Exam (elaborations)
Chapter 39. Perioperative Questions with Solutions
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Chapter 39. Perioperative
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Chapter 39. PerioperativeWhich phase begins when the patient leaves the post anesthesia care unit (PACU) and
ends when the patient has recovered from the surgery?
1) Postoperative
2) Intraoperative
3) Preoperative
4) Perioperative - answer1) Postoperative
Rationale:
The postoperative phase begins when the patient has recovered from anesthesia and
ends when the patient has recovered from surgery. The preoperative phase begins with
the client's decision to have surgery and ends when the client enters the operating
room. The intraoperative phase begins when the client enters the surgical suite and
ends with discharge to the post anesthesia care unit. The perioperative period includes
the preoperative, intraoperative, and postoperative phases.
The health record shows that a patient has been using long-acting oral opioids to
manage severe, chronic back pain secondary to a tumor located along the lumbar
spine. She has just had her appendix removed. Which outcome will assure the nurse
that her pain interventions were effective?
1) The patient is discharged from the hospital on postoperative day five.
2) The patient ambulates from the bed to the bathroom on the day after surgery.
3) Pain is controlled and respirations are in patient's usual range.
4) Wound dressing remains dry and intact for 48 hours. - answer3) Pain is controlled
and respirations are in patient's usual range.
Rationale:
Pain management is a priority for this patient. However, opioids may cause respiratory
depression and increase the risk of atelectasis and pneumonia. Well-managed pain and
clear breath sounds indicate that the plan of care has been effective. The date of
discharge from the hospital is dependent on many variables and is not an effective
evaluative tool for pain—especially because this patient has chronic pain that is
unrelated to her surgery. The distance ambulated depends on the patient's presurgical
, condition; although pain does affect ambulation, this is not the best criterion for
determining the level of pain. The condition of the dressing does not reflect on the
status of the patient's pain.
Which member of the intraoperative team sets up the sterile field, prepares the surgical
instruments, assists with the sterile draping of the patient, anticipates and responds to
the surgeon's needs, and maintains the integrity of the sterile field?
1) Scrub nurse
2) Registered nurse first assistant
3) Certified registered nurse anesthetist
4) Circulating nurse - answer1) Scrub nurse
Rationale:
The registered nurse first assistant (RNFA) is an RN who serves as an assistant to the
surgeon. The RNFA works with the surgeon to perform the surgical procedure. A
certified registered nurse anesthetist (CRNA) may administer anesthesia and is part of
the clean team. The circulating nurse is also part of the clean team and is an RN who
utilizes the nursing process to coordinate all activities in the operating room.
Which of the following potential complications is most likely related to the surgical
procedure rather than to the general anesthetic?
1) Aspiration of gastric contents
2) Cardiovascular compromise
3) Fluid and electrolyte imbalance
4) Respiratory depression - answer3) Fluid and electrolyte imbalance
Rationale:
Most surgical patients are at risk for fluid and electrolyte imbalance. This may result
from blood loss, compromised renal function, the overall health of the patient, or
maintaining the NPO status. Aspiration of gastric contents, cardiovascular compromise,
and respiratory depression are potential complications of anesthesia.
Which of the following nursing interventions would help prevent one of the "never
events" identified by Medicare? Select all that apply.
1) Control unpleasant odors in the room.
2) Give analgesics before the pain becomes severe.
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