a. The nurse recognizes that teaching regarding perianal care has been effective when the patient implements which of the following actions? What should the nurse do when administering this drug? d. Schedule a barium enema to check for inflammation. Broken skin permits microorganisms to enter various layers of the skin, providing deeper microbial breeding. The nurse plans care for the patient based on the knowledge that management of his condition initially involves which of the following actions? Restrict fluid intake to prevent constant liquid drainage from the stoma. 68. While obtaining a nursing history from a patient with IBD, which of the following data leads the nurse to suspect that the patient most likely has ulcerative colitis rather than Crohn’s disease? Assess and report to the physician and/or the anesthesiologist if the patient has had a cold or an upper respiratory infection within the past week. With an inhalation anaesthetic, the nurse needs to assess and treat pain during early anaesthesia recovery. Vital signs should be obtained, and patient status should be compared with the report provided by the PACU. 4-Medical Surgical Nursing Flashcard Maker: Liz Dowling. 41. 15. During preoperative teaching for a patient scheduled for an abdominal–perineal resection, which intervention will the nurse perform? The resident microbial count is reduced to a minimum. The patient is able to drive home alone. Potential complication: thromboembolism, c. Potential complication: renal insufficiency, d. Potential complication: metabolic alkalosis. Applying surgical gloves before the scrub, c. Scrubbing for at least 3 to 5 minutes with an antimicrobial, d. Drying the hands and arms, starting at the elbow and moving toward the fingers. What is the best response to the patient’s remarks? Thirty minutes after admission, her blood pressure is 112/60 mm Hg. One of the discharge criteria for ambulatory surgery discharge is that the patient has not received IV narcotics in the past 30 minutes. Advise the patient to use over-the-counter loperamide (Imodium) to slow gastrointestinal motility. b. Fifty percent of patients who have bowel surgery experience postoperative ileus (POI), a transient cessation of bowel motility that prevents effective passage of intestinal contents and may affect the patient’s tolerance of oral intake. Free shipping for many products! b. The patient receives praise when the activities are completed. This places the patient at an increased risk for hypothermia; therefore, the patient at greatest risk is one undergoing a bowel resection because of the length of the surgery. NCLEX type Questions - Medical Surgical Nursing for competitive exams 2 This is the effort of The Boss Academy to provide high quality study materials & model question papers for all competitive Nursing exams. 84. What should the nurse explain that the test is used to do? Return of brown drainage suggests perforation of the bowel and the need for immediate surgery. d. Diagnostic testing with barium studies and endoscopy. Open the sterile gown and glove package on a clean, dry, flat surface. The patient has removed her jewelry and glasses. Ask family members whether they have discussed the surgical procedure with the physician. She provides the surgeon with instruments. His wife is at his bedside and answers most questions directed to the patient. 4. Older adults usually will have sensory losses, reduced numbers of red blood cells, and increased rigidity of the arterial walls. d. Notify the anaesthesiologist that the patient is ready for discharge from the PACU. The other responses may be appropriate, depending on what is learned in the assessment. d. The surgeon should give the patient information about the surgery. d. Rapid/rebound growth of microorganisms is inhibited. 93. While the patient is in the OR and the OR team is gowned and gloved, the nurse recommends completion of a safety checklist. The nurse would implement postoperative monitoring of a patient’s sedation score when the patient had received which one of the following anaesthetics? The _________________ is a nurse with advanced education who assists the surgeon with the surgical procedure, performing a combination of nursing and delegated medical functions and/or skills. 19. b. Sterile persons must keep hands in view and above the waist and below the neck. Position the patient in a lateral position. Assess for adverse effects of medications. c. Explain that modifications to increase dietary fibre can control the symptoms. c. Uses sterile gloved hands to move a sterile drape under a table, d. Has anyone who is unscrubbed stay at least 1 foot away from the sterile field. He has Type 2 diabetes and is obese. In teaching the patient about the care of her ileostomy, what should the nurse advise the patient to do? b. As you are assisting him to get out of bed, he; Mr. Chin is 8 hours postop from bowel resection and a colostomy. The charge nurse is assigning duties in the surgical arena. Check that the operative procedure is noted on the chart. (Select all that apply.). Remove the indwelling urinary catheter. All findings of the medication history should be documented and communicated to the intraoperative and postoperative personnel. Cover the site with dry sterile dressings. d. It may depress the immune system response, delaying healing. 26. 119. }, Get a unique conceptual approach to nursing care in this rapidly changing healthcare environment. e. The need to wash between patients is reduced. Which of the following is an ambulatory surgery discharge criterion? If the surgical incision is to be thoracic or abdominal, teach the patient to place a pillow over the incisional area and to place his hands over the pillow to splint the incision. Medical-Surgical Nursing. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). These sample questions apply to all exams taken on or after October 25, 2014. The normal daily range of urine volume expected from a patient with an indwelling catheter 1 to 2 days postoperatively is 500 to 700 mL. Allowing the patient to have ice chips, b. The nurse must later check postoperative orders to ensure that scheduled medications unrelated to surgery are not forgotten. a. (Select all that apply. The nurse recognizes that teaching about this drug has been effective when the patient states which of the following? c. Tell the patient that pain medication cannot be given until transfer to the postoperative clinical unit. If no voiding occurs, the abdominal contour should be inspected, and the initial action is to palpate and percuss the bladder for distension. For the best experience on our site, be sure to turn on Javascript in your browser. b. A patient that has a history of controlled asthma would be rated as a II—a mild systemic disease without functional limitations. Holding the gown close to the body before applying, c. Having the circulating nurse tie the gown at the hip, d. Keeping the hands inside the sleeves of the gown until the gloves are applied. She is a “sterile” member of the surgical team. When providing care for a postoperative patient, it is important for the nurse to include which postoperative exercise? Instruct the patient to remain flat in bed. The nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements for a patient who is hospitalized with an acute exacerbation of Crohn’s disease based on which of the following findings? She has a white blood cell count of 14,000 cells/microlitre with a shift to the left. If the patient will be required to follow instructions in the operating room, allow the patient to keep the hearing aid in place. a. Counting sponges, needles, and instruments, c. Passing instruments to the surgeon and assistants, d. Preparing the instrument table and organizing sterile equipment. a. Gowns are sterile from the chest and shoulder to table level. Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. When teaching a patient to irrigate a new colostomy, the nurse recognizes that additional teaching is needed when the patient indicates which of the following? The patient’s age and history of antibiotic use suggest a C. difficile infection. b. 64. The nurse’s initial response should be further assessment of the patient. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Elsevier's COVID-19 Healthcare HubFree health and medical research on the novel coronavirus (SARS-CoV-2) and COVID-19, { c. What medications will be used during surgery, d. What drains and tubes will be present after surgery. Any condition that affects chest wall movement such as obesity, advanced pregnancy, thoracic or abdominal surgery, history of smoking, or presence of reduced hemoglobin level can increase the risk for postoperative complications but will not necessarily require postponement of surgery. b. 102. Turn off the nasogastric tube suction. Direct the teaching toward the wife because she is the obvious support and caregiver for the patient. bsc and Msc nursing courses 92. c. Inform the patient that laboratory testing of blood and stool specimens will be necessary. Showing 1 to 2 of 2 View all . Conduct complete assessment of all vital signs. 13. Studies have found that surgical staff may transmit pathogens via contact with patients and contaminated items. What should the nurse do upon transfer? The nurse understands that the checklist verifies which of the following? d. Administer enemas and laxatives to ensure that the bowel is empty before the surgery. To achieve this goal, antibiotics must be administered when they will be most beneficial. "Magento_Ui/js/core/app": { Report the incident to the oncoming shift. What is one of the most important goals of the registered nurse first assistant? When planning care for a surgical patient, the nurse implements which technique to maintain sterility in the operating room? Which action should the nurse take next? 75. An older adult man is hospitalized with a diagnosis of Giardia lamblia infection. 1. 28. In the case of insulin, it is important to clarify the time and amount of the last dose before surgery. The patient’s clinical manifestations are consistent with appendicitis, and application of an ice pack will decrease inflammation at the area. According to the Canadian Anesthesiologists’ Society, what is the minimum preoperative fasting time period for intake of clear fluids? The nurse’s communication with Sarah is based on the knowledge that the most prevalent fear of patients awaiting surgery is which of the following? a. Surgery is recommended by the physician for a patient with severe ulcerative colitis who has not responded to conservative treatment. 73. A 42-year-old patient is recovering from anaesthesia in the PACU following a hysterectomy. b. 24. You need to have at least 2 years of working experience as a registered nurse or about 2,000 hours of clinical practice in the medical-surgical area before you can apply for a certification exam from the Academy of Medical-Surgical Nurses’ (AMSN) Medical-Surgical Nursing Certification Board. 15. 99. What is the best response? Although performing the diaphragmatic exercises in the upright position is ideal, the patient can still benefit from performing the exercises while laying flat. Pharmacology & Pharmaceutical Science (General), Veterinary Medicine - Small Animals and Exotics, Assessment and Management of Clinical Problems, Skip to the beginning of the images gallery, Free health and medical research on the novel coronavirus (SARS-CoV-2) and COVID-19, Netter's Advanced Head and Neck Flash Cards, Netter's Head and Neck Anatomy for Dentistry, Netter's Dissection Video Modules (Retail Access Card), Permissions Part of the role of the scrub nurse is to perform sponge, sharps, and instrument counts with the circulating nurse before an incision is made, at the beginning of wound closure, and at the end of the surgical procedure. The nurse recognizes that the major loss of circulating fluid volume occurs as a result of which of the following? The meaning of the suffix -ostomy is creation of an opening into; an example is a colostomy. As the nurse prepares a patient the morning of surgery, the patient refuses to remove her wedding ring. This thoroughly revised text includes a more conversational writing style an increased focus on nursing concepts and clinical trends strong evidence-based content and an essential pathophysiology review. 90. What should the nurse do to accomplish preoperative teaching with the patient? Author Information . It prevents tension on the abdominal muscles, which allows for greater diaphragmatic excursion. b. Position patients with spinal anesthetic supine, without elevation of the head, for up to 24 hours to prevent spinal headache from loss of cerebrospinal fluid. 1) Patient advocacy 2) Patient education “The medication suppresses the inflammation in my large intestine.”, c. “I will need lab tests to be sure that I can still fight infections.”, d. “I will take the sulphasalazine as an enema or suppository.”. Cough two to three times and inhale between coughs. a. 18. Huff coughing is used to promote expectoration of mucus. 31. A patient is being transferred to a room from the PACU. a. What is the most appropriate response? Creating Healthy Work Environment. The sides of the drape extending below table level are unsterile. The initial assessment is focused on determining whether the patient has hypovolemic shock; therefore, the priority action is to assess the BP and pulse. 38. The VFP is limited primarily to when IPC cannot be used, as when surgery or injury occurs to the affected lower extremity. Other preoperative information can include the day-of-surgery events such as patient registration, parking, what to wear, and what to bring, but these are not the priority. d. Teach the patient about proper food handling and storage. b. Administer stool softeners as ordered. } c. A total colectomy and ileal reservoir provide the most normal elimination function, but this surgery consists of two procedures, requiring a temporary ileostomy for 8 to 12 weeks. d. Supine with the head of the bed elevated. Intestinal motility may return slowly, depending on anesthetic effects. b. “A drug will be injected through your intravenous line, which will cause you to go to sleep almost immediately.”, b. She is wringing her hands and perspiring, and she has a worried affect. Continue to have the patient do leg exercises with the unaffected leg, not the affected leg. Sterile persons must keep their hands in view, above waist level and below the neckline, and must not turn their back to the sterile field to avoid contamination. The most common cause of postoperative hypoxemia is atelectasis. American Journal of Nursing: February 1999 - Volume 99 - Issue 2 - p 24B. Pharmacological regimens that include the administration of low-dose unfractionated heparin, low-molecular-weight heparin, factor Xa inhibitor (fondaparinux), or warfarin are recommended. Use printed materials for instruction because the patient does not hear well. Long nails and chipped or old polish harbor great numbers of bacteria. Although the skin cannot be sterilized, operating room personnel can greatly reduce the number of microorganisms by chemical, physical, and mechanical means. In talking with the patient, what should the nurse do? Sterile persons must keep their hands in view, above waist level and below the neckline, to avoid contamination. a. During the initial assessment of the patient, what is it most important for the nurse to do? 86. Once in place, gowns are sterile from the front chest and shoulders to table level and on the sleeves to 2 inches (5 cm) above the elbow. Crohn’s disease frequently affects the ileum, where absorption of vitamin B12 occurs, and the B12 must be administered regularly by the intramuscular route to correct the anemia. b. d. The status of fluid and electrolyte balance. Which intervention is implemented to ensure safe nursing care? A hard plastic catheter is not recommended because of the risk of intestinal perforation. c. The nurse’s legal responsibility is to ensure that the patient understands the information presented. A patient is being evaluated in the emergency department for acute lower abdominal pain with diarrhea and vomiting. Which of the following is a neoplastic polyp of the large intestine? a. c. Assure the patient that his lack of control is temporary and will resolve with treatment of the disorder. Prostheses can be lost or damaged during surgery and could cause injury. a. Never position the patient with his hands over his chest (reduces chest expansion). 109. c. The patient has an increased hemoglobin level. 77. a. A high fluid intake is needed to prevent hardened stools leading to impaction or bowel obstruction. Garlic may increase bleeding, especially in patients taking anticoagulants. c. Instruct the patient that another surgery in 8 to 12 weeks will be used to create an ileal–anal reservoir. The scrub nurse’s hands are being washed in preparation for a surgical procedure. RNs, LPNs, and CSTs may assume the scrub nurse role. Anxiety can arise from lack of knowledge, which may range from not knowing what to expect during the surgical experience to uncertainty about the outcome of surgery and the potential findings; therefore, it is important that the nurse help explore the patient’s feelings. The patient is experiencing calf pain, redness, and swelling. As the nurse finishes, the scrub nurse accidentally touches the faucet with one hand. Immediate postoperative glucose control also has been correlated with a reduction in surgical infection. Med Surg 2 Exam 1 MED SURG 2 EXAM 1 - Comprehensive review of Professor Martinez Medical Surgical Nursing II Exam Med Surg Exam #1 - Professor Martinez, Assessment of Cardiovascular Function Medsurg 2 EXAM 2 Review - Professor Martinez, Management of Patients with Structural, Infectious, and Exam 3 - Professor Martinez, Assessment and Management of patients with … d. Adequacy of respiratory muscle movement. 1 - 20 of 197 results. b. 20. d. Each wrapper should be checked for wrapper integrity and changed chemical indicators. While assessing patients for complications during recovery from anaesthesia, the nurse recognizes that which of the following patients is at the greatest risk for developing postoperative hypothermia? Level Up on Your Exams and Career. Text Mode – Text version of the exam 1. Teach the patient to avoid using chest and shoulder muscles while inhaling.. 11. The perineal incision is partially closed and has two drains attached to Jackson-Pratt suction. 123. When providing care for a patient who has received spinal anesthesia, the nurse recognizes that which position prevents spinal headaches? Preparation of the instrument table and sterile equipment is included in both the circulating and scrub roles. Lewis’s Medical-Surgical Nursing, 11 th Edition . Which did the Nursing Executive Center of The Advisory Board identify as an academic-practice gap for new graduate nurses? When would that be? Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. What is the most appropriate nursing action? Management of sterile instruments and handing instruments to the surgeon are included in the scrub role. Treatment of hypotension should always begin with oxygen therapy to promote oxygenation of hypoperfused organs. Davidson’s Principles and Practice of Medicine 23rd edition pdf book, AIIMS Manglagiri Staff Nurse Gr II question paper 2018. b. “Have you discussed these feelings with anyone else?”, c. “I am sure surgical techniques have improved since your mother had surgery.”, d. “Think positively! 69. 76. What is the primary reason the perioperative nurse encourages a family member or a friend to remain with a patient in the preoperative holding area until the patient is taken into the operating room (OR)? c. She is a “nonsterile” member of the surgical team. d. Supplemental fat-soluble vitamins must be taken because the medication blocks absorption of these vitamins. Which of the following are principles of sterile procedure? 37. Med-Surg Endocrine System, part 9: Growth Hormone Deficiency and Excess. Document a list of items and their locations in a preoperative checklist and/or in the nurses’ notes per agency policy. Grid View Grid. Inventory the items and give them to the family. The patient will then cough fully for two to three consecutive coughs without inhaling between coughs. In planning care for the patient, what does the nurse recognize that the medical recommendation for patients with FAP will include? Preoperatively, what is it most important for the nurse to determine? c. Monitor the tumour status after surgery. Although the anaesthesiologist will determine the appropriate schedule and dose of the patient’s routine medications before and after surgery based on the medication history, the nurse must ensure that all of the patient’s medications are identified, administer the medications as ordered, and monitor the patient for potential interactions and complications. A patient has a newly formed ileostomy for treatment of ulcerative colitis. 89. c. Place a pillow over the incisional site for splinting. c. Ask the surgeon to identify the patient and the planned surgical procedure. (Select all that apply. b. Rectal bleeding is associated with colorectal cancer. Annual colonoscopy until the age of 40, c. Routine periodic polypectomies via a colonoscope to remove abnormal growths, d. Biannual colonoscopy for life because of a 50% chance of developing colon cancer. b. Get a unique conceptual approach to nursing care in this rapidly changing healthcare environment. ), d. Certified registered nurse anesthetist. A hemoglobin count of 6.2 mmol/L (10 g/dL) indicates that the patient’s iron is low; anemia is a common complication of Crohn’s disease. The circulating nurse is a “nonsterile” member of the surgical team who assumes responsibility and accountability for maintaining patient safety and continuity of quality care. “Irrigation will help control and train my bowel.”, c. “I should use a hard plastic catheter for irrigating.”, d. “If resistance is met, force is not to be used.”. 142. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Checking blood pressure while sitting and standing, c. Observing the patient’s performance of leg exercises, d. Palpating the suprapubic region for distention. Overall, it is recommended that prophylactic antibiotics be given as close to the time of incision as possible (within 30 to 60 minutes) and not be given for longer than 24 hours postoperatively. The navel ring may decrease circulation. When wearing a sterile gown, do not fold the arms with hands tucked in the axillary region. c. The patient plans to stay overnight at the surgical centre. The patient is very upset and tells the nurse that the stoma is ugly, and she does not think she can live with all the alterations in her body. ), b. This course is a continuation of Medical-Surgical Nursing I with application of the nursing process to the care of the adult patient experiencing medical-surgical conditions along the health-illness continuum in a variety of health care settings. The higher the serum glucose, the greater the potential for infection in both patient groups. In planning surgical care for an older adult patient, the nurse recognizes which of the following as causing the greatest risk for surgery? A pasty stool consistency would be expected with an ileostomy. Order a diet high in fibre and fluids. Reduced glomerular filtration rate and excretory times limit the ability to remove drugs or toxic substances. Only the patient can sign a surgical consent. Apply gloves using the closed-glove method, with hands covered by gown cuffs and sleeves. 70. Her preoperative blood pressure was 120/68 mm Hg, and on admission to the PACU, her blood pressure was 124/70 mm Hg. d. Instruct the patient to exhale with long slow breaths. a. It is believed that having a family member stay with the patient helps relieve anxiety. c. Instruct the patient to breathe through his nose. c. Take prescribed pain medications before a bowel movement is expected. Given that the patient is restricted to the supine position, which intervention provides the patient with adequate chest expansion? 107. (Select all that apply.). The upright position is preferred because it facilitates diaphragmatic excursion by using gravity to keep abdominal contents away from the diaphragm. b. 120. The presence of hyperglycemia in the immediate postoperative period increases the risk for infection in both diabetic and nondiabetic patients. c. It may cause serious elevations in blood pressure. Medical-Surgical Nursing, Patient-Centered Collaborative Care Volume 2 (Volume 2) Donna D. Ignatavicius, M. Linda Workman Hardcover Publisher: Saunders Elsevier Jan 1 2010 Which of the following is true about the circulating nurse’s primary responsibility? Remove the team member to have the nails cut. To ensure the proper identification of the patient before surgery, b. Medical Surgical Nursing 2 Page 7 individual i n situation of chronic illness and in its family members ( So uza A raujo, Sil va, Bezerra, Ono fre, Araujo, & S ilva, 2014) . What is the most appropriate response? d. Place an ice pack on the stoma to reduce swelling. Hypotension is not a complication of obesity. Compare findings with the patient’s normal baseline. His vital signs include temperature 38.3°C, pulse 130 beats/min, respiration 34 breaths/min, and blood pressure (BP) 82/50 mm Hg. 67. The other answer options all cause an increase in body temperature, not a decrease. Confirm the diagnosis of colon cancer. Surgery for ulcerative colitis involves the formation of a temporary ileostomy to divert fecal contents until the large bowel heals. Continue assessing vital signs at least every 15 minutes until the patient’s condition stabilizes. 147. 116. Recent studies suggest starting a clear liquid diet for some types of POI and initiating early ambulation and pharmacological interventions. 800 illustrations (800 in full color), NEW! A 42-year-old patient recently developed abdominal distension, weight loss, steatorrhea, and flatulence.

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