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OUR LADY OF FATIMA UNIVERSITYPerioperative Nursing

Situation1Inthehospitalwhereyouwerehired,allnewlyhirednursesarefirsttrainedtoworkin

eachwardofthehospitalforafewweeks.Youwerefirstassignedtothefemalesurgicalwardina

tertiaryhospital.

1. Thesurgicalexperiencehasthreestages,eachreflectingdifferentbutrelatednursingconcernsand

responsibilities.Whichofthefollowingstatementsaboutthepreoperativephaseistrue?

A. Thepreoperativephasebeginswhenthedecisiontoproceedwithsurgicalinterventionismadeandendswiththetransferofthepatientontotheoperatingroomtable.

B. Thepreoperativephasebeginswiththeonsetoftheconditionthatrequiressurgicalinterventionandendswiththetransferofthepatientontotheoperatingroomtable.

C. Thepreoperativephasebeginsaftersigningtheinformedconsentandendswiththetransferof

thepatientontotheoperatingroomtable.

D. Thepreoperativephasebeginswhenthedecisiontoproceedwithsurgicalinterventionismadeandendswiththeinductionoftheanestheticagent.

2. Whatis

the

first

nursing

responsibility

during

the

preoperative

phase?

A. Assesstheclientforphysiologicfactorsthatmayaffectthepatientsperioperativeexperience.

B. Assesstheclientforpsychological,emotionalandculturalfactorsthatmayaffectthepatients

perioperativeexperience

C. Managepain

D. AandB3. Whichisnotaprimarygoaltobeachievedbyahealthyclientundergoingnonemergentsurgery

duringthepreoperativephase?

A. Togainadequateknowledgeregardingtheprocedure

B. Tomaintainorimproveoptimumhealthpriortothesurgery

C. Togaincopingskillstofacethedemandsandchangesthatwillbebroughtaboutbythesurgery

D. NoneoftheaboveSituation2Amajorconsiderationinprovidingcareandaddressingneedsistheclientsage.Age

groupswhoaremoreatriskforperioperativeproblemsincludeinfants,childrenandtheelderly.

4. Whichofthefollowingcharacteristicsisnotaconcernforinfantswhowillbeundergoingsurgery?

A. SmallbloodvolumeandlimitedfluidreservesB. Largebodysurfaceandimmaturetemperatureregulatorymechanisms

C. FearofseparationfromparentsD. Immatureorgansandorgansystems(kidney,liver,immunesystem)

5. Thecharacteristicdescribedin4a,smallbloodvolumeandlimitedfluidreserves,supportswhichofthefollowingnursingdiagnosis?

A. HighriskforfluidvolumedeficitB. Highriskforalteredthermoregulation

C. Fluidvolumedeficit

D. Alteredthermoregulation

6. Whichofthefollowingteachingandlearningstrategiesistheleastappropriateforchildrenwhowill

undergosurgery?

A. Useofpuppetsanddolls

B. Lecturingusingtechnicaltermsandthoroughdiscussionofthetopics

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C. Roleplaying

D. Includingtheparentsintheteachinglearningactivities

7. Whichofthefollowingcharacteristicsoftheelderlyclientisnotrelatedtotheirneedforfewer

anestheticagentstoproduceanesthesia?

A. Thepercentageofleanbodytissuedecreasesandfattytissuesteadilyincreases

B. Reducedliversize

C. DecreasedkidneyfunctionD. Noneoftheabove

8. Anotherconcernfortheelderlypatientisthedeclineinsensoryfunction.Whileteachinga70yearoldfemaleclienthowtoperformpostoperativeexercises,shekeptonasking,Ineng,anoang

sinasabimo?Hindikomarinig.Duringassessment,youfoundoutthatshepassedthementalstatus

exam.Whatisyournursingdiagnosis?

A. Knowledgedeficit

B. Alteredsensoryperception:AuditoryC. ChronicConfusion

D. Riskforinjury

Situation3

Voluntary

and

written

informed

consent

from

the

patient

is

necessary

before

non

emergentsurgerycanbeperformed

9. Inwhichofthefollowingsituationsistheinformedconsentvalid?

A. Theclientsignedtheinformedconsentafterreceivingadoseofsedative.

B. Thenurseaskedtheclienttosigntheconsentformaftersheexplainedwhatwillhappentothe

clientduringthesurgery.

C. Thenursewitnessedthepatientssignatureafterensuringthattheclientunderstoodtheinformationprovidedbythesurgeonandtheanesthetist.

D. Theconsentwassignedbeforeprovidingtheclientwithappropriateinformation.10.Whoamongthefollowingisnotlegallyallowedtowitnessthesigningofaconsentformtoasurgical

procedure?

A. Theparentsofapatient

B. Thepatientssurgeon

C. Thenursein chargeofthepatient

D. Theheadnurse11.Whoamongthefollowingpatientsisnotlegallyallowedtogivetheirconsenttoasurgery?

A. Asixteenyearoldmarriedmalewhoisemancipated

B. Afifteenyearoldfemalewhoisemancipatedfromherparentsandisindependentlyearningherownliving

C. Theparentsofasevenyearoldfemale

D. Asedated25yearoldmaleSituation

4

Maria,

a35

year

old

female

diagnosed

with

breast

cancer,

was

admitted

to

your

ward.

She

willbeundergoingmastectomy.

12.Duringadmission,Mariawasaskingyouwhatthereasonforthesurgicalprocedureisandwhatwill

happenduringtheadmission.Whatisyournursingdiagnosis?

A. Anticipatorygrieving

B. KnowledgeDeficit(mastectomy)C. Fear

D. IneffectiveCoping

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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. RightsideofthebedC. Footofthebed

D. Itdoesntmatter

16.Movingandturninginbedcanaddstraintothesuture.Whatskillorexercisewillyouteachthe

clienttopreventtheadditionalstrainonthesuturewhenmoving?

A. Movinginslowmotion

B. Deep

breathing

exercises

C. SplintingD. Legexercises

17.Whichofthefollowingpotentialpostoperativeproblemsduetounduestrainonthesuturesitepertainstotheextrusionofinternalorgansandtissuesthroughtheincision?

A. WoundDehiscence

B. WoundEviscerationC. WoundInfectionD. Postoperativeileus

18.Whicharmshouldtheclientinno.17usetosplintthewound?

A. Leftarmandhand

B. RightarmandhandC. A

pillow

D. Anyofthetwoarmsandapillow

19.Whenmovingtothesittingpositionbeforegettingoutofbed,whicharmshouldtheclientinno.17

usetopushdownagainstthemattress?

A. LeftarmandhandB. Rightarmandhand

C. Apillow

D. Anyofthetwoarmsandapillow

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20.Legexercisesarealsoskillsthattheclientneedstoperformafterthesurgery.Whatistherationale

fortheperformanceoflegexercisesafterthesurgery?

A. TopromotecirculationandpreventthrombusformationB. Topromotelungexpansionandtopromoteairwayclearance

C. Topreventinfection

D. Topreventcontractures

21.Afterthesurgery,theclientneedstoperformdeepbreathingandcoughingexercises.Whichofthefollowingisthebestpositionwhenperformingdeepbreathingandcoughingexercises?

A. Sidelyingposition

B. SittingpositionC. Dorsalrecumbent

D. SemiFowlersposition

22. Toprovidetheclientandthenursefeedbackregardingthedepthoftherespiration,whatinstructionshouldbegiventotheclientwhenperformingdeepbreathingexercises?

A. Splinttheincision.

B. Inhaleslowly.C. Placethehandspalmdownontheborderoftheribcage.

D. Holdthe

breath

two

to

three

seconds

after

inhalation.

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 >viC. v > ii >i >vi

D. v

>

ii

>

i

>

iii

>

vi

24.Coughingcancauseadditionalpressureandpainontheincisionsite.Onewaytopreventthisis

throughsplinting.Intheabsenceofabinder,whatistheleastadvisablewaytosplintaleft

abdominalincision?

A. Useonlytherightarmandhand

B. PlacethepalmsofbothhandsoneithersideoftheincisionsiteC. Holdingthepalmofonehandovertheotherdirectlyovertheincisionsite

D. Allareadvisable

Situation6IthasbeenatraditiontoplacetheclientonNPOaftermidnightbeforethedayofthe

surgery.However,theAmericanSocietyofAnesthesiologyhasreviseditsguidelinesforpreoperative

fastingforhealthyclientsundergoingelectiveprocedures.

25.WhichofthefollowingisnotareasonfortheNPOorder?

A. Thereisadangerforvomitingandaspirating

B. Thesurgicalareamaybecontaminatedbyfeces

C. Thebladdermaybeinjuredduringtheprocedure.D. Noneoftheabove

26.Therevisionsintheguidelineswerebasedonreevaluationandresearches.Whatistheleast

probabletypeofresearchusedindeterminingthenecessaryrevisionsintheguidelines?

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A. DescriptiveB. Correlational

C. Quasiexperimental

D. Experimental

27.Whichofthefollowingisnotallowedinrevisedguidelinesforpreoperativefasting?

A. Eatingalightbreakfast6hoursbeforetheprocedure

B. Consumptionofclearliquidsupto2hoursbeforeelectivesurgeryrequiringgeneralanesthesia.C. Aheaviermeal8hoursbeforesurgery

D. Noneoftheabove28.Oneofyourresponsibilitiesduringthepreoperativephaseistoensurethatthenailsaretrimmed

andfreefrompolish.Whatisthemainreasonforthis?

A. Chipsinnailpolisharegoodbreedingsitesofmicroorganisms

B. LongnailsarebreedingsitesofmicroorganismsC. Nailbedswillbevisibleforassessingcirculation

D. Topreventinfection29.Jewelriesshouldberemovedfromtheclientbeforethesurgery.However,evenafterexplainingwhy

jewelriesshouldberemoved,theclientwishedtonothaveherweddingbandremoved.Whichof

thefollowing

should

you

do?

A. Insistonremovingtheweddingband.

B. Allowtheclienttokeeptheweddingbandinherhand.

C. Consultthesurgeonregardingtemporarilycuttingtheringfingersothattheweddingbandwill

bekeptattachedtothefingerandsurgicallyreattachingthefingertothehandafterthesurgery.

D. Tapetheweddingbandinplace.30.Inwhichofthefollowingsituationswillyounotallowaclienttokeepaweddingband?

A. Mastectomyofbothbreasts

B. Cholecystectomy

C. AnysurgeryinthearmsD. AllexceptB

Situation7Adaybeforehersurgery,Mariaavoidedinitiatingconversationswithanybodyand

answeredwithonlyafewwordswhenaskedquestions.Thisseemedveryunlikeher.Whilemakingyour

rounds,yougreetedandaskedherhowsheis.Sheanswered,Mababawasannaangpagkababaeko.Di

akotakotsasakitokayasamangyayarisaakin.Ayawkolangmawalaangpagkababaeko.

31.Whatisyournursingdiagnosis?

A. AnticipatoryGrievingB. KnowledgedeficitC. Fear

D. IneffectiveCoping

32.Whatisthebestresponsetoherstatement?

A. Anoka?

Virgin?

B. HindinamanmagmumutateangDNAmopoathindipomagbabagoangsexchromosomemo.

XXparinnamanpoyanafterthesurgery.

C. Ah,okpo.Angsusomopoangbasehanmopongpagkababaemo.

D. Anopoangibigmongsabihinsasinabimopongmawawalanapoangpagkababaemo?Situation8Inthesurgicalwardwhereyouwereassigned,allpatientsarerequiredtowearantiemboli

stockings.

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33. Whatis/arethereasonsforusingantiembolistockings?

A. Tocompresstheveinsandtherebyfacilitatevenousreturn

B. Toimprovearterialcirculation

C. Topreventorreduceedema

D. Alloftheabove34.Whatisthebesttimetoapplyantiembolismstockings?

A. Inthemorning,beforetheclientarises.

B. Lateevening,beforetheclientsleepsC. Middleoftheday,rightaftertheclientperformsaverystrenuousactivity.D. Anytime

35. Whenapplyingtheantiembolismstockingsonaclient,whatisthebestpositionofthefoot?

A. ParalleltothegroundB. Toesarepointedawayfromthehead(plantarflexion)C. Toesarepointedtowardsthehead(dorsiflexion)

D. Withthefootexternallyrotated

Situation9

After

working

in

the

female

surgery

ward

for

three

weeks,

you

were

reassigned

to

the

operatingroomsofthehospital.

36.Beforetransferringtheclienttotheoperatingroom,youneedtoensurethatallprosthesesare

removed.Removingprosthesesfromtheoralcavity,likedentures,addresseswhatnursing

diagnosis?

A. IneffectiveAirwayClearanceB. IneffectiveBreathingPattern

C. RiskforAspiration

D. Alloftheabove.37.Whentransferringtheclienttotheoperatingroom,afteradministeringthepreanesthetic

medications,

how

should

the

side

rails

be

kept?

A. Thesiderailsshouldalwaysbekeptup.

B. Thesiderailsshouldalwaysbekeptupononesideanddownontheotherwherethe

accompanyinghealthworkerispositioned.

C. Thesiderailsshouldalwayskeptdown.

D. Thesiderailsshouldbekeptupunlessaprocedurewillbedonethatwillneedeasieraccesstotheclient.Insuchcases,thesiderailsonthesidewheretheprocedurewillbedoneshouldbe

putdownduringtheprocedureandbroughtupassoonastheprocedureisdone.

38.Whichofthefollowingstatementsistrueabouttheintraoperativephase?A. Itbeginswhentheincisionismadeandendswhenthesuturingisfinished.B. Itbeginswiththetransferoftheclienttotheoperatingroomtableandendswhenheorsheis

transferredtothepostanesthesiacareunit.

C. Itbegins

with

the

transfer

of

the

client

to

the

operating

room

table

and

ends

when

the

anesthesiawearsoff

D. Itbeginswiththeinductionofanesthesiaandendswhentheanesthesiawearsoff.

Situation10Duetotheimpairmentinaclientsskinintegrity,whichpredisposestheclienttodevelop

infections,duringthesurgery,amajorfocusduringtheintraoperativephaseismaintainingsurgical

asepsis.Priortoyourfirstdayintheoperatingroom,youreviewedthechainofinfectionbecauseitis

thebasisoftheprinciplesofinfectioncontrolandofasepsis.

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39.Sometimes,itisnecessarytoremovehairfromthesurgicalsite.Whichofthefollowingistheleast

preferredmethodofremovinghair?

A. Usingelectricclippers

B. UsingsurgicalbladesC. Usingdepilatorycreams

D. Noneoftheabove40.Whatisthebestwaytominimizethespreadofmicroorganismsand,eventually,infections?

A. HandwashingB. SterilizingallinstrumentsC. Bathingtheclientinantisepticsorgermicides

D. Cleaningtheclientsenvironmentusingantisepticagents

41.Whenperformingsurgicalhandwashingorsterilehandwashing,howshouldthehandsbepositioned?

A. Handslowerthantheelbows

B. HandshigherthantheelbowsC. Handsparalleltotheground

D. Anyof

the

above

42.Afterwashingthehandsusingthesteriletechnique,howshouldyoudryyourhandsusingatowel?

A. Inarotatingmotionfromthefingerstotheelbow.B. Usinglongstrokesfromthefingertotheelbow

C. Inarotatingmotionfromtheelbowtothefingers

D. Usinglongstrokesfromtheelbowtothefingers

Situation11Evenhealthymembersofthesurgicalteamareconsideredreservoirsofmicroorganisms.

Microorganismsmaycomefromthesurgicalteammembersoralandrespiratorytractsandskin.One

waytoensurethatthesedonotgettransmittedtotheclientsistowearORattireproperly.

43. How

should

shirts

and

waist

drawstrings

placed

or

worn?

A. Tucktheshirt,andcutthewaistdrawstringsshortenoughsothatitwillnotbelongerthanyour

actualwaistcircumference

B. TuckboththeshirtandthedrawstringC. Untucktheshirtandjustletthedrawstringhangloosefromthepantssothatyouwonthaveto

touchthesepossiblebreedingsitesofmicroorganisms.

D. Leavetheshirtuntuckedsothatyouwonthavetotouchthispossiblebreedingsitesof

microorganisms,andcutthedrawstringsshortenoughsothatitwillnotbelongerthanyour

actualwaistcircumference.

44.Topreventtransmittingmicroorganismsfromtherespiratoryandoraltract,masksarewornby

membersofthesurgicalteam.Whengoingoutoftheoperatingroom,whatshouldyoudowiththe

mask?

A. ChangeiteverytimeyougoinandoutoftheoperatingroomB. Letthemasktohangaroundtheneckanddonottouchitsothatyourhandswillnotbe

contaminated.

C. Removethemaskandfoldinsuchawaythatthesurfacethatisincontactwithyourownskinis

exposedtotheenvironmentandtheothersurfaceisnotexposed.

D. Noneoftheabove.

45.Whendonningglovesusingtheclosedmethod,inwhichhandareyougoingtoputthegloveson

first?

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A. Thelefthand

B. Therighthand

C. Thedominanthand

D. Thenondominanthand46.Whenascrubnurseputsonagown,whichofthefollowingwaysoftyingthewaisttiewillnot

maintainasepsis?

A. Haveacoworkerholdthetieusingglovesorsterileforceps.Makeathreequarterturn,thentakethetieandsecureitinfrontofthegown.

B. Haveacoworkertakethetwotiesateachsideandtieitatthebackofthegown.

C. Reachingforthebackandtyingitherself.D. Allwillnotmaintainasepsis.

47.Whichpartsofthescrubnursesgownareconsideredsterile?

A. Fromthefrontofthechestattheleveloftheshoulders tothewaist;andfromtwoinchesabovetheelbowtothestockinettecuff

B. Fromthefrontofthechestattheleveloftheshoulders tothelevelofthesterilefield;and

fromtwoinchesabovetheelbowtothestockinettescuff

C. Fromthefrontofthechestattheleveloftheshoulders tothewaist;andfromtwoinches

belowthe

elbow

to

the

stockinette

cuff

D. Fromthefrontofthechestattheleveloftheshoulders tothelevelofthesterilefield;and

fromtwoinchesbelowtheelbowtothestockinettecuff

48.WhenenteringtheOR,howshouldthescrubnursemove?

A. Thenursessidesfacingthewall

B. Thenursefacingthesterilefield

C. ThenursesbackfacingthewallD. AllexceptA

49.Thesurgicalprocedurecanbeaverystressfulexperienceforallthemembersofthesurgicalteam.

ThestressandtheheatfromthelayersoftheORattirecancausethemembersofthesurgicalteam

tosweat.Whichofthefollowingactionswillbreaktheprinciplesofasepsis?

A. The

surgeon

wipes

his

sweaty

forehead

on

the

back

of

another

surgical

members

gown.

B. Thescrubnursewipesthesweatoffthesurgeonsforeheadwithasterilegauze

C. BothAandBD. Noneoftheabove

Situation12Anothermajoraspectofnursingcareduringtheintraoperativephaseistheproper

positioningoftheclienttopreventinjuries.

50.Whenispositioningdone?A. Beforeinducinganesthesiaandbeforesurgicaldraping

B. AfterinducinganesthesiaandbeforesurgicaldrapingC. Beforeinducinganesthesiaandbeforesurgicaldraping

D. Afterinducinganesthesiaandbeforesurgicaldraping51.Howshouldtheclientbeplacedintohisorherposition?

A. Bypushing

B. Bypulling

C. ByliftingD. Alloftheabove

52.Whichofthefollowingisnotamajorconsiderationinchoosingtheclientsposition?

A. Visualizationandaccesstothesurgicalsite

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B. Accessforassessingandmaintaininganesthesiaandvitalfunctions

C. Preventingharmorinjurytotheclient

D. Visualizationoftheclientswholebody53.Aclientwillundergoexplorelaparotomy.Inwhichpositionwillyouexpecthimtobeplaced?

A. DorsalrecumbentB. Prone

C. LithotomyD. Trendelenberg

54.Afemaleclientwillundergovaginoplasty.Inwhichpositionwillyouexpecthertobeplaced?A. Dorsalrecumbent

B. LithotomyC. Sidelying

D. Trendelenberg

Situation13Duringthesurgicalprocedure,thepatientwillneedsedation,anesthesia,ora

combinationofthese.Sedationandanesthesiahasfourlevels:minimumsedation,moderatesedation,

deepsedationandanesthesia.

55.Whichofthefollowingstatementsistrueaboutsedationandanesthesia?

A. Inbothcases,theventilationandcardiovascularfunctionsareaffected.

B. Inbothcases,thepatientisarousable.

C. Thedifferencebetweenanesthesiaandsedationisthattheanesthetizedpersonisnotarousable.

D. AllaretrueexceptC.

56.Anesthesiahasfourstages.Inthebeginninganesthesia,theclientwillexperienceringing,roaringor

buzzingintheears,aswellasanexaggerationinthehearingofnoises.Inthissituation,whatwillbe

yournursingdiagnosis?

A. Anxiety

B.Disturbed

Sensory

Perception

C. Confusion

D. Alloftheabove

57.Whichofthefollowingmeasuresisnotappropriateinaddressingtheidentifiedproblem?A. Avoidmakingunnecessarymotions

B. Avoidmakingunnecessarynoises

C. LeavingtheclientbyhimselfuntilthenextstageofanesthesiaD. Noneoftheabove.Allareappropriate

58.Thesecondstageofanesthesiaisexcitement,whichischaracterizedbystruggling,shouting,crying,laughing,singing,cryingandpossiblyuncontrolledmovements.Becauseofthis,restraintsare

sometimesnecessary.Whenrestraintsareusedonasurgicalclient,whichofthefollowingshould

beobservedordone?

A. Theuse

of

restraints

should

never

be

used.

B. Whenrestraining,astrapshouldalwaysbeplacedacrossthepatientsthighs.C. Thehandshouldbealwaysbesecuredtoanarmboard.

D. Restraintsshouldneverbeappliedovertheoperativesite.

59.Whatnursingdiagnosisareyouaddressinginthesituationinnumber58?

A. Impairedsensoryperception

B. RiskforInjuryC. ImpairedMobility

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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. TurntheclientsheadtothesideB. Lowertheheadoftheoperatingtable

C. Provideabasin

D. None oftheabove

63.Anotheraftereffectofspinalanesthesiaisheadache.Whichofthefollowingareyousupposedto

do?

A. Keeptheclientlyingflat

B. Keeptheenvironmentquiet

C. Keeptheclientwellhydrated

D. Alloftheabove64.Malignanthyperthermiaisanuncommoncomplicationduringtheintraoperativephasebutithasa

mortality

rate

of

50%.

It

occurs

due

to

the

inability

of

the

muscles

cells

to

relax

which

leads

to

an

excessiveuseofATPs.Thisleadstohypermetabolism.Whatisthefirstinterventioninrelationto

malignanthyperthermia?

A. Identifyingrisksfactorsthatpredisposetheclienttomalignanthyperthermiapreoperatively

B. MonitoringtheclientsvitalsignsduringthesurgeryC. Ensuringtheavailabilityofmedicationsandequipment

D. Alloftheabove

Situation14Recently,anincidentinvolvingasurgicalteaminahospitalinCebubecameanational

issue.Avideowasreleasedintheinternetshowingasurgicalteamcelebratingandlaughingoverthe

removalofacanisterfromtheclientsbody.

65.Whatimportant

role

of

the

nurse

was

not

fulfilled

in

this

incident?

A. Researcher

B. Coordinator

C. PatientadvocateD. Primarycaregiver

66.Whichofthefollowingshouldnotbedoneduringthesurgery?

A. Talkaboutthediagnosisbasedontheresultoftheexcisedtissuesample.B. Maintainsterilefield.

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C. Positioningtheclientproperly

D. Noneoftheabove

Situation15After3weeksofbeingassignedtotheoperatingrooms,youwerethenassignedtothe

postanesthesiacareunit(PACU).

67.Whichofthefollowingstatementsistrueaboutthepostoperativephase?A. ItbeginswiththeadmissionoftheclientinthePACUandendswiththedischargefromthe

hospital.

B. ItbeginswhentheanesthesiawearsoffandendswhentheclientisdischargedfromthePACU.

C. ItbeginswiththeadmissionoftheclientinthePACUandendswhenthehealingiscomplete.

D. Itbeginswhentheanesthesiawearsoffandendswhenthehealingiscomplete.68.Whichofthefollowingwillyounotexpectinapostanesthesiacareenvironment?

A. Soft,pleasingcolors

B. BrightcolorsC. Indirectlighting

D. Soundproofceiling

and

equipment

that

minimize

noise

69. ThePACUissometimesdividedintotwophases:PhaseIandPhaseII.Whichofthefollowing

statementsarerelatedtophaseI?

A. IntensivenursingcareB. Preparationfordischarge

C. BothAandB

D. NoneoftheAbove

70. WhichofthefollowingstatementsarerelatedtophaseIIPACU?

A. Intensivenursingcare

B. PreparationfordischargeC. BothAandB

D. None

of

the

Above

71. DuringphaseIPACU,howoftenshouldyoumonitorthevitalsignsoftheclients?

A. Every15minutesforthefirsthour

B. Every15minutesuntilvitalsignsarestablefor30minutesC. Every15minutesuntilvitalsignsareconsistentwithpreoperativevitalsignsforatleast30

minutes

D. AllexceptA72. OneofthemainprioritiesduringphaseIPACUisthemaintenanceofapatentairway.Whichofthe

followingisthebestwaytoassesstheclientsbreathingpattern?

A. Observetherisingandfallingoftheclientschestandabdomen.B. Placeyouhandsovertheclientsabdomenandchesttopalpatethemovements

C. Placethepalmofyourhandneartheclientsnoseandmouth

D. Coverthe

clients

nose

and

mouth

using

your

palm

to

feel

the

clients

exhalation.

73.Duetoanesthesia,musclesarerelaxedincludingthelowerjawandthetongue.Thissituationis

calledhypopharyngealobstruction.Signsincludechoking,noisyrespirations,decreasedoxygen

saturationlevelandcyanosis.Whatisyournursingdiagnosisinthissituation?

A. Impairedbreathingpattern

B. IneffectiveairwayclearanceC. Impairedgasexchange

D. Alloftheabove

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74. Theanesthetistmayleaveahardrubberoraplasticairwayinthepatientsmouth.Whenshouldit

beremoved?

A. UntilthegagreflexhasreturnedB. OnehourpostadmissiontothePACU

C. UponadmissiontothePACU

D. AfterdischargefromthePACU

75.WhichamongthefollowingdescribesthebestpositionforapatientwhileintheimmediatePACUorPhaseI?

A. Headofthebedslightlyelevated;Sidelyingposition;theheadturnedforwardandsupportedbyapillow;withapillowsupportingtheupperarm

B. Lyingflatwithapillowundertheheadandanothertosupporttheupperarm

C. Sidelying;theheadturnedbackwardunsupportedbyapillow;theupperarmsupportedbya

pillow

D. Headofthebedslightlyelevated;Sidelyingposition;theheadturnedforwardunsupportedbya

pillow;withapillowsupportingtheupperarm

Situation16Asidefrommaintainingapatentairway,anotherpriorityisthemaintenanceof

cardiovascularstability.

As

aPACU

nurse,

you

are

aware

that

the

primary

cardiovascular

complications

seeninthePACUincludehypotension,andshock,hemorrhage,hypertension,anddysrhythmias.

Whilemonitoringoneofyourclientswhosevitalsignswerestablewhenyoulastassessedhim,you

noticedthattheclientisbecomingapprehensive,restless,andthirsty;theskinismoist,pale,andcold.

Thepulserateincreased,thetemperaturedecreasedandrespirationsbecamedeepandrapid.You

assessedtheincisionsiteandsawthattheclientsgownwassoakedwithblood.Youreportedthe

situationtothesurgeon.

76.Whichofthefollowingisnotanappropriateintervention?A. Placetheclientinshockposition

B.Check

for

orders

regarding

blood

transfusion

and

availability

of

blood

replacement

C. Assessthecauseofthehemorrhage

D. InfuseIVfluidsrapidly

77.Youplacedtheclientonshockposition.Whatisthepositionoftheclientwhenplacedinshockposition?

A. Flatonback;legselevatedata20degreeangle;kneeskeptstraightB. Headislowered;legsareelevated;kneesarebent

C. Headislowered;legselevatedata20degreeangle;kneeskeptstraightD. Flatonback;legselevatedata20degreeangle;kneesarebent

Situation17Aftercompletingtherotationinallthewards,youwereaskedtochoosewhereyouwant

tobepermanentlyassigned.Youchosetobeassignedtothesurgicalward.

78.Whatisthebestpositionforaclientwhohashadspinalanesthesia?

A. Headofthebedslightlyelevated;Sidelyingposition;theheadturnedforwardunsupportedbyapillow;withapillowsupportingtheupperarmuntilabletomove

B. Flatonthebackfor8to12hours

C. Headisnotelevated,Sidelying;theheadturnedbackwardunsupportedbyapillow;theupper

armsupportedbyapillow

D. Noneoftheabove

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Situation18 Becauseofanesthesia,thetoneoftheurinarybladderbecomestemporarilydepressed.

79.Whichofthefollowingisnotanormalassessmentfindinginapostoperativeclientinrelationto

voiding?

A. Theclientvoidswithin6to8hoursaftersurgery

B. Urinaryoutputoflessthan30ml/hrC. Urinaryoutputof40mlperhourD. Alloftheabove

80.Whatisyourprimarynursingresponsibilityinrelationtotheclientsfluidoutput?A. Monitortheclientsfluidintakeandoutput

B. EnsureadequatefluidintakeC. PercussthebladderD. Ordertheinsertionofaurinarycatheter

81.Allpostoperativepatientswillexperiencepainduetotheincision.Whenwillyouexpecttheclientto

experiencethegreatestpainaftersurgery?

A. Immediatelyaftersuturingtheincision

B. 12to36hoursaftersurgeryC. 36hoursto3daysafterthesurgery

D. 3daysaftersurgery

82.Whenisthebesttimetoadministerpainmedications?

A. Onaroutinebasis(q2htoq6h)forthefirst24to36hours

B. Onaroutinebasis(frequencydependingonthedrug,route,dosage,etc.)

C. Beforescheduledactivitiesandrestperiods

D. AllexceptA83.Apatienthasbeencomplainingtoyouaboutpaineverytimeyouvisithim.Whichofthefollowing

willnothelpinreducingtheclientspainexperiencewithoutusingpainmedications?

A. DiscussingwithhimwhyheisexperiencingpainandtellinghimthateverythingwillbealrightB. Asking

him

what

is

painful

and

what

he

has

done

about

the

pain

C. Tellinghimtopracticedeepbreathing

D. Givinghimatapeofguidedimagerytolistento

84.Howoftenshouldtheclientperformthepostoperativeexercises?

A. Everyhouroratleastevery2hours.B. Whenevertheclientfeelslikedoingit

C. Every10minutes

D. Noneoftheabove85. Oneofthepostoperativeskillsthatyouneedtoteachtheclientishowtogetoutofthebed.One

oftheclientsassignedtoyouhadanincisionontherightsideofhisabdomen,onwhichsideofthe

bedwillyoutellhim/hertoturntoandgetoutof?

A. LeftsideofthebedB. Right

side

of

the

bed

C. Footofthebed

D. Itdoesntmatter

Situation19 Anesthesiaandimmobilitycanalsodisruptnormalgastrointestinalfunction.Theclients

dietwilldependonmanyfactors.

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86.Animportantfactorusedindeterminingthetypeoftheclientsdietisthereturnofthegagreflex

andofperistalsis.Whatisthebestwayforassessingperistalsis?

A. Assessthereturnofthegagreflex

B. AuscultateforthebowelsoundsC. Percusstheabdomen

D. Observetheabdomen

87.Whenoralintakeisadmitted,whatshouldyouofferfirst?A. IcechipsB. Aglassofjuice

C. SipsofwaterD. Afullmeal

Situation20 Thepostoperativeclienthasanincreasedriskofinfectionduetothedisruptioninskin

andtissueintegrity.Topreventthedevelopmentofinfection,thesurgicalwoundshouldbeproperly

caredfor.

88. Aclientforgottosplinttheincisionsitewhenperformingcoughingandturningexercises.

Dehiscenceoccurred

4to

5days

after

the

surgery.

What

is

the

most

appropriate

action?

A. Exposethewoundtoairsothatitcandrynaturally.Informthesurgeon.

B. Coverthedehiscencewithdrysteriledressings.Asktheclienttobendknees.Informthe

surgeon.

C. Placelargesteriledressingssoakedinsterilenormalsalinesolutiononthewound.Asktheclienttobendtheknees.Informthesurgeon.

D. Placelargesteriledressingssoakedinsterilewateronthewound.Asktheclienttoextendthe

knees.Informthesurgeon.

89.Whichofthefollowingshouldyouexpectinaclientwithahealingwound?

A. SomebleedingandtheappearanceofaclotbindingthewoundedgesB. Whitepurulentfluidinwoundedges1to3daysafterthesurgery

C. Redness

at

the

wound

edges

D. Elevatedtemperature

90. Whenremovingthewounddressing,howshouldyouremovetheadhesivetape?

A. Liftingthedressingandcuttingtheadhesiveusingscissors

B. HoldingdowntheskinandpullingthetapegentlyawayfromthewoundC. Holdingdowntheskinandpullingthetapeabruptlytowardfromthewound

D. Holdingdowntheskinandpullingthetapegentlytowardthewound

91. Whencleaningtheincision,howshouldyouholdtheforceps?A. ThetipsatthelevelofthehandleB. Thetipslowerthanthewrist

C. Thetipslowerthanthehandle

D. Thetipshigherthehandle92. How

should

you

clean

the

wound?

A. Fromthesuturetothesurroundingareas,using5swabs:1forthemiddle,andtwoforeach

side.

B. Fromthesuturetothesurroundingareas,discardingtheswabaftereachstroke.C. Fromthesurroundingareastothesuture,discardingtheswabaftereachstroke.

D. Fromthesuturetothesurroundingareas,usingdifferentsidesofonlyoneswabforthewhole

procedure.

93.IfaJacksonPrattdrainispresent,whatistheproperorderofactivities?

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i. Emptythedrainagesystemandmeasureamountofdrainage

ii. Cleanthedrainagesystem

iii. Cleanthewound

iv. Removethedressings

v. Flattenthesuction

vi. Dressthewoundandthedrainage

a. iv >v >i >iii >ii >vib. iv >i >v >iii >ii >vic. iv >v >i >ii >iii >vid. iv >i >v >ii >iii >vi

94.WhatisthepreferredmethodofcreatingthesuctionoftheJacksonPrattdevice?

A. Holdthedeviceusingbothhands.Pressthedevicefirmlyusingbothhands.

B. Placethecontaineronasolid,flatsurfacewiththeportclosed.Pressthedeviceusingbothhands.

C. Placethecontaineronasolid,flatsurfacewiththeportopen.Pressthedeviceusingboth

hands.

D. Placethecontaineronasolid,flatsurfacewiththeportopen.Pressthedeviceusingthepalmof

one

hand.

The

other

hand

will

be

used

to

cleanse

the

opening.

95.Aftercleaningthewound,whatareyousupposedtodo?

A. DrythewoundandthesurroundingskinwithdryswabsB. Drythewoundwithdryswabsbutnotthesurroundingskin

C. Donotdrythewoundbutdrythesurroundingskinwithdryswabs

D. Donotdryboththewoundandthesurroundingskin

96. Whendressingadrainusing4inx4inuncutgauze,whatshouldyoudo?

A. Cutthegauzeinthemiddleandplaceitsnuglyaroundthedrain.

B. Openagauzepadandfolditlengthwisetoforma2inx8ingauze.Wrapitaroundthedrainso

thattheendsoverlap.

C. Open2gauzepadsandfoldeachlengthwiseinto2inx8instrips.Placeeachsidebyside,

inserting

the

drain

between.

D. Anyoftheabove.97.Whereshouldyouplacethebulkofthedressings?

A. OvertheincisionB. Onthesidesoftheincision

C. Overthedrainareaandbelowthedrainarea,dependingontheclientsusualposition

D. Alloftheabove98.Howshouldyoutapethedressing?

A. AroundtheedgesofthegauzepadB. Acrossthegauzepadparalleltotheincision

C. AcrossthegauzepadperpendiculartotheincisionD. Diagonallyacrossthedressing

99.Whendressing

over

an

incision

on

ajoint

area,

how

should

you

place

the

tapes?

A. Vertical

B. Oppositethedirectionofthebodyaction

C. Aroundtheedgesofthegauzepad

D. Diagonally100. Whichofthefollowingwillyouexpecttoseewhenassessingtheclientswound8daysafterthe

surgery?

A. Aclotbindingthewoundedges

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B. Rednessandswellingatthewoundedges.

C. ThewoundisbridgedandclosedD. Feverandpresenceofdrainage