Medical-Surgical Nursing Exam #1 Questions And Answers, Exams of Nursing

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Answers

What Are the 2017 Hospital National Patient Safety Goals? - correct answer - Identify patients correctly

• Improve staff communication
• Use medicines safely
• Use alarms safely
• Identify patient safety risks
• Prevent Infection
• Prevent mistakes in surgery What Are the Purposes of Surgery? - correct answer - Diagnosis (Yes or No)
• Exploration (Find Problem)
• Cure (Remove/Fix)
• Prevention (Early Stages)
• Palliation (Dying, Hospice, Comfort, No Cure)
• Cosmetic Improvement (Burns, Mastectomy, Reconstruction) What Are the Three Surgical Phases? - correct answer 1.) Preoperative (Until the OR) 2.) Intraoperative (Inside OR) 3.) Postoperative (PACU)

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What is Elective Surgery? - correct answer A planned surgery Ex: Knee replacement What is An Emergency Surgery? - correct answer Unplanned Ex: Burst appendix Inpatient vs. Outpatient - correct answer Inpatient

• Same day admission Outpatient (Ambulatory)
• Leave hospital when recovered and awake Nursing Management of the Surgical Client - correct answer - Knowledge of the nature of the disorder
• Determine the client's response to the stress of surgery
• Assess the results of preoperative diagnostic tests (Look at lab tests) What does the patient know, why are they here Preoperative:

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Stress raises glucose levels; always ask about pain Identify caregivers, also the patient must know what is happening Anxiety & Nursing Assessment - correct answer Anxiety can arise from:

• Lack of knowledge (More they know the better, use layman's terms)
• Unrealistic expectations (I will have this surgery and be fine)
• Information lessens anxiety Preoperative Nursing Assessment - correct answer - Health Hx
• Family Diseases (Anesthesia problems/malignant hypothermia)
• Previous and Current Diagnoses medical conditions
• Previous surgeries or problems
• Menstrual/Obstetric History (Pregnant?)
• Current Medications
• Drug Intolerance (Allergies/Adverse Rxn) What Objective Information is Important from the Preoperative Client Interview? - correct answer - Physical Exam
• Lab Diagnostic Testing

Answers

• Document Relevant findings and report to the perioperative team Always have a CBC; electrolytes, blood sugars, EKG, Chest X-Ray, etc. Know the normal labs, LOW PLATELETS IS A BIG DEAL Cardiovascular System Objective Data - correct answer - Heart rate, blood pressure, skin color, sounds, capillary refill, edema, history of heart attack or cardiac problems, blood clots in legs? REPORT: Any cardiac problems so they can be monitored during the intraoperative period. The use of cardiac drugs, and the presence of a pacemaker/ICD (Implantable Cardioverter Defibrillator) Respiratory System Objective Data: - correct answer - Respiratory rate, lung sounds, O2 Saturation REPORT: History of dyspnea, coughing, or hemoptysis (Blood)
• COPD or Asthma (High risk for atelectasis and hypoxemia)
• Smokers (Encourage to quit) Nervous System Objective Data: - correct answer - Level of Consciousness, can they follow commands, sight, hearing
• Evaluation of neurological functioning (Vision or hearing loss can influence results)
• Cognitive function (Determine if any deficits are present)

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Musculoskeletal System Objective Data: - correct answer - Arthritis (Changes in knuckles, if their head needs to be put back, bring mobility aid)

• Cannot flex lumbar spine Endocrine System Objective Data: - correct answer - Clients with Diabetes Mellitus are especially at risk for delayed healing time, changes in blood sugar, higher risk for infections
• Clients with thyroid dysfunction have an altered metabolic rate
• Clients with adrenal insufficiency (Addison's Disease) also do not heal as well; sterioids Immune System Objective Data: - correct answer - Auto-Immune Disorders
• Will not heal as well
• Clients with a history of compromised immune system or use of immunosuppressant drugs can have infections and delayed healing Fluid and Electrolyte Balance Objective Data: - correct answer - Assess Electrolytes
• Use of diuretics (Evaluate serum electrolyte levels; can alter K+)
• NPO Status (Dehydrated)

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• Critical assessment for older adults because they have a reduced adaptive capacity Nutritional Status Objective Assessment: - correct answer - Obesity can change incisions; changes medications, dehiscence is more likely
• Underweight clients may have healing issues, as well as bony prominences
• Dietary habits that may affect recovery (Caffeine) Preoperative Nursing Management 1 - correct answer The Joint Commission (TJC) requires a history and a physical
• Preoperative teaching
• Client has the right to know what to expect and how to participate
• Limited time available, address needs of highest priority Three Types of Information - correct answer Sensory: Hear/See/Smell/Feel Process: What is being done, more info Procedure: How they are doing all the work Basic Information Before Arrival - correct answer - Time and place
• Fluids and food restrictions (Do not want to throw up)

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• Surgeon is responsible for obtaining consent
• Nurse may obtain and witness the signature
• Consent for surgery and anesthesia Emergency surgery may override need for consent
• Legally appointed representatives of family may consent if the client is: A minor, unconscious, or mentally incompetent Day-of-Surgery Preparation - correct answer - Final preoperative teaching
• Assessment and report of pertinent findings
• Verify signed consent
• Labs
• History and physical examinations
• Baseline vitals
• Consultation results
• Nurse's notes (Documentation)
• Client should not wear cosmetics
• Dentures, contacts, prostheses are removed - Identification and allergy bands on wrist

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• Void before surgery to: Prevent involuntary elimination under anesthesia or during early postoperative recovery; before medication administration Atropine - correct answer Oral and respiratory secretions dry up!!!! Suffix meanings - correct answer - ectomy: excision or removal of
• lysis: destruction of
• orrhaphy: repair or suture of
• oscopy: looking into
• ostomy: creation of opening into
• otomy: cutting into or incision of
• plasty: repair or reconstruction of Intraoperative Nursing Care Requires the Understanding of? - correct answer - Anesthesia
• Pharmacology
• Surgery
• Surgical Interventions What Specialties Have the Highest Number of Surgical Clients? - correct answer - Opthalmology

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• National Patient Safety Goals (NPSGs) require a preprocedure verification processing including:
• Verification of relevant documentation
• Required blood products and equipment
• Diagnostic and radiology test results
• Procedure site marked Surgery Room Preparation - correct answer - Electrical and Mechanical Equipment checked for proper function
• Perioperative nurse: Client advocate throughout surgical experience Surgical Suite is Divided into Three Distinct Areas - correct answer - Provides a controlled environment, minimizes the spread of infection, and allows smooth flow of clients, personnel, and instruments/equipment 1.) Unrestricted Areas
• Locker room
• Information Areas (Nursing station/Control desk)
• Holding Area (Inside or adjacent to surgical area where family and friends are allowed 2.) Semirestricted Areas

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3.) Restricted Areas

• Operating rooms
• Scrub sink areas Physical Environment in Operating Room - correct answer UV Lighting = Not as much dust or microorganisms Positive Air Pressure = Prevent hallway air Nursing Management Safety: Transferring Client - correct answer - Client transported into OR after preparation
• Caution with monitor leads, IVs, and catheters What is the Role of the Scrub Nurse? - correct answer - Follow the designated scrub procedure
• Gowned and gloved in sterile attire
• Remains in the sterile field What is the Role of the Circulating Nurse? - correct answer - Not scrubbed, gowned, or gloved REMAINS IN UNSTERILE FIELD
• Documents

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Supine = Back Prone = Stomach

• Prevent occlusion of arteries and veins General Anesthesia - correct answer Combination of:
• Hypnosis, analgesia, and amnesia
• Loss of sensation with loss of consciousness
• IV or Inhalation
• Skeletal muscle relaxation
• Possible impaired ventilatory and cardiovascular function
• Elimination of coughing, gagging, vomiting, and sympathetic nervous system responsiveness (Could have pneumonia, so you cannot eat before)
• IV agents: Beginning of virtually all general anesthesia; TIVA (Total IV Anesthesia) Monitored Anesthesia Care (MAC)