!DOCTYPE html> 7-1. Warming intravenous (IV) fluids helps to prevent heat loss resulting from the following mechanism: a. Radiation b. Conduction c. Convection d. Evaporation 7-2. Examples of active warming measures include all of the following EXCEPT: a. Forced-air convection system b. Circulating-water mattresses c. Application of warmed blankets d. Radiant warmers 7-3. A patient is in the Phase I PACU after surgery to remove a benign pituitary tumor. The nurse will monitor the patient’s temperature carefully during this phase of recovery. The nurse is aware that a consequence of this surgery includes hyperthermia (a result of hypothalamic influence) and hypothermia, which is a result of: a. Decreased thyroid-stimulating hormones b. Increased thyroid-stimulating hormones c. Impaired metabolism d. Impaired glucose regulation 7-4. Which of the following statements is true? a. Near-core measures of oral temperatures best approximate core b. Near-core measures of rectal temperatures best approximate core c. Near-core measures of tympanic temperatures best approximate core d. Near-core measures of temporal temperatures best approximate core Consider this scenario for questions 7-5 and 7-6. A nurse relieving another nurse for break asks for a report on the patient. The second nurse states, “Why should I give you a report? You won’t understand it anyway.” Then she rolls her eyes and walks away from the patient and relief nurse. 7-5. What term best describes this interaction? a. Immature behavior b. Nurse fatigue c. Female relationships d. Horizontal violence 7-6. This type of behavior threatens patient safety because it: a. Forces nurses who don’t like each other to work together b. Creates barriers to effective communication c. Distracts and entertains the rest of the staff d. Makes nurses look unprofessional Consider this scenario for questions 7-7 and 7-9. A 42-year-old male patient is in the Phase I PACU after a hernia repair under spinal anesthesia. Preoperatively his BP was 130/60 and HR was 70. 7-7. After 90 minutes, his BP is 160/90 and HR is 110. He denies any pain. Based on knowledge of evidence-based practice, the nurse suspects the patient may be at risk for: a. Pulmonary hypertension (PHTN) b. Postoperative urinary retention (POUR) c. Postoperative nausea and vomiting (PONV) d. Posttraumatic stress disorder (PTSD) 7-8. What intervention should the nurse consider as the first action? a. Notify the physician b. Treat hypertension c. Scan the bladder d. Use distraction 7-9. Loss of body heat due to transfer to the surrounding cooler air is an example of: a. Radiation b. Conduction c. Convection d. Evaporation 7-10. Mrs. Jones presents to the Phase I PACU after undergoing a right knee arthroscopy. Her surgeon has ordered ketorolac 30 mg to be given for pain. During handoff, the anesthesia provider reports that ketorolac 15 mg was administered intraoperatively. While reading Mrs. Jones’s health history, the nurse has learned that this 70-year-old patient has previously been treated for acute kidney injury. The nurse should consider all of the following EXCEPT: a. Question the order of ketorolac 30 mg in a patient over the age of 60 b. Limit IV fluids because she has a history of renal impairment c. Request an order for IV acetaminophen 1000 mg instead of ketorolac d. Monitor Mrs. Jones’s urinary output 7-11. On arrival to the Phase I PACU, a 9-month-old child is alert and moving all extremities, with a BP of 75/40 and HR of 180. Twenty minutes after arrival, the patient’s HR is 230, a strong brachial pulse is present, and her cardiac rhythm is a narrow complex tachycardia. The perianesthesia nurse immediately prepares for: a. Defibrillation b. Carotid massage c. Adenosine d. An ice pack 7-12. Potential causes of hypothermia during a pediatric surgery include all of the following EXCEPT: a. Neuromuscular blocking agents b. Opioid analgesic agents c. Volatile inhalation agents d. Intravenous fluids 7-13. Which of the following would place the patient at the highest risk of postoperative nausea and vomiting (PONV)? a. Stapedectomy b. Abdominal surgery c. History of seasickness d. Obesity 7-14. Which of the following drugs would be preferred for the management of nausea and vomiting due to motion sickness? a. Dexamethasone b. Dronabinol c. Haloperidol d. Scopolamine 7-15. A Phase I PACU nurse routinely works “double shifts” caring for patients 16 hours a day, 3 or 4 days within a 5-day work week. Understanding current evidence regarding nursing fatigue, a colleague is concerned because this work schedule can: a. Triple the medical error rate b. Double the medical error rate c. Increase patient length of stay d. Decrease patient satisfaction 7-16. Each of the following drugs could be appropriately prescribed for the management of postoperative nausea and vomiting EXCEPT: a. Granisetron b. Haloperidol c. Lorazepam d. Dolasetron 7-17. A 42-year-old female patient is admitted to the Phase I PACU after a laparoscopic cholecystectomy. The patient’s BP is 130/60, HR is 84, RR is 20, and SpO2 is 88%. The perianesthesia nurse understands this patient is at risk for: a. Increased lung volume b. Decreased lung volume c. Decreased dead space d. Increased minute volume 7-18. Normothermia is defined as a core temperature between: a. 34° C and 36° C b. 35° C and 37° C c. 36° C and 38° C d. 37° C and 39° C 7-19. Which of the following agents is likely to produce confusion, motor incoordination, and hallucinations? a. Scopolamine b. Ondansetron c. Granisetron d. Dexamethasone Consider this scenario for questions 7-20 and 7-21. While monitoring an intubated patient using capnography, the nurse recognizes a sudden decrease in end-tidal CO2 (ETCO2) to near 0. 7-20. What is the first action the nurse immediately takes? a. Call the anesthesiologist b. Reset the ventilator alarm c. Simulate the patient d. Auscultate the lungs 7-21. A sudden increase in end-tidal CO2 may be an indication of: a. Inadvertent narcotization b. Malignant hyperthermia c. Dislodged endotracheal (ET) tube d. Pulmonary embolism 7-22. Family presence in the PACU: a. Should be discouraged to prevent infection b. Should be encouraged to decrease anxiety c. Is a Health Insurance Portability and Accountability Act (HIPAA) violation d. Should be open to improve Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) scores 7-23. Signs of pain in patients with intellectual disabilities can include all of the following EXCEPT: a. Fidgeting b. Guarding c. Grimacing d. Vital signs 7-24. When providing discharge instructions, the perianesthesia nurse in the Phase II PACU reiterates the need to call a physician when there is pain not relieved by the prescribed pain management protocol, bleeding beyond the expected volume, symptoms of urinary retention, and a fever with a temperature above: a. 37.8° C b. 38° C c. 38.3° C d. 39° C 7-25. During a busy evening in the Phase I PACU, the charge nurse decides to combine Preoperative, Phase I, and Phase II patients in one area. Patients are carefully moved so that: a. Preanesthesia patients are separated from recovering patients b. Phase I postanesthesia patients are closer to the operating room (OR) doors c. Phase II postanesthesia patients are nearest to the door d. Patients are mixed together, regardless of the level of care, as long as there are competent staff 7-26. Which of the following agents reduces nausea and vomiting by increasing gastric emptying? a. Diazepam b. Granisetron c. Diphenhydramine d. Metoclopramide 7-27. Hyperalgesia is defined as: a. Extreme physical or mental pain b. Altering or adaptation according to circumstances c. Increased sensitivity to pain d. A lessening of pain without loss of consciousness 7-28. Pain tolerance is defined as the: a. Decreased sensitivity to painful stimuli b. Point at which a person does not feel pain c. Maximum level of pain a person accepts d. Disturbance of neural pain processes 7-29. A 25-year-old female trauma patient presents from the emergency surgery under general anesthesia following a motor vehicle accident. The family indicates a possible history of malignant hyperthermia. The best course of action would be to: a. Conduct emergency genetic testing b. Pretreat with 2.5 mg/kg of dantrolene before anesthesia induction c. Conduct an emergency muscle biopsy d. Avoid exposure to malignant hyperthermia–triggering agents 7-30. A patient appears upset and tearful but denies pain and refuses pain medication because “my sibling is a drug addict and I am afraid of getting hooked.” What is the priority intervention for this patient? a. Encourage expression of fears of past experiences b. Provide accurate information about the use of pain medication c. Explain that addiction is unlikely among acute care patients d. Seek family assistance in resolving this problem 7-31. A perianesthesia nurse caring for a patient in Phase I is assigned a second patient. While receiving a report for the second patient, the nurse learns this patient is classified as an ASA IV, hemodynamically unstable, and has an extensive cardiac history. The nurse immediately contacts the charge nurse because the nurse understands that safe staffing should reflect: a. Nurse competency b. Number of nurses c. Patient comorbidities d. Patient acuity 7-32. While searching for the most comprehensive evidence-based statement regarding a clinical practice issue, the perianesthesia nurse seeks out a/an: a. Systematic integrative study b. Randomized control trial c. ASPAN position statement d. Clinical practice guideline 7-33. The most common clinical symptom of malignant hyperthermia is: a. Masseter jaw spasm b. Unstable blood pressure c. Hypercarbia d. Hypoxia 7-34. To reduce the noise level in the Phase I PACU, several of the nurses have decreased the volume of the pulse oximeter alarms. The prudent perianesthesia nurse is concerned because: a. Noise volume in the unit still remains too loud b. PACU patient satisfaction scores are still low c. The Joint Commission National Patient Safety Goal is not being met d. Patients complain they cannot sleep comfortably 7-35. When caring for a young child with pain, which assessment tool is the most useful? a. Simple description pain intensity scale b. 0-10 numerical rating scale (NRS) c. FACES pain-rating scale d. McGill-Melzack pain questionnaire 7-36. When the patient develops malignant hyperthermia in the operating room, the first action that should be taken is: a. Reconstitute dantrolene b. Ventilate with high-flow oxygen c. Discontinue all triggering agents d. Initiate cooling measures 7-37. A patient with chronic low back pain who took hydromorphone around the clock for the past year was told to stop the medication preoperatively by a provider. The preoperative nurse recognizes that this patient may experience symptoms of: a. Addiction b. Tolerance c. Pseudoaddiction d. Physical dependence 7-38. Infants are at higher risk for hypothermia due to the lack of a shiver response between birth and: a. Age 12 months b. Age 9 months c. Age 6 months d. Age 3 months 7-39. A 75-year-old, frail, elderly female patient presents to the preoperative area on the day of surgery with an oral temperature of 36° C. The best intervention to prevent unplanned perioperative hypothermia in this patient would be: a. Infuse 1 L of intravenous fluid b. Increase the room temperature c. Apply socks and gloves d. Apply forced-air warming 7-40. When applying the principles of pain management, what is the first consideration? a. Treatment is based on the patient’s and family’s goal b. A multidisciplinary approach is needed c. The patient must be believed about perceptions of their own pain d. Medication side effects must be prevented and managed 7-41. _________ results in compulsive use of a drug despite harmful effects. a. Addiction b. Tolerance c. Physical dependence d. Addiction and physical dependence 7-42. Intravenous insulin and glucose are administered during a malignant hyperthermia episode to treat: a. Hyperkalemia b. Hypothyroidism c. Hypokalemia d. Hyperthyroidism 7-43. An elderly woman with a history of a stroke that left her confused and unable to communicate returns from the procedure area after a gastrostomy tube placement. The provider has addressed pain management with an order that reads as follows: oxycodone 2.5 mg (1/2 tab), per tube, q 4 hours, prn. Which action by the nurse is most appropriate? a. No action is required by the nurse because the order is appropriate b. Request to have the order changed to around-the-clock (ATC) for the first 48 hours c. Ask for a change of medication to hydromorphone 0.2 mg IVP, q 3 hours, prn d. Begin the oxycodone when the patient shows nonverbal symptoms of pain 7-44. An example of a preemptive intervention for postoperative pain management include all of the following EXCEPT: a. Administration of oral acetaminophen for 24 hours preoperatively b. Injection of local anesthetic into the tissues prior to incision c. The provision of a peripheral nerve block in the Phase I PACU d. A single dose of a short acting opioid just prior to entering the operating room Consider this scenario for questions 7-45 and 7-46. An 8-year-old child is admitted to the Phase I PACU after an appendectomy. 7-45. Considering that the child was exposed to chickenpox the day before surgery, what action does the charge nurse take? a. Send him directly to an inpatient room b. Place him on contact precautions in the PACU c. Place him on airborne precautions in the PACU d. Assign him to a nurse who was also exposed 7-46. During transport of this patient, what does the nurse advocate for? a. No special considerations during travel
Maintenance of Normothermia, Physiologic Comfort, and the Therapeutic Environment
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