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113 Cards in this Set

  • Front
  • Back
Which of the following types of anesthesia is administered by injection a local anesthetic around a nerve trunk supplying the area of surgery?

a. Nerve block

b. Subdural Block

c. Surface anesthesia

d. Local infiltration lidocaine
When obtaining a consent form from a patient scheduled to undergo surgery the nurse should consider which of the following facts?

a. A consent form is legal even if the patient is confused or sedated.

b. The form that is signed is not a legal document and would not hold up in court.

c. In emergency situations the doctor may obtain consent over the telephone.

d. The responsibility for securing informed consent from the patient lies with the nurse.
A 9 month old baby is scheduled for heart surgery. When preparing this patient for surgery the nurse should consider which of the following surgical risks associated with infants?

a. Prolonged wound healing

b. Potential for hypothermia or hyperthermia

c. Congestive heart failure

d. Gastrointestinal upset
Mr. Lemke, age 42 is scheduled for elective hernia surgery. While taking a medical history for Mr. Lemke you find out he is taking antibiotics for an infection. To which of the following surgical risks would Mr. Lemke be predisposed because of his use of antibiotics?

a. Hemorrhage

b. Electrolyte imbalances

c. Cardiovascular collapse

d. Respiratory paralysis
When preparing a patient who has diabetes mellitus for surgery the nurse should be aware of which of the following potential surgical risks associated with this disease?

a. Fluid and electrolyte imbalance

b. Slow wound healing

c. Respiratory depression from anesthesia

d. Altered metabolism and excretion of drugs.
Mr. Pete is an obese 62yrs old man scheduled for heart surgery. Which of the following surgical risks related to obesity should be considered when performing an assessment for this patient?

a. Delayed would healing and would infection

b. Alteration in fluid and electrolyte balance.

c. Respiratory distress

d. Hemorrhage
When teaching a postoperative patient about pain control the nurse should consider which of the following statements?

a. When giving pain medication PRN the patient should ask for the medication when the pain becomes severe.

b. The nurse is responsible for ordering and administering pain medication.

c. Medications for pain usually are given by injection for the first few days or as long as the patient is NPO.

d. Alternate pain control methods such as TENS and PCA should not be used after surgery.
To prevent post operative complications which of the following measures should be taken after surgery?

a. The patient should be instructed to avoid coughing if possible to minimize damage to the incision.

b. The patient should take shallow breaths to prevent collapse of the alveoli.

c. The patient should be instructed to do leg exercises to increase venous return.

d. The patient should not be turned in bed until the incision is no longer painful.
Which of the following is the most common post-anesthesia recovery emergency?

a. Respiratory obstruction

b. Cardiac distress

c. Wound infection

d. Dehydration
Mr. Fischer has returned to your unit after cardiac surgery. Which of the following interventions would be appropriate to prevent cardiovascular complication for him?

a. Position him in bed with pillows placed under his knees to hasten venous return.

b. Keep him from ambulating until the day after surgery.

c. Implement leg exercises and turn him in bed every 2hrs.

d. Keep him cool and uncovered to prevent elevated temperature.
Which of the following intervention should be carried out by the nurse when a postoperative patient is in shock?

a. Remove extra covering on the patient to keep temperature down.

b. Place the patient in a flat position with legs elevated 45 degrees.

c. Do not administer any further medication

d. Place the patient in the trendelenburg or shock position.
Which of the following is a recommended physical preparation for a patient undergoing surgery?

a. Shave the area of the incision with a razor.

b. Empty the patients bowel of feces.

c. Do not allow the patient to eat or drink anything for 8 to 12hrs before surgery.

d. Be sure the patient is well nourished and hydrated.
Which of the following preoperative medications would be prescribed to decrease pulmonary and oral secretions and prevent laryngospasm?

a. Narcotic analgesics

b. Anticholiergics

c. Neuroleptanalgesic agents

d. Prone position
Which of the following positions would be used in minimally invasive surgery of the lower abdomen or pelvis?

a. Trendelenburg position

b. Sims position

c. Lithotomy position

d. Prone position
Your post-surgical patient is experiencing decreased lung sounds dyspnea, cyanosis crackles, restlessness and apprehension. Which of the following conditions would you diagnose?

a. Atelectasis

b. Pneumonia

c. Pulmonary embolus

d. Thrombophlebitis
Which of the following would be an appropriate reaction to a patient experiencing pulmonary embolus?

a. Try to over hydrate the paeitn with fluids.

b. Instruct the patient to perform Valsalva's maneuver.

c. Place the patient in semi fowlers position.

d. Assist the patient to ambulate every 2 to 3 hrs.
includes outpatient, same-day, or short-stay surgery that does not require an over night hospital stay.
ambulatory surgery
the patient’s autonomous decision about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options,and the risks and benefits involved
informed consent
period of time that begins with transfer of the patient to the operating room table and continues until the patient is admitted to the post anesthesia care unit.
intraoperative phase
period of time that constitutes the surgical experience; includes the preoperative, intra operative, and postoperative phases of nursing care
perioperative phase
period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow-up evaluation in the clinical setting or home
postoperative phase
diagnostic testing performed before admission to the hospital
preadmission testing
period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table
preoperative phase
Which of the following action would be performed in the postoperative phase of the perioperative period? (Select all that apply)

a. The nurse prepares the patient for home care.

b. The physician informs the patient that surgical intervention is necessary.

c. The patient is transferred to the recovery room.

d. the patient is admitted to the recovery area.

e. The patient begins to emerge form anesthesia.

f. The patient participates in a rehabilitation program after surgery.
a, d, f
Which of the following examples of surgery would be classified as surgical procedures based on purposed? (select all that apply)

a. Control of hemorrhage

b. Breast biopsy

c. Cleft palate repair

d. Colostomy

e. Tracheostomy

f. Breast reconstruction
b, c, d, f
Regional anethesia may be accomplished through wiht of the following methods? (select all that apply)

a. Inhalation

b. Spinal block

c. Intravenous

d. Oral route

e. Nerve block

f. Epidural block
b, e, f
Which of the following pieces of information must be provided to a patient to obtain informed consent? (select all that apply)

a. A description of the procedure or treatment along with potential alternative therapies.

b. The name and qualifications of the nurse providing preoperative care.

c. The underlying disease process and its natural course

d. Explanation of the risks involved and how often they occur.

e. Explanation that a signed consent form is binding and cannot be with drawn.

f. Customary insurance coverage for the procedure.
a, c, d
Which of the following statements accurately describe the surgical risks related to the developmental stage of the patient? (select all that apply)

a. Infants are at a greater risk from surgery than are middle aged adults.

b. Infants experience a slower metabolism of drugs that require renal bio-transformation.

c. Muscle relaxants and narcotics have a shorter duration of action in infants.

d. Older adults have decreased renal blood flow and a reduced bladder capacity necessitating careful monitoring of fluid and electrolyte status and input and output.

e. Older adults have an increase gastric pH and require monitoring of nutritional status during the preoperative period.

f. Older adults have an increased hepatic blood flow liver mass and enzyme function that prolongs the duration of medication effects.
a, b, d, e
Which of the following statements accurately describe ow preexisting disease states affect surgical risk? (Select all that apply)

a. Cardiovascular disease increase the risk for dehydration after surgery.

b. Patients with respiratory disease may experience alteration in acid base balance after surgery.

c. Kidney and liver disease influence the patients response to anesthesia.

d. Endocrine disease increase the risk for hyperglycemia

e. Endocrine disease increase the risk for slow surgical wound healing.

f. Pulmonary disorders increase the risk for hemorrhage and hypovolemic shock after surgery.
Which of the following statements accurately describe the effects the patients medications may have on surgical risk: (select all that apply)

a. Diuretics may precipitate hemorrhage.

b. Anticoagulants may cause electrolyte imbalances.

c. Diuretics may cause respiratory depression from anethesia

d. Tranquilizers may increase the hyportensive effect of anesthetic agents.

e. Adrenal steriods may cause respiratory paralysis.

f. Abrupt withdrawal from adrenal steroids may cause cardiovascular collapse in long term users.
c, d, f
Which of the following are significant abnormal findings related to pre surgical screening tests? (select all that apply)

a. An elevated white blood cell count indicating an infection.

b. Decreased hematocrit and hemoglobin level indicating bleeding or anemia.

c. Increase hyperkalemia or hypokalemia indicating possible renal failure.

d. Elevated blood urea nitrogen or creatinine levels indicationg an increased risk for cardiac problems.

e. Abnormal urine constituents indicating an infection or fluid loss.

f. Increased hemoglobin level indicating infection.
a, b, e
The Perioperative Nursing Data Set (PNDS)categorizes the practice of perioperative nursing practice into four domains: What are they?
safety, physiologic responses, behavioral responses, and health care systems.
The first three domains reflect phenomena of concern to perioperative nurses and are composed of _________________
nursing diagnoses, interventions, and out-comes
The fourth domain, the health care system, consists of?
Structural data elements and focuses on clinical processes and outcomes. The model is used to depict the relationship of nursing process components to the achievement of optimal patient outcomes.
The pressure to reduce hospital stays and contain costs has resulted in diagnostic
______________ and preoperative preparation prior to admission.
preadmission testing
What are the 7 stages of Preadmission Testing (PAT)
1.Initiates initial preoperative assessment

2.Initiates teaching appropriate to patient’s needs

3.Involves family in interview

4. Verifies completion of preoperative diagnostic testing.

5.Verifies understanding of surgeon-specific preoperative or-ders (eg, bowel preparation, preoperative shower)

6.Discusses and reviews advanced directive document

7.Begins discharge planning by assessing patient’s need for postoperative transportation and care
What are the 8 stages of Admission to Surgical Center?
1.Completes preoperative assessment

2.Assesses for risks for postoperative complications

3.Reports unexpected findings or any deviations from normal

4.Verifies that operative consent has been signed

5.Coordinates patient teaching and plan of care with nursingstaff and other health team members

6.Reinforces previous teaching

7.Explains phases in perioperative period and expectations

8.Answers patient’s and family’s question
In the Holding Area these 9 things happen:
1.Assesses patient’s status, baseline pain, and nutritionalstatus

2.Reviews chart

3.Identifies patient

4.Verifies surgical site and marks site per institutional policy

5.Establishes intravenous line

6.Administers medications if prescribed

7.Takes measures to ensure patient’s comfort

8.Provides psychological support

9.Communicates patient’s emotional status to other appropriate members of the health care team
During the Intraoperative Phase
of Maintenance of Safety what 7 steps should be followed?
1.Maintains aseptic, controlled environment

2.Effectively manages human resources, equipment, and supplies for individualized patient care

3.Transfers patient to operating room bed or table

4.Positions patient based on functional alignment and expo-sure of surgical site

5.Applies grounding device to patient

6.Ensures that the sponge, needle, and instrument counts are correct

7.Completes intraoperative documentation
During the Intraoperative Phase
of Physiologic Monitoring what 4 steps are followed?
1.Calculates effects on patient of excessive fluid loss or gain

2.Distinguishes normal from abnormal cardiopulmonary data

3.Reports changes in patient’s vital signs

4.Institutes measures to promote normothermia
What are the three steps of psychological support before Induction when patient is conscious
1.Provides emotional support to patient

2.Stands near or touches patient during procedures and in-duction

3.Continues to assess patient’s emotional status
What are the steps to the Postoperative Assessment in the Recovery Area
1.Determines patient’s immediate response to surgicalintervention

2.Monitors patient’s vital signs and physiologic status

3.Assesses patient’s pain level and administers appropriate pain relief measures

4.Maintains patient’s safety (airway, circulation, prevention of injury)

5.Administers medications, fluid, and blood component therapy, if prescribed

6.Provides oral fluids if prescribed for ambulatory surgerypatient

7.Assesses patient’s readiness for transfer to in-hospital unit or for discharge home based on institutional policy.
If your patient admitted to the ER and presents with severe bleeding, bladder or intestinal obstruction fractured skull gunshot or stab wounds extensive burns this patient would be considered what type of surgery patient?
I. Emergent—Patient requires immediate attention; disorder may be life-threatening.
If your patient is admitted to the ER and presents with Acute gallbladder infection Kidney or ureteral stones this patient would be considered what type of surgery patient?
II. Urgent—Patient requires prompt attention. Surgery required within 24 to 30hrs
If your patient is admitted with Prostatic hyperplasia without bladder obstruction or thyroid disorders or Cataracts this patient would be considered what type of surgery patient?
III. Required—Patient needs to have surgery
If your patient is wanting to repair of scars, simple hernia or vaginal repair what kind of surgery would this be considered?
IV. Elective—Patient should have surgery but not catastrophic if not done.
Cosmetic surgery is known as a __________ surgery
V. Optional—Decision rests with patient
includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay but may entail an admission to an inpatient hospital setting for less than 24 hours.
true or false

For the unconscious patient, informed consent and essential information, such as pertinent past medical history and allergies, need to be obtained from a family member, if one is available.
true or false

While the nurse may ask the patient to sign the consent form and witness the signature, it is the surgeon’s responsibility to provide a clear and simple explanation of what the surgery will entail prior to the patient giving consent.
true or false

If the patient is non–English speaking, it is necessary to provide consent (written and verbal) in a language that isunderstandable to the client
Informed consent should be in writing. What should it contain?
•Explanation of procedure and its risks

•Description of benefits and alternatives

•An offer to answer questions about procedure

•Instructions that the patient may withdraw consent

•A statement informing the patient if the protocol differs from customary procedure
true or false

If the patient is non–English speaking, it is necessary to provide consent (written and verbal) in a language that is understandable to the client.
Surgical outcomes may be altered by genetic conditions that may cause complications with anesthesia name a few.
•Malignant hyperthermia
•Central core disease (CCD)
•Duchenne muscular dystrophy
•Hyperkalemic periodic paralysis
•King-Denborough syndrome
Cardiovascular collapse can occur if discontinued suddenly. Therefore, a bolus of corticosteroid may be administered intravenously immediately before and after surgery.
Prednisone (Deltasone)
During anesthesia, may cause excessive respiratory depression resulting from an associated electrolyte imbalance
Hydrochlorothiazide (HydroDIURIL)
May increase the hypotensive action of anesthetic
Chlorpromazine (Thorazine)
May cause anxiety, tension, and even seizures if withdrawn suddenly
Diazepam (Valium)
Interaction between anesthetics and insulin must be considered when a patient with diabetes is undergoing surgery. Intravenous insulin may need to be administered to keep the blood glucose within the normal range.
When combined with a curariform muscle relaxant, nerve transmission is interrupted and apnea from respiratory paralysis may result.
Erythromycin (Ery-Tab)
Can increase the risk of bleeding during the intraoperative and postoperative periods; should be discontinued in anticipation of elective surgery. The surgeon will determine how long before the elective surgery the patient should stop taking an anticoagulant, depending on the type of planned procedure and the medical condition of the patient.
Warfarin (Coumadin)
Intravenous administration of medication may be needed to keep the patient seizure-free in the intraoperative and postoperative periods.
Antiseizure Medications
Intravenous administration may be needed during the postoperative period to maintain thyroid level
Thyroid Hormone
Levothyroxine sodium (Levothroid)
Long-term use of opioids for chronic pain (6 mo or greater) in the preoperative period may alter
the patient’s response to analgesic agents.
True or false

Currently, it is recommended that the use of herbal products be discontinued 2 to 3 weeks before surgery
Protecting patients from injury is one of the major roles of the______________ nurse.
True or false

The major purpose of withholding food and fluid before surgery is to prevent aspiration.
____________ is a rare life-threatening condition triggered by exposure to most anesthetic agents inducing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the body’scapacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if untreated. It is often inherited as an auto somaldominant disorder
malignant hyperthermia
previously referred to as conscious sedation, involves use of sedation to depress the level of consciousness without altering the patient’s ability to maintain a patent airway and to respond to physical stimuli and verbal commands
moderate sedation
________________ is moderate sedation administered by an anesthesiologist or anesthetist
monitored anesthesia care
____________ is
an anesthetic agent is injected around nerves so that the area supplied by these nerves is anesthetized
regional anesthesia
_________________- is an
area in the operating room where scrub attire and surgical masks are required; includes operating room and sterile core areas
restricted zone
_____________ is a
registered nurse, licensed practical nurse, or surgical technologist who scrubs and dons sterile surgical attire, prepares instruments and supplies, and hands instruments to the surgeon during the procedure
scrub nurse
________________ is an
area in the operating room where scrub attire is required; may include areas where surgical instruments are processed
semirestricted zone
______________ is
achieved when a local anesthetic agentis introduced into the subarachnoid space of the spinalcord
spinal anesthesia
_______________ is the
absence of microorganisms in the surgical environment to reduce the risk for infection
surgical asepsis
_________________ is an
area in the operating room that interfaces with other departments; includes patient reception area and holding area
unrestricted zone:
_______________ is
a state of narcosis, analgesia, relaxation, and loss of reflexes
_________ is a
physician trained to deliver anesthesia and to monitor the patient’s condition during surgery
________ is
the substance, such as a chemical or gas, used to induce anesthesia
anesthetic agent
________________ is a
health care professional, such as a nurse anesthetist, who is trained to deliver anesthesia and to monitor the patient’s condition during surgery
__________________ is a
registered nurse who co-ordinates and documents patient care in the operating room
circulating nurse (or circulator)
_______________ is a
state of narcosis, analgesia, relaxation,and loss of reflexes achieved by injecting an anestheticagent into the epidural space of the spinal cord
epidural anesthesia
_________________ is the
state of narcosis, analgesia,relaxation, and loss of reflexes produced by pharmacologic agents
general anesthesia
______________ is the
injection of a solution containing the anesthetic agent into the tissues at the planned incision site
local anesthesia
___________ is the name for the wide variety of nursing intervention carried out before during and after surgery
Peri-operative nursing
Surgical procedures are usually classified according to ___________, ____________, and ____________
Urgency, risk, purpose
Surgery that is planned and based on the patients choice is classified as ________________
Elective surgery
Surgery is classified as minor or major based on ____________-
Degree of risk
________________ anesthesia does not cause narcosis but results in analgesia and reflex loss.
The three states of anesthesia are _______, ____________, and _______
Induction, maintenance, and emergence
A patient who is scheduled for a colonoscopy would most likely receive what type of sedation?
___________ is a patients voluntary agreement to undergo a particular procedure or treatment after receiving the appropriate information from the physician.
Informed consent
Two common forms of advance directive are _________ and ____________.
Living will durable power of attorney
member of sterile team who maintains surgical asepsis while draping and handling instruments and supplies
Scrub nurse
Actively assists the surgeon by providing exposure hemostatsis and wound closure.
RNFA (first assistant RN)
Coordinates care activities and collaborates with physicians and nurses in all phases of perioperative post-anesthesia care
Assess the patient on admission to the operating room and collaborates in safely positioning the patient on the operating bed.
Circulating nurse
Integrates care management critical paths and research into care of the surgical patient.
Assists with monitoring the patient during surgery provides additional supplies and maintains environmental safety.
Circulating nurse
True or false

A patient who is classified as P2, P3, or P4 has a systemic disease that may or may not be related to the cause of surgery.
True or false

If a patient with a classification of P1, P2, P3, P4, or P5 requires emergency surgery, an E is added to the physical status designation (eg, P1E, P2E).
True or false

To help decrease microbes, the surgical area is divided into three zones: the
unrestricted zone,
where street clothes are allowed; the
semirestricted zone,
where attire consists of scrub clothes and caps; and the
restricted zone,
where scrub clothes, shoe covers, caps, and masks are worn
___________________is an extensive conduction nerve block that is produced when a local anesthetic agent is introduced into the subarachnoid space at the lumbar level,usually between L4 and L5
Spinal anesthesia
partial or complete separation of wound edges
protrusion of organs through the surgical incision
method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulation
first-intention healing
area designated for care of surgical patients immediately after surgery and for patients whose condition warrants close monitoring
Phase I PACU
area designated for care of surgical patients who have been transferred from a phase IPACU because their condition no longer requires the close monitoring provided in a phase I PACU
setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility
area where postoperative patients are monitored as they recover from anesthesia; formerly referred to as the recovery room or postanesthesia recovery room
postanesthesia care unit (PACU)
method of healing in whichwound edges are not surgically approximated and integumentary continuity is restored by the process known as granulation
second-intention healing
method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by apposing areas of granulation
third-intention healing