1. The nurse is preparing a client for surgery.

What is the most effective method for obtaining an

Answer
Use a cuff that is wide enough to cover the upper two thirds of the client’s arm

To obtain an accurate reading in an adult, the blood pressure cuff should cover the upper two thirds of
the clients arm; it should be positioned approximately 2 inches above the antecubital space

2. Which of the following items on a client’s presurgery 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

Answer
Hemoglobin 9.5 mg/dl

The hemoglobin level is low, and the nurse needs to make sure that the surgeon has the most recent
laboratory values before surgery. This client may need transfusion before surgery

3. To prevent complications of immobility, which activities would 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 passive range of motion three times a day
D. It is not necessary to worry about complications of immobility on the first postoperative day

Answer
Get the client out of bed and ambulate to a bedside chair

Weight bearing increases the vascular tone and decreases venous stasis, thereby preventing thrombi
from developing; the increase in activity increases respiratory expansion and quality of breathing

4. 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 airway
D. Insert an oral airway and suction the nasopharynx

Answer
Reposition the head and determine patency of airway

It is important to determine if the airway is patent and whether the client is breathing. If there is a lot of
mucus and gurgling in the upper airway, the client should be suctioned. The airway must be assessed
before determining a course of action

5. A client is scheduled for surgery in the morning. Preoperative orders have been written. What is most
important to do before surgery?
A. Remove all jewelries or tape wedding ring
B. Verify that all laboratory work is complete
C. Inform family or next of kin
D. Have all consent forms signed

Answer

6.
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

Answer
2, 3, 1, 4

The clients status is NPO immediately after surgery. Desired diet progression advances to clear liquid,
full liquid, soft and finally a regular diet as tolerated by the client

7. 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

Answer
Full liquid diet

A full liquid diet includes and foods that are liquid at room temperature

8. The nurse is preparing the preoperative client for surgery. The following statements that indicate the
client is knowledgeable about his impending surgery, except:
Discuss
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”

Answer
After surgery, I will need to wear the pneumatic compression device while sitting in the chair”

The pneumatic compression device is worn during bed rest, not during ambulation. The informed
consent document should be signed before preoperative medication administration and before the
client enters the operating room

9. 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

Answer
To prevent aspiration pneumonia

NPO for 6 to 8 hours before surgery prevents vomiting, regurgitation of gastric content. Therefore, this
prevents aspiration pneumonia. The primary purpose for maintaining NPO before surgery is to prevent
aspiration pneumonia

10. 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

Answer
The afternoon or evening prior to surgery

The best time to provide preoperative teaching is the afternoon or evening prior to surgery. This time,
the patient had finished undergoing different laboratory and diagnostic procedures. Therefore, he/she
can now concentrate on the teachings. Teachings given days before surgery may tend to be forgotten.
Teachings given before administration of preoperative medications may not be understood anymore
because the anxiety level more likely is high during this time

11. Which of the following factors ensure validity of informed written consent, except:
A. The patient is of legal age with 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

Answer
If the patient is unable to write, the nurse signs the consent for the patient
These are the factors that ensure validity of a written consent. The nurse may sign as a witness, but she
is not legally allowed to sign the consent for the patient

12. Which of the following drugs is administered to minimize respiratory secretions preoperatively?
A. Valium (diazepam)
B. Phenergan (promethazine)
C. Atropine sulfate
D. Demerol (Meperidine)

Answer

13. 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

Answer
The patient is unconscious

During general anesthesia, the patient is unconscious, with complete analgesia (relief of pain). Loss of
sensation in the lower half of the body is experienced by the patient who received spinal anesthesia

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

15. Which of the following postoperative patients is at risk for respiratory complications?
A. The obese patient with long history of smoking who had undergone upper abdominal surgery
B. The patient with 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

Answer
The obese patient with long history of smoking who had undergone upper abdominal surgery

Obesity and long history of smoking pose high risk for respiratory complications among postop clients.
Upper abdominal incision is near the diaphragm. This usually inhibits deep breathing by the client due to
anticipation of pain. This factor further contributes to risk for respiratory complications

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

Answer
Flat on bed for 6 to 8 hours

To prevent headache after spinal anesthesia, the client should be placed lat on bed for 6 to 8 hours

17. The nurse is admitting a patient to the operating room. Which of the following nursing actions
should be given 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

Answer
Checking the patient’s identification and correct operative permit

Checking the patients identification and correct operative permit should be given highest priority when
admitting a patient to the operating room. This ensures that the right patient undergoes the right
surgical procedures

18. 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 return of motion and sensation in the patient’s legs and toes
B. The character if the patient’s respiration
C. The patient’s level of consciousness
D. The amount of wound drainage

Answer
The time of return of motion and sensation in the patient’s legs and toes

The most important assessment data to determine in a patient who has received spinal anesthesia is the
time of return of motion and sensation in the patients legs and toes. This indicates recovery from the
spinal anesthesia

19. The nurse is transferring the patient from the postanesthesia care unit to the surgical unit. Which of
the following is the primary reason for 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

Answer
To prevent sudden drop of blood pressure
Gradual change of the patients position during transfer primarily prevents sudden drop of blood
pressure

20. The nurse is caring for a patient who had 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 is 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

Answer
The patient’s urine output is 20 ml/hr for the past 2 hours

Urine output of 20 ml/hour for the past 2 hours should be reported to the physician. Oliguria may
indicate postoperative bleeding. The normal urine output is 30 to 60 ml/hour

21. The patient had undergone 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

Answer
Apprehension and restlessness

The earliest signs of poor tissue perfusion and poor respiratory function are apprehension and
restlessness. The brain is the first organ affected by poor tissue perfusion and oxygenation. This also
results from stimulation of the sympathetic nervous system

22. The diabetic patient who had undergone abdominal surgery experiences 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 water-soaked gauze
D. Leave the wound uncovered and pull the skin edges together

Answer
Cover the wound with sterile gauze moistened with sterile normal saline

Wound evisceration should be covered with sterile dressings moistened with normal saline to prevent
drying and necrosis of protruding abdominal organs

23. 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

Answer
Assess the patient’s pain level and vital signs

The first nursing action in managing pain is to assess the patients pain level and vital signs. This is to
determine the amount of analgesic to be administered as prescribed. Assessment is done before
implementation

24. Which of the following are not members of the sterile team in the operating room, except:
A. Surgeon
B. Scrub nurse
C. Radiology technician
D. Circulating nurse

Answer
Circulating nurse

The anesthesiologist and circulating nurse are not members of the sterile surgical team. The surgeon,
radiology technician, scrub nurse directly come in contact with the sterile field. They comprise the sterile
surgical team

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