!DOCTYPE html> 9-1. Cultural competency is essential because it promotes: a. Meaningful plans of care b. Expedient assessments c. Standardized care d. Traditional practices 9-2. The perianesthesia nurse is caring for a toddler after dental surgery for multiple dental caries. The nurse knows pain behavior may be demonstrated as grimacing and: a. Agitation b. Passiveness c. Contentedness d. Whimpering 9-3. Entering a preoperative room, the nurse notes the patient and her family belong to an ethnic group the nurse has no knowledge of or experience with. Attempting to provide culturally sensitive care, the nurse: a. Makes sincere eye contact b. Shakes everyone’s hand c. Speaks slowly and loudly d. Shows respect to the males 9-4. When interviewing a 17-year-old during a preoperative assessment, a successful communication strategy is to: a. Ask sensitive questions first b. Interview with parents present c. Use brief yes or no questions d. Ensure patient confidentiality During a preoperative assessment of an 82-year-old patient, the nurse is concerned to discover the patient drinks two to three cups of chamomile tea daily. The last time the patient drank this tea was last night. 9-5. The nurse recognizes the herb may cause: a. Anticoagulation b. Hypotension c. Bradycardia d. Hypoglycemia 9-6. The preadmission nurse has just completed an assessment on a patient who reports a history of lupus erythematosus. The nurse remembers that lupus is an autoimmune disorder of connective tissues that is characterized by joint pain and swelling. Although the etiology is unknown, lupus is more common in all of the following EXCEPT: a. Females b. Asians c. Caucasians d. African Americans 9-7. A 64-year old female patient arrives for a left breast lumpectomy. She learned from the internet that vitamin E can be used to support a healthy immune system and has been taking supplements twice a day in preparation for her surgery. Her last dose of vitamin E was the day before her surgery at bedtime. What action should the nurse take? a. Consult with the anesthesia provider b. Notify the surgeon immediately c. Prepare to administer platelets preoperatively d. Nothing; vitamin E supplements are harmless Consider this scenario for questions 9-8 to 9-12. The ambulatory nurse is completing the preoperative admission for a 60-year-old male patient with early-onset Alzheimer’s disease. After verifying with the patient and family that they followed all the preoperative instructions, the nurse verifies that the consents were signed at the surgeon’s office. 9-8. To decrease anxiety for this patient, the preop nurse will: a. Place him in a waiting room with family b. Maintain a calm, unhurried, and accepting manner c. Distract him when placing the intravenous d. Have all the providers together for the admission interview 9-9. The patient’s wife reports that he had to resign from his job as a service repair technician in the last 6 months because he was unable to complete his jobs. Some behavioral characteristics you would expect are impaired reading ability and: a. Paranoia b. Gentleness c. Depression d. Repetitive movements 9-10. In the Phase I PACU, to minimize the risk of aspiration, the head of the bed is raised. Other important measures to assist this Alzheimer’s patient to have an uncomplicated recovery are to: a. Restrain him for safety until fully awake b. Suction frequently to remove secretions c. Prepare administration of antipsychotics d. Have a family member with him 9-11. The patient is able to transfer to the Phase II PACU in preparation for discharge. Together the Phase I PACU nurse and Phase II PACU nurse reorient the patient to surroundings, verify safe transportation, and: a. Let him watch TV as a distraction b. Verify there is a competent adult at home c. Give only written discharge instructions d. Use a numeric pain scale for consistency 9-12. When caring for a patient of advanced years, keep in mind that he or she may be experiencing sensory loss, such as presbyopia or presbycusis. In communicating with this patient the nurse must: a. Face the patient when speaking b. Speak softly to reduce overstimulation c. Document concurrently in the electronic health record (EHR) d. Have the patient remove his or her glasses 9-13. For what age range is the Face, Legs, Activity, Cry, Consolability (FLACC) scale useful to measure pain and distress in children? a. Infant to 5 years b. Infant to 7 years c. 2 to 7 years old d. 5 to 7 years old 9-14. Pediatric patients who present with disorders on the autism spectrum require watchful monitoring to keep them safe in the perianesthesia environment. In the Phase I PACU the patient may manifest: a. Seizure activity b. Garbled speech c. Hand flapping d. Dulled reflexes 9-15. A frustrated surgeon insists the Phase I PACU nurse transfuse blood into a patient who is a Jehovah’s Witness. Aware of patients’ rights, the nurse refuses knowing that the patient’s right to refuse blood products is supported by: a. The Joint Commission Annual Safety Goals b. Patient Self-Determination Act c. Centers for Medicare and Medicaid Services Guidelines for Safety d. National Standards on Cultural Care 9-16. A 2-year-old child wakes up restless in the Phase I PACU. After assessing the child and determining he is physiologically stable, the nurse: a. Provides explanations for experiences b. Covers the child completely for privacy c. Sets clear limits and boundaries d. Reunites the child with the caregiver quickly 9-17. While considering discharge teaching for an 82-year-old Native American patient, the nurse takes into consideration that traditionally Native Americans do not: a. Take prescription medications b. Believe in Western medicine c. Listen to women d. Believe in infection 9-18. While conducting a preoperative assessment for an older adult patient, the prudent nurse includes risk factors for: a. Migraine b. Hardiness c. Anorexia d. Delirium 9-19. While in the Phase I PACU, a 16-year-old female patient has been medicated for pain. Although her pain score has decreased from 7 to 5, she remains restless. An effective strategy to use with her is: a. Deep breathing b. Essential oils c. Acupressure d. Parental separation 9-20. During the preoperative assessment, Mr. Y answers “yes” to every question. The nurse questions the accuracy of the assessment because the patient: a. Disrespects Western medicine b. Is being secretive c. Is not really listening d. Wishes to prevent disharmony 9-21. A 32-year-old Asian female patient is ready for the operating room. She has asked her anesthesia provider permission to take a piece of jade with her to have it nearby during her surgery. The provider is aware that the reason for this request is that the Chinese Americans believe jade prevents: a. Nausea b. Pain c. Harm d. Fear 9-22. Which of the following statements concerning a Jehovah’s Witness is true? a. A Jehovah’s Witness will agree to a transfusion only if life saving b. A Jehovah’s Witness may refuse surgery on Christmas c. A Jehovah’s Witness will agree to plasma and platelets d. A Jehovah’s Witness may not agree to autologous blood transfusions 9-23. While caring for a 5-year-old patient in the Phase II PACU, what approach or techniques will the nurse incorporate to enhance discharge teaching? a. Speaking clearly to the parents b. Hands-on experience for the child c. Plan teaching to last 5 to 10 minutes d. Parallel play to clarify the topic 9-24. In the African American culture, perceptions of health derive from religious and holistic beliefs and practices. Good health is defined as: a. Reward for body and mind b. Love and service to God c. Harmony with nature d. Control of evil influences 9-25. During the hour a 13-year-old female patient has been in the Phase I PACU, her pain score has decreased after pain medication administration. She has been responding politely and appropriately to the nurse. When her parents arrive at her bedside, the patient begins to sob and cries out, “This pain is killing me!” Understanding adolescent behavior, the nurse recognizes that: a. Adolescents often lie b. Adolescents are secretive c. Regression is common d. Girls are dramatic Consider this scenario for questions 9-26, 9-27, and 9-28. The perianesthesia nurse is assigned to admit a 19-year-old female patient coming to the same-day surgery center for a large loop excision of transformation zone (LLETZ) procedure of the cervix after an abnormal Pap smear. During the admission assessment she is busy texting with friends. 9-26. The nurse asks that she put her phone down so that the admission can be completed. Her behavior demonstrates: a. Projecting an aura of calm and cool b. Rejection of hospital rules c. Indifference to the needs of others d. Staying in control of self 9-27. In late adolescence there is more commitment to intimate relationships. Another common characteristic of late adolescence is: a. Mature communication with parents b. Unrealistic expectations of partners c. Establishing own value system d. Conforming to societal norms 9-28. In the Phase I PACU the patient does not want the nurse to check her sanitary pad. The PACU nurse knows this is related to: a. Wanting to appear in control b. Concern about body image c. Intensity of pain d. Anxiety about bleeding 9-29. A patient presents for parathyroidectomy in the preoperative area. The perianesthesia nurse knows that a preoperative calcium level is important information in providing safe postoperative care. Another important preoperative assessment is: a. Patient teaching about position b. Patient voice quality c. History of palpitation d. History of asthma 9-30. The perianesthesia nurse is taking care of a male patient, age 9, with a known moderate developmental delay. It is expected that his behavior would: a. Be appropriate for his age b. Demonstrate a flat affect after anesthesia c. Be appropriate for a 2- to 6-year-old d. Include making a lot of noise or talking 9-31. While on call, the perianesthesia nurse is assigned to a patient she finds ethically difficult to provide care for. What is the nurse’s responsibility to the patient? a. Provide care until another nurse can provide relief b. Explain her ethical concerns to the patient c. Limit communication with the patient/family d. Continue to care for the patient until discharge 9-32. To improve communication with a developmentally delayed patient, remain calm, relaxed, and: a. Mimic their words b. Speak slower and louder c. Talk to the parent or caregiver d. Repeat the information 9-33. In the preoperative unit, a non–English-speaking mother of a 5-year-old patient becomes upset when the nurse attempts to remove a bracelet from the child. What intervention could the nurse investigate? a. Remind the interpreter compliance is necessary b. Notify the surgeon of the need to cancel the case c. Call security to restrain and remove the mother d. Secure the item elsewhere on the child’s body 9-34. Taking the time to know an older patient’s personal preferences will assist in prioritizing his or her care. Chronological age, however, is just one consideration. In order of importance, the perianesthesia nurse must first consider: a. Level of understanding of instructions
Diversity and Psychosocial Assistance
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Diane Swintek, Nancy Strzyzewski, and Theresa Clifford