107. 10. Oxygen saturations should be >90%, according to the PACU discharge criteria, which must be met for ambulatory surgery discharge. She is sleepy but awakens easily and is oriented when spoken to. “I must avoid all sources of wheat, rye, and oats in my diet.”, c. “A course of antibiotics is usually effective in treating this disorder.”, d. “To control the fatty, greasy stools, I should eat only very low-fat or fat-free foods.”. When providing teaching to a patient, which action is important to help the patient in performing controlled coughing? Notify the surgeon and anticipate orders for bed rest, leg elevation, and initiation of anticoagulation (e.g., heparin intravenous drip). 24. Explain that the drug will help prevent clot formation in the legs. 80. If no voiding occurs, the abdominal contour should be inspected, and the initial action is to palpate and percuss the bladder for distension. d. No intravenous (IV) narcotics have been given in the past 30 minutes. }, Get a unique conceptual approach to nursing care in this rapidly changing healthcare environment. 57. The circulating nurse is a “nonsterile” member of the surgical team who assumes responsibility and accountability for maintaining patient safety and continuity of quality care. Which of the following is the meaning of the suffix -ostomy? What is an appropriate nursing intervention for this problem? Content covers all aspects of nursing care including health promotion acute intervention and ambulatory care. Because swelling is likely to affect the scrotum, a scrotal support and ice are used to reduce edema. c. Place a pillow over the incisional site for splinting. The physician suspects an intussusception and orders placement of an nasogastric (NG) tube while determining whether surgery is indicated. Which of the following is an integumentary system clinical manifestation of inadequate oxygenation? Reassure her that IBS has a specific, identifiable cause. When would that be? The total colectomy and ileal reservoir enable the patient to pass stool rectally but require two procedures 8 to 12 weeks apart. What is the most appropriate response? Medical-Surgical Nursing. Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam. The _______________ phase begins when the patient enters the operating room suite and ends with admission to the post anesthesia care unit (PACU). Reassure the patient that the stoma will shrink, and she will get used to caring for the ileostomy. 17. An 82-year-old man is admitted to the hospital the evening before a prostatectomy for cancer of the prostate. View the Latest MEDSURG Nursing Issues . a. High-fibre foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Never position the patient with hands over the chest (reduces chest expansion). 134. Lewis’s Medical-Surgical Nursing, 11 th Edition . She will speak with the surgeon to see if he will make an exception. & apply online links. What is the most appropriate intervention in response to the patient’s complaint? Grasp one end of the sterile towel to dry one hand thoroughly, moving from fingers to elbow in a rotating motion. c. Diaphragmatic breathing exercises still can be performed. 146. Washing hands for a minimum of 15 minutes with soap and water, b. c. The nurse’s legal responsibility is to ensure that the patient understands the information presented. Medical Surgical Nursing Practice Test Part 2 (Exam Mode) By Rnpedia.Com 13 Questions | By Rnpedia | Last updated: Jun 8, 2015 | Total Attempts: 11788 Questions All questions 5 questions 6 questions 7 questions 8 questions 9 questions 10 questions 11 … a. Patients with FAP have a high likelihood of developing colorectal cancer by age 40; therefore, total colectomy with ileostomy is recommended for these patients. The nurse plans care for the patient based on the knowledge that management of his condition initially involves which of the following actions? 120. d. The patient is warned about complications that can occur without the activities. While supervising the surgical team, the charge nurse notices that a team member’s nails are long and chipped. Medical-Surgical Nursing. The patient may wear makeup if she insists. Studies have found that surgical staff may transmit pathogens via contact with patients and contaminated items. During a preoperative assessment, which of the following reported allergies does the nurse recognize as a risk for latex allergy in the patient? Healthcare is evolving at an incredible pace and with it, the roles and responsibilities of the medical-surgical nurse. 11. During the nursing history, what is the most helpful question to obtain information regarding the patient’s condition? The nurse recognizes that which of the following statements is true? The patient’s age and history of antibiotic use suggest a C. difficile infection. Document a list of items and their locations in a preoperative checklist and/or in the nurses’ notes per agency policy. The goal of prophylactic antibiotic therapy is to protect the patient from infection with as little risk as possible. Hereditary polyposis syndromes are neoplastic polyps of the large intestine. Report wound dehiscence and/or evisceration to the surgeon immediately because it could be life threatening. Use printed materials for instruction because the patient does not hear well. Unscrubbed persons should always stay at least 1 foot away from the sterile field while keeping it in constant view and should contact only unsterile areas. 115. c. Ask the surgeon to identify the patient and the planned surgical procedure. 29. b. Topics that med surg nurses can typically find in med surg CEUs include patient restraints, complication prevention, UTIs and oral antibiotics, clotting disorders, and more. 14. b. The nurse can be a patient advocate, verifying that the patient (or a family member) understands the consent form and its implications and that consent for surgery is truly voluntary. b. A patient with Crohn’s disease develops a fever and symptoms of a urinary tract infection. Opening the sterile gown pack on a sterile surface, b. “The medication will prevent infections that cause the diarrhea.”, b. b. Elsevier's COVID-19 Healthcare HubFree health and medical research on the novel coronavirus (SARS-CoV-2) and COVID-19, { Her preoperative blood pressure was 120/68 mm Hg, and on admission to the PACU, her blood pressure was 124/70 mm Hg. Which one of the following intraoperative patient positions would the nurse anticipate for the patient who is being prepared for abdominal surgery? The nurse recognizes that evidence-based care is appropriate when the nurse witnesses the surgeon take which step? 45. b. The registered nurse first assistant’s primary role is to carry out preoperative, intraoperative, and postoperative nursing responsibilities to ensure a safe, efficient patient experience. e. Sterile persons may position themselves with their back to the sterile field. Remove the indwelling urinary catheter. d. Keep these items with her until the patient returns. (Select all that apply.). d. Supine with the head of the bed elevated. Be careful not to create a tourniquet effect with tape around the finger. d. Have the patient exercise that extremity. Start studying Medical surgical nursing 2. The initial assessment is focused on determining whether the patient has hypovolemic shock; therefore, the priority action is to assess the BP and pulse. Counting sponges, needles, and instruments, c. Passing instruments to the surgeon and assistants, d. Preparing the instrument table and organizing sterile equipment. The scrub nurse’s hands are being washed in preparation for a surgical procedure. The stoma appearance indicates good circulation to the stoma. b. Administer stool softeners as ordered. a. a. Administer analgesics as written in the patient’s postoperative orders. a. b. 800 illustrations (800 in full color), NEW! Older adults often have osteoporosis and osteoarthritis. Healthcare is evolving at an incredible pace and with it the roles and responsibilities of the medical-surgical nurse. Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam. 26. A woman diagnosed with irritable bowel syndrome (IBS) tells the nurse that her friends say her problem is “all in [her] head.” In caring for the woman, what is it most important for the nurse to do? What should the nurse do next? While the patient is in the OR and the OR team is gowned and gloved, the nurse recommends completion of a safety checklist. Encourage the patient to take deep breaths. 23. The nurse’s communication with Sarah is based on the knowledge that the most prevalent fear of patients awaiting surgery is which of the following? Management of sterile instruments and handing instruments to the surgeon are included in the scrub role. Huff coughing is used to promote expectoration of mucus. The inflammatory process causes the shift of fluids into the peritoneal space. “Only your surgeon can tell you for sure what method of anaesthesia will be used. c. Assure the patient that his lack of control is temporary and will resolve with treatment of the disorder. Some respiratory depression is evident. Which of the following have been identified as evidence-based guidelines to reduce surgical site infections (SSIs)? , Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN and Courtney Reinisch, RN, DNP, FNP-BC, Approx. In teaching the patient about the care of her ileostomy, what should the nurse advise the patient to do? 40. Position the patient in a lateral position. An allergy to bananas puts the patient at risk for a latex allergy. 145. To help maintain the patient’s self-esteem, what should the nurse implement? Clinical manifestations of a small intestine obstruction include a rapid onset, frequent and copious vomiting, colicky, cramplike, intermittent pain, feces for a short time, and minimal abdominal distension. If the patient states that she might be pregnant, information should be immediately given to the surgeon to avoid maternal and subsequent fetal exposure to anaesthetics during the first trimester. A 20-year-old university student is admitted to the emergency department for evaluation of abdominal pain with nausea and vomiting. 78. 98. Apply an ice pack to the right lower quadrant. 64. Repositioning the patient regularly reduces the risk for vascular complications. A patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as illustrated. This thoroughly revised text includes a m......view more. Using alcohol hand scrub for 15 minutes, c. Using alcohol combined with chlorhexidine gluconate hand scrubs, d. Using a combination of soap and alcohol as a scrub. The nurse would anticipate a patient that was being prepared for abdominal surgery to be in a supine position for surgery. A patient presents at the emergency department with complaints of diarrhea and weight loss. A 26-year-old woman is diagnosed with Crohn’s disease after having frequent diarrhea and a weight loss of 4.5 kg over 2 months. Put these items in the patient’s bedside stand. A 74-year-old man is to have a left inguinal hernia repair at the outpatient surgical clinic. This course is a continuation of Medical-Surgical Nursing I with application of the nursing process to the care of the adult patient experiencing medical-surgical conditions along the health-illness continuum in a variety of health care settings. Never use a felt tip marker to mark the dressing because ink can bleed into the gauze, contaminating the incision site. An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO status. (Select all that apply. The patient is in the hospital awaiting surgery. “The medication suppresses the inflammation in my large intestine.”, c. “I will need lab tests to be sure that I can still fight infections.”, d. “I will take the sulphasalazine as an enema or suppository.”. An ambulatory surgical patient meets discharge criteria when no IV narcotics have been administered for the past 30 minutes, a responsible adult is present to accompany the patient home, respiratory depression is not present, and oxygen saturation is greater than 90%. Annual colonoscopy until the age of 40, c. Routine periodic polypectomies via a colonoscope to remove abnormal growths, d. Biannual colonoscopy for life because of a 50% chance of developing colon cancer. Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. Palpate pedal pulses. JavaScript seems to be disabled in your browser. Position the patient on his side with head facing down and neck slightly extended. The patient tells the nurse that the physician has not really told him what is involved in the surgical procedure. Text Mode – Text version of the exam 1. Place a nose clip on the patient’s nose. c. Check the patient’s temperature, and apply warm blankets. Long fingernails can puncture gloves, causing contamination. When planning care for a PACU or recovery room patient, how often should the nurse plan to assess the patient? A peritoneal lavage returns brown drainage. d. Recognize that this is a difficult period for the patient, and avoid intervening until she has had time to adjust to her situation. 21. 50. The nurse explains to the patient that the incentive spirometer is used to promote which of the following outcomes? When planning care for a surgical patient, the nurse recognizes that surgical site infections account for what percentage of hospital-acquired infection? 109. 25. The patient tells the nurse that she feels distended and has gas pains. A 36-year-old woman has been admitted to the hospital for knee surgery. According to the Canadian Anesthesiologists’ Society, the minimum preoperative fasting time period for intake of clear fluids is 2 hours. The patient will do this 2 to 3 times every hour he is awake. Showing 1 to 2 of 2 View all . Increased production of stress hormones, c. Extracellular fluid shift into the peritoneal cavity, d. Drainage of excessive fluids from the appendix into the peritoneal cavity. Which of the following would the nurse anticipate would be administered preoperatively? 6. c. Dietary sources of fibre should be eliminated from the diet to prevent excessive gas formation. b. These medications may alter the patient’s perceptions about surgery. b. Which assessment provides the nurse with information about this postoperative complication? Artificial nails harbor gram-negative microorganisms and fungus. d. Any proposed surgery for treatment of ulcerative colitis should be given serious consideration because the disease often recurs in previously unaffected parts of the bowel. The navel ring may impede assessment of the skin. Which action should the nurse take next? Cover the site with dry sterile dressings. Instruct the patient to assume semi-Fowler’s or high-Fowler’s position, and place a nose clip on the patient’s nose. Sarah, 46 years old, is in the preoperative assessment area awaiting surgery. c. Determine the presence of Rovsing’s sign. Conversational, reader-friendly writing style, Content written and reviewed by leading experts in the field. c. Take prescribed pain medications before a bowel movement is expected. c. Check the results of the partial thromboplastin time before administration. d. Check the postoperative orders for catheterization orders. The other answer options all cause an increase in body temperature, not a decrease. b. While caring for a postoperative patient, what should the nurse expect that a physiological response to stress during the first 2 to 5 days postoperatively will result in? Abdominal distension is seen in lower intestinal obstruction. d. Supplemental fat-soluble vitamins must be taken because the medication blocks absorption of these vitamins. 39. The nurse notes that there are no preoperative orders regarding the patient’s daily insulin dose. ), d. Certified registered nurse anesthetist. Reduced glomerular filtration rate and excretory times limit the ability to remove drugs or toxic substances. 73. Which of the following should be the nurse’s preoperative consideration when the patient states that she takes a garlic pill every day? "components": { A visitor from an ostomy support group who has had similar experiences may be helpful to the patient. b. Understanding patient safety, the nurse tells the patient that which item may remain in place? 91. Takes a sitz bath for 40 minutes following each stool, b. Lewis’s Medical-Surgical Nursing 11th Edition gives you a solid foundation in medical-surgical nursing. b. Being overweight or obese increases the risk for many diseases and health conditions, including which of the following? The nurse will contact the surgeon and explain the need for additional information if the patient is unclear about operative plans. Confirm the diagnosis of colon cancer. VNG 1332: Medical-Surgical Nursing II (3-2-3). The scrub nurse/technician who accidentally touches the faucet with one hand while rinsing will rescrub. a. b. b. In the case of insulin, it is important to clarify the time and amount of the last dose before surgery. When planning care for a surgical patient, the nurse implements which technique to maintain sterility in the operating room? Through the use of an antimicrobial agent and sterile brushes or sponges, the surgical hand scrub removes debris and transient microorganisms from the nails, hands, and forearms, and inhibits rapid/rebound growth of microorganisms. b. c. For no longer than 24 hours after surgery. For the best experience on our site, be sure to turn on Javascript in your browser. d. She performs delegated medical functions or skills. b. Administer the dose with meals to prevent gastrointestinal irritation and bleeding. The colostomy is dressed with petroleum jelly gauze and dry-gauze dressings. Text Mode – Text version of the exam 1. a. d. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. d. It may depress the immune system response, delaying healing. Representatives, By Mariann M. Harding, PhD, RN, FAADN, CNE, Jeffrey Kwong, DNP, MPH, RN, ANP-BC, FAAN, FAANP, Dottie Roberts, RN, MSN, MACI, CMSRN, OCNS-C, CNE 69. Open the sterile gown and glove package on a clean, dry, flat surface. d. Develop a trusting relationship with her to allow for the expression of her concerns. What should the nurse do to accomplish preoperative teaching with the patient? 82. A tube will be inserted into your throat to deliver a gas that will put you to sleep.”, d. “You will be so sleepy from the preoperative medication you have received that you will not be aware of the anaesthetic administration.”. The charge nurse is assigning duties in the surgical arena. The nurse identifies that teaching about the treatment of the disease has been effective when the patient makes which of the following statements? 128. When wearing a sterile gown, do not fold the arms with hands tucked in the axillary region. A patient with acute diarrhea of 24 hours’ duration calls the clinic to ask for directions for care. When a patient is transferred from the PACU to the clinical surgical unit, what is the first nursing action on the surgical unit? Calf tenderness, redness, and edema in the lower extremity are signs and symptoms of venous thrombosis or thrombophlebitis. The nurse will anticipate teaching the patient about the ongoing need for which of the following? a. MEDSURG Nursing is a scholarly journal dedicated to advancing evidence-based medical-surgical nursing practice, clinical research, and professional development. Patients may brush their teeth but should not swallow water. a. Treatment of hypotension should always begin with oxygen therapy to promote oxygenation of hypoperfused organs. 72. Instruct the patient to remain flat in bed. While obtaining a nursing history from a patient scheduled for a colonoscopy, what would the nurse be most concerned about? All findings of the medication history should be documented and communicated to the intraoperative and postoperative personnel. b. What is the most appropriate nursing action? Overview of Health Concepts for Medical-Surgical Nursing 4. 2. The patient is able to drive home alone. If the surgical incision is to be thoracic or abdominal, teach the patient to place a pillow over the incisional area and to place his hands over the pillow to splint the incision. gives you a solid foundation in medical-surgical nursing.. Key topics such as interprofessional care delegation safety and prioritization are integrated throughout. The nurse recognizes that the major loss of circulating fluid volume occurs as a result of which of the following? a. Stool cultures reveal the presence of Clostridium difficile. The nurse identifies a nursing diagnosis of impaired skin integrity related to diarrhea for a patient with ulcerative colitis. When the patient returns from surgery, however, he cannot be placed upright and must remain flat. This includes supervising the conduct of the scrub technician and delegating tasks to licensed and unlicensed nursing assistive personnel (NAP) as appropriate. The nurse understands that the checklist verifies which of the following? Avoidance of gluten-containing foods is the only treatment for celiac disease. d. A 24-hour diet history that reveals a 1500-calorie intake. What are the physical environment and traffic control measures of the OR primarily designed to do? What will the nurse anticipate that the patient will need to do? Medical-Surgical Nursing, Patient-Centered Collaborative Care Volume 2 (Volume 2) Donna D. Ignatavicius, M. Linda Workman Hardcover Publisher: Saunders Elsevier Jan 1 2010 He closes his eyes and will not talk to the nurse when his linens are changed and skin care is performed. Check that the operative procedure is noted on the chart. a. What does the nurse tell the patient about performing the diaphragmatic exercises? Marco who was diagnosed with brain … When evaluating a health care team member’s ability to put on a sterile gown and perform closed gloving, it is most important for the nurse to assess for which outcome? Anxiety can arise from lack of knowledge, which may range from not knowing what to expect during the surgical experience to uncertainty about the outcome of surgery and the potential findings; therefore, it is important that the nurse help explore the patient’s feelings. Decreased risk for exposure to bloodborne pathogens, c. Increased perforations to the innermost glove, d. Decreased risk for surgical wound infection, 140. Although the skin cannot be sterilized, operating room personnel can greatly reduce the number of microorganisms by chemical, physical, and mechanical means. Which member of the surgical team should be assigned to the role of circulating nurse? 129. b. Upon entering a patient’s room, the nurse finds that the abdominal surgical wound has eviscerated. A downward position of the head moves the tongue forward, and mucus or vomitus can drain out of the mouth, preventing aspiration. d. Ask the patient’s wife to wait in the hall in order to focus on preoperative teaching with the patient himself. Preoperatively, what is it most important for the nurse to determine? Giving antibiotics immediately after the procedure, 126. c. Sterile persons must fold arms across chest with hands tucked into the axillary region. Medical-Surgical Nursing Exam Sample Questions. If the patient prefers not to remove a wedding ring, the ring can be taped securely to the finger to prevent loss. After being treated for a respiratory tract infection with a 10-day course of antibiotics, a 69-year-old patient calls the clinic and tells the nurse about developing frequent, watery diarrhea. “Have you discussed these feelings with anyone else?”, c. “I am sure surgical techniques have improved since your mother had surgery.”, d. “Think positively! a. Which of the following is part of the minimum requirements for the health record in ambulatory surgery facilities? The RNFA is a nurse with advanced education who assists the surgeon with the surgical procedure, performing a combination of nursing and delegated medical functions and/or skills. Which of the following is a clinical manifestation of an obstruction in the small intestine as opposed to the large intestine? Hypothermia during the first 12 hours after surgery is probably caused by the effects of the anaesthesia or body heat loss during surgical exposure. b. Her surgical dressing is dry and intact. a. Auscultating for bowel sounds every 4 hours, b. Why should the nurse notify the anaesthesiologist about this use of St. John’s wort? What is the best response? 3. c. The drainage is liquid at this site but less odorous than at higher sites. b. Monitoring drainage from the colostomy stoma, c. Assessing perineal drainage and incision, d. Encouraging acceptance of the colostomy site. She is splinting her abdomen and complaining of pain, and bowel sounds are decreased. Do not touch the outside of the gown, and do not allow it to touch the floor. Instruct the patient to coordinate turning and leg exercises with diaphragmatic breathing, incentive spirometry, and coughing exercises. d. Identify the need for radiation or chemotherapy. 51. d. Ask the team member why the nails are long and chipped. A leg unaffected by surgery can be exercised safely unless the patient has preexisting phlebothrombosis (blood clot formation) or thrombophlebitis (inflammation of the vein wall). Thirty minutes after admission, her blood pressure is 112/60 mm Hg. 41. What is an appropriate collaborative problem for the nurse to identify for the patient at this time? When teaching the patient about positive expiratory pressure therapy (PEP) and “huff” coughing, the nurse incorporates which of the following in the plan of care? a. Latest from AMSN. Which did the Nursing Executive Center of The Advisory Board identify as an academic-practice gap for new graduate nurses? b. Verbalization of anxiety by the patient, c. The patient asking about the details of the surgical procedure, d. An 8-mm Hg increase in systolic blood pressure from the time of hospital admission. A patient is admitted to the emergency department with severe abdominal pain, anorexia, and chills. The circulating nurse is always an RN who is the charge nurse in the operating room. Choose from 500 different sets of medical surgical nursing 2 flashcards on Quizlet. Before undergoing a colon resection for cancer of the colon, a patient has an elevated carcinoembryonic antigen (CEA) test result. c. Use care when eating high-fibre foods to avoid obstruction of the ileum. The most common cause of postoperative hypoxemia is atelectasis. Which stool consistency would the nurse expect to see in a patient with a sigmoid colostomy? a. When the patient asks about the tube and the drainage, what is the nurse’s best response? On the third inhale he should hold the breath to a count of 3. She provides the surgeon with instruments. Postoperatively, a patient is receiving low–molecular weight heparin. 71. b. Although performing the diaphragmatic exercises in the upright position is ideal, the patient can still benefit from performing the exercises while laying flat. a. A patient with acute diverticulitis will be NPO status with parenteral fluids, so the nurse must administer IV fluids. All other oral medications are withheld. What is the most appropriate response? d. A family member or friend is available for transportation and care at home. b. 114. Level Up on Your Exams and Career. A patient who had bowel surgery 2 days ago has orders for morphine sulphate 4 mg IV every 2 hours and a clear liquid diet. Once in place, gowns are sterile from the front chest and shoulders to table level and on the sleeves to 2 inches (5 cm) above the elbow.
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