatingroom,youneedtoensurethatallprosthesesare removed.Removingprosthesesfromtheoralcavity,likedentures,addresseswhatnursing diagnosis? A. IneffectiveAirwayClearance B. IneffectiveBreathingPattern C. RiskforAspiration D. Alloftheabove. 37. Whentransferringtheclienttotheoperatingroom,afteradministeringthepreanesthetic medications,howshouldthesiderailsbekept? A. Thesiderailsshouldalwaysbekeptup. B. Thesiderailsshouldalwaysbekeptupononesideanddownontheotherwherethe accompanyinghealthworkerispositioned. C. Thesiderailsshouldalwayskeptdown. D. Thesiderailsshouldbekeptupunlessaprocedurewillbedonethatwillneedeasieraccessto theclient.Insuchcases,thesiderailsonthesidewheretheprocedurewillbedoneshouldbe putdownduringtheprocedureandbroughtupassoonastheprocedureisdone. 38. Whichofthefollowingstatementsistrueabouttheintraoperativephase? A. Itbeginswhentheincisionismadeandendswhenthesuturingisfinished. B. Itbeginswiththetransferoftheclienttotheoperatingroomtableandendswhenheorsheis transferredtothepostanesthesiacareunit. C. Itbeginswiththetransferoftheclienttotheoperatingroomtableandendswhenthe anesthesiawearsoff D. Itbeginswiththeinductionofanesthesiaandendswhentheanesthesiawearsoff. Situation10Duetotheimpairmentinaclientsskinintegrity,whichpredisposestheclienttodevelop infections,duringthesurgery,amajorfocusduringtheintraoperativephaseismaintainingsurgical asepsis.Priortoyourfirstdayintheoperatingroom,youreviewedthechainofinfectionbecauseitis thebasisoftheprinciplesofinfectioncontrolandofasepsis.

 39. Sometimes,itisnecessarytoremovehairfromthesurgicalsite.Whichofthefollowingistheleast preferredmethodofremovinghair? A. Usingelectricclippers B. Usingsurgicalblades C. Usingdepilatorycreams D. Noneoftheabove 40. Whatisthebestwaytominimizethespreadofmicroorganismsand,eventually,infections? A. Handwashing B. Sterilizingallinstruments C. Bathingtheclientinantisepticsorgermicides D. Cleaningtheclientsenvironmentusingantisepticagents 41. Whenperformingsurgicalhandwashingorsterilehandwashing,howshouldthehandsbe positioned? A. Handslowerthantheelbows B. Handshigherthantheelbows C. Handsparalleltotheground D. Anyoftheabove 42. Afterwashingthehandsusingthesteriletechnique,howshouldyoudryyourhandsusingatowel? A. Inarotatingmotionfromthefingerstotheelbow. B. Usinglongstrokesfromthefingertotheelbow C. Inarotatingmotionfromtheelbowtothefingers D. Usinglongstrokesfromtheelbowtothefingers Situation11Evenhealthymembersofthesurgicalteamareconsideredreservoirsofmicroorganisms. Microorganismsmaycomefromthesurgicalteammembersoralandrespiratorytractsandskin.One waytoensurethatthesedonotgettransmittedtotheclientsistowearORattireproperly. 43. Howshouldshirtsandwaistdrawstringsplacedorworn? A. Tucktheshirt,andcutthewaistdrawstringsshortenoughsothatitwillnotbelongerthanyour actualwaistcircumference B. Tuckboththeshirtandthedrawstring C. Untucktheshirtandjustletthedrawstringhangloosefromthepantssothatyouwonthaveto touchthesepossiblebreedingsitesofmicroorganisms. D. Leavetheshirtuntuckedsothatyouwonthavetotouchthispossiblebreedingsitesof microorganisms,andcutthedrawstringsshortenoughsothatitwillnotbelongerthanyour actualwaistcircumference. 44. Topreventtransmittingmicroorganismsfromtherespiratoryandoraltract,masksarewornby membersofthesurgicalteam.Whengoingoutoftheoperatingroom,whatshouldyoudowiththe mask? A. Changeiteverytimeyougoinandoutoftheoperatingroom B. Letthemasktohangaroundtheneckanddonottouchitsothatyourhandswillnotbe contaminated. C. Removethemaskandfoldinsuchawaythatthesurfacethatisincontactwithyourownskinis exposedtotheenvironmentandtheothersurfaceisnotexposed. D. Noneoftheabove. 45. Whendonningglovesusingtheclosedmethod,inwhichhandareyougoingtoputthegloveson first?

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A. Thelefthand B. Therighthand C. Thedominanthand D. Thenondominanthand Whenascrubnurseputsonagown,whichofthefollowingwaysoftyingthewaisttiewillnot maintainasepsis? A. Haveacoworkerholdthetieusingglovesorsterileforceps.Makeathreequarterturn,then takethetieandsecureitinfrontofthegown. B. Haveacoworkertakethetwotiesateachsideandtieitatthebackofthegown. C. Reachingforthebackandtyingitherself. D. Allwillnotmaintainasepsis. Whichpartsofthescrubnursesgownareconsideredsterile? A. Fromthefrontofthechestattheleveloftheshoulderstothewaist;andfromtwoinches abovetheelbowtothestockinettecuff B. Fromthefrontofthechestattheleveloftheshoulderstothelevelofthesterilefield;and fromtwoinchesabovetheelbowtothestockinettescuff C. Fromthefrontofthechestattheleveloftheshoulderstothewaist;andfromtwoinches belowtheelbowtothestockinettecuff D. Fromthefrontofthechestattheleveloftheshoulderstothelevelofthesterilefield;and fromtwoinchesbelowtheelbowtothestockinettecuff WhenenteringtheOR,howshouldthescrubnursemove? A. Thenursessidesfacingthewall B. Thenursefacingthesterilefield C. Thenursesbackfacingthewall D. AllexceptA Thesurgicalprocedurecanbeaverystressfulexperienceforallthemembersofthesurgicalteam. ThestressandtheheatfromthelayersoftheORattirecancausethemembersofthesurgicalteam tosweat.Whichofthefollowingactionswillbreaktheprinciplesofasepsis? A. Thesurgeonwipeshissweatyforeheadonthebackofanothersurgicalmembersgown. B. Thescrubnursewipesthesweatoffthesurgeonsforeheadwithasterilegauze C. BothAandB D. Noneoftheabove

Situation12Anothermajoraspectofnursingcareduringtheintraoperativephaseistheproper positioningoftheclienttopreventinjuries. 50. Whenispositioningdone? A. Beforeinducinganesthesiaandbeforesurgicaldraping B. Afterinducinganesthesiaandbeforesurgicaldraping C. Beforeinducinganesthesiaandbeforesurgicaldraping D. Afterinducinganesthesiaandbeforesurgicaldraping 51. Howshouldtheclientbeplacedintohisorherposition? A. Bypushing B. Bypulling C. Bylifting D. Alloftheabove 52. Whichofthefollowingisnotamajorconsiderationinchoosingtheclientsposition? A. Visualizationandaccesstothesurgicalsite

B. Accessforassessingandmaintaininganesthesiaandvitalfunctions C. Preventingharmorinjurytotheclient D. Visualizationoftheclientswholebody 53. Aclientwillundergoexplorelaparotomy.Inwhichpositionwillyouexpecthimtobeplaced? A. Dorsalrecumbent B. Prone C. Lithotomy D. Trendelenberg 54. Afemaleclientwillundergovaginoplasty.Inwhichpositionwillyouexpecthertobeplaced? A. Dorsalrecumbent B. Lithotomy C. Sidelying D. Trendelenberg Situation13Duringthesurgicalprocedure,thepatientwillneedsedation,anesthesia,ora combinationofthese.Sedationandanesthesiahasfourlevels:minimumsedation,moderatesedation, deepsedationandanesthesia. 55. Whichofthefollowingstatementsistrueaboutsedationandanesthesia? A. Inbothcases,theventilationandcardiovascularfunctionsareaffected. B. Inbothcases,thepatientisarousable. C. Thedifferencebetweenanesthesiaandsedationisthattheanesthetizedpersonisnot arousable. D. AllaretrueexceptC. 56. Anesthesiahasfourstages.Inthebeginninganesthesia,theclientwillexperienceringing,roaringor buzzingintheears,aswellasanexaggerationinthehearingofnoises.Inthissituation,whatwillbe yournursingdiagnosis? A. Anxiety B. DisturbedSensoryPerception C. Confusion D. Alloftheabove 57. Whichofthefollowingmeasuresisnotappropriateinaddressingtheidentifiedproblem? A. Avoidmakingunnecessarymotions B. Avoidmakingunnecessarynoises C. Leavingtheclientbyhimselfuntilthenextstageofanesthesia D. Noneoftheabove.Allareappropriate 58. Thesecondstageofanesthesiaisexcitement,whichischaracterizedbystruggling,shouting,crying, laughing,singing,cryingandpossiblyuncontrolledmovements.Becauseofthis,restraintsare sometimesnecessary.Whenrestraintsareusedonasurgicalclient,whichofthefollowingshould beobservedordone? A. Theuseofrestraintsshouldneverbeused. B. Whenrestraining,astrapshouldalwaysbeplacedacrossthepatientsthighs. C. Thehandshouldbealwaysbesecuredtoanarmboard. D. Restraintsshouldneverbeappliedovertheoperativesite. 59. Whatnursingdiagnosisareyouaddressinginthesituationinnumber58? A. Impairedsensoryperception B. RiskforInjury C. ImpairedMobility

D. Pain 60. Medullarydepressionisreachedwhentoomuchanesthesiahasbeenadministered.Asanurse, whatwillbeyourfirstactioninrelationtomedullarydepression? A. Assistinmonitoringtheclientsvitalsignsandthereflexesofthepupils. B. Discontinuetheanesthesia C. Initiaterespiratoryandcirculatorysupport. D. Assistinadministeringstimulants. 61. Intravenousanesthesiahasapleasantonsetasopposedtoinhalationanesthesia,wherethe buzzing,roaringanddizzinessoccursafteritsadministration.However,intravenousanesthesias advantageisthatithasapowerfulrespiratorydepressanteffect.Asanurse,whatisyourprimary intervention? A. Assesstheclientsrespiratoryandcardiovascularfunction. B. Ensurethatoxygencanbeadministeredimmediately. C. Maintainasepsis D. Ensurethatconsentformwassigned. 62. Nauseaandvomitingarepotentialintraoperativecomplicationsofspinalanesthesia.Ifgagging occurs,whichofthefollowingareyounotgoingtodo? A. Turntheclientsheadtotheside B. Lowertheheadoftheoperatingtable C. Provideabasin D. Noneoftheabove 63. Anotheraftereffectofspinalanesthesiaisheadache.Whichofthefollowingareyousupposedto do? A. Keeptheclientlyingflat B. Keeptheenvironmentquiet C. Keeptheclientwellhydrated D. Alloftheabove 64. Malignanthyperthermiaisanuncommoncomplicationduringtheintraoperativephasebutithasa mortalityrateof50%.Itoccursduetotheinabilityofthemusclescellstorelaxwhichleadstoan excessiveuseofATPs.Thisleadstohypermetabolism.Whatisthefirstinterventioninrelationto malignanthyperthermia? A. Identifyingrisksfactorsthatpredisposetheclienttomalignanthyperthermiapreoperatively B. Monitoringtheclientsvitalsignsduringthesurgery C. Ensuringtheavailabilityofmedicationsandequipment D. Alloftheabove Situation14Recently,anincidentinvolvingasurgicalteaminahospitalinCebubecameanational issue.Avideowasreleasedintheinternetshowingasurgicalteamcelebratingandlaughingoverthe removalofacanisterfromtheclientsbody. 65. Whatimportantroleofthenursewasnotfulfilledinthisincident? A. Researcher B. Coordinator C. Patientadvocate D. Primarycaregiver 66. Whichofthefollowingshouldnotbedoneduringthesurgery? A. Talkaboutthediagnosisbasedontheresultoftheexcisedtissuesample. B. Maintainsterilefield.

C. Positioningtheclientproperly D. Noneoftheabove Situation15After3weeksofbeingassignedtotheoperatingrooms,youwerethenassignedtothe postanesthesiacareunit(PACU). 67. Whichofthefollowingstatementsistrueaboutthepostoperativephase? A. ItbeginswiththeadmissionoftheclientinthePACUandendswiththedischargefromthe hospital. B. Itbeginswhentheanesthesiawearsoffandendswhentheclientisdischargedfromthe PACU. C. ItbeginswiththeadmissionoftheclientinthePACUandendswhenthehealingiscomplete. D. Itbeginswhentheanesthesiawearsoffandendswhenthehealingiscomplete. 68. Whichofthefollowingwillyounotexpectinapostanesthesiacareenvironment? A. Soft,pleasingcolors B. Brightcolors C. Indirectlighting D. Soundproofceilingandequipmentthatminimizenoise 69. ThePACUissometimesdividedintotwophases:PhaseIandPhaseII.Whichofthefollowing statementsarerelatedtophaseI? A. Intensivenursingcare B. Preparationfordischarge C. BothAandB D. NoneoftheAbove 70. WhichofthefollowingstatementsarerelatedtophaseIIPACU? A. Intensivenursingcare B. Preparationfordischarge C. BothAandB D. NoneoftheAbove 71. DuringphaseIPACU,howoftenshouldyoumonitorthevitalsignsoftheclients? A. Every15minutesforthefirsthour B. Every15minutesuntilvitalsignsarestablefor30minutes C. Every15minutesuntilvitalsignsareconsistentwithpreoperativevitalsignsforatleast30 minutes D. AllexceptA 72. OneofthemainprioritiesduringphaseIPACUisthemaintenanceofapatentairway.Whichofthe followingisthebestwaytoassesstheclientsbreathingpattern? A. Observetherisingandfallingoftheclientschestandabdomen. B. Placeyouhandsovertheclientsabdomenandchesttopalpatethemovements C. Placethepalmofyourhandneartheclientsnoseandmouth D. Covertheclientsnoseandmouthusingyourpalmtofeeltheclientsexhalation. 73. Duetoanesthesia,musclesarerelaxedincludingthelowerjawandthetongue.Thissituationis calledhypopharyngealobstruction.Signsincludechoking,noisyrespirations,decreasedoxygen saturationlevelandcyanosis.Whatisyournursingdiagnosisinthissituation? A. Impairedbreathingpattern B. Ineffectiveairwayclearance C. Impairedgasexchange D. Alloftheabove

74. Theanesthetistmayleaveahardrubberoraplasticairwayinthepatientsmouth.Whenshouldit beremoved? A. Untilthegagreflexhasreturned B. OnehourpostadmissiontothePACU C. UponadmissiontothePACU D. AfterdischargefromthePACU 75. WhichamongthefollowingdescribesthebestpositionforapatientwhileintheimmediatePACUor PhaseI? A. Headofthebedslightlyelevated;Sidelyingposition;theheadturnedforwardandsupported byapillow;withapillowsupportingtheupperarm B. Lyingflatwithapillowundertheheadandanothertosupporttheupperarm C. Sidelying;theheadturnedbackwardunsupportedbyapillow;theupperarmsupportedbya pillow D. Headofthebedslightlyelevated;Sidelyingposition;theheadturnedforwardunsupportedbya pillow;withapillowsupportingtheupperarm Situation16Asidefrommaintainingapatentairway,anotherpriorityisthemaintenanceof cardiovascularstability.AsaPACUnurse,youareawarethattheprimarycardiovascularcomplications seeninthePACUincludehypotension,andshock,hemorrhage,hypertension,anddysrhythmias. Whilemonitoringoneofyourclientswhosevitalsignswerestablewhenyoulastassessedhim,you noticedthattheclientisbecomingapprehensive,restless,andthirsty;theskinismoist,pale,andcold. Thepulserateincreased,thetemperaturedecreasedandrespirationsbecamedeepandrapid.You assessedtheincisionsiteandsawthattheclientsgownwassoakedwithblood.Youreportedthe situationtothesurgeon. 76. Whichofthefollowingisnotanappropriateintervention? A. Placetheclientinshockposition B. Checkforordersregardingbloodtransfusionandavailabilityofbloodreplacement C. Assessthecauseofthehemorrhage D. InfuseIVfluidsrapidly 77. Youplacedtheclientonshockposition.Whatisthepositionoftheclientwhenplacedinshock position? A. Flatonback;legselevatedata20degreeangle;kneeskeptstraight B. Headislowered;legsareelevated;kneesarebent C. Headislowered;legselevatedata20degreeangle;kneeskeptstraight D. Flatonback;legselevatedata20degreeangle;kneesarebent Situation17Aftercompletingtherotationinallthewards,youwereaskedtochoosewhereyouwant tobepermanentlyassigned.Youchosetobeassignedtothesurgicalward. 78. Whatisthebestpositionforaclientwhohashadspinalanesthesia? A. Headofthebedslightlyelevated;Sidelyingposition;theheadturnedforwardunsupported byapillow;withapillowsupportingtheupperarmuntilabletomove B. Flatonthebackfor8to12hours C. Headisnotelevated,Sidelying;theheadturnedbackwardunsupportedbyapillow;theupper armsupportedbyapillow D. Noneoftheabove

 Situation18Becauseofanesthesia,thetoneoftheurinarybladderbecomestemporarilydepressed. 79. Whichofthefollowingisnotanormalassessmentfindinginapostoperativeclientinrelationto voiding? A. Theclientvoidswithin6to8hoursaftersurgery B. Urinaryoutputoflessthan30ml/hr C. Urinaryoutputof40mlperhour D. Alloftheabove 80. Whatisyourprimarynursingresponsibilityinrelationtotheclientsfluidoutput? A. Monitortheclientsfluidintakeandoutput B. Ensureadequatefluidintake C. Percussthebladder D. Ordertheinsertionofaurinarycatheter 81. Allpostoperativepatientswillexperiencepainduetotheincision.Whenwillyouexpecttheclientto experiencethegreatestpainaftersurgery? A. Immediatelyaftersuturingtheincision B. 12to36hoursaftersurgery C. 36hoursto3daysafterthesurgery D. 3daysaftersurgery 82. Whenisthebesttimetoadministerpainmedications? A. Onaroutinebasis(q2htoq6h)forthefirst24to36hours B. Onaroutinebasis(frequencydependingonthedrug,route,dosage,etc.) C. Beforescheduledactivitiesandrestperiods D. AllexceptA 83. Apatienthasbeencomplainingtoyouaboutpaineverytimeyouvisithim.Whichofthefollowing willnothelpinreducingtheclientspainexperiencewithoutusingpainmedications? A. Discussingwithhimwhyheisexperiencingpainandtellinghimthateverythingwillbealright B. Askinghimwhatispainfulandwhathehasdoneaboutthepain C. Tellinghimtopracticedeepbreathing D. Givinghimatapeofguidedimagerytolistento 84. Howoftenshouldtheclientperformthepostoperativeexercises? A. Everyhouroratleastevery2hours. B. Whenevertheclientfeelslikedoingit C. Every10minutes D. Noneoftheabove 85. Oneofthepostoperativeskillsthatyouneedtoteachtheclientishowtogetoutofthebed.One oftheclientsassignedtoyouhadanincisionontherightsideofhisabdomen,onwhichsideofthe bedwillyoutellhim/hertoturntoandgetoutof? A. Leftsideofthebed B. Rightsideofthebed C. Footofthebed D. Itdoesntmatter Situation19Anesthesiaandimmobilitycanalsodisruptnormalgastrointestinalfunction.Theclients dietwilldependonmanyfactors.

86. Animportantfactorusedindeterminingthetypeoftheclientsdietisthereturnofthegagreflex andofperistalsis.Whatisthebestwayforassessingperistalsis? A. Assessthereturnofthegagreflex B. Auscultateforthebowelsounds C. Percusstheabdomen D. Observetheabdomen 87. Whenoralintakeisadmitted,whatshouldyouofferfirst? A. Icechips B. Aglassofjuice C. Sipsofwater D. Afullmeal Situation20Thepostoperativeclienthasanincreasedriskofinfectionduetothedisruptioninskin andtissueintegrity.Topreventthedevelopmentofinfection,thesurgicalwoundshouldbeproperly caredfor. 88. Aclientforgottosplinttheincisionsitewhenperformingcoughingandturningexercises. Dehiscenceoccurred4to5daysafterthesurgery.Whatisthemostappropriateaction? A. Exposethewoundtoairsothatitcandrynaturally.Informthesurgeon. B. Coverthedehiscencewithdrysteriledressings.Asktheclienttobendknees.Informthe surgeon. C. Placelargesteriledressingssoakedinsterilenormalsalinesolutiononthewound.Askthe clienttobendtheknees.Informthesurgeon. D. Placelargesteriledressingssoakedinsterilewateronthewound.Asktheclienttoextendthe knees.Informthesurgeon. 89. Whichofthefollowingshouldyouexpectinaclientwithahealingwound? A. Somebleedingandtheappearanceofaclotbindingthewoundedges B. Whitepurulentfluidinwoundedges1to3daysafterthesurgery C. Rednessatthewoundedges D. Elevatedtemperature 90. Whenremovingthewounddressing,howshouldyouremovetheadhesivetape? A. Liftingthedressingandcuttingtheadhesiveusingscissors B. Holdingdowntheskinandpullingthetapegentlyawayfromthewound C. Holdingdowntheskinandpullingthetapeabruptlytowardfromthewound D. Holdingdowntheskinandpullingthetapegentlytowardthewound 91. Whencleaningtheincision,howshouldyouholdtheforceps? A. Thetipsatthelevelofthehandle B. Thetipslowerthanthewrist C. Thetipslowerthanthehandle D. Thetipshigherthehandle 92. Howshouldyoucleanthewound? A. Fromthesuturetothesurroundingareas,using5swabs:1forthemiddle,andtwoforeach side. B. Fromthesuturetothesurroundingareas,discardingtheswabaftereachstroke. C. Fromthesurroundingareastothesuture,discardingtheswabaftereachstroke. D. Fromthesuturetothesurroundingareas,usingdifferentsidesofonlyoneswabforthewhole procedure. 93. IfaJacksonPrattdrainispresent,whatistheproperorderofactivities?

i. Emptythedrainagesystemandmeasureamountofdrainage ii. Cleanthedrainagesystem iii. Cleanthewound iv. Removethedressings v. Flattenthesuction vi. Dressthewoundandthedrainage a. iv>v>i>iii>ii>vi b. iv>i>v>iii>ii>vi c. iv>v>i>ii>iii>vi d. iv>i>v>ii>iii>vi 94. WhatisthepreferredmethodofcreatingthesuctionoftheJacksonPrattdevice? A. Holdthedeviceusingbothhands.Pressthedevicefirmlyusingbothhands. B. Placethecontaineronasolid,flatsurfacewiththeportclosed.Pressthedeviceusingboth hands. C. Placethecontaineronasolid,flatsurfacewiththeportopen.Pressthedeviceusingboth hands. D. Placethecontaineronasolid,flatsurfacewiththeportopen.Pressthedeviceusingthepalm ofonehand.Theotherhandwillbeusedtocleansetheopening. 95. Aftercleaningthewound,whatareyousupposedtodo? A. Drythewoundandthesurroundingskinwithdryswabs B. Drythewoundwithdryswabsbutnotthesurroundingskin C. Donotdrythewoundbutdrythesurroundingskinwithdryswabs D. Donotdryboththewoundandthesurroundingskin 96. Whendressingadrainusing4inx4inuncutgauze,whatshouldyoudo? A. Cutthegauzeinthemiddleandplaceitsnuglyaroundthedrain. B. Openagauzepadandfolditlengthwisetoforma2inx8ingauze.Wrapitaroundthedrainso thattheendsoverlap. C. Open2gauzepadsandfoldeachlengthwiseinto2inx8instrips.Placeeachsidebyside, insertingthedrainbetween. D. Anyoftheabove. 97. Whereshouldyouplacethebulkofthedressings? A. Overtheincision B. Onthesidesoftheincision C. Overthedrainareaandbelowthedrainarea,dependingontheclientsusualposition D. Alloftheabove 98. Howshouldyoutapethedressing? A. Aroundtheedgesofthegauzepad B. Acrossthegauzepadparalleltotheincision C. Acrossthegauzepadperpendiculartotheincision D. Diagonallyacrossthedressing 99. Whendressingoveranincisiononajointarea,howshouldyouplacethetapes? A. Vertical B. Oppositethedirectionofthebodyaction C. Aroundtheedgesofthegauzepad D. Diagonally 100. Whichofthefollowingwillyouexpecttoseewhenassessingtheclientswound8daysafterthe surgery? A. Aclotbindingthewoundedges

B. Rednessandswellingatthewoundedges. C. Thewoundisbridgedandclosed D. Feverandpresenceofdrainage