Perioperative NCLEX style questions and answers. 100% proven pass rate

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Which teaching by the nurse during the preoperative period best informs the patient regarding the primary purpose of an incentive spirometer? - ✔✔The PURPOSE (key word!) of the incentive spiromete... r is that it will encourage lung expansion, thus decreasing atelectasis. Proper use entails holding the breath 3 to 5 seconds at a time, setting daily goals, and sealing the lips tightly around the mouth piece are all directions on how to use the device, but do not describe its function. (be careful of key words in question!) The nurse interviews a patient scheduled to undergo general anesthesia for a hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 or 4 cups of coffee every morning before going to work. b. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. c. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. d. The patient's father died after receiving general anesthesia for abdominal surgery. - ✔✔D. The patient's father died after receiving general anesthesia for abdominal surgery. The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications. A patient who takes a diuretic and a beta-blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery? a. Hematocrit 36% b. Blood pressure 144/82 c. Pulse rate 58 beats/minute d. Serum potassium 3.2 mEq/L - ✔✔d. Serum potassium 3.2 mEq/L ANS: D The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety. The lower heart rate would be expected in a patient taking a -blocker. The hematocrit is in the low normal range but does not require any intervention before surgery. A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team? a. Allergy to bee and wasp stings b. History of lactose intolerance c. No previous experience with surgery d. Use of multiple herbs and supplements - ✔✔d. Use of multiple herbs and supplements Some herbs and supplements can interact with medications, so this information needs to be reported as the priority. An allergy to bee and wasp stings should not affect the client during surgery. Lactose intolerance should also not affect the client during surgery but will need to be noted before a postoperative diet is ordered. Lack of experience with surgery may increase anxiety and may require higher teaching needs, but is not the priority over client safety. ***side note:pt taking St. John's wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery.** Ten hours after surgery, a postoperative client reports that the antiembolism stockings and sequential compression devices itch and are too hot. The client asks the nurse to remove them. What response by the nurse is best? a. "Let me call the surgeon to see if you really need them." b. "No, you have to use those for 24 hours after surgery." c. "OK, we can remove them since you are stable now." d. "To prevent blood clots you need them a few more hours." - ✔✔d. "To prevent blood clots you need them a few more hours." According to the Surgical Care Improvement Project (SCIP), any prophylactic measures to prevent thromboembolic events during surgery are continued for 24 hours afterward. The nurse should explain this to the client. Calling the surgeon is not warranted. Simply telling the client he or she has to wear the hose and compression devices does not educate the client. The nurse should not remove the devices. An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best? a. Answer the questions and document that teaching was done. b. Do not have the client sign the consent and call the surgeon. c. Have the client sign the consent, then call the surgeon. d. Remind the client of what teaching the surgeon has done. - ✔✔ANS: B Do not have the client sign the consent and call the surgeon. In order to give informed consent, the client needs sufficient information. Questions about potential complications should be answered by the surgeon. The nurse should notify the surgeon to come back and answer the client's questions before the client signs the consent form. The other actions are not appropriate. The most dangerous metabolic side effect of general anesthesia that can occur during surgery is: Hyperglycemia Hyperthermia Hypoglycemia Hypothermia Explanation: Malignant hyperthermia is the most dangerous metabolic side effect of general anesthesia. - ✔✔Hyperthermia Explanation: Malignant hyperthermia is the most dangerous metabolic side effect of general anesthesia. Mr. Baltazar will be undergoing surgery with general anesthesia. The client should be given which of the following instructions preoperatively? Eat big breakfast Expect to be incontinent of urine postoperatively Double your medication doses Eat big breakfast Expect to be incontinent of urine postoperatively Expect nausea, vomiting, shivering, and pain postoperatively. - ✔✔Expect nausea, vomiting, shivering, and pain postoperatively. Explanation: These responses should be expected, and the client should be prepared for them. Food is contraindicated before surgery. Urinary retention, not incontinence is likely. Medication is more likely to be held on the day of surgery. Which of the following statements about shivering is correct? Shivering is a response controlled by the brainstem. Shivering can occur in the absence of hypothermia. Shivering is effectively treated with small doses of naloxone. Shivering is an uncomfortable, though harmless, effect of anesthesia. - ✔✔Shivering can occur in the absence of hypothermia Explanation: Shivering can also appear after surgery. This is known as postanesthetic shivering. The nurse receives the client in the postanesthesia care unit (PACU) following a procedure requiring general anesthesia. The most important assessment made by the nurse relates to the client's: Level of consciousness. Pain. Vital signs. Respiratory status. - ✔✔Respiratory status. Explanation: General anesthesia causes relaxation of all muscles, including respiratory muscles, requiring mechanical ventilation. The client's respiratory status must be monitored closely following general anesthesia. All narcotics, regardless of their origin, reduce pain by: Stimulating opiate receptors Promoting the release of excitatory transmitters Releasing large quantities of endorphin Blocking the mu receptors - ✔✔Stimulating opiate receptors Explanation: It is the stimulation of cerebral opiate receptors that reduces pain. Excitatory transmitters are not released during administration of morphine. Endorphin release is not associated with narcotic pain relief. The mu receptors mediate analgesia and are not blocked during narcotic administration [Show More]

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