1.

You are the recovery room nurse who is admitting a patient from the
OR. What is the first assessment you would make on a newly admitted
patient?
A) Heart rate
B) Nail perfusion
C) Core temperature
D) Patency of the airway

2. Your patient is in the recovery room following chest surgery. The

patient complains of severe nausea. What would you do next?
A) Administer an analgesic
B) Apply a cool cloth to the patient's forehead
C) Offer the patient a small amount of ice chips
D) Turn the patient completely to one side

3. You are discharging your patient home from day surgery after a general
anesthetic. What instruction would you give the patient prior to the
patient leaving the hospital?
A) The patient is not to drive a vehicle
B) The patient should have a glass of brandy the first night home to
help him or her sleep
C) Eat a large meal at home
D) Do not sign important papers for the first 12 hours after surgery

4. Your patient is a 78-year-old male who has had outpatient surgery. You
are getting him up for his first walk postoperatively. To decrease the
potential for orthostatic hypotension, what should you plan to have the
patient do?
A) Sit in a chair for 10 minutes prior to ambulating
B) Drink plenty of fluids to increase circulating blood volume
C) Stand upright for 2 to 3 minutes prior to ambulating
D) Sit upright on the side of the bed for 15 minutes prior to
ambulating

5. You admit a patient to the PACU who has undergone a surgical procedure
that required the use of general anesthesia. What is the patient most at
risk for following general anesthesia?
A) Atelectasis
B) Anemia
C) Dehydration
D) Peripheral edema

6. You are caring for a postoperative patient on the medical-surgical

unit. During each patient assessment, you evaluate your patient for
infection. Which sign or symptom would be most indicative of infection?
A) Presence of an indwelling urinary catheter
B) Rectal temperature of 100°F (37.8°C)
C) Red, warm, tender incision
D) White blood cell (WBC) count of 8,000/mL

7. The nursing instructor is with a student nurse who is going to be

changing an abdominal dressing. The first step is to provide the patient
with information regarding the procedure. Which of the following is the
best statement for completing this task?
A) "The dressing change is often painful, and we will be giving you
pain medication prior to the procedure so you do not have to worry."
B) "During the dressing change, I will provide privacy at a time of
your choosing, it should not be painful, and you can look at the incision
and help with the procedure
if you want to."
C) "The dressing change should not be painful, but you can never be
sure, and infection is always a concern."
D) "The best time for doing a dressing change is during lunch so we
are not interrupted. I will provide privacy, and it should not be
painful."

8. Your patient is 2 hours postoperative with a Foley catheter in situ.

The last hourly urine output you recorded for this patient was 10 mL. The
tubing of the Foley is patent. What
should you do?
A) Irrigate the Foley with 30 mL normal saline
B) Notify the physician, and continue to closely monitor the hourly
urine output
C) Decrease the IV fluid rate
D) Have the patient sit in high-Fowler's position

9. You are caring for a 79-year-old man who has returned to the medical-
surgical unit following abdominal surgery. Your patient is unable to
ambulate and is now refusing to wear an external pneumatic compression
stocking. You explain that refusing to wear external pneumatic
compression stockings places him at significant risk for what?
A) Sepsis
B) Infection
C) Pulmonary embolism
D) Hematoma

10. You admit a patient to the postanesthesia care unit with a blood
pressure of 130/90 and a pulse of 68 beats per minute. After 30 minutes,
the patient's blood pressure is 120/65, and the pulse is 100. You
document the patient's skin as cold, moist, and pale. What is the patient
showing signs of?
A) Hypothermia
B) Hypovolemic shock
C) Neurogenic shock
D) Malignant hypothermia

11. You are a nurse in the PACU caring for a 56-year-old male patient who
had a hernia repair. The patient's blood pressure is now 164/92, he has
no history of hypertension prior to surgery, and his preoperative blood
pressure was 112/68. You know that hypertension following surgery is
often related to what?
A) Dysrhythmias, blood loss, and hyperthermia
B) Electrolyte imbalances and neurologic changes
C) A parasympathetic reaction and low blood volumes
D) Pain, hypoxia, or bladder distention, which all cause sympathetic
stimulation
12. You are the nurse caring for a patient after abdominal surgery in the
postanesthesia care unit. The patient's blood pressure has increased and
the patient is restless. The patient's oxygen saturation is 97%. You know
that the change in your patient is most likely caused by what?
A) The patient's temperature is low.
B) The patient is in shock.
C) The patient is in pain.
D) The patient is nauseated.

13. You are the nurse in the emergency department (ED). You are caring
for a man who has returned to the ED after receiving ten stitches for a
knife wound while cleaning fish. The wound is now infected, the stitches
were removed, and the wound is cleaned and packed with gauze. The ED
doctor plans to have the man return tomorrow to remove the packing and
resuture the wound. You are aware that the wound will now heal by what?
A) Late intention
B) Second intention
C) Third intention
D) First intention

14. You are the nurse caring for 82-year-old women in the PACU. The woman
begins to awaken and responds to her name but is confused, restless, and
agitated. What are you
aware of?
A) Postoperative confusion is an indication of an oxygen problem or
possibly a stroke
during surgery.
B) Confusion, restlessness, and agitation are normal postoperative
findings and will
diminish in time.
C) Postoperative confusion is common in the elderly, but it could also
indicate a
significant blood loss.
D) Confusion, restlessness, and agitation indicate inadequate pain
management, and
analgesics will help.

15. A 38-year-old patient has just been admitted to the PACU following
abdominal surgery. As the patient begins to awaken, he is restless and
asking for "a drink of water." The nurse checks his skin and it is cold,
moist, and pale. What is the nurse concerned the
patient may be at risk for?
A) Hemorrhage and shock
B) Loss of airway and hypotension
C) Pain and anxiety
D) Hypertension and dysrhythmias

16. The nursing instructor is discussing postoperative care with the

junior nursing students. A student nurse asks, "Why does the patient go
to the PACU prior to the medical-surgical unit?" What is the nursing
instructor's best response?
A) "The PACU allows the patient to recover from anesthesia in a
stimulating environment to facilitate awakening and reorientation."
B) "The PACU allows the patient to recover from the effects of
anesthesia, and the patient stays in PACU until he or she is oriented,
has stable vital signs, and is
without complications."
C) "Frequently, patients are recovered in the medical-surgical unit, but
hospitals are usually short of beds, and the PACU is an excellent place
to triage patients."
D) "The medical-surgical unit is frequently very busy and unable accept
the patient from surgery, so the patients are observed and monitored in
PACU until a bed is
available."

17. The PACU nurse is caring for a patient who has arrived from the
operating room who is still unconscious. During the initial assessment,
the nurse notices that the patient's skin is blue and dusky. She looks,
listens, and feels for breathing, and determines the patient is not
breathing. The priority intervention is to
A) check an oxygen saturation rate, continue to monitor for apnea, and
perform a focused assessment.
B) treat the possible airway obstruction by tilting the head back and
pushing forward on the angle of the lower jaw.
C) check the arterial pulses, and place the patient in the
Trendelenburg position.
D) call a code blue, and then get a rapid intubation kit and prepare to
reintubate.

18. You are doing teaching with a patient who has a leg ulcer. You are
teaching about tissue repair and wound healing. Which of the following
statements by the patient indicates that teaching has been effective?
A) "I'll limit my intake of protein."
B) "I'll make sure that the bandage is wrapped tightly."
C) "My foot should feel cold."
D) "I'll eat plenty of fruits and vegetables."

19. You are the nurse caring for a patient who just had surgery. What is
your highest priority?
A) Assessing for hemorrhage
B) Maintaining a patent airway
C) Managing the patient's pain
D) Assessing vital signs every 15 minutes

20. Your patient has undergone a colon resection. While turning him,
wound dehiscence with evisceration occurs. What is your first response?
A) Call the physician
B) Place saline-soaked sterile dressings on the wound
C) Take a blood pressure and pulse
D) Pull the dehiscence closed

21. You are the PACU nurse caring for a 45-year-old male patient who had
a left lobectomy. You assess your patient frequently for airway patency
and cardiovascular status. You know that the most common cardiovascular
complications seen in the PACU include what? (Mark all that apply.)
A) Hypotension
B) Hypervolemia
C) Heart murmurs
D) Dysrhythmias
E) Hypertension

22. Your postoperative patient suddenly presents with hypotension; rapid,

thready pulse; oliguria; and cold, pale skin. You suspect hemorrhage.
What would be your first nursing action?
A) Notify the physician
B) Determine the cause of hemorrhage
C) Order blood work
D) Put the patient in Trendelenburg position

23. You are the intraoperative nurse transferring a patient from the OR
to the PACU after replacement of the right knee. The patient is a 73-
year-old female. You know that special attention must be paid to what?
A) Cardiovascular status
B) Positioning
C) Keeping the patient warm
D) Keeping the patient hydrated

24. What are the determining factors for a patient to be discharged from
the PACU? (Mark all that apply.)
A) Temperature within normal limits
B) Stable blood pressure
C) Ability to respond to voice commands
D) Adequate oxygen saturation
E) Adequate respiratory function

25. You are the nurse in a same-day surgery center. What can you do to
ensure patient safety and recovery?
A) Record vital signs and intake and output
B) Document all your assessment findings
C) Report to the home health nurse all of the pertinent details
D) Provide expert teaching

26. You are discharging a patient home from a same-day surgery center.
You have gone
over all of the discharge instructions with the patient and her
caregiver. What else should you do before letting the patient leave the
facility? (Mark all that apply.)
A) Provide all discharge instructions in writing
B) Provide the nurse's or surgeon's telephone number
C) Give prescriptions to the patient
D) Give advice on nutrition to the caregiver
E) Provide dates and times of new appointments

27. The nursing instructor is discussing the difference between

ambulatory surgical centers and hospital-based surgical units. A student
asks why some patients have surgery in the hospital and others are sent
to ambulatory surgery centers. What is the instructor's best response?
A) "Patients who go to ambulatory surgery centers have more family
support than patients admitted to the hospital."
B) "Patients admitted to the hospital for surgery have multiple needs."
C) "Only emergency and trauma patients are admitted to the hospital."
D) "Patients who have surgery in the hospital can't afford the added
expense of ambulatory surgery centers."

28. You have just received a postoperative patient from the PACU to the
medical-surgical unit. Your patient is an 84-year-old female who had
surgery for a left hip replacement. What is a primary concern for this
patient in the first few hours on the unit?
A) Ability to ambulate
B) Clean dressings on the surgical site
C) Neurologic status
D) Ability to communicate

29. The nurse's aide notifies you that your patient has decreased oxygen
saturation levels. You assess the patient and find that he is tachypneic,
has crackles on auscultation, and his sputum is frothy and pink. What do
you suspect is wrong with this patient?
A) Flash pulmonary embolism
B) Atelectasis
C) Laryngospasm
D) Flash pulmonary edema

30. You are performing your shift assessment of your patient. You find
his mental status, level of consciousness, speech, and orientation are
intact and at baseline. Your patient tells you he is very anxious. What
would you do next?
A) Assess oxygen levels
B) Give anti-anxiety medications
C) Notify the physician
D) Make a social services consult

31. You are the nurse writing a plan of care for a patient who is status
postsurgery for a broken femur. What is the most important goal for this
patient?
A) Relief of pain
B) Optimal respiratory function
C) Optimal cardiovascular function
D) Unimpaired wound healing

32. You are caring for a 71-year-old patient who is 4 days postoperative
for bilateral inguinal hernias. The patient has a history of congestive
heart failure and peptic ulcer disease. The patient is refusing to
ambulate and will not drink fluids except for hot tea with her meals. The
nurse's aide reports to you that this patient's vital signs are slightly
elevated and she has a nonproductive cough. When you assess the patient,
you find there are crackles at the base of the lungs. What would you
suspect is wrong with your patient?
A) Flash pulmonary edema
B) Pneumonia
C) Hypostatic pulmonary congestion
D) Right-sided heart failure

33. The nurse is admitting a patient to the medical-surgical unit from

the PACU. A concern for this patient is pneumonia. What would the nurse
do to help the patient clear secretions and help prevent pneumonia?
A) Encourage the patient to eat a balanced diet that is high in
protein
B) Encourage the patient to visit with his family in the waiting room
C) Encourage the patient to take his medications as ordered
D) Encourage the patient to use the incentive spirometer every 2 hours

34. Your patient has just returned to the unit from PACU with patient-
controlled anesthesia (PCA). You know that the requirements for PCA
include what?
A) An understanding of the need to self-dose
B) An understanding of how to adjust the medication dosage
C) A caregiver who can administer the medication as ordered
D) An understanding of the medication that is ordered

35. Wound assessment is an important part of the nursing care of the

postoperative patient. What does ongoing assessment of the surgical site
involve?
A) Adherence of the dressing to the wound
B) Discolouration
C) Blanching
D) Granulation of the wound

36. In portable wound suction, the use of gentle, constant suction

enhances drainage of
these fluids and collapses the skin flaps against the underlying tissue,
thus removing "dead space." Which of the following is a portable suction
device?
A) Penrose
B) Chest tube
C) Jackson--Pratt
D) Hemodynavac

37. The nurse is caring for a postoperative patient who needs daily
dressing changes. The patient is 3 days post-op and should be going home
the next day. Up until now, the patient has refused to learn how to
change her dressing. What would indicate to the nurse the patient's
readiness to learn how to change her dressing? (Mark all that apply.)
A) The patient wants you to teach a family member to do dressing
changes.
B) The patient expresses interest in the dressing change.
C) The patient looks at the incision.
D) The patient expresses dislike of the surgical wound.
E) The patient assists in opening the packages of dressing material
for the nurse.

38. The nursing instructor is talking with a group of medical-surgical

students about deep vein thrombosis (DVT). A student asks what factors
contribute to the formation of a DVT. What would be the instructor's best
response?
A) "There is a genetic link in the formation of deep vein thrombi."
B) "Hypervolemia is a contributory factor to deep vein thrombi."
C) "There are no factors that contribute to the formation of deep vein
thrombi; they just occur."
D) "Dehydration is a contributory factor to the formation of deep vein
thrombi."

39. The home health nurse is caring for a postoperative patient who was
discharged home on day 2 after surgery. The nurse is making her initial
visit on the patient's post-op day 3. The nurse will assess for wound
infection. Generally speaking, what is the latest post-op day that a
wound infection may become evident?
A) Day 6
B) Day 5
C) Day 4
D) Day 3

40. You are caring for an 88-year-old patient who is recovering from an
ileac-femoral bypass graft. The patient is 2 days post-op and has been
mentally intact. When you assess the patient, you find he is confused and
has disturbed sleep patterns and impaired psychomotor skills. What would
you suspect is the problem with the patient?
A) Postoperative delirium
B) Postoperative dementia
C) Senile dementia
D) Senile confusion
Answer Key
1.D
2.D
3.A
4. C
5.A
6. C
7. B
8. B
9.0
10. B
11. D
12. C
13.C
14. C
15.A
16.B
17. B
18.D
19. B
20.B
21. A, D, E
22.B
23.0
24. B, D, E
25.D
26. A, B, C
27. B
28. C
29.D
30.A
31. B
32. C
33.D
34.A
35.B
36. C
37. B, C, E
38.D
39. B
40.A