Lesson 8. Self Test and Answers - Nursing Fundamentals II

INSTRUCTIONS: To complete this exercise, circle the letter of the response that best answers the question or completes the statement or write the answer in the space provided. After you have completed the all of the exercises, turn to “Solutions to Exercises” at the end of this lesson and check your answers. If you have responded to any of the exercises incorrectly, reread the material referenced after the answer.

1. ________________________ refers to the total span of surgical intervention.

2. The _______________________ phase of the surgical experience begins with the decision that surgical intervention is necessary and ends when the patient is transferred to the operating room table.

3. The _______________________ phase of the surgical experience is the period during which the patient is undergoing surgery.

4. The _______________________ phase of the surgical experience lasts from the patient’s admission to the recovery room through his complete recovery from surgery.

5. Based on the degree of risk, surgery is classified as ____________ or _________.

6. ___________________ surgery is necessary, but scheduled at the convenience of the patient and the health care provider.

7. ___________________ surgery carries a high degree of risk and has the potential of postoperative complications.

8. ___________________ is the descriptor used when the purpose of a surgical procedure is to remove a diseased organ or structure.

9. When surgical intervention is to relieve pain, the purpose is described as ___________________.

10. DD Form 1924, ________________________________________ has a space to document all preoperative nursing measures.

11. SF 522 ___________________________________________________________

is a legal document, which satisfies the requirement for informed consent.

12. List five nursing implications related to the preoperative preparation of a patient.

________________________________________________________

13. The key members of the surgical team are:

________________________________________________________

14. The _______________________________ must have extensive knowledge of all surgical instruments and how they are used, because this member of the surgical team assists thesurgeon by preparing the set-up and passing instruments.

15. The _______________________________ is the liaison between scrubbed personnel in the operating room and those outside.

16. The _________________________________________ is responsible for continuous monitoring of the patient’s physiologic status to include oxygen exchange, systemic circulation, neurologic status, and vital signs. 17. Three major classifications of anesthetic agents are__________________, ______________________, and _________________________.

18. General anesthesia produces:

________________________________________________________

19. ________________ anesthesia results in analgesia and loss of reflexes

20. ________________ anesthesia produces loss of sensation in a small area of tissue.

SPECIAL INSTRUCTIONS FOR EXERCISES 21 THROUGH 25. Certain drugs increase surgical risks. For exercise items 21 to 25, match the potential risk in Column I with the appropriate drug category in Column II.

Column I

Column II

21. ___ May increase the hypotensive effect of the anesthetic agent, thus contributing to shock.

22. ___ May precipitate hemorrhage.

23. ___ May cause respiratory paralysis when combined with certain muscle relaxants used during surgery.

24. ___ Abrupt withdrawal may cause cardio- vascular collapse in long-term users.

25. ___ May cause electrolyte imbalances resulting in respiratory depression from the anesthesia.

a. Antibiotics in the mycine group.

b. Anticoagulants

c. Diuretics

d. Tranquilizers

e. Adrenal steroids.

26. Because some medications interact adversely with other medications and with anesthetic agents, preoperative assessment should include ________________

_______________________________________________________________.

27. General nursing goals of care for a patient in the recovery room are:

________________________________________________________

28. The most common recovery room emergency is ___________________________.

29. Respiratory status is assessed by monitoring the patient’s ____________________,

_____________________, and ________________________ and by observing

______________________________.

30. List four nursing implications related to the prevention of respiratory distress.

________________________________________________________

31. Four common signs and symptoms of hypovolemic shock are:

_______________________________________________________

________________________________________________________

32. Nursing implications related to detection of pending hypovolemic shock include inspection of the surgical dressing. The nurse should also inspect ______________________________ for signs of bleeding.

33. Nursing implications related to general patient care in the recovery room include observation and documentation of_____________________________________, which returns in reverse order.

34. The patient who has had a spinal anesthetic should be kept in a supine position for ____________ to _____________ hours.

35. Postoperative patient care includes receiving the patient on the nursing unit and making an initial assessment which includes:

________________________________________________________

36. Pulmonary efficiency is reduced by the effects of anesthesia on the respiratory system, increasing the possibility of ______________________________.

37. Anesthesia slows or stops the peristaltic action of the intestines resulting in

____________________________, _____________________________ .and

______________________________. Anesthesia may also cause _____________

and _____________________________resulting in a fluid imbalance.

38. Wounds heal by one of three processes: primary intention, secondary intention, or tertiary intention. _________________________________________ is healing of an open wound where there has been a significant loss of tissue.

SPECIAL INSTRUCTIONS FOR EXERCISES 39 THROUGH 41. Match the signs and symptoms described in Column I with the appropriate wound complications in Column II.

Column I

Column II

39. ___ A separation of wound edges with the protrusion of organs through the incision.

40. ___ The wound edges are approximated but the wound is swollen, reddened, and feels hot.

41. ___ The wound edges are separated without protrusion of organs.

a. Wound infection

b. Dehiscence

c. Evisceration

42. Which of the following is NOT true of a Penrose drain?

a. It is made of flexible, soft rubber and causes little tissue reaction.

b. It has a reservoir to maintain constant low suction.

c. It acts by drawing any pus or fluid along its surfaces through the incision or a stab wound adjacent to the main incision.

d. The tube is pulled out and shortened 1 to 2 inches each day until it falls out.

43. Thrombophlebitis and emboli are potential complications of surgery. To prevent thrombophlebitis, instruct the patient to _______________________________ while on bed rest.

44. There are two methods of caring for wounds: the __________________ method in which no dressing is used to cover the wound and the __________________ method in which a dressing is applied.

45. Advantages of using a dressing to cover a wound are:

________________________________________________________

46. Carelessness in observing medical and surgical asepsis when changing dressings is the most common cause of ______________________________________.

47. When preparing the patient and family for disposition, you should supply them with written instructions for:

________________________________________________________

Check Your Answers

SOLUTIONS TO EXERCISE, LESSON 8

1. Perioperative. (para 8-1a)

2. Preoperative (para 8-1b(1))

3. Intraoperative (para 8-1b(2))

4. Postoperative (para 8-1b(3))

5. Major; minor. (para 8-2a)

6. Elective. (para 8-2a)

7. Major. (para 8-2a(2))

8. Ablative. (para 8-2b(1))

9. Palliative. (para 8-2b(5))

10. Surgical Check List. (para 8-3b(1))

11. Request for Administration of Anesthesia and for Performance of Operations and Other Procedures. (para 8-3b(2))

12. Any five of the following.

Assist the patient with personal hygiene and related preoperative care.
Provide information concerning surgery.
Provide preoperative morning care.
Remove prostheses.
Record vital signs.
Recheck the accuracy of DD Form 1924.
Administer preoperative medications.
Assist the operating room technician. (paras 8-4a–e)

13. The surgeon.
The anesthesiologist or anesthetist.
The scrub nurse or scrub assistant.
The circulating nurse. (paras 8-6b–e)

14. Scrub nurse/assistant. (para 8-6d)

15. Circulating nurse. (para 8-6e)

16. Anesthesiologist/anesthetist. (para 8-6c(4))

17. General; regional; local. (para 8-7a)

18. Narcosis.
Analgesia.
Lose of reflexes.
Relaxation. (para 8-8a)

19. Regional. (para 8-8a)

20. Local. (para 8-8a)

21. d (para 8-8d(2))

22. b (para 8-8d(2))

23. a (para 8-8d(2))

24. e (para 8-8d(2))

25. c (para 8-8d(2))

26. A thorough medication history. (para 8˜8d(1))

27. To support the patient through his state of dependence to independence.
To relieve the patient’s discomfort.
Early detection of complications.
Prevention of complications. (paras 8-10a(1)–(4))

28. Respiratory distress. (para 8-11a)

29. Respiratory rate; rhythm; depth; skin color. (para 8-12a)

30. Any four of the following.
Monitor respiratory status.
Report labored respirations to the supervisor.
Report shallow, rapid respirations to the supervisor.
Maintain a patent airway.
Maintain the patient in a position to facilitate lung expansion.
Administer oxygen as ordered.
Prevent aspiration of vomitus.
Suction the patient as ordered. (para 8-12a–h)

31. Any four of the following.
Hypotension.
Cold, clammy skin.
A weak, thready, and rapid pulse.
Deep, rapid respirations.
Decreased urine output.
Thirst.
Apprehension.
Restlessness. (para 8-13a)

32. The bedding beneath the patient. (para 8-14a)

33. Level of consciousness. (para 8-15b(3))

34. Six; eight. (para 8-15b(5))

35. Position and safety.
Vital signs.
Level of consciousness.
Intravenous fluids.
Wound.
Drains and tubes.
Skin color and temperature.
Comfort. (paras 8-16b(1)–(7))

36. Pneumonia. (para 8-17a(1))

37. Constipation, abdominal distention, flatulence; nausea, vomiting. (para 8-17a(4))

38. Secondary intention. (para 8-20a(2))

39. c (para 8-19a(3))

40. a (para 8-19a(1))

41. b (para 8-19a(2))

42. b (para 8-22b)

43. Exercise the legs while on bedrest. (para 8-23b)

44. Open; closed. (para 8-23e(1))

45. Dressings absorb drainage.
Dressings protect the wound from injury and contamination.
Dressings provide physical, psychological, and aesthetic comfort for the patient. (para 8-23e(1))

46. Nosocomial infections. (8-23e(2))

47. Wound care.
Medications.
Making outpatient appointments.
An emergency, including the phone numbers for the doctor and/or clinic. (para 8-24i)

Basic Nursing Education