NUR 340 - Sherpath Q's -
Postoperative
Which patient assessments are completed by the PACU nurse following the initial
admission assessment? - answer Dressings
Pain Level
O2 sat
Which assessment would the PACU nurse perform if a patient were suspected of
having an airway obstruction? - answer Mouth inspection
Which assessment findings must be present before patients are discharged from the
PACU? - answerControlled drainage
Normal temp
Vitals at baseline
Which initial assessments would the nurse perform on a patient admitted to the PACU
following a lengthy surgery? - answerRespiratory status and neurological status
Which nursing diagnosis would the PACU nurse individualize for a patient with a genetic
bleeding disorder? - answerRisk for impaired skin integrity related to genetic bleeding
disorder
Which nursing diagnosis would the nurse select for a patient who develops a fever and
purulent incisional drainage 48 hours after surgery? - answerImpaired skin integrity
related to infection
Which goals are appropriate for a PACU patient with the nursing diagnosis "Risk for
deficient fluid volume related to surgical blood loss and NPO status"? - answerThe
patient will remain free from hypovolemia
The patient will maintain hemodynamic stability
Which actions would the PACU nurse implement for a patient going into hypovolemic
shock? - answerEstablish patent airway
Administer prescribed IV fluids
Which nursing actions would the nurse implement for a patient with atelectasis? -
answerEncourage frequent coughing
Promote use of IS
Place patient in Fowler or semi-Fowler position
Postoperative
Which patient assessments are completed by the PACU nurse following the initial
admission assessment? - answer Dressings
Pain Level
O2 sat
Which assessment would the PACU nurse perform if a patient were suspected of
having an airway obstruction? - answer Mouth inspection
Which assessment findings must be present before patients are discharged from the
PACU? - answerControlled drainage
Normal temp
Vitals at baseline
Which initial assessments would the nurse perform on a patient admitted to the PACU
following a lengthy surgery? - answerRespiratory status and neurological status
Which nursing diagnosis would the PACU nurse individualize for a patient with a genetic
bleeding disorder? - answerRisk for impaired skin integrity related to genetic bleeding
disorder
Which nursing diagnosis would the nurse select for a patient who develops a fever and
purulent incisional drainage 48 hours after surgery? - answerImpaired skin integrity
related to infection
Which goals are appropriate for a PACU patient with the nursing diagnosis "Risk for
deficient fluid volume related to surgical blood loss and NPO status"? - answerThe
patient will remain free from hypovolemia
The patient will maintain hemodynamic stability
Which actions would the PACU nurse implement for a patient going into hypovolemic
shock? - answerEstablish patent airway
Administer prescribed IV fluids
Which nursing actions would the nurse implement for a patient with atelectasis? -
answerEncourage frequent coughing
Promote use of IS
Place patient in Fowler or semi-Fowler position
