RNSG 1517 Intraoperative and Postoperative Care Questions And Answers Rated A

1. A patient is being prepared for a laparoscopic cholecystectomy. Which position will the patient be placed in for this procedure? a) Supine b) Prone c) Trendelenburg d) Reverse Trendelenburg Answer: d) Reverse Trendelenburg Explanation: Laparoscopic procedures of the upper abdomen often use the reverse Trendelenburg position. This position uses gravity to move the abdominal contents downward, away from the surgical site (the gallbladder), providing better visualization and access for the surgeon. 2. The surgical team is performing a time-out. What is the primary purpose of this critical step? a) To allow the surgeon to review the patient's lab results. b) To ensure the correct patient, procedure, and site are identified. c) To give the anesthesia provider time to administer pre-operative antibiotics. d) To count all surgical instruments and sponges. Answer: b) To ensure the correct patient, procedure, and site are identified. Explanation: The time-out is the final verification step in the Universal Protocol. It is performed immediately before the procedure begins and involves the entire surgical team actively confirming the patient's identity, the specific procedure to be performed, and the correct surgical site. 3. A post-operative patient reports severe pain in the calf that is worse with dorsiflexion of the foot. What is the nurse’s priority action? a) Apply a warm compress to the area. b) Encourage the patient to ambulate. c) Notify the healthcare provider immediately. d) Administer a prescribed muscle relaxant. Answer: c) Notify the healthcare provider immediately. Explanation: Calf pain with dorsiflexion (a positive Homan's sign) is a classic sign of a possible Deep Vein Thrombosis (DVT). A DVT is a serious postoperative complication that can lead to a life-threatening pulmonary embolism. The provider must be notified immediately for a diagnostic workup. Ambulation and massage are contraindicated. 4. Which of the following is a significant risk factor for malignant hyperthermia? a) A history of diabetes mellitus b) A family history of malignant hyperthermia c) An allergy to penicillin d) A previous surgery with no complications Answer: b) A family history of malignant hyperthermia Explanation: Malignant hyperthermia (MH) is an autosomal dominant inherited disorder. A family history of MH or a known susceptibility is the most significant risk factor. It is triggered by certain inhalation anesthetics (like halothane) and the muscle relaxant succinylcholine. 5. In the immediate postoperative period, the nurse assesses a patient with a respiratory rate of 8 breaths/min and pinpoint pupils. Which medication is most likely responsible for these findings? a) Ketamine b) Succinylcholine c) Fentanyl d) Propofol Answer: c) Fentanyl Explanation: Fentanyl is a potent opioid analgesic. Opioids are known to cause respiratory depression and miosis (pinpoint pupils). Ketamine and propofol are anesthetics, and succinylcholine is a paralytic that would cause apnea and muscle paralysis, but not pinpoint pupils. 6. What is the primary purpose of applying a pneumatic compression device to a postoperative patient's legs? a) To prevent skin breakdown on the heels. b) To promote venous return and prevent DVT. c) To assess for peripheral neuropathy. d) To keep the patient's legs warm during surgery. Answer: b) To promote venous return and prevent DVT. Explanation: Pneumatic compression devices (SCDs) are a form of mechanical prophylaxis. They intermittently inflate and deflate, mimicking the calf muscle pump, which increases venous blood flow velocity and helps prevent venous stasis, a key factor in DVT formation. 7. A patient is to receive general anesthesia. What is the primary reason for administering an anticholinergic drug like glycopyrrolate during the pre-anesthetic phase? a) To reduce anxiety. b) To decrease gastric acidity. c) To dry up oral and respiratory secretions. d) To provide amnesia. Answer: c) To dry up oral and respiratory secretions. Explanation: Anticholinergic drugs block the parasympathetic nervous system, which reduces salivation and respiratory tract secretions. This helps keep the airway clear and prevents aspiration during intubation and surgery. 8. The circulating nurse's role in the operating room includes which of the following? a) Scrubbing and handing instruments to the surgeon. b) Managing the patient's anesthesia. c) Documenting care and managing the overall environment. d) Performing the surgical incision. Answer: c) Documenting care and managing the overall environment. Explanation: The circulating nurse is a registered nurse who manages the nursing care in the OR, coordinates the team, documents the procedure and counts, and ensures a safe environment. They are not scrubbed in and do not handle sterile instruments directly. 9. A patient is 4 hours post-surgery and has not voided. The nurse palpates a distended bladder. What is the most appropriate initial nursing action? a) Insert a Foley catheter immediately. b) Encourage the patient to try to void in the bathroom. c) Apply warm compresses to the perineum and assist the patient to a normal voiding position. d) Notify the provider for an order for an ultrasound bladder scan. Answer: c) Apply warm compresses to the perineum and assist the patient to a normal voiding position. Explanation: Before escalating to a bladder scan or catheterization, the nurse should attempt non-invasive measures to promote voiding. Providing privacy, assisting to a normal position, and using a warm compress can help stimulate the micturition reflex. A bladder scan would be the next step if these are unsuccessful. 10. Which of the following is a late sign of hypovolemic shock in a postoperative patient? a) Tachycardia b) Thirst c) Hypotension d) Decreased urine output Answer: c) Hypotension Explanation: The body compensates for blood loss initially with tachycardia, peripheral vasoconstriction (cool, pale skin), and decreased urine output to maintain blood pressure. Hypotension is a late and ominous sign that indicates the compensatory mechanisms are failing and the patient is in decompensated shock. 11. During a "count" in the operating room, the scrub nurse and circulating nurse are reconciling the number of sponges. What action should be taken if the count is incorrect? a) Close the surgical wound and finish the case quickly. b) Inform the surgeon and perform a thorough search, including on the floor and in the wound. c) Ignore the discrepancy and continue the surgery. d) Assume a sponge was miscounted initially and document the count as correct. Answer: b) Inform the surgeon and perform a thorough search, including on the floor and in the wound. Explanation: An incorrect count is a critical patient safety issue. A retained foreign body (like a sponge) can cause serious complications. The surgeon must be informed immediately, and a systematic search of the sterile field, the surgical wound, and the surrounding floor area must be conducted until the discrepancy is resolved.