CHAPTER 37: Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford

Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford Chapter 37: Perioperative Nursing Care Multiple Choice Questions 1. Which intervention should the nurse implement to address the risk for perioperative positioning injury related to immobilization during surgery? A. Use adequate assistance to move patient onto the OR table. B. Monitor for hypovolemia caused by NPO status. C. Use therapeutic touch to reduce anxiety. D. Pad bony prominences and avoid hyperextension of extremities. Answer: D Explanation: Padding bony areas and preventing hyperextension directly reduce positioning injury risks during prolonged immobility. Why Other Options Are Wrong: A prevents transfer injuries but not positioning complications. B addresses fluid balance. C focuses on psychological support. 2. A surgical technician is preparing to shave a patient's chest for open-heart surgery. Which action requires correction by the nurse? A. Using a straight razor with antibiotic foam. B. Trimming hair with electric clippers. C. Cleansing skin with antibacterial soap. D. Removing only hair near the surgical site. Answer: A Explanation: Straight razors increase infection risk from micro-cuts; electric clippers are standard. Why Other Options Are Wrong: B, C, and D follow evidence-based preoperative skin preparation guidelines. 3. A postoperative patient has multiple tubes in place. Which should the nurse assess first? A. IV lines. B. Urinary catheter. C. Nasogastric tube. D. Endotracheal tube. Answer: D Explanation: Airway patency is the priority; endotracheal tube assessment ensures adequate oxygenation. Why Other Options Are Wrong: A, B, and C are secondary to maintaining respiratory function. 4. Which medication should be ready for a patient with a family history of anesthesia reactions? A. Protamine sulfate. B. Dantrolene sodium. C. Activated charcoal. D. Folinic acid. Answer: B Explanation: Dantrolene treats malignant hyperthermia, a life-threatening reaction to anesthesia. Why Other Options Are Wrong: A reverses heparin. C treats poisoning. D counters methotrexate toxicity. 5. Which action best demonstrates OR nurse accountability? A. Providing warm blankets for comfort. B. Holding the patient's hand pre-anesthesia. C. Verifying visible surgical site markings after draping. D. Using a calming tone with the patient. Answer: C Explanation: Ensuring visible site markings prevents wrong-site surgery, a critical safety measure. Why Other Options Are Wrong: A, B, and D are compassionate but don't directly prevent errors. 6. What does a patient's signature on a surgical consent form indicate? A. Agreement with the diagnosis. B. Permission for the procedure. C. Acceptance of uncovered costs. D. Awareness of all treatment options. Answer: B Explanation: Consent documents the patient's authorization for surgery, not financial or diagnostic agreement. Why Other Options Are Wrong: A, C, and D are not legally implied by consent. 7. A sedated postoperative patient snores with SpO2 of 88%. What is the nurse's priority action? A. Assess airway and administer oxygen. B. Call anesthesia for reintubation. C. Remove the pillow. D. Elevate the head of bed. Answer: A Explanation: Snoring and desaturation indicate airway obstruction; oxygen and repositioning are first-line interventions. Why Other Options Are Wrong: B is premature. C and D alone won't resolve obstruction. 8. A postoperative patient refuses to ambulate due to pain. How should the nurse respond? A. Explain the risks of immobility like DVT. B. State the physician ordered ambulation. C. Allow rest until pain improves. D. Notify the doctor of refusal. Answer: A Explanation: Educating on complications (e.g., DVT) encourages adherence to mobility goals. Why Other Options Are Wrong: B lacks patient-centered rationale. C delays necessary activity. D is passive. 9. A patient reports "something ripped" with fresh blood on their abdominal gown. What is the priority? A. Inspect the incision. B. Lower the patient to the floor and call for help. C. Return to bed for saline irrigation. D. Check vital signs. Answer: B Explanation: Sudden bleeding and "ripping" suggest dehiscence; minimizing tension on the wound is critical. Why Other Options Are Wrong: A risks further injury. C and D delay emergency intervention. 10. What type of surgery relieves bowel obstruction in advanced colon cancer? A. Palliative. B. Reconstructive. C. Diagnostic. D. Ablative. Answer: A Explanation: Palliative surgery alleviates symptoms (e.g., obstruction) without curing disease. Why Other Options Are Wrong: B restores function. C confirms diagnoses. D removes diseased tissue. 11. What is the priority when positioning an anesthetized prone patient? A. Preventing endotracheal tube kinking. B. Aligning the head to avoid nerve injury. C. Taping eyes shut to prevent abrasions. D. Padding the OR table. Answer: A Explanation: Maintaining airway patency supersedes other positioning considerations. Why Other Options Are Wrong: B, C, and D are important but secondary to respiratory safety. 12. What is the priority after preoperative sedation? A. Confirm consent form completion. B. Dim lights for quiet. C. Raise stretcher side rails. D. Mark the surgical site. Answer: C Explanation: Sedation impairs coordination; side rails prevent falls. Why Other Options Are Wrong: A, B, and D should occur pre-sedation. 13. A postoperative patient has diminished breath sounds and SpO2 96% on room air. What is the priority? A. Administer pain medication. B. Give 2L oxygen via nasal cannula. C. Order a chest x-ray. D. Ensure hourly incentive spirometer use. Answer: D Explanation: Spirometer use combats atelectasis, likely causing the assessment findings. Why Other Options Are Wrong: A may worsen hypoventilation. B is unnecessary with normal SpO2. C is premature. 14. What is the priority when a post-ankle-surgery patient arrives on the unit? A. Teach call light use. B. Assess foot color/warmth. C. Check next pain medication due. D. Obtain vital signs and SpO2. Answer: D Explanation: Baseline vital signs are essential post-transfer to detect early complications. Why Other Options Are Wrong: A, B, and C can follow initial stabilization. 15. Which action indicates incorrect incentive spirometer use? A. Slow marker rise during inhalation. B. Use 5–12 times hourly while awake. C. Tight lip seal around mouthpiece. D. Holding breaths for 3–5 seconds. Answer: A Explanation: Slow rises indicate insufficient deep inhalation; the marker should rise briskly. Why Other Options Are Wrong: B, C, and D are correct technique components. 16. Which goal aligns with the diagnosis "risk for perioperative positioning injury"? A. Denies extremity numbness post-op. B. Maintains urine output ≥30 mL/hr. C. Exhibits elastic skin turgor. D. Reports no postoperative nausea. Answer: A Explanation: Numbness may indicate nerve damage from improper positioning. Why Other Options Are Wrong: B, C, and D relate to fluid balance or nausea, not positioning. 17. What is the priority diagnosis for a trauma patient who ate lunch pre-accident? A. Risk for temperature imbalance. B. Risk for aspiration. C. Risk for positioning injury. D. Risk for delayed recovery. Answer: B Explanation: Recent food intake increases aspiration risk during emergency anesthesia. Why Other Options Are Wrong: A, C, and D are less immediately life-threatening. 18. What is the priority diagnosis for a postoperative COPD patient? A. Ineffective airway clearance. B. Readiness for enhanced knowledge. C. Risk for delayed recovery. D. Activity intolerance. Answer: A Explanation: COPD patients are prone to mucus retention and bronchospasm post-intubation. Why Other Options Are Wrong: B, C, and D are relevant but secondary to airway management. 19. Which patient should the nurse prioritize? A. Awaiting discharge teaching. B. Needs first postoperative ambulation. C. Hasn't voided in 8 hours post-catheter. D. Requires daily dressing change. Answer: C Explanation: Urinary retention risks bladder distention and requires prompt intervention. Why Other Options Are Wrong: A, B, and D are less urgent. Multiple Response Questions 1. Which preoperative assessments are crucial for emergency appendectomy? (Select all that apply.) A. Current medications. B. Tobacco/alcohol use. C. Allergies. D. Last tetanus shot. E. Insurance preauthorization. F. Pregnancy possibility. Answer: A, B, C, F Explanation: Medication interactions, substance use, allergies, and pregnancy affect anesthesia safety. Why Other Options Are Wrong: D and E are non-urgent administrative details. 2. Which tasks can the nurse delegate to an assistant for postoperative patients? (Select all that apply.) A. Assess pain levels. B. Empty catheter bags. C. Teach spirometer use. D. Provide ice chips post-NPO. E. Monitor incisions. F. Apply TED hose. Answer: B, D, F Explanation: Delegatable tasks include routine measurements (B), oral care (D), and compression device application (F). Why Other Options Are Wrong: A, C, and E require nursing assessment/education. 3. Which patients need preoperative splinting education? (Select all that apply.) A. Coronary bypass. B. Breast biopsy. C. Hip replacement. D. Spinal decompression. E. Retinal detachment. F. Abdominal hysterectomy. Answer: A, F Explanation: Splinting supports abdominal/chest incisions during coughing postoperatively. Why Other Options Are Wrong: B, C, D, and E involve non-torso surgical sites. 4. Which findings indicate readiness for oral intake post-bowel resection? (Select all that apply.) A. Passing flatus. B. Active bowel sounds. C. Hunger without nausea. D. Intact incision. E. Steady gait. F. Clear urine. Answer: A, B, C Explanation: Flatus, bowel sounds, and hunger signal returning GI function. Why Other Options Are Wrong: D, E, and F don't directly reflect GI readiness. 5. Which signs suggest internal bleeding post-abdominal surgery? (Select all that apply.) A. Urine output 40 mL/hr. B. Pulse increase (76→112). C. Worsening abdominal pain. D. Generalized itching. E. Hematocrit drop (14.6→11.0). F. No bowel movement. Answer: B, C, E Explanation: Tachycardia, increased pain, and dropping hematocrit are classic bleeding indicators. Why Other Options Are Wrong: A reflects adequate hydration. D and F are unrelated to hemorrhage.