Perioperative Nursing

Question 1

Most commonly the stress response to surgery and pain leads to what VS changes?

Accepted Answer

Hypertension and tachycardia

Question 2

What settings can facilitate a PACU?

Accepted Answer

Outpatient PACU Freestanding Surgical Center, Outpatient PACU Provider's Office, Procedural Areas for Endoscopy, Inpatient PACU or ICU

Question 3

Increased intracranial pressure would be assessed through what?

Accepted Answer

Irregular pupillary reaction, Irregular puli size, Changes to LOC, decreases in GCS

Question 4

With blood loss you would see what happen most commonly to pt's VS?

Accepted Answer

Tachycardia and hypotension

Question 5

What is the treatment for the medical emergency of malignant hyperthermia?

Accepted Answer

Administer Dantrolene, Infuse cold NS through pt's IV, Place ice bags in the axilla and groin

Question 6

Pt had an open reduction and internal fixation of a long bone. Sudden ^WOB, RR 24, O2 89%, & CP 8/10. You suspect what

Accepted Answer

Pulmonary Embolism

Question 7

What can contribute to a post-op paralytic ileus?

Accepted Answer

Narcotics, Immobility, anesthesia slowing bowl motility, GI surgery

Question 8

PONV can cause what complications?

Accepted Answer

Increased LOS and decreased performance of ADLs, Wound dehiscence or aspiration, ED visit and readmission, Dehydration and electrolyte imbalances

Question 9

In the event of an opioid overdose what medication should the nurse have on hand and ready to administer?

Accepted Answer

Naloxone

Question 10

Begins from the time of decision for surgery and ends when pt is transferred to the surgery suite.

Accepted Answer

Preoperative Phase

Question 11

Pt shower with betadine or hexachlorophene soap prior to admission.

Accepted Answer

Skin Prep

Question 12

Assess for hyperglycemia, increased healing time, increased risk of hemorrhage and infection.

Accepted Answer

Corticosteroids

Question 13

Defines a patient's wishes if they are deemed incompetent to express their wishes during a medical emergency.

Accepted Answer

Advance Directive

Question 14

Phase III of post-op recovery includes which of these?

Accepted Answer

Extended observation in PACU for those awaiting to leave once criteria met, Goal is for the pt for transfer to in-pt when bed is ready or DC home, Most delayed discharges from this area, are caused by N/V or pain

Question 15

Who is responsible for obtaining the consent?

Accepted Answer

Surgeon

Question 16

in PACU your pt has weak pulses, cool pale skin, and increased cap refill. What do you suspect?

Accepted Answer

Hypovolemia due to blood loss in OR or hemorrhaging, causing decreased CO

Question 17

Most common postsurgical complications between 2012-2018 included which of these?

Accepted Answer

Embolic events DVT's, PE, and CVA, Atelectasis, Pneumonia, and UTI's, Surgical site infection and sepsis

Question 18

In addition to an ileus anesthesia, opioids, & immobility can lead to what?

Accepted Answer

Urinary Retention

Question 19

Cloudy tea or cola colored urine, and urine with foul odor are signs of a UTI.

Accepted Answer

True

Question 20

Your Pre-Op pt is a BKA wearing a crucifix. What are appropriate measures for the RN to do?

Accepted Answer

Place an 18 gauge IV., Remove the pt's prosthetic., Ask when the pt last had anything PO.

Question 21

These are surgical complications to educate your patient on.

Accepted Answer

DVT, Constipation, Pneumonia, Surgical Site Infection

Question 22

Continued decreased LOC, restlessness, agitation, confusion may indicate what?

Accepted Answer

Inadequate reversal of anesthesia and can result in hypoxia

Question 23

These can affect tolerance of anesthesia, depress cardiac function output and pulses.

Accepted Answer

Antiarrhythmics

Question 24

Contributing factors for surgical site infections include which of these?

Accepted Answer

Older age, malnourished patients, Longer hospital stays

Question 25

How frequently should VS be monitored in PACU?

Accepted Answer

Q 15 min

Question 26

An increase in temperature 72 hr post-operatively would make you suspect what complication?

Accepted Answer

pulmonary infection, surgical site infection

Question 27

What are the priority Assessments in the care of PACU pt?

Accepted Answer

Patency of IV, drains, and hydration status., LOC, motor function and sensation, and pain., Airway patency and respiratory status including lung sounds and O2 sat., VS, apical and periph pulses, cardiac monitoring and temp., EKG, X-rays, H & H, electrolytes, renal function and coags., Dressing, bleeding, drainage, and condition of visible incision.

Question 28

Decreased UO in postop pt is most likely a result of what?

Accepted Answer

Dehydration, Initiation of the RAAS due to stress and fluid loss, Release of antidiuretic hormone (ADH), Urinary retention

Question 29

Anesthesia and opioids can decrease RR drive and depth and increase apneic threshold, resulting in what?

Accepted Answer

Decreased LOC, Decreased pulse oximetry, hypercarbic respiratory failure

Question 30

What are the components of a surgical consent?

Accepted Answer

Reason for and alterntives to surgery., Consent for anesthesia and blood products., Consent for procedure and surgeon's name.

Question 31

Reversible unconscious state achieved by inhalation of volatile agents, IV meds, & muscle relaxants.

Accepted Answer

General Anesthesia

Question 32

Skeletal muscle rigidity, unexplained tachycardia, myoglobinuria, and fever.

Accepted Answer

MH

Question 33

What is included in Phase I of recovery in either PACU or the ICU?

Accepted Answer

Focus on cardiac, respiratory, and nero, surgical site, pain and temp., Goal is to stabilize VS, allow awakening, and achieve pain control., Intensive, close monitoring of VS with continuous cardiac monitoring.

Question 34

Increased UO in the initial postop period may be due to what?

Accepted Answer

Fluid Overload, Excessive fluid given in OR

Question 35

This can be subtle and temporary or last for weeks or months.

Accepted Answer

POCD

Question 36

Exacerbating causes of positioning in the OR which contribute to pressure injuries.

Accepted Answer

Long surgeries, Bony prominences, Vascular surgery

Question 37

Surgeon, Surgical Assistant, Scrub.

Accepted Answer

Sterile Team Members

Question 38

These can all contribute to excessive bleeding during and after surgery.

Accepted Answer

Anticoagulants, Antiplatelets, NSAIDs, Corticosteroids

Question 39

Who is at greatest risk for PONV?

Accepted Answer

22 yr female soccer player with an ACL tear who had general anesthesia

Question 40

Complications of airway management include what?

Accepted Answer

Tracheal occlusion and laryngospasm, Aspiration, Bronchial intubation, tracheal/esophageal perforation

Question 41

How to prevent Post Op complications?

Accepted Answer

Early ambulation & foot pumps, SCD's & TED hose, CDB & IS

Question 42

This is done by pre-op nurse, again with the circulating nurse on transfer, and again immediately preceding incision.

Accepted Answer

Time Out

Question 43

Phase II of post-op recovery includes which of these?

Accepted Answer

Monitoring is less intensive; met transfer criteria., Focus on preparing for DC to an extended care environment or home.

Question 44

Postoperative care phase begins immediately after surgery and continues until when?

Accepted Answer

Pt's first follow visit

Question 45

Upon arrival to in-pt unit these are priorities

Accepted Answer

Assessment of pt, VS immediately upon arrival, Review orders

Question 46

The OR calls to say your pt's surgery is going to be postponed 2 Hr. What should you do?

Accepted Answer

Hold the preop antibiotics and notify the provider., Inform the pt and family of the delay.

Question 47

Family care and teaching post op should include which of these?

Accepted Answer

Inform family when pt arrives in PACU and update them ever hour., Provide DC instructions to family as the patient may not remember.

Question 48

Facedown, resting on abd/chest, head turned placed on donut, breasts moved laterally, male genitals free from pressure.

Accepted Answer

Prone

Question 49

The nurse' role is to clarify information and ensure patient understanding prior to consent being obtained.

Accepted Answer

True

Question 50

Consent must be obtained before what?

Accepted Answer

administration of sedatives, administration of pain medication, administration of anesthesia

Question 51

The Joint Commission cites this as the leading cause for medication errors, delays in treatment, wrong-site surgeries.

Accepted Answer

Communication failure

Question 52

What intervention would you expect to be ordered for this pt?

Accepted Answer

NGT for gastric decompression, NPO until bowel motility returns

Question 53

Pt is post-op day 1 with N/V and absent bowel sounds x 4 quadrants. What complication do you suspect?

Accepted Answer

Paralytic Ileus

Question 54

Non-sterile Team members.

Accepted Answer

OR Director, Circulating RN, Anesthesia Provider

Question 55

Pt having abdominal, intestinal, gyn, or rectal surgery.

Accepted Answer

Bladder Prep, Foley Catheter Insertion, Bowel Prep

Question 56

What needs to be assessed preoperatively?

Accepted Answer

Smoking, drug use history, advance directives, & implants., Allergies, current meds, past surgical history., Chronic conditions, prior anesthesia experiences, Piercings., Last PO intake, height/weight, gyn and mental illness.

Question 57

Post-Op delirium is associated with what?

Accepted Answer

Effects of anesthesia lingering after completion of the surgery, Increased age or persistant conitive decline, Increased mortality, Prolonged ICU and hospital stays

Question 58

What are the phases of perioperative nursing?

Accepted Answer

PACU, Pre-Op, Intra-Op

Perioperative Nursing

Questions 58

Perioperative Nursing

Questions 58