NUR 242 EXAM 1: MEDICAL-SURGICAL
NURSING ()
MODULE 1: PERIOPERATIVE NURSING
**Question 1**
A patient is scheduled for a laparoscopic cholecystectomy. During the preoperative
assessment, the patient states they take St. John’s Wort for mild depression. What is
the priority nursing action?
A. Document the herbal supplement in the chart and proceed with surgery.
B. Instruct the patient to stop taking the St. John’s Wort 2 weeks prior to surgery due to
the risk of serotonin syndrome when combined with anesthesia.
C. Tell the patient to take their usual dose of St. John’s Wort on the morning of surgery
to prevent withdrawal.
D. Ask the provider to prescribe a stronger SSRI to replace the herbal supplement.
**Correct Answer: B**
*Rationale:* St. John's Wort is an herbal supplement that acts as a weak serotonin
reuptake inhibitor. When combined with certain anesthetic agents (like ketamine or
meperidine) or postoperative opioids, it can precipitate serotonin syndrome, a life-
threatening condition. It also increases metabolism of other drugs. It should be
discontinued at least 2 to 3 weeks prior to surgery.
**Question 2**
, The circulating nurse in the operating room notices that the surgical patient’s
temperature has dropped to 35.8°C (96.4°F). Which complication is this patient at the
greatest risk for developing in the immediate postoperative period?
A. Malignant hyperthermia
B. Increased blood loss
C. Delayed wound healing and surgical site infection
D. Hyperactive bowel sounds
**Correct Answer: C**
*Rationale:* Mild perioperative hypothermia (normothermia is 36.5°C to 37.5°C) causes
peripheral vasoconstriction, leading to decreased oxygen delivery to the surgical
wound. This impairs leukocyte function and collagen synthesis, significantly increasing
the risk of surgical site infections and delaying wound healing. Malignant hyperthermia
is a hypermetabolic crisis triggered by specific anesthetics, not a drop in temperature.
**Question 3**
The post-anesthesia care unit (PACU) nurse receives a patient following a total
abdominal hysterectomy. The patient is restless, moaning, and thrashing around on the
bed. Their blood pressure is 170/100 mmHg, heart rate is 110 bpm, and respiratory rate
is 28 bpm. What is the priority nursing intervention?
A. Administer a PRN antiemetic as the patient is likely nauseous.
B. Apply soft wrist restraints to prevent self-injury.
C. Assess for a distended bladder and prepare to insert a Foley catheter.
D. Administer an IV bolus of normal saline to treat hypovolemia.
**Correct Answer: C**
*Rationale:* The patient is exhibiting classic signs of emergence delirium/agitation
combined with potential pain, but the most common physiological cause of sudden
restlessness, tachycardia, and hypertension in the immediate postoperative period of
an abdominal surgery is a distended bladder (urinary retention). Once pain and
oxygenation are ruled out/managed, assessing for urinary retention is the priority
intervention.
NURSING ()
MODULE 1: PERIOPERATIVE NURSING
**Question 1**
A patient is scheduled for a laparoscopic cholecystectomy. During the preoperative
assessment, the patient states they take St. John’s Wort for mild depression. What is
the priority nursing action?
A. Document the herbal supplement in the chart and proceed with surgery.
B. Instruct the patient to stop taking the St. John’s Wort 2 weeks prior to surgery due to
the risk of serotonin syndrome when combined with anesthesia.
C. Tell the patient to take their usual dose of St. John’s Wort on the morning of surgery
to prevent withdrawal.
D. Ask the provider to prescribe a stronger SSRI to replace the herbal supplement.
**Correct Answer: B**
*Rationale:* St. John's Wort is an herbal supplement that acts as a weak serotonin
reuptake inhibitor. When combined with certain anesthetic agents (like ketamine or
meperidine) or postoperative opioids, it can precipitate serotonin syndrome, a life-
threatening condition. It also increases metabolism of other drugs. It should be
discontinued at least 2 to 3 weeks prior to surgery.
**Question 2**
, The circulating nurse in the operating room notices that the surgical patient’s
temperature has dropped to 35.8°C (96.4°F). Which complication is this patient at the
greatest risk for developing in the immediate postoperative period?
A. Malignant hyperthermia
B. Increased blood loss
C. Delayed wound healing and surgical site infection
D. Hyperactive bowel sounds
**Correct Answer: C**
*Rationale:* Mild perioperative hypothermia (normothermia is 36.5°C to 37.5°C) causes
peripheral vasoconstriction, leading to decreased oxygen delivery to the surgical
wound. This impairs leukocyte function and collagen synthesis, significantly increasing
the risk of surgical site infections and delaying wound healing. Malignant hyperthermia
is a hypermetabolic crisis triggered by specific anesthetics, not a drop in temperature.
**Question 3**
The post-anesthesia care unit (PACU) nurse receives a patient following a total
abdominal hysterectomy. The patient is restless, moaning, and thrashing around on the
bed. Their blood pressure is 170/100 mmHg, heart rate is 110 bpm, and respiratory rate
is 28 bpm. What is the priority nursing intervention?
A. Administer a PRN antiemetic as the patient is likely nauseous.
B. Apply soft wrist restraints to prevent self-injury.
C. Assess for a distended bladder and prepare to insert a Foley catheter.
D. Administer an IV bolus of normal saline to treat hypovolemia.
**Correct Answer: C**
*Rationale:* The patient is exhibiting classic signs of emergence delirium/agitation
combined with potential pain, but the most common physiological cause of sudden
restlessness, tachycardia, and hypertension in the immediate postoperative period of
an abdominal surgery is a distended bladder (urinary retention). Once pain and
oxygenation are ruled out/managed, assessing for urinary retention is the priority
intervention.
