Perioperative NCLEX style questions and verified answers
The nurse is completing a medication history for the surgical patient in preadmission testing. Which of the
following medications should the nurse instruct the patient to hold in preparation for surgery?
a.Ibuprofen
b.Acetaminophen
c. Vitamin C
d. Miconazole - ansANS: A
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen inhibit platelet aggregation and prolong
bleeding time, increasing susceptibility to postoperative bleeding. Acetaminophen is a pain reliever that has no
special implications for surgery. Vitamin C actually assists in wound healing and has no special implications for
surgery. Miconazole is an antifungal and has no special implications for surgery.
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually
awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is
very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which
priority action at this time?
a. Assessment of the patient's pain level
b. Immediate intubation and artificial ventilation
c. Administration of naloxone (Narcan) - ansANS: C Naloxone, an opioid-reversal agent, is used to reverse the
effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression.
This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not
appropriate because the patient is still breathing at 7 breaths per minute. It would be inappropriate to assess
the patient's level of pain.
,A patient in a medical-surgical unit reports that something popped out from his surgical wound while coughing.
Which nursing intervention may benefit the patient? - ansThe patient could have an evisceration, or protrusion
of the internal organs, so the nurse should apply a sterile nonadherent dressing or a saline dressing to the
wound and notify the primary health care provider or surgeon immediately.
A patient is scheduled for surgery. What factor plays an important role in determining the dose and type of
anesthesia to be given?
1
Patient gender
2
Duration of the procedure
3
Patient ethnicity
4
Number of hospital personnel present - ans2. The type and dosage of anesthesia to be given depend on
multiple factors, one of which is the duration of the procedure. Anesthetic agents can be short-acting or long-
acting; therefore, the anesthesiologist determines which drug to use based on the length of the procedure. The
patient's sex or ethnicity and number of hospital personnel present do not play a major role in deciding which
drug and dosage to use.
A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis
would be appropriate for this patient?
a.Anxiety related to the use of an anesthetic
b. Risk for injury related to increased sensorium from general anesthesia
c.Decreased cardiac output related to systemic effects of local anesthesia
d.Impaired gas exchange related to central nervous system depression produced by general anesthesia -
ansANS: D
, The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be
appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased.
Cardiac output is affected by general anesthesia, not local anesthesia.
A patient undergoing hip replacement surgery suddenly develops unexplained bradycardia. The anesthetist
administers epinephrine to the patient. Which complication is the anesthetist trying to prevent? - ansCardiac
arrest is a common complication of spinal anesthesia, which is manifested as unexplained bradycardia and can
be managed by administering epinephrine.
A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action
should the nurse take first?
a. Administer the ordered opioid.
b. Check the oxygen (O2) saturation.
c. Take the blood pressure and pulse.
d. Apply wrist restraints to secure IV lines. - ansANS: B
Emergence delirium may be caused by a variety of factors. However, the nurse should first assess for
hypoxemia. The other actions also may be appropriate, but are not the best initial action.
A patient who takes a diuretic and a beta-blocker to control blood pressure is scheduled for breast
reconstruction surgery. Which patient information is most important to communicate to the health care
provider before surgery?
a. Hematocrit 36%
b. Blood pressure 144/82
The nurse is completing a medication history for the surgical patient in preadmission testing. Which of the
following medications should the nurse instruct the patient to hold in preparation for surgery?
a.Ibuprofen
b.Acetaminophen
c. Vitamin C
d. Miconazole - ansANS: A
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen inhibit platelet aggregation and prolong
bleeding time, increasing susceptibility to postoperative bleeding. Acetaminophen is a pain reliever that has no
special implications for surgery. Vitamin C actually assists in wound healing and has no special implications for
surgery. Miconazole is an antifungal and has no special implications for surgery.
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually
awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is
very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which
priority action at this time?
a. Assessment of the patient's pain level
b. Immediate intubation and artificial ventilation
c. Administration of naloxone (Narcan) - ansANS: C Naloxone, an opioid-reversal agent, is used to reverse the
effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression.
This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not
appropriate because the patient is still breathing at 7 breaths per minute. It would be inappropriate to assess
the patient's level of pain.
,A patient in a medical-surgical unit reports that something popped out from his surgical wound while coughing.
Which nursing intervention may benefit the patient? - ansThe patient could have an evisceration, or protrusion
of the internal organs, so the nurse should apply a sterile nonadherent dressing or a saline dressing to the
wound and notify the primary health care provider or surgeon immediately.
A patient is scheduled for surgery. What factor plays an important role in determining the dose and type of
anesthesia to be given?
1
Patient gender
2
Duration of the procedure
3
Patient ethnicity
4
Number of hospital personnel present - ans2. The type and dosage of anesthesia to be given depend on
multiple factors, one of which is the duration of the procedure. Anesthetic agents can be short-acting or long-
acting; therefore, the anesthesiologist determines which drug to use based on the length of the procedure. The
patient's sex or ethnicity and number of hospital personnel present do not play a major role in deciding which
drug and dosage to use.
A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis
would be appropriate for this patient?
a.Anxiety related to the use of an anesthetic
b. Risk for injury related to increased sensorium from general anesthesia
c.Decreased cardiac output related to systemic effects of local anesthesia
d.Impaired gas exchange related to central nervous system depression produced by general anesthesia -
ansANS: D
, The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be
appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased.
Cardiac output is affected by general anesthesia, not local anesthesia.
A patient undergoing hip replacement surgery suddenly develops unexplained bradycardia. The anesthetist
administers epinephrine to the patient. Which complication is the anesthetist trying to prevent? - ansCardiac
arrest is a common complication of spinal anesthesia, which is manifested as unexplained bradycardia and can
be managed by administering epinephrine.
A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action
should the nurse take first?
a. Administer the ordered opioid.
b. Check the oxygen (O2) saturation.
c. Take the blood pressure and pulse.
d. Apply wrist restraints to secure IV lines. - ansANS: B
Emergence delirium may be caused by a variety of factors. However, the nurse should first assess for
hypoxemia. The other actions also may be appropriate, but are not the best initial action.
A patient who takes a diuretic and a beta-blocker to control blood pressure is scheduled for breast
reconstruction surgery. Which patient information is most important to communicate to the health care
provider before surgery?
a. Hematocrit 36%
b. Blood pressure 144/82
