PERIOP WORKBOOK 5. The nurse has conducted preoperative teaching for a client 9.

erative teaching for a client 9. Which nursing action would be best when a preoperative
scheduled for surgery in 1 week. The client has a history of client verbalizes fear of postoperative pain? *
1. The nurse is developing a plan of care for a client scheduled arthritis and has been taking aspirin. The nurse determines that a. Providing diversional activities when client reports fear of
for surgery. The nurse should include which activity in the the client needs additional teaching if the client makes which pain
nursing care plan for the client on the day of surgery? * statement? * b. Encouraging the client to verbalize concerns regarding the
a. Avoid oral hygiene and rinsing with mouthwash. a. “Aspirin can cause bleeding after surgery.” fear of pain
b. Verify that the client has not eaten for the last 24 hours. b. “Aspirin can cause my ability to clot blood to be abnormal.” c. Informing the client of experiences and the likelihood of
c. Have the client void immediately before going into surgery. c. “I need to continue to take the aspirin until the day of pain pre- and postoperatively
d. Report immediately any slight increase in blood pressure or surgery.” d. Explaining the medications ordered for pain control,
pulse. d. “I need to check with my health care provider about the need availability, and treatment goals
to stop the aspirin before the scheduled surgery.”
2. A client with a perforated gastric ulcer is scheduled for 10. A client who is scheduled for an emergency appendectomy
surgery. The client cannot sign the operative consent form 6. A client who has undergone preadmission testing has had tested positive in the pregnancy test. What should the nurse do
because of sedation from opioid analgesics that have been blood drawn for serum laboratory studies, including a complete first? *
administered. The nurse should take which most appropriate blood count, coagulation studies, and electrolytes and creatinine a. Inform the client of the results
action in the care of this client? * levels. Which laboratory result should be reported to the b. Call the laboratory to verify the test results
a. Obtain a court order for the surgery surgeon’s office by the nurse, knowing that it could cause c. Report the results immediately to the surgeon
b. Send the client to surgery without the consent form being surgery to be postponed? * d. Notify the client’s attending physician of the results
signed. a. Sodium, 141 mEq/L
c. Have the charge nurse sign the informed consent b. Hemoglobin, 8.0 g/dL 11. The potential effects of medication therapy must be
immediately. c. Platelets, 210,000/mm3 evaluated before surgery. Which among the following drug
d. Obtain a telephone consent from a family member, following d. Serum creatinine, 0.8 mg/dL classifications may cause electrolyte imbalance in a
agency policy. perioperative patient? *
7. The nurse is reviewing a health care provider’s (HCP’s) a. Corticosteroids
3. A preoperative client expresses anxiety to the nurse about prescription sheet for a preoperative client that states that the b. Insulin
upcoming surgery. Which response by the nurse is most likely client must be NPO after midnight. The nurse would telephone c. Phenothiazines
to stimulate further discussion between the client and the the HCP to clarify that which medication should be given to the d. Diuretics
nurse? * client and not withheld? *
a. “If it’s any help, everyone is nervous before surgery.” a. Prednisone 12. Which among the following choices is an example of an
b. “I will be happy to explain the entire surgical procedure to b. Ferrous sulfate urgent surgical procedure? 
you.” c. Cyclobenzaprine (Flexeril) a. Appendectomy
c. “Can you share with me what you’ve been told about your d. Conjugated estrogen (Premarin) b. Exploratory laparotomy
surgery?” c. Face-lift
d. “Let me tell you about the care you’ll receive after surgery 8. During a presurgical admission assessment, a client states, d. Repair of multiple stab wounds
and the amount of pain you can anticipate.” “I’ve told my surgeon that I am a Jehovah’s Witness and I
won’t accept a blood transfusion.” Which statement by the 13. An informed consent is required for which of the following
4. During her preoperative teaching with a client about the use nurse would be most appropriate? * procedures? *
of an incentive spirometer, which of the following information a. “Tell me about your fear of receiving a blood transfusion.” a. Irrigation of the external ear canal
should the nurse include? * b. “Your request to not receive a transfusion would be honored. b. Urethral catheterization
a. Inhale as rapidly as possible. Your consent is needed to administer blood or blood products.” c. Closed reduction of a fracture
b. The best results are achieved when sitting up or with the c. “You don’t need to worry about getting a blood transfusion. d. Insertion of an intravenous catheter
head of the bed elevated 45 to 90 degrees. We have newer equipment that causes less blood loss during
14. A patient who is scheduled for a cholecystectomy tells the
c. Keep a loose seal between the lips and the mouthpiece. surgery.”
nurse, “I cannot stop thinking about my surgery.” How should
d. After maximum inspiration, hold the breath for 15 seconds d. “Are you sure you wouldn’t want a blood transfusion if one
the nurse appropriately respond? *
and exhale. is needed during surgery? You can always change your mind
a. “Relax. Your recovery period will be shorter if you’re less
after surgery.”
nervous.”
b. “You don’t have to worry. Your doctor has done 5. A postoperative client who received a spinal anesthetic is a. Blood pressure 70/60 with small pulse pressure
cholecystectomy to several patients before.” experiencing a headache, photophobia, and double vision. A b. Increased urine specific gravity
c. “You seem nervous about your surgery.” nurse’s initial intervention should be to: * c. Heart rate of 119 bpm and a thread pulse
d. “Stop worrying. It only makes you more nervous.” a. Position the client flat in bed. d. Elevated central venous pressure reading
b. Limit the client’s fluid intake.
PERIOPERATIVE NURSING 3 c. Administer steroid medications.
d. Immediately notify the surgeon.
1. The nurse has just reassessed the condition of a postoperative
client who was admitted 1 hour ago to the surgical unit. The 6. A nurse assesses that a client on the second postoperative day
nurse plans to monitor which parameter most carefully during following abdominal surgery has diminished breath sounds in
the next hour? * both lung bases, is taking shallow breaths, is able to achieve
a. Urinary output of 20 mL/hour only 500 mL on an incentive spirometer, and has been smoking
b. Temperature of 37.6 ° C (99.6 ° F) one pack of cigarettes per day prior to surgery. The nurse’s best
c. Blood pressure of 100/70 mm Hg interpretation of these findings is that the client is
d. Serous drainage on the surgical dressing experiencing: *
a. Atelectasis.
2. A postoperative client asks the nurse why it is so important to
b. Pneumonia.
deep-breathe and cough after surgery. When formulating a
c. Chronic obstructive pulmonary disease (COPD).
response, the nurse incorporates the understanding that retained
d. A normal postoperative course.
pulmonary secretions in a postoperative client can lead to which
condition? * 7. A nurse monitoring the status of a postoperative client would
a. Pneumonia become most concerned with which sign of probable
b. Hypoxemia complication? (174) *
c. Fluid imbalance a. Blood pressure of 110/70mmHg
d. Pulmonary embolism b. Hypoactive bowel sounds in all four quadrants
c. Increasing restlessness
3. During orientation of a head nurse to a newly hired-nurse to
d. A pulse of 86bpm
the post-anesthesia care unity (PACU), which statements by the
new nurse would alert the head nurse that further instructions 8. A postoperative client reports that she is unable to void. The
are needed? * nurse should perform which of the following actions initially? *
a. “Once a client responds verbally after a spinal anesthetic, the a. Palpating the client’s bladder
client can be transferred to the nursing unit.” b. Inserting a urinary catheter
b. “If a client has an opioid overdose, I should expect to c. Reviewing the client’s chart for the time of the last voiding
administer naloxone hydrochloride (Narcan®).” d. Turning on running water
c. “I should monitor vital signs and perform a pain assessment
every 15 minutes or more often if necessary.” 9. The PACU nurse receives an unconscious client who has
d. “Lactated Ringer’s (LR) and 5% dextrose with LR are experienced prolonged anesthesia, with all her muscles relaxed.
among the typical IV solutions administered in the PACU.” The nurse knows that the most accurate way to determine
whether the patient is breathing is to: *
4. A nurse is reviewing a plan of care for a postoperative client a. Inspect for diaphragmatic movement.
with a history of sickle cell disease. Which nursing diagnosis, b. Place his or her palm over the patient’s nose and mouth
documented on the client’s care plan, should the nurse address c. Auscultate for breath sounds.
first? * d. Palpate for thoracic changes.
a. Anxiety
b. Impaired skin integrity 10. A postoperative patient develops hypovolemic shock from
c. Deficient fluid volume the blood loss from her surgery. The nurse caring for this client
d. Ineffective airway clearance expects the following findings, except: *