CPAN EXAM 2024 WITH ATUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS BY EXPERTS, Exams of Nursing

Download CPAN EXAM 2024 WITH ATUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS BY EXPERTS and more Exams Nursing in PDF only on Docsity! 1 | P a g e CPAN EXAM 2024 WITH ATUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS BY EXPERTS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+ |NEWEST|GUARANTEED PASS |LATEST UPDATE 3 A 24y/o adopted male patient engaged to be married in the fall has been told that he is at risk for MH. He is anxious about the possibility of passing on this susceptibility to any offspring. The nurse interviewing this patient knows that the most definitive test for MH is: 1. Serial serum studies 2. Thermoregulation challenge test 3. Caffeine-halothane contracture test 4. Genetic testing 4 Dantrolene sodium require dilution. The most appropriate diluent is: 1. Sterile water with a bacteriostatic agent 2. Sterile saline with a bacteriostatic agent 3. Sterile saline without a bacteriostatic agent 4. Sterile water without a bacteriostatic agent 1 Common signs of MH that follow an increase in ETCO2 include tachycardia, tachypnea, and: 1. Muscle spasm 2. Complete pharyngeal relaxation 2 | P a g e 3. Sudden drop in ETCO2 4. Piloerection 2 Complications after an acute MH crisis include: 1. Acute hepatic failure 2. Acute renal failure 3. Permanent muscle contractures 4. Cardiomyopathy 4 Temperature elevation associated with MH: 1. Occurs after the patient is brought to the Phase I PACU 2. Often occurs immediately 3. Occurs before a rise un ETCO2 but after masseter spasms 4. Occurs as a late sign of MH event 1 Adverse effects of dantrolene include transient muscle weakness, GI upset, ventilatory compromise and: 1. Phlebitis 2. Oliguria 3. Hyperactivity 4. Polycythemia 1 A patient is suspected of having a MH event. Lab work is drawn. CK is elevated. This indicates: 1. Muscle breakdown 2. Falling calcium levels 3. Acidosis 4. Rising calcium levels 1 Lab test during the acute phase of MH are required. These include: 1. CK, myoglobins, and CMP 2. PTT, glucose, and blood cultures 3. Acetylcholinesterase, C-reactive protein, and CBC 4. PTT, fibrinogen, and immunoglobuins 4 5 | P a g e 2. cleaning of common items 3. standard precautions 4. limited traffic patterns 1 Following general anesthesia, the patient develops supraclavicular retraction, expiratory wheezing, diaphoresis, tachycardia, severe apprehension, and profuse frothy pink sputum. These signs and symptoms most precisely indicate: 1. pulmonary edema 2. pulmonary embolus 3. pulmonary infarction 4. pulmonary fibrosis 1 A patient has received an automatic implantable cardioverter defibrillator AICD. Postoperative teaching includes advising the patient to avoid: 1. MRI scans 2. microwave ovens 3. CT scans 4. chest X-rays 3 Treatment protocols in the respiratory resuscitation of an infant in the PACU always include administration of: 1. cool mist FiO2 35% 2. racemic epinephrine 3. FiO2 100% 4. naloxone IV 1 As the defendant in a lawsuit filed by a patient, a hospital is most likely to be at risk because of: 1. incomplete documentation of patient care 2. prejudice in favor of the patient 3. incomplete witnesses 4. failure of nursing personnel to submit an incident report at the time of an accident 3 The perianesthesia nurse caring for a patient with a history of malignant hypertension knows that capnography is the measurement of: 6 | P a g e 1. alveolar air flow 2. end respiratory pressure changes 3. exhaled carbon dioxide 4. respiratory muscle strength 2 Post-operative patients are susceptible to infection. The perioperative nurse is aware that primary to infection control and prevention of disease transmission is: 1. timely administration of antibiotics 2. proper handwashing 3. use of disposable care items 4. use of isolation precautions 2 Which of the following conditions would be of primary concern following hepatectomy in a patient with a history of coronary artery disease? 1. sinus tachycardia 2. potential large blood loss 3. hyponatremia 4. magnesium level of 1.5 1 The anesthesiologist reports to the PACU nurse that a laryngeal mask airway was used during intravenous anesthesia. The nurse interprets this as an indication of difficult ventilation in: 1. bearded patients 2. morbidly obese patients 3. pregnant patients 4. intestinal obstruction patients 4 Metabolic acidosis is relatively benign at a bicarbonate level of: 1. 2.5 mEq/L 2. 5.5 mEq/L 3. 7.5 mEq/L 4. 15 mEq/L 1 Tidal volume is most precisely defined as the amount of: 1. gas passing into or out of the lungs in each respiratory cycle 7 | P a g e 2. air exchange with full inspiration and expiration 3. gas remaining within the chest after maximal expiration 4. air exchange in one minute 2 According to the ASPAN Standards, the following MUST be available at the bedside in Phase I level of care: 1. capacity to measure end-tidal CO2 2. means to ensure patient privacy 3. visual aids for acceptable pain scales 4. peripheral nerve stimulator 3 The perianesthesia nurse's MOST EFFECTIVE tool to asses ICP of a pediatric patient with a traumatic brain injury is: 1. Glascow coma scale rating 2. observation for seizure activity 3. direct ventricular pressure monitoring 4. ongoing MRI imaging 4 The perianesthesia nurse reviews the current evidence in perioperative management of patients with malignant hyperthermia susceptibility, which includes the following information: 1. midazolam is now contraindicated 2. premedication with anticholinergics is effective 3. monitoring patients for a minimum of 12 hours after surgery 4. pretreatment with dantrolene is no longer indicated 4 Rapid correction of chronic respiratory acidosis MOST LIKELY results in: 1. ventricular fibrillation 2. respiratory alkalosis 3. convulsions 4. apnea 1 A teaching plan based upon the development stage of a 9 year old patient includes: 1. allowing the patient to assist with care 2. restricting the use diagrams 10 | P a g e 3 A 32 year old s/p total abdominal hysterectomy is admitted to PACU after having returned to the OR for cauterization of an arterial bleed. As a Jehovah Witness (JW), the patient signed a refusal for blood consent prior to surgery. On arrival to PACU the patient is pale, diaphoretic, and lethargic. Anesthesia reports and EBL = 1200cc and hemoglobin 7.2. Current vitals HR 36, BP 72/35, and oxygen saturation 88% on a non-rebreather. The perianesthesia nurse has an order to transfuse 2 units of PRBCs stat. The nurse response is to: 1. visit with patients' family about the grim outcome and obtain consent to permit this transfusion. 2. petition the leader of the Jehovah's witness church to allow a one-time life-saving transfusion 3. abide by the JW religious preferences and refuse to follow the doctor's transfusion orders. 4. follow the doctor's order and prepare to administer 2 units packed red blood cells (PRBC). 3 An 80 year old male arrives in PACU status post splenectomy for abdominal trauma sustained in an MVA. Patient has significant blood loss in OR. BP 90/60, HR 125, RR 30. A set if arterial blood gases are obtained. Results: pH 7.27, pO2 120, CO2 30, and HCO3 -18. What is the best INITIAL treatment for this patient? 1. start a dopamine infusion at 5 mcg/kg/minute 2. increase the ventilator tidal volume 3. administer a bolus of isotonic fluids 4. administer sodium bicarbonate 1mg/kg 4 An elderly patient requires re-intubation in PACU and a propofol infusion is started. The patient's blood pressure has decreased to 88/45 mmHg. The FIRST consideration of the perianesthesia nurse should be that: 1. the medication should be changed because the drug is not tolerated well in geriatric patients. 2. transient hypotension is no unusual with this medication. Observe only. 3. unless accompanied by tachycardia, no intervention usually required. 4. the infusion rate may be adjusted because the drug may cause dose-related hypotension. 1 Which of the following drugs produces an inactive metabolite making it suitable for use in patients with end stage renal disease? 1. hydromorphone 2. morphone 3. meperidine 4. tizandinine 2 11 | P a g e A PACU nurse manager receives a report that two PACU nurses who do not work well together area discussing their conflicts in front of a patient. Before taking disciplinary action, the nurse manager will FIRST: 1. discuss solution of the conflict with the perioperative nursing director 2. acknowledge the existence of a conflict and identify a solution 3. send a written warning about the incident to the nurses involved 4. refer both nurses to human resources to deal with the conflict 2 A patient in PACU status post right ankle ORIF develops sternal chest pain, tachypnea, and pallor. The monitor shows a blood pressure of 84/45. Oxygen is applied via NRM at 10L per minute and ECG shows new onset of atrial fibrillation. The PACU nurse initiates intervention and plans initial treatment which is to: 1. check the patient's blood sugar 2. relieve chest pain 3. prepare for possible code blue 4. examine fractured limb for bleeding 1 In the treatment of post anesthesia emergence phenomena associated with ketamine administration, the drug of choice is: 1. diazepam 2. meperidine hydrochloride 3. morphine 4. chlorpromazine hydrochloride 4 restlessness/agitation first signs of hypoxia A 79 year old patient admitted to the PACU following general anesthesia is restless, agitated, screaming, and demanding to go home. The perianesthesia nurs's BEST response is to: 1. obtain an order for valium to calm the patient down. 2. apply a full body restraint on the patient for safety. 3. have patient sign the "discharge against medical advice" form. 4. remain with patient and frequently assess oxygenation. 3 Before initiating a blood transfusion, the perianesthesia nurse ensures that the patient received: 1. diazepam 12 | P a g e 2. involuntary consent 3. informed consent 4. diphenhydramine 2 The perianesthesia nurse monitors a patient's respiratory status capnography. Patient's temperature is 95.9 F. On rewarming the patient, the perianesthesia nurse appraises the increase of ETCO2 as: 1. a decrease in metabolic rate 2. normal as metabolic rate increases 3. an untoward reaction 4. pulmonary hypoperfusion 4 By minimizing harm and maximizing comfort, the perianesthesia nurse exhibits which of the following principles? 1. Respect for autonomy 2. Justice 3. Confidentiality 4. Non-maleficence 1 In caring for the patient in PACU, the nurse recognizes that post-operative nausea and vomiting: 1. can increase cardiovascular demand placing compromised patients at risk for myocardial infarction. 2. is rated by patients as being less debilitating than postoperative pain. 3. does not include other drugs therapies like neuroleptics for prevention and treatment. 4. occurs in as many as 15% of all surgical patients and in 50% of high risk patients. 3 When caring for a postoperative patient who is recently extubated, the perianesthesia nurse's most appropriate choice of a short term, high flow oxygen delivery system to augment inspired oxygen concentrations and reduce dyspnea is: 1. venturi mask 2. t-piece 3. high flow nasal cannula 4. face tent 1 An ASA IV patient with sever coronary artery disease is admitted to the Ambulatory Surgical Center from a local nursing home for insertion of a suprapubic tube. Before leaving the OR the patient developed airway issues and now arrives in phase I PACU on a non-rebreather mask with sidestream capnography. 15 | P a g e state his/her date of birth. There are no available family members either in the waiting room or by telephone. The OR staff is present and waiting to take the patient. The perianesthesia nurse should: 1. proceed with surgery and obtain a phone consent once a relative can be reached. 2. inform the OR staff there will be a delay or possible cancellation of the case. 3. ask the surgeon to declare the surgery an emergency and proceed. 4. leave the consent as is since it was signed in the surgeon's office. 1 A patient with a BMI of 38 arrives at the PACU following an exploratory laparotomy under general anesthesia. The perianesthesia nurse observes the patient to be snoring with an SPO2 of 88%. The priority nursing intervention is to: 1. reposition the patient's airway 2. maintain patient in a supine position 3. report initial set of vital signs to the anesthesiologist 4. apply oxygen via mask at 40% O2 4 Which of the following preoperative patients would the nurse assess as at risk for PONV? 1. A 50 year old male scheduled for a right cataract extraction with lens implantation 2. A 25 year old female scheduled for a laparoscopic cholecystectomy 3. A 40 year old male scheduled for a lithotripsy for right renal calculus 4. A 38 year old female scheduled for a second surgery for breast reconstruction 3 A patient enters the PACU following a left shoulder rotator cuff repair. The patient received MAC (monitored anesthesia care), anesthesia and an intrascalene nerve block. Which of the following assessments requires the perianesthesia nurse to notify the surgeon? 1. numbness and inability to move left arm 2. pain level of 3 in the numeric scale and decreased motor activity left arm 3. SPO2 of 88% of 2L oxygen via nasal cannula and complaint of chest pain 4. shallow respirations and pain in left shoulder 1 The perianesthesia nurse is aware that discharge teaching after an arteriovenous AV fistula left arm placement includes: 1. keep surgical arm elevated for several days 2. allow injections but no BP measurements 3. place circumferential dressings only 4. keep surgical arm at the heart level 16 | P a g e 2 The perianesthesia nurse was informed is told that ASPAN's standard for staffing and personnel management are met in PACU phase I at night by the presence of the RN in the OR suite. This is: 1. in compliance 2. not in compliance 3. in compliance with but not acceptable with position statement "on-call/work schedule" 4. acceptable with position statement "on-call/work schedule" 1 One hour after extubation, a four-year old child arrives in PACU, Phase II, with a hoarse, barking cough. The perianesthesia nurse assesses the child for: 1. post-extubation croup 2. post-extubation irritation 3. possible aspiration 4. fluid overload 4 The perianesthesia nurse instructs a patient to continue taking metoprolol prior to surgery because: 1. antidysrhythmic medications decrease fibrillation threshold during anesthesia induction. 2. vagolytic medications prevent tachycardia and perioperative myocardial infarction 3. vasodilators increase systemic vascular resistance in the post-operative phase 4. beta blockers aid in controlling the sympathetic responses in the perioperative phase 2 A federal law passed in 1990 that requires hospitals and other health care providers to provide written information to patients regarding their rights under state law to make medical decisions and execute advance directives. A patient being prepared for surgery informed the perianesthesia nurse about his/her decision to cancel surgery. The perioperative nurse is aware the patient has the right to accept or refuse medical or surgical treatment under: 1. U.S. Department of health and human services 2. Patient self-determination act 3. Patient Bill of Rights 4. Patient's Right to Autonomy 1 A patient in the pre-op holding area inquires about chewing gum while waiting to go to surgery. The nurse instructs the patient to : 17 | P a g e 1. avoid chewing gum 2. stop chewing at least 15 minutes before surgery 3. use sugarless gum 4. chew gum for a very brief period of time 3 The perianesthesia nurse's MOST effective assessment of a 4-year old's postoperative pain level is: 1. observing for intermittent crying 2. evaluating vital signs 3. using a face scale 4. determining the type of surgery 3 The surgeon's notes stated, "Will obtain patient's consent for release of carpel tunnel right wrist." During the pre-op visit, the patient stated that the surgeon will operate on the left wrist. The nurse should: 1. obtain consent for left wrist carpal tunnel release 2. confirm the correct site through a diagnostic procedure 3. clarify the correct operative site with the surgeon 4. obtain consent for right wrist carpal tunnel release 2 During a postoperative phone call, the patient describes symptoms of akathisia. The perianesthesia nurse suspects a reaction to: 1. fentanyl 2. prochlorperazine 3. odansetron 4. dexamethasone 3 During preoperative screening, a 28 year old male reports cocaine use. The perianesthesia nurse informs the patient that cocaine use may cause: 1. significant vasodilation and decreased blood pressure 2. depression of the central nervous system 3. myocardial ischemia with cardiovascular instability 4. postoperative hypotension and bradycardia 4 20 | P a g e 3. Monitor vital signs, urinary output, and labs, if ordered 4. All of the above 2 Enhanced recovery pathways encourage patients to fast from clear liquids for at least 6 hours prior to their procedure. 1. True 2. False 1 A urinary output rate of greater than 0.5mL/kg/hr in adult patients indicates adequate fluid volume and renal perfusion. 1. True 2. False 3 ECG monitoring is important for patients with acute renal failure with hyperkalemia. ECG tracing may shows all of the following EXCEPT: 1. Tall peaked T wavees 2. Heart blocks 3. U waves 4. Depressed ST segment 2 streroid increase BP, decrease would healing, increase glucose level The nurse caring for a patient with Addison's disease is aware that perioperative steroid administration can increase the risk of: 1. Hypotension 2. Stress ulcers 3. Improve would healing 4. Increase glucose tolerance 4 Pheochromocytoma is a benign tumor of the adrenal medulla with release of catecholamine. Symptoms include all of the following EXCEPT: 1. Severe hypertension 2. Hyperglycemia 21 | P a g e 3. Hypermetabolism 4. Decreased epinephrine 4 muscle rigidity seen in MH Thyrotoxic crisis can mimic MH. Which of the following symptoms can help differentiate that the patient is experiencing thyrotoxic crisis? 1. Rapid development of hyperthermia 2. Obvious onset of tachycardia 3. Discernible hypercarbia 4. Lack of muscle rigidity 3 nurse will treat with antidiuretic hormone A patient comes to the phase I PACU after a transsphenoidal resection of a pituitary tumor. It is reported there were no complications during surgery, vital signs are stable, 1500 mL of IVF administered, UO was 200mL, and there was minimal blood loss. The patient has been in PACU for 1 hour and the nurse empties the catheter drainage bag of 2000mL of slightly yellow urine. The patient is slightly tachycardic and hypotensive. IVF for the hour was 100mL. The patient did not receive any diuretics. The nurse suspects that the patient may be exhibiting symptoms of: 1. Diabetes mellitus 2. Syndrome of inappropriate antidiuretic hormone 3. Diabetes insipidus 4. Cushing syndrome 3 Checking for pupillary constriction is an assessment of the: 1. Optic nerve 2. Abducens nerve 3. Oculomotor nerve 4. Trochlear nerve 1 Opioids can cause pupillary constriction. 1. True 2. False 3 22 | P a g e A positive Babinski reflex sign is normal present in patients: 1. 3 years old 2. 18 years old 3. 15 months old 4. 20 months old 2 Decorticate posturing is described as: 1. Extension of arms across chest 2. Flexion of arms across the chest 1 Decerebrate posturing is described as: 1. Extension of arms and legs held straight out, toes pointed downward, and head and neck arched backwards 2. Flexion of arms across the chest, legs extended, toes pointed downward 1 The GCS is the most reliable indicator of change in LOC and neurological status. 1. True 2. False 2 A patient presented with the following responses when assessing LOC using the GCS: open eyes to pain, is confused, and withdraws extremities from pain. What is the patient's GCS score? 1. 9 2. 10 3. 11 4. 12 3 The normal value for ICP is: 1. 0-10 mmHg 2. 10-25 mmHg 3. 0-20 mmHg 4. 20-35 mmHg 25 | P a g e 1. 15 min 2. 10 min 3. 20 min 4. 5 min 4 When testing for sensation corresponding to L4 surgical site, the nurse focuses attention to the _____ dermatome level. 1. Anterior, medical thigh 2. Posterior, lateral thigh 3. Posterior, lateral calf 4. Anterior, medical calf 4 This patient is experiencing foot drop preoperatively. After microdisectomy with partial hemilaminectomy, the phase I nurse want to test ability and strength to: 1. Invert 2. Plantarflex 3. Evert 4. Dorsiflex 2 Strength of motor function is assessed as 4 points. This means: 1. Able to slide along support surfaces such as a bed or chair 2. Able to lift extremity against gravity and maintain position without wavering 3. Able to lift extremity against gravity, but wavers and cannot sustain 4. Full strength, no deficit or weakness 3 Pain and fear that activate the sympathetic nervous system have which effect on the stomach? 1. Increase in gastric secretions and increased motility 2. Increase in gastric secretions and decreased emptying 3. Decreased gastric secretions and emptying 4. Rapid emptying 4 Cranial nerve XI, the spinal accessory, is mixed type nerve, although primarily it provides motor function signals. In the cranial portion it sends impulses to and from the voluntary muscle of the: 1. Pharnyx 26 | P a g e 2. Tongue 3. Abdominal vicsera 4. Trapezius 1 After lumber spine surgery, it is important to protect the patient from DVT by: 1. Use of SCDs 2. Use of a foot board 3. Positioning with stabilization pillows 4. Frequent passive range of motion 4 Chronic subdural hematoma are seen most often in older adults. Treatment consist of: 1. Low dose anticoagulant therapy 2. Craniectomy to relieve pressure 3. Evacuation through burr holes 4. Continued monitoring for cognitive deficit 2 Baseline prepping neurological assessment must include vital signs. LOC and: 1. Motor function of extremities and eye movement 2. Pupillary response, skin color, and temp 3. Orientation and speech 4. Proprioception and sensory function of extremities 4 Pupil size and reactions are controlled by cranial nerve III and the brain stem. Which anesthetic agent may cause the patient to exhibit photo sensitivity in the Phase I PACU? 1. Midazolam 2. Ketamine 3. Neostigmine 4. Glycopyrrolate 1 For patients undergoing anterior cervical disectomy, it is important to monitor the patient for: 1. Tracheal edema 2. Coughing 3. Rhonchi 4. Headache 27 | P a g e 2 The mechanism of injury to the spinal cord and spine is often result of all except: 1. Hyperflexion 2. Decompression 3. Rotational forces 4. Hyperextension 1 ICP monitoring has multiple purposes. The most common site for placement of an ICP device is: 1. The anterior horn of lateral ventricle 2. The subarachnoid space 3. An intraparenchymal site 4. The subdural space 3 The middle cerebral artery supplies blood to the: 1. Pituitary gland 2. Parietal lobe 3. Lateral surface of the hemispheres 4. Temporal lobes bilaterally 2 Triple H therapy can prevent Vasospasm: hypertension, hemodilution, and hypervolemia Major risk associated with craniotomy is postoperative Vassos-ask. This risk can be decreased through controlled hypertension and: 1. Hemodilution and hypervolemia 2. Low-dose anticoagulant therapy 3. Keeping ICP<15 4. Position HOB>30 degrees 3 The patient with an ICP drain requires careful monitoring of the drainage system while in phase I PACU. The nurse is assessing for dampened waveform and: 1. Need to irrigate 2. ICP>20 30 | P a g e What motor area coordinates gross skeletal muscle activities that area largely autonomic in nature? 1. Basal ganglia 2. Primary motor area 3. Extrapyramidal system 4. Medulla 4 Tardive dyskinesia is characterized by involuntary and abnormal movements of the jaw, lips and tongue. Typical symptoms include facial grimacing, sticking out the tongue, sucking or fish-like movements of the mouth. The patient displays symptoms of continual chewing and rapid darting tongue movement after receiving droperidol during surgery. What type of extrapyramidal reaction is this? 1. Parkinsonism 2. Dystonic reaction 3. Akathesia 4. Tardive dyskinesia 2 decerebrate affect midbrain/pons decorticate cerebral hemispheres or Cervical spine What type of posturing occurs when the cerebral cortex is isolated from the reticular activating system by disease or injury of the upper portion of the midbrain? 1. Decorticate posturing 2. Decerebrate posturing 3. Opisthotonus 4. Flexor posturing 4 What is absolutely contraindicated for the patient with cranial surgery? 1. Tracheal suctioning 2. Endotracheal suctioning 3. Oropharyngeal suctioning 4. Nasal suctioning 2 increase metabolic demands/acidity, vasodilate, increasing CBF 31 | P a g e What is the effect of carbon dioxide on cerebral blood flow? 1. Increased CO2 causes the cerebral vasculature to constrict, increasing blood flow to the brain 2. Increased CO2 causes the cerebral vasculature to dilate, increasing blood flow to the brain 3. As the CO2 level falls, the vasculature will vasodilate, decreasing blood flow to the brain 4. Decreased CO2 causes the vasculature to dilate, increasing blood flow to the brain 1 Which of the following can compromise cerebral perfusion pressure and blood flow to the brain? 1. Decreased mean arterial pressure 2. Semi-Fowler's position 3. Decreased intracranial pressure 4. Increased mean arterial pressure 1 What is a massive uninhibited sympathetic cardiovascular response to noxious stimuli, such as bowel obstruction or bladder distention, exhibited by patients who have spinal cord injuries above the level of T6? 1. Autonomic dysreflexia 2. Anterior cord syndrome 3. Central syndrome 4. Spinal shock 1 Linear skull fractures. This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary. Depressed skull fractures. This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity. Diastatic skull fractures. These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants. Basilar skull fracture. This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital. 32 | P a g e Which skull fracture is diagnosed with clinical data that includes periorbital ecchymosis, ecchymosis around the mastoid process, and CSF otorrhea? 1. Basilar skull fracture 2. Compound fracture 3. Depressed skull fracture 4. Eggshell fracture 3 What type of hemorrhage from TBI can result in vasospasm within 3-7 days after the bleed? 1. Subdural 2. Intraventricular 3. Subarachnoid 4. Epidural 4 In an ICP assessment, what does a positive Babinski reflex indicate in those older than 18 months of age? 1. Increased cerebral perfusion pressure 2. Increased CBF 3. Early signs of decreased ICP 4. Late signs of increased ICP 4 What is a primary intervention to prevent secondary injury? 1. Fusion 2. Steroids 3. Anti-inflammatory 4. Immobilization 4 no IM shots because it causes local tissue inflammation Which of these medications should never be administered below the level of the spinal lesion due to local inflammation, tissue breakdown, and negligible absorption? 1. Subcutaneous 2. Intravenous 3. Intrathecal 4. Intramuscular 35 | P a g e 3 High risk for latex allergies: atopic immunologic reactions, contact dermatitis, allergies to nuts, fruits, bananas, avocados, celery, figs, chestnuts, papayas, neural tube defects (spina bifida, meningoceles) caths Patients at risk for an allergic reaction to latex include all of the following except: 1. History of contact dermatitis 2. Allergies to bananas and papayas 3. Allergies to tomatoes and grass 4. Retreated bladder catheterizations 2 According to the Surgical Care Improvement Care Project (SCIP) measures, appropriate hair removal must be done by clipping or depilatory. According to measures supported by the Surgical Care Improvement Project (SCIP), which of the following actions would NOT decrease the patient's risk for postoperative infection? 1. Maintaining normothermia 2. Administering an IV antibiotic before incision 3. Avoiding wife glucose swings 4. Preparing the surgical site with surgical razors 4 Spironolactone is a potassium-sparing diuretic used to treat ascites of the liver. When compared with furosemide, spironolactone has a greater rate of diuresis in patient with ascites. The diuretic used to treat patients with fluid overload due to cirrhosis is: 1. Triamterene 2. Hydrochlorothiazide 3. Furosemide 4. Spironolactone 4 Hydrochlorothiazide acts on the distal convoluted tubules to increase urine output without the loss of potassium. A patient requires a potassium-sparing diuretic postopertively. The nurse anticipates giving the patient: 1. Furosemide 2. Acetazolamide 36 | P a g e 3. Spironolactone 4. Hydrochlorothiazide 3 U waves are typically seen in hypokalemia Electrocardiogram ECG monitoring is important for patients with acute renal failure with hyperkalemia. ECG tracings may show all of the following EXCEPT: 1. High-peaked T waves 2. Heart Block 3. U waves 4. Depressed ST segment 1 Burns can cause dehydration due to the loss of fluids from the injury The nurse is caring for a patient with extensive burns who has now been diagnosed with acute renal failure. The nurse recognizes the renal failure is probably prerenal and a result of: 1. volume depletion 2. volume shifts 3. volume expansion 4. vascular anomalies 4 Steal syndrome us ischemic pain that is related to vascular insufficiency due to the fistula formation. This should be reported to the physician because revision or additional procedures are needed to correct the problem. The nurse is caring for a patient after a procedure to create an arteriovenous AV fistula for dialysis. The patient is complaining of pain distal to the graft site along with pallor and diminished pulses. The nurse suspects: 1. Infection 2. Aneurysm 3. Thrombosis 4. Steal syndrome 3 The skin of patients with arterial insufficiency is pale and cyanotic and is often cool, shiny, dry, and thin, whereas the skin of patients with venous insufficiency is warm; has a reddish-brown pigmentation; and is scaly, scarred, and thick. 37 | P a g e When performing an integumentary assessment of a patient with arterial insufficiency, the nurse finds the skin: 1. Thick, scaly, and scarred 2. Brawny (reddish-brown color) 3. Thin, shiny, dry 4. Warm and mottled 2 The infant has produced approximately 5ml/kg/hr urine, which is above the minimal expected 2 to 3 ml/kg/hr. He is not demonstrating signs of dehydration, as his vital signs are in the normal range for his age. He is eating well and not demonstrating signs and symptoms of pain or a distended bladder. A perianesthesia nurse is caring for a 6month old infant status postinguinal hernia repair who weights 8.4 kg. He has been out of surgery for 3 hours. He has breastfed twice, with the mother reporting that he appeared to feed normally and has an IV of lactated ringer's now at TKO. He received a total of 320ml of IV fluid in the operating room and an additional 30 ml since being on the unit. He is smiling and playful. During discharge teaching the nurse assesses the infant's surgical site, which is still clean, dry, and intact, and notes that his abdomen is soft. She shows the site to the baby's mother and changes the diaper. After weighing the diaper the nurse notes that the infant has had 100ml urine output. His HR is 112 and RR is 32. The mother states that the diaper seems pretty dry. The correct response of the nurse is: 1. I am going to call the surgeon because I, too, am concerned that his diaper is so dry 2. This is an acceptable amount of urine for the baby's body weight 3. It is normal for your baby not to urinate, he hasn't received much IV fluid 4. I am going to get an order to increase your baby's IV rate so he can produce more urine 3 The nurse should assess for a functional graft or fistula. This would be demonstrated by a soft pulse and a bruit audible on auscultation. This demonstrates that the access is patent with good blood flow. If the site is visible due to a dressing, then a doppler ultrasound should be used to document the presence of a pulse or bruit. When assessing the function of a new graft or fistula for hemodialysis, the perianesthesia nurse should monitor for the presence of: 1. Pink skin with a brisk capillary refill at the access site 2. A clean, dry, and intact pressure dressing 3. A pulse and audible bruit with a stethoscope 4. Ease when drawing blood from the site 2 Glycolic acid is used for chemical peels and would not be used immediately after laser resurfacing. 40 | P a g e 3. Osteoarthritis 4. Perinatal status 3 The nurse is aware that ages 7-11 years are Piaget's period 3 of concrete operations. At this time children become more logical and systematic. They can follow a step-by-step description but will need concrete objects and activities to full understand the process. Books and pictures would be helpful to describe the anesthesia induction, with simple words and phrases used. The nurse can look for simple educational resources to send to the parent to help with preparation. The prescreening nurse receives a telephone call from a mother of an 8 year old female patient who will have an indwelling catheter after her ureteral reimplantation surgery. The mother is looking for advice regarding preparing her daughter for surgery. The nurse knows that this patient is in this stage of Piaget's cognitive development and will base her recommendations accordingly: 1. Sensorimotor 2. Preoperational 3. Concrete operations 4. Formal operations 3 glomerulonephritis is an example of an intrarenal or intrinsic failure. Intrarenal failure is caused by a dysfunction of one or more of the structural components of the kidney, such as the glomeruli, tubules, interstitium, or vessels. This dysfunction causes a sudden and rapid loss of kidney function. Pyelonephritis causes renal scarring and formation or renal lesions, which can lead to acute or chronic renal failure and hypertension. It has been found that renal scarring can even occur after a single first UTI. glomerulonephritis can contribute to the development of acute renal failure ARF. This is an example of what type of failure? 1. Prerenal failure 2. Postrenal failure 3. Intrarenal (intrinsic) failure 4. Infectious failure 2 The nurse must provide meticulous maintenance of the catheters and be aware that they may become occluded by clots or debris The nurse is caring for a patient after unilateral pyelolithotomy. The patient comes to the phase I PACU with ureteral and urethral catheters in place, with pink-tinged urine draining from both catheters. Over the next hour, the drainage from the ureteral catheter is less than 5ml of darker pink drainage, and the urethral catheter has drained 75 ml. The nurse suspects this is due to: 41 | P a g e 1. Compression of the dependent side during surgery 2. Occlusion of the ureteral catheter 3. Perforation of the ureter during surgery 4. Acute renal failure due to surgery 4 As the largest organ of the body, the skin is the first line of defense against trauma and infection, and this protective barrier is its most important function. It aids in the thermoregulation by way of vasoconstriction, vasodilation, and evaporation of water. The skin also serves to support reaction to environmental stimuli, including sensation and communication of pressure, pain, touch, and temperature. All of the following are functions of the skin EXCEPT: 1. Protection 2. Thermoregulation 3. Communication 4. Proprioception 4 Orchiopexy is a procedure to return the testicle to the correct position. It can be performed when the patient has congenital cryptorchidism (testes fail to descend) but in this case the trauma to the scrotum most likely cause torsion of the testicle that must be repaired. The nurse is caring for a young male patient who fell while straddling a bicycle. He is now scheduled for an orchiopexy. The nurse recognizes this procedure is needed to repair his: 1. Cryptorchidism 2. Varicocele 3. Hydrocele 4. Testicular torsion 4 if a drain is present, it should be checked to ensure that it is activated, or it may be connected to a vacuum blood tube. The drain is placed to minimize the bleeding into the wound and to reduce the possibility of infection. Drains should be checked every 1 or 2 hours to maintain proper vacuum, and the output should be recorded on the intake and output records. Care of the patient with a surgical wound drain includes assessing that the drain is activated or maintains the proper vacuum: 1. Every 30 minutes 2. Every shift 42 | P a g e 3. At every handoff 4. Every 1 to 2 hours 1 NSAIDS must be used cautiously to prevent blocking production of prostaglandins that help regulate vascular resistance in arterioles of the glomerular capillaries. NSAIDS can also affect sodium and water retention, as well as cause acute renal failure in the presence of dehydration. Prostaglandins are produced in the renal medulla and help maintain several renal functions. Which of the following medications may block the production of prostaglandins? 1. NSAIDS 2. Aspirin 3. Acetaminophen 4. Ketamine 3 Contributing causes of acute glomerulonephritis include streptococci, staphylococci, autoimmune diseases (lupus), poly arthritis nodosa, amyloidosis, and Alpert's syndrome. The nurse reviewing the patient's medical history in the preoperative holding area sees a history of acute glomerulonephritis. Potential causes of this disorder include all of the following EXCEPT: 1. Streptococci infection 2. Staphylococci infection 3. Osteoarthritis 4. Autoimmune disease 2 Normothermia is defined as a core temperature ranging from 36C to 38C. This patient's temperature is considered hypothermic and requires active warming measures, such as the application of a forced-air warming system and warmed humidified inspired oxygen. A 28 year old female patient arrives in the phase I PACU with initial temperature of 35.5C (95.9F) after exploratory laparotomy for lysis of adhesions. Perioperative hypothermia is defined as: 1. Patient complaint of feeling cold 2. Core temperature less than 36C (96.8 F) 3. Patient shivering with a temperature of 36.7 C(98.1F) 4. Skin feels cold to touch 4 The goal is to return to normothermia while decreasing adverse effects of the patient discomfort, 45 | P a g e patient's pain, he is complaining of a feeling of facial swelling with a crackling sensation when he touches it. The nurse recognizes this subcutaneous emphysema is a result of: 1. Increased fluid retention 2. Reaction to anesthetic gases 3. Leak of CO2 from insufflation 4. Reaction to latex products 4 the shock waves from ESWL break renal calculus into small fragments, which are washed out in the urine. Larger calculus can potentially form a blockage in the ureter or kidney, which then causes pain and decreased output of urine. The blockage can cause renal colic as well as urine backing up into the kidney. This must be corrected to prevent damage to the kidney. Pain reduces after ESWL, with hematuria subsiding in 2-3 days. The patient should be encouraged to drink large amounts of fluids to help flush the calculus from the kidney and ureter, but if an obstruction is occurring, the extra fluids may not be helpful. The phase II PACU nurse is caring for a patient status post extracorporeal shock wave lithotripsy ESWL. She is reviewing discharge instructions when her patient begins complaining of flank pain on the treated side. The patient has one episode of hematuria but states now that he is unable to void. The most critical point the nurse is aware of is that: 1. This can occur after ESWL due to swelling from the shock trauma, which will rapidly subside 2. She will need to encourage her patient to drink more during the postoperative period 3. The bruising from the ESWL can cause pain and hematuria 4. Obstructions can develop after ESWL 2 TURP are at risk for transurethral resection syndrome with hyponatremia due to dilutional syndrome and water intoxication. The nurse is caring for a patient after TURP. During report the circulating nurse indicated that 6000ml of irrigation was used. The patient is now exhibiting shortness of breath, confusion, tachycardia, and hypotension. The nurse suspects that the symptoms are related to the amount of irrigation fluid that has caused: 1. Hypokalemia 2. Hyponatremia 3. Hypochloremia 4. Hypophosphatemia 2 at 5 years, Jane is in the Piaget's developmental stage of preoperational thought. This is the stage where cognition is dominated by egocentrism and magical thought. 46 | P a g e Sensorimotor stage: This represents the period from infancy and up to two years of age. At this period, movement and application of senses takes place. Additionally, mental images begin to form while images of objects remain engrained in the child's mind. Preoperational period: It takes place between two and seven years where symbolic thoughts develop. Reasoning is nonetheless shallow. Measurement abilities are equally low even when features of objects change. Concrete stage: Children between the ages of seven to eleven learn to reason and perform mental problems on numbers; the children also look into problems from different perspectives and can reverse activities mentally. Formal operation stage: It occurs from eleven years of age to adulthood. Abstract thinking takes center stage. Similarly, in this stage hypothesis formation and deduced reasoning become easier to understand. Jane is a 5 year old female patient who presents with her mother and father for a bilateral intravesicular ureteral reimplantaion. The current plan for care if that Jane will stay in the extended care unit for a 23- hour admission. Jane has a history of recurrent urinary tract infections and has been diagnosed with grade IV vesicoureteral reflux. When the nurse comes to meet Jane, she hides behind her father's leg. While admitting the patient, the perianesthesia nurse is aware that the patient is in this stage of Piaget's cognitive development: 1. Sensorimotor 2. Preoperational thought 3. Concrete operations 4. Formal operations 1 This statement relates to the egocentric nature of preoperational thought, informing the patient of all of the things that she will think and do, giving her the perception of being in control. The reference to fun smells will appeal to the child's magical thinking, allow her to better process the procedure. The admission nurse is explaining an inhalation anesthetic to Jane. Being aware of Piaget's stage of preoperational thought, the nurse introduces the mask to Jane stating "This mask will help you fall asleep." Which of the following statements would be most appropriate for a patient of Jane's age? 1. You get to pick a fun smell for the mask! 2. It doesn't hurt 3. The doctor will put it on your face for you 4 All the kids like it 3 47 | P a g e The distal tubule is made up of the distal convoluted tubule and collecting ducts. It is the site of aldosterone actions and the primary mechanism for potassium secretion. It is also the site for acid-base regulation, as well as the site of antidiuretic hormone action and water reabsorption. The kidney site for acid-base regulation, hydrogen ion secretion, and bicarbonate reabsorption: 1. Glomerulus 2. Proximal tubule 3. Distal tubule 4. Loop of henle 2 smoking is associated with an increased risk of COPD, heart disease, HTN, PVD, hypoxia, poor tissue healing, wound dehiscence, postoperative pulmonary complications (6x greater than nonsmokers), hyperreactive airway, and a higher rate of prolonged mechanical ventilation. Patients who are nonsmokers actually have a higher risk of PONV. A 34 year old truck driver is having a preanesthesia assessment in anticipation of video-assisted thorascopic surgery VATS to evaluate and treat a lung lesion. He is reportedly a heavy smoker, and he say he has cut down but has not stopped completely. Complications associated with the use of inhaled tobacco include all of the following EXCEPT: 1. Hypertension 2. PONV 3. Poor tissue perfusion 4. Surgical wound dehiscence 4 keratinocytes produce keratin, a protein that gives skin its strength and flexibility and waterproofs the skin surface. The epidermis also has keratinizing appendages comprise the hair and the nails. The epidermis provides a physical barrier due largely to the presence of: 1. Melanin 2. Carotene 3. Collagen 4. Keratin 1 Adult renal transplant patients often receive mannitol and diuretics during the surgical procedure. Polyuria (more than 500ml of urine output) is common in the early postoperative period. FLuids should be replaced and a careful record of output maintained. A common protocol posttransplant is to restrict fluid replacement to a maximum of 500ml/hr. This is done to stimulate the kidney to begin concentrating the urine. 50 | P a g e 2. Direct contact with a dry, crust lesion 3. Direct contact with a clear vehicle rash 4. Droplet transmission 2 Obesity, defined as weight greater than 20% ideal body weight, presents an increased incidence of wound dehiscence and infection. In addition, obese patients generally have poorly vascularized adipose, which increases the risk of ischemia. A patient with a body mass index BMI of 52 faces a number of potential postop complications, including: 1. An increased risk of wound dehiscence and decreased risk of infection 2. An increased risk of wound dehiscence and increased risk of infection 3. A decreased risk of wound dehiscence and decreased risk of infection 4. A decreased risk of wound dehiscence and increased risk of infection 4 Full-thickness/3rd degree burns cause severe injury or destruction to the deepest layer of the skin, tissues, hair follicles, and sweat glands. Full thickness burns are often the least painful because nerve endings have been destroyed, causing absence of sensation. Superficial, or 1st degree, burns damage only the outer layer of skin (epidermis). Partial-thickness/2nd degree burns injure the outer layer and layer underneath. a 4th degree burn involves bone, muscle, and often organs A 42 year old construction worker experienced a traumatic injury while at work. He is presenting to the hospital now for surgery to treat third-degree burns sustained on his left lower extremity. A third degree burn involves: 1. Red, dry, nonblistered skin with allodynia 2. Superficial, oozing, and painful blisters 3. Moist, painful skin that blanches 4. Leathery, dry wound with little or no pain 2 hypoventilation as a result of residual anesthetic along with the introduction of the PCA has Cause the patient to become sedated. IF there are no perfusion issues, the mismatch perfusion ventilation will result in the increased CO2 reading. The nurse is caring for a patient after a kidney transplant. Vital signs are stable, and the urine output is clear yellow and greater than 30mL on evaluation. The patient is receiving medication via patient- controlled analgesia PCA pump and reports good control of postoperative pain. At the next check of vital 51 | P a g e signs, the nurse see that the end-tidal CO2 reading is 52mmHg and recognizes this is a result of: 1. Hypoperfusion 2. Hypoventilation 3. Hypovolemia 4. Hypocarbia 2 Creatinine is the only filtered substance not reabsorbed. It is entirely secreted, Which allows creatinine to serve as an indicator of glomerular filtration ability and kidney function. Creatinine is an important indicator of glomerular filtration ability because: 1. It is a large molecule that should not fit through the glomeruli 2. Creatinine is the only filtered substance not reabsorbed 3. Creatinine is reabsorbed in limited quantities along with urea and phosphate 4. It helps play a role in the secretion of hydrogen and potassium ions 4 Ketorolac should be avoided because it can be nephrotoxic. It is not recommended for use in patients with impaired renal function This medication should be avoided in the patient with impaired renal function: 1. Furosemide 2. Morphine 3. Acetaminophen 4. Ketorolac 4 The bariatric patient with multiple skin folds experiences issuers related to impaired hygiene due to the difficulty the patient has with reaching and properly cleaning and drying skin. The larger skin folds as well as tissue around the groin, perineum, breasts, and axilla are susceptible to breakdown. In patients with multiple skin folds and redundant skin, the nurse is aware that a thorough inspection of the skin is necessary to determine if there are any excoriation or rashes. Problem areas tend to be found in the groin, perineum, a Lila, and large skin folds, and: 1. Between the toes 2. Behind the knees 3. Under the chin folds 4. Beneath the breasts When assessing a bariatric patient preoperatively, the pre-op nurse knows that 52 | P a g e 3 When educating the patient on what to expect during the administration of spinal anesthesia, the perianesthesia nurse understands that the progression of blockage occurs in the following order: 1. sensory, motor, autonomic 2. motor, sensory, autonomic 3. autonomic, sensory, motor 4. motor, autonomic, sensory 3 After extubation of a patient, which of the following would be considered most serious? 1. Sore throat 2. Impaired swallowing ability 3. Inspiratory stridor 4. Hoarseness 1 Which of the following interventions would be used first to maintain adequate perfusion and oxygen supply to cardiac muscles following hepatic surgery in a patient with a history of coronary artery disease: 1. Ensure a hemoglobin concentration ≥ 10 g. 2. Treat tachydysrhythmias and hypotension. 3. Monitor oxygen saturation via pulse oximetry. 4. Administer appropriate medications. 4 The use of the pulse oximeter has become a routine part of PACU care. The post anesthesia nurse may decide that oximetry monitoring is indicated when the patient: 1. has had minor surgery. 2. has normal vital signs. 3. has had regional anesthesia. 4. is severely hypothermic. 3 The perianesthesia nurse is aware that a dramatic decrease in the calcium may be cause by removal of the: 1. pituitary gland. 2. thyroid gland. 3. parathyroid gland. 4. adrenal glands. 55 | P a g e 3 A PACU education/research committee should have three commitments, which must include all of the following except: 1. development of innovative thinking. 2. freedom of inquiry. 3. individual progress of each nurse. 4. excellence in practice. 2 The dissociative state attributed to ketamine anesthesia can be modified by the administration of a/an: 1. antiarrhythmic. 2. benzodiazepine. 3. narcotic. 4. anticonvulsant. 4 Following a hernia repair, a 3-month-old is admitted to the PACU positioned on his side with a pacifier in his mouth. The airway becomes obstructed by the tongue. The obstruction can be alleviated by: 1. removing the pacifier. 2. pinching the cheeks. 3. turning him on his back. 4. jaw thrust or chin lift 2 A post-op patient awaiting transport to a surgical floor is awake and responds appropriately to commands. The perioperative nurse instructs the patient to flex and extend his/ her lower extremities; the purpose of this is to: 1. ensure that the patient follows commands. 2. prevent the complication of venous stasis. 3. accelerate emergence from anesthesia. 4. assess if patient is ready for discharge. 2 A geriatric patient's advanced age puts them at an increased risk for post-operative: 1. anorexia. 2. hypothermia. 3. nausea. 4. pain. 56 | P a g e 3 During emergence from general anesthesia, a patient exhibits rapidly increasing symptoms of asthma. Vital signs are: BP = 190/100, HR = 144, R = 36, and SaO2 = 86%. The perianesthesia nurse anticipates giving which of the following medications initially? 1. Dexamethasone 2. Nebulized epinephrine 3. Nebulized albuterol 4. Isoproterenol 3 A patient with streptococcal group A pharyngitis arrives in Phase I PACU. The perianesthesia nurse plans that the nurse to patient ratio should be: 1. two nurses to one patient. 2. one nurse to two patients. 3. one nurse to one patient. 4. one nurse to three patients. 3 A 35-year-old patient arrives in the Phase I PACU crying and repeatedly asks, "Can't my mother come in here with me?" The perianesthesia nurse: 1. informs the patient that visitation is prohibited in the PACU. 2. reassures the patient and administers an analgesic. 3. allows a brief visit at a time appropriate for patient, visitors, and staff. 4. sedates the patient secondary to postanesthetic confusion. 3 In a patient status post thyroidectomy, the perianesthesia nurse would anticipate postoperative signs of thyrotoxic crisis to include: 1. hyponatremia. 2. hypothermia. 3. tachycardia. 4. bradycardia. 3 Which of the following nursing interventions is most effective for a patient with a history of postoperative nausea and vomiting? 1. Providing ice chips 2. Administering ranitidine 57 | P a g e 3. Prevention 4. Avoiding administration of analgesics 2 A perianesthesia nurse is providing discharge instructions to a patient who asks questions about the phenazopyridine prescription. The nurse explains that it: 1. needs to be taken on an empty stomach. 2. provides relief from urgency and burning sensation. 3. helps minimize bleeding and formation of blood clots. 4. treats bacteria present in the urinary tract. 1 A patient in the PACU following hip arthroplasty complains of numbness to toes of affected extremity. The patient has most likely sustained an injury to the: 1. peroneal nerve. 2. femoral artery. 3. Achilles tendon. 4. sciatic nerve. 1 Surgery is scheduled for 0830. The patient reports drinking 6 ounces of water at 0600 with medications. Following American Society of Anesthesiologists (ASA) minimum fasting guidelines for n.p.o., the perianesthesia nurse: 1. continues with the preoperative check-in process. 2. medicates the patient for nausea. 3. informs the patient that the case may be cancelled. 4. notifies the surgeon. 2 A patient who speaks limited English is preparing for gallbladder surgery. The perianesthesia nurse is aware that the appropriate interpreter to utilize for this patient is: 1. an interpreter who is married to the patient's sister. 2. an interpreter who has a contract with the facility. 3. the patient's English-speaking husband. 4. the patient's bilingual significant other. 2 A potential negative side effect of positive end-expiratory pressure (PEEP) is: 1. alveolar collapse. 60 | P a g e 2. Left lateral tilt position 3. Supine 4. Trendelenburg 4 The axillary approach to the brachial plexus is considered the safest of the four approaches because of reduced risk to surrounding structures such as the risk of phrenic nerve blockade and/or pneumothorax, but the general risks of accidental intravascular and intraneural injection still exists. When preparing a patient for a brachial plexus nerve block for upper extremity surgery, the perianesthesia nurse is aware that the safest and easiest approach is: 1. subclavicular. 2. supraclavicular. 3. interscalene. 4. axillary. 1 To decrease nausea, the perianesthesia nurse instructs the patient to: 1. take deep breaths. 2. take several quick breaths. 3. turn their head to the side. 4. utilize Reiki or imagery. 4. Halothane also has excellent bronchodilatory properties and remains an acceptable alternative for induction Isoflurane - Isoflurane is a good bronchodilator, but it is not ideal for induction of anesthesia since it is more pungent than sevoflurane and halothane and has a slower onset than sevoflurane. Sevoflurane - We prefer sevoflurane for inhalation induction since it has the most pronounced bronchodilatory properties of the available agents. Desflurane - We avoid desflurane during induction of anesthesia in patients with COPD. Because of its extreme pungency, desflurane may increase secretions and cause coughing, laryngospasm, and/or bronchospasm during induction, particularly in current smokers, and it may increase airway resistance. The perianesthesia nurse would expect a patient with COPD to have received which of the following anesthetic agents? 1. Isoflurane 2. Nitrous oxide 61 | P a g e 3. Enflurane 4. Halothane 4 In a preoperative visit, information to be collected by the perianesthesia nurse includes: 1. type of surgery to be performed, previous surgical history and verification of payment source. 2. cardiac status, vaccination status, respiratory status, and location of patient's family postoperatively. 3. surgical procedure, whether the patient has signed the consent form, and type of anesthesia to be used. 4. preexisting diseases, laboratory values, neurological status, current medications, and allergies. 4 A patient calls the preoperative center asking whether to continue taking his daily dose of clonidine. The perianesthesia nurse is aware that clonidine should be: 1. taken only if the surgeon deems it necessary. 2. stopped at least 3 days preoperatively. 3. stopped at least 5 days preoperatively. 4. taken daily as prescribed. 4 Six hours postoperatively, a patient has not voided and his bladder is palpably distended. The patient refuses catheterization. If the nurse catheterizes the patient against his wishes, this is considered: 1. tort. 2. assault. 3. malpractice. 4. battery. 1 A preoperative patient is admitted to the holding area prior to joint surgery. The patient asks what the facility is doing to prevent postoperative surgical site infections. The perianesthesia nurse is aware that according to the surgical care improvement project (SCIP), preop antibiotics should be administered: 1. within 60 minutes of incision time. 2. prior to induction. 3. prior to leaving the holding area. 4. upon arrival to the facility. 1 The perianesthesia nurse is aware that a dramatic decrease in the serum calcium level may be caused by removal of the: 62 | P a g e 1. parathyroid glands. 2. pineal gland. 3. adrenal glands. 4. pituitary gland. 3 increased salivation due to stimulation of muscarinic receptors (can be contolled using an antimuscarinic) Other Side Effects: catatonia amnesia deficits in working and episodic memory (associated with frequent use) analgesia elevated heart rate, cardiac output & blood pressure post-op disorientation sensory & perceptual illusions vivid dreams ulcerative cystitis (associated with chronic drug use) Contraindications: The perianesthesia nurse recognizes that upon a patient's arrival to the PACU, a side effect of ketamine anesthesia is: 1. decreased muscle tone. 2. hypotension. 3. marked salivation. 4. nausea and vomiting. 2 By asking a tympanoplasty patient to wrinkle the forehead, pucker lips, smile, and squeeze eyelids together, the PACU nurse is assessing the function of cranial nerve: 1. V. 2. VII. 3. IX. 4. XII. 2 The Faces Pain Rating Scale measurement tool is most appropriate for: 1. a 2-year-old toddler. 2. an 8-year-old child. 65 | P a g e 3. a loss of sensation of temperature in the legs. 4. pain control for 12 hours. 4 Preoperative instructions for oral fluid restriction for patients with no risk factors include NPO for clear liquids prior to surgery because emptying occurs within: 1. 30 minutes. 2. 1 hour. 3. 90 minutes. 4. 2 hours. 3 According to ACLS guidelines, the dosage of drugs administered via the endotracheal tube route is: 1. half the normal IV dose. 2. one time the normal IV dose. 3. two times the normal IV dose. 4. three times the normal IV dose. 4 Which of the following places the patient at the highest risk of postoperative nausea and vomiting (PONV)? 1. Type of surgery. 2. Smoking status. 3. Duration of surgery. 4. Female gender. 1 Anxious parents are at the bedside of a toddler who is crying, kicking, and thrashing following bilateral myringotomy with insertion of tympanostomy. The perianesthesia nurse informs the parents that this behavior is: 1. the emergence excitement phase after anesthesia. 2. a temper tantrum often seen in toddlers. 3. associated with the surgical procedure. 4. uncommon in children of this age. 3 Which of the following is an indicator of readiness for extubation in a post anesthesia patient weighing 60 kg? 1. Respiratory rate of 30 breaths per minute 66 | P a g e 2. Tidal volume of 300 ml and a vital capacity of 900 ml 3. Ability to open eyes and move extremities on command 4. Ability to sustain a head lift for 3 seconds 2 Characteristics of Sevoflurane include all of the following except: 1. Sweet smelling, good for induction 2. Lowers ICP 3. Useful in ambulatory settings 4. Less airway irritation than other inhalation agents 3 Characteristics of Nitrous Oxide include all of the following except: 1. Depress CNS 2. Non-irritating to the respiratory system 3. Can be mixed with room air 4. Minimal cardiovascular effects 3 The primary process of elimination for inhalation agents is: 1. Hepatic 2. Renal 3. Pulmonary 4. Fat cells 2 The stage of anesthesia during which their patient is at most risk to harm themselves is: 1. Stage I 2. Stage II 3. Stage III 4. Stage IV 4 Pharmacokinetics: factors that affect how the drug is distributed in the body Pharmacokinetic properties of inhalation agents include all except: 1. Cardiac output 2. Age 67 | P a g e 3. Blood solubility 4. Gender 4 Recovery and emergence are dependent upon: 1. The duration of anesthesia 2. Use of additional medications 3. Physical status of the patient 4. All of the above 4 Nursing Considerations in caring for the patient receiving inhalation agents include: 1. Depression of laryngeal and pharyngeal reflexes 2. Dysrhythmic effects 3. Analgesic requirements 4. All of the above 5 Postoperative shivering due to intraoperative vasodilation is a consideration with: 1. Halothane 2. Desflurane 3. Isoflurane 4. Enflurance 5. All of the above 1 Seizure activity may be enhanced by the administration of: 1. Enflurane 2. Nitrous oxide 3. Sevoflurane 4. Halothane 3 In normal neuromuscular transmission, the enzyme/neurotransmitter released at the neuromuscular junction resulting in depolarization is: 1. Acetylcholinesterase 2. Pseudocholinesterase 3. Acetylcholine 4. Plasma cholinesterase 70 | P a g e 3. Reviewing case scenarios 4. Conducting mock MH drills 3 During the perianesthesia nurse is performing an assessment, the nurse knows that MH is an inherited disorder that affects: 1. Homeostatic thermoregulation 2. The baroreceptors of the heart 3. Muscle metabolism 4. Cardiopulmonary gas exchange 3 MHAUS recommends core temp monitoring for all patients undergoing general anesthesia lasting more than ____ minutes. 1. 120 2. 90 3. 30 4. 60 2 A patient with know susceptibility to MH has just undergone a surgical procedure suing "safe" anesthesics. The patient should be monitored in the Phase I PACU for at least: 1. until discharge criteria is met 2. 60 minutes 3. 30 minutes 4. 90 minutes 1 A patient with know susceptibility to MH has just undergone a surgical procedure suing "safe" anesthesics. The patient should be monitored in the Phase II PACU for at least: 1. 1-1.5 hours 2. 3-3.5 hours 3. 2-2.5 hours 4. Until Phase II discharge criteria is met 4 Rhabdomyolysis is an indication of: 1. Hyperthermia 2. Carbon dioxide 71 | P a g e 3. Hyperkalemia 4. Release of dead muscle fibers into the bloodstream 4 Although a MH event can be triggered at the first exposure of a patient to anesthesia, the average patient will demonstrate the first signs of MH after ____ anesthetics4 1. 2 2. 4 3. 5 4. 3 3 3 states with high incidents of MH are: 1. Alaska, Hawaii, and Oregon 2. Florida, Mississippi, and Louisiana 3. Wisconsin, Michigan, and West Virginia 4. Main, Massachusetts, and Rhode Island 1 Signs that a MH crisis is resolving include declining ETCO2, declining temp, and: 1. Decreasing HR 2. Spontaneous return of circulation 3. Increasing HR 4. Spontaneous return of ventilation 3 The goals of therapy for patient experiencing MH include prompt administration and dantrolene, treatment of hyperkalemia, rapid cooling, and: 1. Rapid extubation 2. Initiation of cardiopulmonary bypass 3. Hyperventilation 4. Treatment of hyperglycemia 4 MH cart must be availble wherever anesthesia is administered. Kits store in the cart include all of the following except: 1. Transducer kits for arterial cannulation 2. Central venous pressure sets 72 | P a g e 3. Esophageal or core temp monitoring kit 4. Lumbar puncture kit 1 Agents known to be safely administered to patients with MH susceptibility include: 1. Propofol 2. Desflurane 3. Isoflurane 4. Sevoflurane 4 Dantrolene belongs to the drug class: 1. Antipyretic 2. Nucleoside reverse transcriptase inhibitor 3. Antihypercaonia agent 4. Skeletal muscle relaxant Stage of analgesia Stage I begins with anesthesia initiation and ends with loss of consciousness. Patients can open the eyes on command, breathe spontaneously, maintain protective reflexes, and respond to stimuli Stage of delirium Stage II starts with loss of consciousness and ends with a change in breathing pattern. Untoward responses such as cardiac arrest, vomiting, and laryngospasm are more likely to occur Stage of Surgical Anesthesia Stage III lasts from the change in breathing pattern to cessation of spontaneous respirations. The patient does not respond to surgical incision. Stage III is divided into four planes that begin with the loss of eyelid reflexes and end with intercostal muscle paralysis Overdose stage Stage IV is characterized by medullary depression. It can be fatal without complete respiratory and circulatory support. Ramsay score 1 Awake: patient anxious and agitated or restless or both Ramsay score 2 Awake: patient cooperative, oriented and tranquil Ramsay score 3 75 | P a g e Medications used to treat MH Laryngospasm Strider, Jaw thrust Bronchospasm Wheezing, bronchodilators Pneumothorax Absent breath sounds, O2, chest XR Subglottic edema Peds (Croup), humidified air Glucose goal for med-surg patients Less than 180 Right lung Most common site of pulmonary aspiration Blood counts after splenectomy Increased platelets, RBCs, WBCs During the administration of bupivacine, some of the medication is accidentally administered IV and patient develops ventricular arrhythmias. The nurse anticipates administration of amiodarone A patient post appendectomy goes into SVT. BP = 125/75, HR = 168, R = 16. The nurse anticipates giving adenosine Following the treatment of malignant hyperthermia, dysrhythmias persist despite the correction of hyperkalemia and acidosis. The nurse questions an order for Verapamil (increases calcium) The post op nurse may decide that pulse ox monitoring is contraindicated when the patient is severely hypothermic When caring for a young child, an uncuffed endotracheal tube is preferred because the larynx is funnel shaped Parents visiting the PACU find that their 4-year old child refuses to allow them to console or give care. The nurse explains that this behavior is a normal response to the separation anxiety that the child is feeling 76 | P a g e a patient has received pancuronium bromide IV as part of the anesthesia regimen. The nurse anticipates which of the following for reversal? sugammadex an ambulatory surgery patient who is post direct laryngoscopy with GA exhibits stridor. The nurse anticipates orders for administration of nebulized racemic epinephrine after extubation of a patient, which of the following would be most serious? inspiratory stridor after arrival in the PACU following a radical neck dissection, the patient becomes tachypneic with tracheal deviation and oxygen desaturation. The nurse suspects tension pneumothorax the universal symptom of compartment syndrome is excessive pain which of the following drugs is contraindicated in patients who are sensitive to soybean oil, egg lecithin, or glycerol? propofol postop discharge teaching for a patient who received an interscalene block with ropivacaine should include instructions for the patient to protect the elbow to avoid damage to ulnar nerve until block resolves crutch training instruction after arthroscopic right knee surgery should include leading with the unaffected leg when conducting a discharge phone call on a patient following a partial thyroidectomy, which of the following complaints prompts for an immediate follow up tetany a 6 yo child and parents are experiencing anxiety prior to surgery. In this situation, the nurse would most appropriately allow the parents to remain with the patient up until surgery The PACU nurse is concerned with renal blood flow in a patient recovering from repair of an abdominal aortic aneurysm. The expected urine output is 0.5 ml/kg/hr the dissociative state attributed to ketamine anesthesia can be modified by the administration of benzodiazepine 77 | P a g e a patient complains of dyspnea and chest pain after the insertion of a central-line catheter. the patient's breath sounds are diminished. after physician notification, the priority nursing action is to prepare for an insertion of a chest tube a potential negative side effect of positive end-expiratory pressure (PEEP) is decreased intrapulmonary shunting a patient post op hip arthroplasty complains of numbness to toes. This patient has most likely sustained an injury to the peroneal nerve surgery is scheduled for 0830. the patient reports drinking 6 oz of water at 0600 with meds. following the ASA, minimum fasting guidelines for NPO, the nurse continues with the pre op check in process the most common type of reaction to latex-containing product is irritating nonallergic reaction a periop nurse is providing discharge instructions to a patient who asks questions about the phenazopyridine prescription. the nurse explains that is provides relief from urgency and burning senstation in a patient status post thyroidectomy, the nurse would anticipate post op signs of thyrotoxic crisis to include tachycardia Following a hernia repair, a 3-month-old is admitted to the PACU positioned on his side with a pacifier in his mouth. The airway becomes obstructed by the tongue. The obstruction can be alleviated by: A. removing the pacifier. B. pinching the cheeks. C. turning him on his back. D. jaw thrust or chin lift jaw thrust or chin lift in administering flumazenil, the nurse is aware that it inhibits the central effects of benzos by competing for the receptor sites tidal volume is defined as the amount of gas passing into or out of the lungs in each respiratory cycle which of the following interventions would be used first to maintain adequate perfusion and oxygen supply to cardiac muscles following hepatic surgery with a history of CAD ensure a hemoglobin concentration >10g 80 | P a g e a registered nurse providing continuous monitoring when prepping a patient for a brachial plexus nerve block for an upper extremity surgery, the periop nurse is aware that the safest and easiest approach is axillary which of the following anesthetic gases is less likely to induce coughing and laryngospasm - isoflurane - nitrous oxide - enflurane - halothane halothane the progression of blockage occurs in the following order autonomic, sensory, motor a side of effect of ketamine anesthesia is marked salivation by asking a tympanoplasty patient to wrinkle the forehead, pucker lips, smile, and squeeze eyelids together, the pacu nurse is assessing the function of the cranial nerve VII a 52 yo patient states that he has been hospitalized twice in the past year for management of insulin dependent DM. the ASA status of this patient is Class III kussmaul rapid breathing cheyne-stokes waxing and waning pulmonary edema pinky frothy sputum biots irregular, apnea, icp, stroke horner's syndrome symptoms stroke symptoms Spironolactone 81 | P a g e potassium sparing drug for cirrhosis TURP increase in water intoxication and hyponatremia due to fluid boluses von willdebrand bleeding FLAP initial assessment white + gray shingles + zoster direct contact with clear vesicle rash ketorolac also known as toradol ketorolac (toradol) is bad for renal function DKA elevated glucose, polyuria, kussmauls thyroidectomy hypocalcemia addison's disease needs extra steroids, may cause stress ulcer amiodarone ventricular tachycardia procainamide ventricular fibrillation normal co2 levels 35-45 mmHg what effect do steroids have on wound healing poor wound healing clonic jerking 82 | P a g e tonic rigid what is fentanyl good for? renal failure crutches criteria 2-3 fingers under armpit, 20-30 degrees arm bent laying on left side increases cardiac output lithotripsy complication obstruction LAST symptom metallic taste LAST treatment 20% lipid, 1.5 mg/kg embolism symptom petechiae LAST symptom numbness in mouth lithotripsy treatment forced hydration cyanosis in indicated of what venous obstruction malignant hyperthermia raises CO2 addiction compulsive physical dependence routine chickenpox isolation is 85 | P a g e Which of the following is done to test radial nerve sensation? -touch the web space between thumb and index -touch the tip of the index finger -touch the tip of the small finger -touch the tip of the thumb with the small finger touch the web space between thumb and index Patient education priorities after extracorporeal shock wave lithotripsy (ESWL) focus on -scheduled analgesia -hematuria -forced hydration forced hydration Addison's disease with administration of steroid can increase the risk of stress ulcers a patient with cushing syndrome and corticosteroid hypersecretion can cause poor wound healing Each of the following drugs is good for PONV EXCEPT -granisetron -haloperidol -lorazepam -dolasetron lorazepam (ativan) Normothermia is defined as a core temp between - 34-36 C - 35-37 C - 36-38 C - 37-39 C 36-38 C A sudden increase in co2 my be indicated of -inadvertant narconization -malignant hyperthermia -dislodged ET tube -pulmonary embolism malignant hyperthermia Most common clinical symptom of malignant hyperthermia is -masseter jaw spasm -unstable bp 86 | P a g e -hypercabnia -hypoxia hypercabnia, high co2 how long should a patient with MH be monitored postop -6 to 12 -12 to 24 -24 to 48 -48 to 72 24 to 48 the most accurate measure of core temp is -pulmonary artery cath -nasal cannula probe -bladder oral pulmonary artery catheter During the anesthesia stage of delirium the patient is at risk for vomiting, laryngospasm, cardiac arrest Malignant hyperthermia is an inherited disorder that affects -homeostatic thermoregulation -cardiopulmonary gas exchange -muscle metabolism muscle metabolism a patient with decreased breathing and weak pulses, RR 8 and distant breath sounds. what meds to give -oxygen and naloxone -glycopyrrolate and atropine -neostigmine and glycopyrrolate neostigmine and glycopyrrolate urine goal for a patient with MH 2 ml/kg/h symptom of last tinnitus and dizziness, confusion dantrolene is a skeletal muscle relaxant 87 | P a g e dantrolene sodium requires dilution. the most appropriate is -sterile saline with bacteriostatic -sterile saline without bacteriostatic -sterile water with bacteriostatic -sterile water without bacteriostatic sterile water without a bacteriostatic agent a patient experiences fixed chest syndrome after fentanyl. the first thing a nurse should do is -elevate head of the bed -encourage patient to cough -obtain order for naloxone -give succinylcholine give succinylcholine temperature elevation with MH: is a late sign of MH Ketamine is contraindicated in patients who are at risk for -cardiovascular shock -increased intracranial pressure -reactive airway disease -decreased intracranial pressure increased intracranial pressure dantrolene dose? 2.5 mg/kg dantrolene will be adminstered to treat any recurrence of the symptoms of MH for a period of 48-72 hours Attempting to provide culturally sensitive care, the nurse: -makes sincere eye contact -shakes everyone's hand -speaks slowly and loudly -shows respect to the males shows respect to the males the patient with MS will have motor symptoms like paresis, bladder dysfunction, and -dyesthesia -dysphagia -nystagmus -decreased energy dysphagia 90 | P a g e what should a patient having a gtube placed be observed for? -sepsis or peritonitis -embolization syndrome -hypotension -pseudothrombosis sepsis or peritonitis aspans core values for a culture of safety include communication advocacy, competency, timeliness, teamwork, and: -patient centered -assertiveness -efficiency-timeliness -balance efficiency-timeliness a patient in the ED needs emergency surgical attention but his identity is not yet established. which consent is considered -informed -implied -emergent -assumed implied flumazenil reversal agent for benzos can be used for mask induction sevolfane and halothane desmopressin Antidiuretic and Clotting promoter It can treat diabetes insipidus duloxetine Antidepressant and Nerve pain medication It can treat depression, anxiety, diabetic peripheral neuropathy, fibromyalgia, and chronic muscle or bone pain. failure to sense turn up sensitvity failure to pace turn down sensitivity 91 | P a g e Post operative teaching with crutches using only "toe touch", the RN tells patient :: Do not put weight on affected leg Post op teaching with patient who had anterior hip arthroplasty RN tells patient no abduction pillow needed pt with av fistula post op teaching keep arm elevated at home fo a few days ASA 1 and II pts who meet all stage 1 criteria: can go directly to phase 2 from OR pt arrives in PACU after urology procedure shivering and temp of 38.3 early signs of sepsis fentanyl can cause chest wall rgidity if you ask the pt to stick out their tongue the RN is checking The Hypoglossal nerve During MH Crisis the RN never gives Calcium channel blockers and verapamil pt s/p thyroidectomy in pacu has slightly deviated trachea RN suspects hematoma Negative Pressure Pulmonary Edema can be caused by fluid overload post op calls s/p blephoplasty, pt eye is swollen and eccymosis RN tells patient apply ice packs a 2 year old who had a tonsils and adenoidectomy, you tell parents baby must be a face down lying for bleeding #1 contraindication for any procedure pt refuses a patient who has a left lobectomy you instruct the patient to lie semi fowlers position After lobectomy, segmentectomy, and wedge resection, the patient can 92 | P a g e turn freely from side to side to allow for full expansion of lung tissue on both the operative and non operative sides Pneumectomy lie on operative side. good lung up What is HELLP syndrome in pregnancy? A major complication that requires referral to high-risk OB. It's like DIC in a pregnant woman. - Hemolysis -Elevated Liver enzymes and - Low platelet count *baby will likely need to be delivered ASAP unstable patient with HR 180 and SOB Cardiovert-only if unstable Capnograpy measures ventilation pt has Altered mental status and signed constant what does the RN do Prepare patient for surgery as this is an EMERGENT SITUATION when is RN 1:1 unstable critical patient children under 8 years older a baby in pacu with slight stridor but basis of the lungs are clear RN should use humidifed oxygen in the PACU how many RN's need to be present 1 RN with the patient and the other in the same room if patient received Ketamine the RN should encourage a quiet environment stop bang score of 5 RN should use multimodal apprach post op teaching should begin in pre op Horner's syndrome 95 | P a g e multimodal approach peds patient with chicken pox should be transferred on stretcher with mask on st johns wart causes drowsiness and is contradicted with MAOI and SSRI and thiamine food also with Myasthenia Gravis Rhythm Strips to know A Fib- stable v. unstable ( amio, BB, cardiovert) Vtach VFib Torsades-treat with mag sickle cell and hypothermia stop shivering because patient can go into crisis Inhalation anesthetic Sevoflurane- sweet can use for children Isoflurane- Desflurane- highest incidence of larygnospams nitroous oxide-not a violiate gas induction agents Medications used to permit rapid transition from consciousness to unconsciousness by quickly bypassing the excitement phase of general anesthesia propofol, midazolam, ketamine, etomidate Propofol Used for sedation in ICU, rapid anesthesia induction, short procedures. can cause rash/pruitus and HYPOTENSION( turn off or adjust rate) -give etomidate if pt is unsstable because it does not lower BP - contradinction allergies- soy Ketamine -a dissociative anesthetic drug, similar to PCP, that acts as an NMDA receptor antagonist - used for GA/MAC -marked increase saliva -s/e--> halluncination and delrium- children may need restraints Midazolam 96 | P a g e Benzodiazepine -can cause amnesia affects used in induction -sedation for intubated/vented patients Narcan (naloxone) reversal for opioids can cause -pulmonary edema if pushed too quickly inital dose: 0.4mg- 2mg IV -can cause HTN and tachycardia if desired effect is not reached you can repeat dose in 2-3 minutes Flumazenil reversal for benzodiazepines -do not given to epileptic patients can cause convulsions and precipaite seizures -can cause blurred vision, n/v, hyperventilation, dose: 0.2mg iv over 15 seconds Neostigmine, Pyridostigmine anticholinesterase -reversal fo non depolrizing NMB -can treat myasthenia gravis. -give glycol and atropine after to help with BRady -Side effects = Nausea, bradycardia, resp depression. Suggamadex -reversal for non depolorizing neuromuscular blocking agents -Drug used to reverse the effects of rocuronium and vecuronium; -causes less bradycardia -Side effects = Nausea, vomitting, hypotension,pain Atropine Glycopyrrolate Anticholinergics decreases salavia -reversal of NMB -reverse bradycardia, vagal reflexes can cause- decrease urine, headache, sore throat, DRY, Precedex conscious sedation- does not need to protect airway can cause bradycardia 97 | P a g e pt recieved general and is awake, stable, VSS, when the RN removes O2. saturation drops to 88% periodically, what should the nurse do stirr up regimen post dual puncture headache can increase pain when patient is upright position which of the following conditions would be a primary concern following hepatectomy in pt with CAD potential large blood loss and hypovolemia a patient has recieved an AICD post op teaching include no MRI scans RN with anesthesia plan for pain management for post op patientwith OSA multimodal approach intubated pt is no awake and following commands, in prep for 'awake' endotracheal extubating, the RN interperts that the muscle relaxant is fully reversed when the pt demonstrated sustainted head lift for 5 seconds and elderly patient required re-intubatedion in PACU and a propofol drip is started, the pt BP is 88/45. first action of RN infusion rate should be adjusted precedex does not affect respiratory rate alot midazolam can be safely used in post op patients with complex spine surgey healthy 18 yr old in pacu s/p right tibia interna fixation. pt has long leg cast. right toes are cool and pale and pt describes tingling in the right lower extremitiy. several doses of narcotics have been given and the pt still has 10/10 pain. rn suspects compartment syndrome the RN is aware that discharge teaching after an AV fistula of left arm include keep surgical arm elevated for several days treatment priority for a hypotensive, tachycardia pt with a neuraxial block (spinalm epidural) include elevate legs the RN is aware that which drugs is contraindicated in the pregnant patient