PERI-OPERATIVE MEDSURG REVIEWER

1. 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?
A. Urine output of 20ml/hour
B. Temperature of 37.6 C
C. Blood pressure of 114/70
D. Serous drainage on the surgical dressing

*Urine output should be maintained at a minimum of 30mL/hour for an adult. An output of less than
that for each of 2 consecutive hours should be reported to the health care provider.

2. 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?
A. Pneumonia
B. Hypoxemia
C. Fluid imbalance
D. Pulmonary embolism

*Postoperative respiratory problems are atelectasis, pneumonia and pulmonary emboli. Pneumonia
is the inflammation of lung tissue that causes productive cough, dyspnea, and lung crackles and
can be caused by the retention of pulmonary secretions.

3. 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?
A. Avoid oral hygiene and rinsing with mouthwash
B. Verify that the client has not eaten for the last 24 hours
C. Have the client void immediately before going into surgery
D. Report immediately any slight increase in BP or pulse

*The nurse would assist the client to void immediately before surgery so that the bladder will be
empty. Oral hygiene is allowed, but the client should not swallow any water. The client usually has a
restriction of food and fluids for 6 to 8 hours before surgery instead of 24 hours. A slight increase in
BP and pulse is common during the preoperative period due to anxiety.

4. 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?
A. Obtain a court order for the surgery.
B. Have the charge nurse sign the informed consent immediately
C. Send the client to surgery without the consent form being signed
D. Obtain a telephone consent from a family member, following agency policy

*A telephone consent must be witnessed by two persons who hear the family member's oral
consent. The two witnesses then sign the consent with the name of the family member, noting that
an oral consent was obtained.

5. A preoperative client expresses an”Iety’to the nurse about upcoming surgery. Which response by the
nurse is most likely to stimulate further discussion between the client and the nurse?
A. “If it’s any help, everyone is nervous before surgery.”
B. “I will be happy to explain the entire surgical procedure with you.”
C. “Can you share with me what you’ve been told about your surgery?”
D. “Let me tell you about the care you’ll receive after surgery and the amount of pain you can
anticipate”.

*Explanations should begin with the information that the client knows. By providing the client with
individualized explanations of care and procedures, the nurse can assist the client in handling
anxiety and fear for a smooth preoperative experience.
6. 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?
A. Inhale as rapidly as possible
B. Keep a loose seal between the lips and the mouthpiece
C. After maximum inspiration, hold the breath for 15 seconds and exhale.
D. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees

* For optimal lung expansion with the incentive spirometer, the client should assume the semi-
Fowlers or high fowlers position. The mouthpiece should be covered completely and tightly while the
client inhales slowly, with a constant flow through the unit. The breath should be held for 5 seconds
before exhaling slowly.

7. 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. The nurse determines that the client needs
additional teaching if the client makes which statement?
A. “Aspirin can cause bleeding after surgery.”
B. “Aspirin can cause my ability to clot blood to be abnormal.”
C. “I need to continue to take the aspirin until the day of surgery.”
D. “I need to check with my HCP about the need to stop the aspirin before the scheduled surgery.”

*Anticoagulants altered normal clotting factors and increase the risk of bleeding after surgery.
Aspirin has properties that can alter the clotting mechanism and should be discontinued at least 48
hours before surgery.

8. The nurse assess a client’s surgical incision for signs of infection. Which finding by the nurse would be
interpreted as a normal finding at the surgical site?
A. Red, hard skin
B. Serous drainage
C. Purulent drainage
D. Warm tender skin

*Serous drainage is an expected finding at a surgical site. The other options indicate signs of wound
infection. Wound infection usually appears 3 to 6 days after surgery.

9. 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
A. Contact the surgeon
B. Instruct the client to remain quiet
C. Prepare the client for wound closure
D. Document the findings and actions taken
E. Place a sterile saline dressing and icepacks over the wound
F. Place the client in a prone position without a pillow under the head.

*1, 2, 3 ,4
Wound dehiscence is the separation of the wound edges. Wound evisceration is protrusion of the
internal organs through an incision. If wound dehiscence or evisceration occurs, the nurse should
call for help, stay with the client, and ask another nurse to contact the surgeon and obtain needed
supplies to care for the client. The nurse places the client in a low fowlers position and the client is
kept quite and instructed not to cough. Protruding organs are covered with a sterile saline dressing.
Ice is not applied because of its vasoconstrictive effect. The treatment for evisceration is usually
immediate wound closure under local or general anesthesia. The nurse also documents the findings
and actions taken.

10. A client who has undergone preadmission testing, has had blood drawn for serum lab studies, including
a complete blood count, coagulation studies and electrolytes and creatine levels. Which lab result should
be reported to the surgeon’s office by the nurse, knowing that it could cause surgery to be postponed?
A. Sodium, 141mEq/L
B. Hemoglobin, 8.0 g/dL
C. Platelets, 210,000/mm3
 D. Serum creatine, 0.8 mg/dL

*The complete blood count includes the hemoglobin analysis. All these values are within normal
range except for hemoglobin. If a client has a low hemoglobin level, the surgery likely could be
postponed by the surgeon
Sodium – 135-145 mEq/L Hemoglobin – 12 – 17 G/dL Platelets – 150,000-400,000
Serum Creatinine - 0.7 to 1.3 mg/dL

11. 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?
A. Assess the patency of the airway
B. Check tubes or drains for patency
C. Check the dressing to assess for bleeding
D. Assess the vital signs to compare with preoperative measurements

*The first action of the nurse is to assess the patency of the airway snd respiratory function. If the
airway is not patent, the nurse must take immediate measures for the survival of the client.

12. The nurse is reviewing a prescription sheet for preoperative client that states that he client must be
NPO after midnight. The nurse would telephone the physician to clarify that which medication should be
given to the client and not withheld?
A. Prednisone
B. Ferrous sulfate
C. Cyclobenzaprine (Flexeril)
D. Conjugated estrogen (Premarin)

*Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which
reduces the ability of the body to withstand stress. When stress is severe corticosteroids are
essential to life. Before and during surgery, dosages may be increased temporarily. These last few
medications may be withheld before surgery without undue effects on the client.

13. The nurse is preparing a client for surgery. What is the most effective method for obtaining an accurate
blood pressure reading from the client?
A. Obtain a cuff that covers the upper one-third of the client’s arm.
B. Position the cuff approximately 4 inches above the antecubital arm.
C. Use a cuff that is wide enough to cover two-thirds of the client’s upper arm.
D. Identify the Korotkoff sounds, and take a systolic reading at 10 mmHg after the first sound.

14. Which of the following items on a client’s pre-surgery laboratory results would indicate a need to contact
the surgeon?

A. Platelet count of 250,000/cu.mm.

B. Total cholesterol of 325 mg/dl.
C. Blood urea nitrogen (BUN)) 17 mg/dl.
D. Hemoglobin 9.5 mg/dl.

15. To prevent complications of immobility, which activities would help the nurse plan for the first
postoperative day after a colon resection?
A. Turn, cough, and deep breathe every 30 minutes around the clock.
B. Get the client out of bed and ambulate to a bedside chair.
C. Provide a passive range of motion three times a day.
D. It is not necessary to worry about complications of immobility on the first postoperative day.

16. In the recovery room, the postoperative client suddenly becomes cyanotic. What is the most
appropriate nursing action?
A. Start administration of oxygen through a nasal cannula.
B. Call for assistance.
C. Reposition the head and determine patency of the airway.
D. Insert an oral airway and suction the nasopharynx.
17. A client is scheduled for surgery in the morning. Preoperative orders have been written. What is most
important to do before surgery?
A. Have all consent forms signed.
B. Remove all jewelry or tape wedding ring.
C. Verify that all laboratory work is complete.
D. Inform family or next of kin.

18. The nurse is caring for a first-day postoperative surgical client. Prioritize the patient’s desired dietary
progression. Arrange in sequence the dietary progression from 1 to 4: 1. Full liquid; 2. NPO; 3. Clear
liquid; 4. Soft
A. 1, 2, 3, 4
B. 2, 3, 1, 4
C. 2, 1, 4, 3
D. 4, 3, 2, 1

19. A postoperative client receives a dinner tray with gelatin, pudding, and vanilla ice cream. Based on the
foods on the client’s tray, what would the nurse anticipate the client’s current diet order to be:
A. Bland diet
B. Soft diet
C. Full liquid diet
D. Regular diet

* A full liquid diet typically includes foods that are liquid at room temperature or turn into a liquid at
body temperature. Gelatin, pudding, and liquid ice cream are consistent with the items allowed on a
full liquid diet.

20. The nurse is preparing the preoperative client for surgery. The following statements indicate the client is
knowledgeable about his impending surgery, except:
A. “After surgery, I will need to wear the pneumatic compression device while sitting in the chair.”
B. “The skin prep area is going to be longer and wider than the anticipated incision.”
C. “I cannot have anything to drink or eat after midnight on the night before the surgery.”
D. “To ensure my safety, a ‘time out’ will be conducted in the operating room.”

21. Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery?
A. To prevent malnutrition.
B. To prevent electrolyte imbalance.
C. To prevent aspiration pneumonia.
D. To prevent intestinal obstruction.

22. The nurse will provide preoperative teaching on deep breathing, coughing, and turning exercises. When
is the best time to provide the preoperative teachings?
A. Before administration of preoperative medications.
B. The afternoon or evening prior to surgery.
C. Several days prior to surgery.
D. Upon admission of the client in the recovery room.

23. Which of the following factors ensure the validity of informed written consent, except:
A. The patient is of legal age with a proper mental disposition.
B. If the patient is a child, secure consent from the parents or legal guardian.
C. The consent is secured before administration of preoperative medications.
D. If the patient is unable to write, the nurse signs the consent for the patient.

24. Which of the following drugs is administered to minimize respiratory secretions preoperatively?
A. Valium (diazepam)
B. Phenergan (promethazine)
C. Atropine sulfate
D. Demerol (Meperidine)
25. Which of the following is experienced by the patient who is under general anesthesia?
A. The patient is unconscious.
B. The patient is awake.
C. The patient experiences slight pain.
D. The patient experiences loss of sensation in the lower half of the body.

26. Which of the following is the most dangerous complication during induction of spinal anesthesia?
A. Cardiac arrest
B. Hypotension
C. Hyperthermia
D. Respiratory paralysis

* Hypotension is a potentially dangerous complication during induction of spinal anesthesia. It can

lead to inadequate perfusion and oxygenation of vital organs, requiring prompt intervention to
stabilize the patient.

27. Which of the following postoperative patients is at risk for respiratory complications?
A. The obese patient with a long history of smoking who had undergone upper abdominal surgery.
B. The patient with a normal pulmonary function who had undergone upper abdominal surgery.
C. An adolescent patient with diabetes mellitus who had undergone cholecystectomy.
D. A football player who had undergone knee replacement surgery.

28. The patient had undergone spinal anesthesia for appendectomy. To prevent spinal headaches, the
nurse should place the patient in which of the following positions?
A. Semi-Fowler’s
B. Flat on the bed for 6 to 8 hours.
C. Prone position.
D. Modified Trendelenburg position.

29. The nurse is admitting a patient to the operating room. Which of the following nursing actions should be
given the highest priority by the nurse?
A. Assessing the patient’s level of consciousness.
B. Checking the patient’s vital signs.
C. Checking the patient’s identification and correct operative permit.
D. Positioning and performing skin preparation to the patient.

30. Which of the following assessment data is most important to determine when caring for a patient who
has received spinal anesthesia?
A. The time of the return of motion and sensation in the patient’s legs and toes.
B. The character of the patient’s respiration.
C. The patient’s level of consciousness.
D. The amount of wound drainage.

31. The nurse is transferring the patient from the postanesthesia care unit to the surgical unit. Which of the
following is the primary reason for the gradual change of position of the patient?
A. To prevent muscle injury.
B. To prevent sudden drop of blood pressure.
C. To prevent respiratory distress.
D. To promote comfort.

32. The nurse is caring for a patient who has undergone exploratory laparotomy. Which of the following
postop findings should the nurse report to the physician?
A. The patient pushes out the oral airway with his tongue.
B. The patient’s urine output has been 20 ml/hr for the past 2 hours.
C. The patient’s vital signs are as follows: BP = 100/70 mmHg; PR = 95 bpm; RR = 9 minute; T =
36.8°C.
D. The patient’s wound drainage.
33. The patient had undergone a thyroidectomy. Which of the following are the earliest signs of poor tissue
perfusion and poor respiratory function?
A. Cyanosis, lethargy.
B. Fast, thready pulse, bradypnea.
C. Apprehension and restlessness.
D. Faintness, pallor.

34. The diabetic patient who had undergone abdominal surgery experienced wound evisceration. Which of
the following is the most appropriate immediate nursing action?
A. Cover the wound with sterile gauze moistened with sterile normal saline.
B. Cover the wound with sterile dry gauze.
C. Cover the wound with a water-soaked gauze.
D. Leave the wound uncovered and pull the skin edges together.

35. The patient had undergone a total hip replacement. He complains of pain in the operative site. Which of
the following is the appropriate initial nursing action?
A. Administer the ordered analgesic.
B. Instruct the patient to do deep breathing and coughing exercises.
C. Assess the patient’s pain level and vital signs.
D. Change the patient’s position.

36. Which of the following individuals is not typically considered a member of the sterile team in an
operating room?
A. Surgeon
B. Scrub nurse
C. Radiology technician
D. Circulating nurse

37. The best position for kidney, chest, or hip surgery is:
A. Supine
B. Trendelenburg
C. Lithotomy
D. Lateral

38. A patient is to have a left inguinal hernia repair at the outpatient surgical clinic. Preoperatively, it is most
important for the nurse to determine whether the
A. Patient has had any experience with outpatient surgery in the past.
B. Patient’s medical plan covers outpatient surgery.
C. Patient plans to stay overnight at the surgical center.
D. Patient has someone available for transportation and care at home.

39. The nurse is assessing a 36-year-old woman who has been admitted for knee surgery. Which
information obtained during the preoperative assessment should be reported to the surgeon before
surgery?
A. The patient’s lack of knowledge about postoperative pain control measures
B. The patient’s statement that her last menstrual period was 8 weeks previously
C. The patient’s history of a postoperative infection following a prior cholecystectomy
D. The patient’s concern that she will be unable to care for her children postoperatively

40. During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the
nurse about using St. John’s wort to prevent depression. The nurse should alert the staff in the
postanesthesia recovery area that the patient may
A. Have more postoperative bleeding than expected.
B. Take longer to recover from the anesthesia
C. Have hypertensive episodes
D. Experience increased pain
41. The nurse asks a hospitalized patient to sign the operative permit as directed in the health care
provider’s preoperative orders. The patient tells the nurse, “I do not really understand what is involved in
the surgery.” The nurse should
A. Postpone the consent form signing and notify the holding room staff that the health care provider
needs to discuss the surgery with the patient.
B. Explain what the planned surgical procedure entails before having the patient sign the consent
form.
C. Have the patient sign the form and ask the health care provider to visit the patient before
surgery to further explain the procedure.
D. Have the patient sign the from and then Notify the health care provider that the informed
consent process is not complete.

42. During the preoperative interview with the nurse, a patient scheduled for an elective hysterectomy to
treat benign tumors of the uterus tells the nurse that she just does not know whether she can go through
with the surgery because she knows she will die in surgery as her mother did. The most appropriate
response by the nurse is
A. Tell me more about what happen to your mother.”
B. “You will receive medications to reduce your anxiety.”
C. “Surgical techniques have improved a lot in recent years.”
D. “Many people have fears and anxieties about surgery.”

43. The patient’s statement may indicate an unusually high anxiety level or a family history of problems
such as malignant hyperthermia, which will require precautions during surgery. The other statements are
accurate, but the nurse’s initial response should be further assessment.
Which information about medication use in a preoperative patient is most important to communicate to the
health care provider?
A. The patient takes garlic capsules daily but did not take any on the surgical day.
B. The patient took a sedative medication the previous night to assist in falling asleep.
C. The patient uses acetaminophen (Tylenol) as needed for occasional aches and pains.

D. The patient has a history of cocaine use but quit using the drug over 10 years ago.

44. Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a
sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not
impact on the surgical outcome.
Ten minutes after receiving the ordered preoperative opioid by intravenous (IV) injection, the patient
asks to get up to go to the bathroom to urinate. The most appropriate action by the nurse is to
A. Offer a urinal or bedpan and position the patient in bed to promote voiding.
B. Assist the patient to the bathroom and stay with the patient to prevent falls.
C. Ask the patient to wait because catheterization is performed at the beginning of the surgical
procedure.
D. Allow the patient up to the bathroom because the onset of the medication takes more than
10 minutes.

45. The patient will be at risk for a fall after receiving the opioid, so the best nursing action is to have the
patient use a bedpan or urinal. Having the patient get up up either with assistance or independently
increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the
bladder is full during transport to the operating room.A patient becomes restless and agitated in the in the
postanesthesia care unit (PACU) as he begins to regain consciousness. The first action the nurse should
take is:
A. Administer the ordered postoperative pain medication.
B. Turn the patient to a lateral position.
C. Check the patient’s oxygen saturation with a pulse oximeter,
D. Orient the patient and tell him that the surgery is over.

46. While in the PACU, the patient’s blood pressure drops from an admission pressure of 126/82 to 106/78
with a pulse change of 70 to 94. The nurse administers oxygen and then
A. Increases the rate of the IV fluids,
B. Performs neurovascular checks on the lower extremities.
 C. Uses a cardiac monitor to assess the patient’s heart rhythm.
D. Notifies the anesthesia care provider.

47. The nurse is preparing to discharge a patient from the ambulatory surgery center following an inguinal
hernia repair. The nurse delays the release of the patient upon discovering that the patient
A. Had IV morphine 45 minutes ago.
B. Has an oxygen saturation of 92%.
C. Has not voided since before surgery.
D. Had one episode of vomiting 30 minutes ago.

48. 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