5-1. The function of the proximal tubule in the glomerulus is to:

5-2. The preadmission nurse makes a screening phone call to a 32-year-old male patient scheduled for a varicocelectomy. A varicocele is caused by:

5-3. While monitoring the patient’s vital signs, the Phase I PACU nurse may notice some of the normal physiologic changes related to pregnancy. Normal clinical findings include all of the following EXCEPT:

5-4. John Jones is a 16-year-old male patient who presents to outpatient surgery with his parents for arthroscopy with anterior cruciate ligament (ACL) repair. He is an athlete with no preexisting health problems before tearing his ACL while being tackled in football. John arrives with crutches that were used by his father.

    The day-of-surgery nurse notes that the patient’s father is significantly taller than his son. To assess for proper fit of his axillary crutches, the nurse must have the patient stand upright with the crutches in place and note that the central post allows:

5-5. The drug of choice for postoperative pain control in a patient with chronic renal failure is:

5-6. The preadmisson nurse makes a preoperative phone call to a 66-year-old patient scheduled for a total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), anteroposterior (AP) repair, and cystoscopy. The patient has questions because she does not understand what an AP repair is. The nurse explains what this is because she knows an AP repair is repair of:

5-7. The Phase I PACU nurse admits a 33-year-old patient after an emergent appendectomy. The patient is 34 weeks pregnant. Upon arrival, what is the best position for the patient?

5-8. The renin–angiotensin–aldosterone (RAA) system is a major renal hormonal regulator for all of the following EXCEPT:

5-9. The Phase I PACU nurse admits an 8-year-old child after hypospadius repair. Which of the following is a postanesthesia priority for this patient?

5-10. A Phase II PACU nurse gives discharge instructions to a 32-year-old patient after a diagnostic laparoscopy. Her vital signs have remained stable throughout her Phase I and II course, pain is moderately controlled with a rating of 5/10, she has taken a few sips of water with her oral pain medication, and she voided when she got up to get dressed. She states she felt slightly nauseated, but it is late in the day and she wants to get home. The instructions given to the patient should include information to notify the physician if she has symptoms of unrelieved pain, nausea and vomiting, and unresolved fever due to the possible complication of a:

5-11. The Phase II PACU nurse gives discharge instructions to a 25-year-old patient who had a cervical cerclage under spinal anesthesia. The patient should be instructed that which of the following is expected after this surgery?

5-12. The Phase II PACU discharge nurse continues to give instructions to this same patient regarding her spinal. She instructs the patient to do which of the following if she develops a persistent headache?

    Consider this scenario for questions 5-13 and 5-14.

    An 88-year-old male patient is transferred to the Phase I PACU after receiving general anesthesia for a left-sided extracorporeal shock wave lithotripsy (ESWL). Report is received, and the initial assessment is completed. The patient’s health history includes hypertension that is controlled with hydrochlorothiazide, 25 mg once daily, and an omega-3 fish oil supplement daily.

5-13. The patient is complaining of mild discomfort, and ketorolac 15 mg IV is ordered. It is MOST important to understand that ketorolac:

5-14. It is most important to assess this patient’s urinary output because of:

5-15. The Phase II PACU nurse is discharging a patient after insertion of a neurostimulator implant for urge incontinence. The nurse should tell the patient to avoid:

5-16. The preadmission nurse is making a screening telephone call to a 90-year-old patient scheduled for a cystoscopy and fulguration bladder tumors on an outpatient basis. Her history includes hypertension, coronary artery disease, gastric reflux, and osteoarthritis. She lives alone in an assisted care facility. Regarding NPO guidelines, the preadmission nurse should instruct the patient that it is permissible to:

5-17. The Phase I PACU nurse is preparing to transfer a patient who is status post–anterior cruciate ligament (ACL) repair and has an indwelling nerve catheter of 0.1% ropivacaine in 100 mL of normal saline infusing at 8 mL/hr. He quickly becomes increasingly agitated, stating that he has a metallic taste in his mouth and his lips are numb. The nurse’s first response after calling for help should be:

5-18. While obtaining a patient’s preoperative history, the preadmission nurse learns that the patient has symptoms of urgency and frequency. Urinary urgency is:

5-19. For a patient exhibiting symptoms of local anesthetic systemic toxicity (LAST), the recommended initial dose of intralipids is:

5-20. A 50-year-old female patient is admitted to the preoperative unit in preparation for a triple arthrodesis on the right foot. Pertinent baseline assessments for this surgery include:

5-21. The Phase II PACU nurse has initiated discharge teaching to a patient who is going home with an indwelling femoral nerve catheter. The instructions will include reminding the patient that after removing the catheter, it is critical to immediately check:

5-22. The nurse knows that the patient who is being treated with chlorothiazide for high blood pressure may present with a potassium deficiency. This deficiency may affect the function of neuromuscular blocking agents by:

5-23. The Phase I PACU nurse is caring for Mrs. Smith after surgical reduction of a displaced femoral fracture requiring pinning. She was struck by a car while crossing the street. The report indicated the patient had no preexisting health problems. No loss of consciousness occurred during the event, and the patient was alert, verbal, and oriented before surgery. The patient arrived in the Phase I PACU awake and responsive to verbal stimuli.

    While assessing the patient, the nurse notes a petechial rash evident on the patient’s head, neck, and chest. The patient’s SpO₂ is 85%, and crackles are evident bilaterally to auscultation of her lungs. She does not respond to verbal stimuli. The perianesthesia nurse is concerned the patient is exhibiting symptoms of:

5-24. The most common complication after lower extremity joint arthroplasty is:

5-25. A patient demonstrating weak or absent dorsiflexion of the foot and ankle and numbness of the lateral aspect of the great toe and medial aspect of the second toe is demonstrating what complication of hip arthroplasty?

5-26. The Phase I PACU nurse receives a 10-year-old patient who fell skateboarding and suffered a comminuted fracture of his humerus. This type of fracture is defined as:

5-27. The Phase I PACU nurse receives a 57-year-old female patient after placement of an arteriovenous (AV) graft in her right upper extremity for hemodialysis. Besides her chronic renal failure, her history includes diabetes, hypertension, systemic lupus erythematosus (SLE), stroke, myocardial infarction (MI), cataracts, fibromyalgia, morbid obesity, and polycystic kidney disease. Which of the following is a primary cause of chronic renal failure?

5-28. A preadmission nurse makes a screening phone call to a 75-year-old female patient scheduled for outpatient surgery to repair a right radial Colles’s fracture that she sustained when she fell getting out of bed. The patient’s history includes hypertension, coronary artery disease (CAD), Type I diabetes, and stroke with slight left arm weakness. The patient uses a walker or cane and lives alone. The patient states she is worried because she does not have any family to help her at home when she is discharged. There is a neighbor who will bring her to the hospital and take her home, but no one to stay with her. Based on this information, the preadmission nurse should:

5-29. The broad ligaments of the uterus:

5-30. The Phase I nurse admits a 45-year-old patient who had a repair of a vesicovaginal fistula. Which of the following is correct regarding this fistula?

5-31. The union of the vas deferens with the duct from the seminal vesical forms the:

5-32. The Phase I PACU nurse performs a neurologic assessment on a patient who had an L4–5 laminectomy. The patient is asked to move his foot by bending the toes and foot forward. This movement is called:

5-33. Aldosterone is released from the:

5-34. A strain injury is most likely a result of:

5-35. The preadmission nurse calls a 35-year-old patient at 30 weeks’ gestation scheduled for a fractured ankle repair after falling on ice. During the interview the patient mentions some symptoms that she has been having that she did not experience with prior pregnancies. Which of the following cardiovascular changes during pregnancy that mimic cardiac disease would need further investigation?

5-36. A 25-year-old male patient arrives to the Phase I PACU after repair of a left tibial plateau fracture after a motor vehicle crash. The nurse assesses the patient frequently for signs of compartment syndrome, which include all of the following EXCEPT:

5-37. In the preoperative unit, the nurse is called to assist with placement of an interscalene block on a 40-year-old patient scheduled for shoulder arthroscopy. Anesthesia has ordered midazolam 1 mg IV and fentanyl 50 mcg IV to be given for the procedure. Which of the following statements is correct regarding assisting with this procedure?

5-38. A 45-year-old male patient who works in a warehouse is admitted to the Phase I PACU after a rotator cuff repair. His history includes previous shoulder injuries, including subluxations. A subluxation injury is:

5-39. The Phase I PACU nurse performs frequent neurovascular assessments on a patient’s postoperative hand. Which of the following is done to test radial nerve sensation?

5-40. A patient was diagnosed with pyelonephritis. Which laboratory value supports this diagnosis?

5-41. A late-stage compartment syndrome symptom is:

5-42. A patient has arrived from the operating room with a urinary catheter in place. Which of the following findings is AGAINST standard practice?

5-43. The Phase II PACU is providing discharge teaching to a 65-year-old male patient going home after a shoulder arthroscopy. The patient received preoperative medications, including midazolam 2 mg IV, acetaminophen 1000 mg PO, oxycodone 10 mg PO, and gabapentin 600 mg PO. In the operating room, he received general anesthesia, and the surgeon placed a disposable pump device for postoperative pain control. The bulb is filled with 400 mL of 0.5% bupivacaine and will infuse at 5 mL/hr with an additional PRN demand dose of 5 mL/hr. The nurse provided discharge instructions regarding diet, wound care, showering, pain management, follow-up appointment, and care/removal of the pump infusion line. For what issue should the nurse instruct the patient to call the surgeon?

5-44. The preadmission nurse is making a screening phone call to a 65-year-old patient scheduled for a cystoscopy and retrograde pyelogram (RPG). The nurse explains that the RPG provides:

5-45. The Phase I PACU nurse receives a 63-year-old patient following a total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and omentectomy. She has a history of hypertension, heart failure, hypothyroidism, and chronic pain. She received 1500 mL Lactated Ringer’s in the operating room and had a 300 mL blood loss. After 3 hours in the Phase I PACU, the patient’s urine output is averaging 10 mL/hr, BP is 99/60, and HR is 110. The surgeon orders a complete blood count (CBC) and basic metabolic panel (BMP). The patient’s creatinine was 1.6 preop and is now 3.0. This is a sign of:

5-46. The Phase I PACU nurse admits a 23-year-old patient after a diagnostic laparoscopy and excision of an ovarian cyst. The patient presents to the Phase I PACU restless and complaining of abdominal pain, nausea, and right shoulder pain. The patient’s BP is 140/88, HR is 120, RR is 26, and SpO₂ is 99%. These symptoms are likely related to:

5-47. The nurse in the Phase I PACU is caring for a 58-year-old male patient after receiving general anesthesia during a 4-hour procedure. He repeatedly attempts to get out of bed, removes his oxygen mask, and picks at his abdominal dressing. The perianesthesia nurse attempts to reorient the patient and reassure him while assessing for likely causes of his restlessness, including hypoxia, pain, and:

a. Distended bladder

b. Sepsis

c. Electrolyte imbalance

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