6-1. A 62-year-old male patient has had a transurethral resection of the prostate. He arrives in the Phase I PACU with initial vital signs of BP 165/90, HR 58, RR 31, and SpO₂ 96%. Oxygen is placed on the patient, and the nurse receives the handover report. The patient received adequate fluid replacement in surgery and had minimal blood loss. The patient has continuous bladder irrigation at this time. On initial assessment of the patient, the nurse finds that he is complaining of feeling nauseated, short of breath, and restless. Based on the initial assessment, what would be the optimal nursing intervention for this patient?

6-2. The perianesthesia nurse is providing discharge instructions for the patient who has just had a subtotal thyroidectomy. The nurse is aware that the patient could experience hypocalcemia and includes all of the following symptoms in the instructions EXCEPT:

6-3. A 68-year-old male patient arrives in the Phase I PACU after a pancreaticoduodenectomy (Whipple procedure). There were multiple complications intraoperatively, and a pulmonary artery catheter was inserted. The nurse assesses the vital signs of the patient and reviews the first set of readings from the pulmonary artery catheter. The readings are as follows: central venous pressure (CVP) is 6, pulmonary artery pressure systolic/pulmonary artery pressure diastolic (PAS/PAD) is 16/10, pulmonary artery wedge pressure (PAWP) is 10. Vital signs are BP 107/64, HR 87, RR 19, and SpO₂ 98%. Reviewing the readings, the nurse recognizes that the patient is:

6-4. A 23-year-old male patient had spinal anesthesia for his bone marrow donation procedure. On arrival to the Phase I PACU, his vital signs are BP 80/60, HR 48, RR 20, T 96.8° F (36° C), and SpO₂ 97%. The nurse recognizes that the patient is experiencing:

    Consider this scenario for questions 6-5 and 6-6.

    A 25-year-old male patient with type I diabetes arrives for surgery. In the preoperative interview he is complaining of nausea and thirst. His skin is warm and dry. He seems lethargic when the nurse is speaking to him. The nurse checks his glucose level with the bedside glucose meter and results are 642 mg/dL He also reports that he has been urinating every 30 minutes.

6-5. Based on the presenting symptoms, the nurse suspects that the patient has:

6-6. All of the following may have precipitated this disorder EXCEPT:

6-7. A healthy 46-year-old patient arrives in the Phase I PACU after a total parathyroidectomy and will be staying in the Phase I PACU overnight. Twenty-four hours later as the nurse assists the patient with ambulation to the bathroom, he stumbles and apologizes, saying that he has numbness in his toes and has been experiencing muscle spasms. He also reports a tingling sensation around his mouth. What is the MOST likely complication that the nurse is concerned about at this time?

6-8. The nurse caring for a patient with Addison’s disease is aware that perioperative steroid administration can increase the risk of:

6-9. Pheochromocytoma is a benign tumor of the adrenal medulla with release of catecholamine. Symptoms include all of the following EXCEPT:

6-10. Which of the following patients all undergoing the same procedure is most at risk for dehydration postoperatively?

6-11. The patient arrives in the Phase I PACU after a liver biopsy to rule out malignancy. His vital signs on admission are BP 96/67, HR 126, RR 27, and SpO₂ 96%. The nurse places the patient on nasal cannula at 4 L/min oxygen and medicates the patient for abdominal pain with intravenous opioids. He states his pain level is 6 (numerical rating scale 0–10). After 15 minutes the patient’s vital signs are BP 90/68, HR 130, RR 27, and SpO₂ 95%. The patient reports a pain level of 8/10. Preoperatively the patient’s vital signs were BP 134/72, HR 90, RR 18, and SpO₂ 98% on room air. What would be the MOST likely course of action for the nurse to consider first?

6-12. The perianesthesia nurse is caring for a patient after partial thyroidectomy. While assessing the patient for potential nerve damage, the nurse will ask the patient to say:

6-13. A 37-year-old female patient arrives in the Phase I PACU after cardiac arrest in the operating room. During the arrest, it was noted that the patient was having peaked T waves and widening QRS complexes on the cardiac monitor. When reviewing potential electrolyte causes of cardiac arrest, what electrolytes would the nurse consider FIRST to be a potential cause of the arrest?

6-14. A 53-year-old male patient has suffered a cardiac arrest, and during the code his rhythm shows that he has torsades de pointes. What is the medication of choice for terminating this rhythm?

6-15. The perianesthesia nurse caring for a hyperthyroidism patient with exophthalmos recognizes that in the perioperative period, the patient may be at increased risk for:

6-16. A patient was diagnosed with intestinal ileus after 2 days of vomiting. In the emergency department, the patient had a nasogastric (NG) tube placed and attached to suction. The patient arrives in the Phase I PACU after colon resection and the NG tube is reattached to wall suction. As a result of this the nurse recognizes that the patient is at risk for which acid–base imbalance?

6-17. Thyrotoxic crisis (thyroid storm) can mimic malignant hyperthermia. Which of the following symptoms can help differentiate that the patient is experiencing thyrotoxic crisis?

    Consider this scenario for questions 6-18 and 6-19.

    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 were stable, 1500 mL of IV fluid were infused, urine output was 200 mL, and there was minimal blood loss.

6-18. The patient has been in the PACU for 1 hour and the nurse empties the catheter drainage bag of 2000 mL of light yellow urine. The patient is slightly tachycardic and hypotensive. IV fluids for the hour were 100 mL. The patient did not receive any diuretic medications intraoperatively or in the PACU. The nurse suspects that the patient may be exhibiting symptoms of:

6-19. The nurse anticipates that the patient will be treated with:

6-20. A 57-year-old male patient underwent a transurethral resection of the prostate (TURP) and is experiencing symptoms of TURP syndrome. The patient’s serum sodium level is 118 mEq/L. Due to the decreased sodium level, the nurse would anticipate an order for what fluid?

6-21. What is the dosage of sodium bicarbonate for a child in arrest who has severe metabolic acidosis or hyperkalemia?

6-22. A child with poor skin turgor, sunken fontanel, marked oliguria, and tachycardia may be exhibiting the signs of what physiologic state?

6-23. A 43-year-old patient with von Willebrand disease has undergone colon resection for removal of a tumor. The patient experienced a large blood loss, and transfusion would be optimal to support the patient’s fluid status; however, the patient is a devout Jehovah’s Witness who will not allow blood transfusion. Which of the following colloids would be the MOST likely to be acceptable to this patient?

6-24. The preadmission nurse is listening to the anesthesiologist explain to a hypothyroid patient that a fiber-optic scope will be used to facilitate intubation. The nurse recognizes that the patient with hypothyroidism is at risk for a difficult intubation due to:

6-25. A 32-year-old female patient with Addison’s disease arrives in the Phase I PACU after repair of the right tibia–fibula fracture. What electrolytes would the nurse look for that might indicate the patient was experiencing an Addisonian crisis?

6-26. What is the amount of an initial fluid bolus to be given to a child who is suspected of being in cardiogenic shock?

6-27. A patient is in cardiac arrest after surgery for an adrenal tumor. Capnography is in use, and the nurse recognizes return of spontaneous circulation with an end tidal carbon dioxide level of:

6-28. Which of the following patients has the highest risk for dehydration or fluid overload postoperatively?

6-29. A patient arrives in the Phase I PACU after a craniotomy, and mannitol is ordered to be administered. The nurse caring for the patient recognizes that the mannitol will affect intracranial pressure (ICP) by acting as:

6-30. Postoperative nausea and vomiting is MOST likely to significantly affect which patient?

6-31. After surgery for total thyroidectomy, the nurse is alert for signs of hypocalcemia that include all of the following EXCEPT:

6-32. The perianesthesia nurse is aware that in the perioperative period the most common cause of morbidity in a patient with diabetes is:

6-33. A patient is scheduled for surgery to repair a fractured radius and ulna after a fall at home. During the preadmission interview the patient describes symptoms of increased thirst, decreased urine output, nausea, and headache. The nurse checks for edema of the lower extremities and finds none. A review of the preprocedure laboratory values shows hyponatremia. The nurse suspects that the patient may have:

6-34. What is the impact of anesthetic agents on extracellular fluid (ECF)?

6-35. The perianesthesia nurse caring for a patient with Cushing syndrome recognizes that the corticosteroid hypersecretion by the adrenal glands can cause:

6-36. A 46-year-old patient arrives in the preanesthesia holding area before his scheduled procedure for removal of renal calculi. The preanesthesia nurse reviews the patient’s history, which includes congenital central diabetes insipidus. For treatment, the patient’s medications would include:

6-37. A 27-year-old patient with diabetes and asthma arrives in the Phase I PACU after a total knee replacement. His surgery was delayed until late in the day. He arrives with stable vital signs, but he is drowsy, vomiting and complaining of abdominal pain, polyuria, and polydipsia. As the nurse, what would be the first priority for this patient?

6-38. The nurse caring for the patient with Graves disease knows that it is most commonly a result of:

6-39. The nurse is reviewing the home medication list of a patient with diabetes. Which of the following medications may contribute to hypoglycemia?

6-40. When the nurse in the preoperative area is preparing the patient with chronic renal failure for surgery, which set of laboratory blood work is most likely ordered other than a blood urea nitrogen (BUN) and creatinine?

6-41. Patients with diabetes who are scheduled for interventional radiology procedures with contrast should be instructed to hold which medication?

6-42. A patient’s arterial blood gas (ABG) results are the following: pH 7.38, PaCO₂ 40, HCO₃ 24, and PaO₂ 95%. What does the nurse interpret these results to be?

6-43. The perianesthesia nurse is caring for a patient with diabetes in the preoperative area. The nurse recognizes that surgical stress may precipitate all of the following in this patient EXCEPT:

a. Decreased peripheral insulin resistance

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