Answers 100% Pass
1. A patient is being admitted to the hospital on the day before a scheduled surgery.
What is the most appropriate initial question for the nurse to ask this preoperative
patient?
a) "What did your surgeon say to you about the type of surgery you are having?"
b) "What questions do you have about your surgery?"
c) "What type of surgery are you having and why are you having it done?"
d) "What do you know about what will be done to you?" - ✔✔c) "What type of
surgery are you having and why are you having it done?"
2. A benzodiazepine has been administered to a patient preoperatively. After the
drug has been administered, the nurse plans to monitor the patient for which side
effects? Select all that apply.
a) Anxiety
b) Hypotension
c) Hypocalcemia
d) Level of Consciousness
e) Sedation - ✔✔a) Anxiety
d) Level of Consciousness
e) Sedation
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,3. A preoperative patient has an elevated hemoglobin and hematocrit. What would
the nurse suspect regarding the significance of this increased value?
a) Immune deficiency
b) Kidney dysfunction
c) Malignancy
d) Dehydration - ✔✔d) Dehydration
4. Which activities should the nurse carry out in the preoperative period for a client
scheduled for surgery? Select all that apply.
a) Identify potential or actual health problems.
b) Verify the presence of a signed consent form.
c) Assess patient's response to interventions.
d) Intervene to prevent complications.
e) Assess effectiveness of teaching related to postoperative recovery. - ✔✔a) Identify
potential or actual health problems.
b) Verify the presence of a signed consent form.
e) Assess effectiveness of teaching related to postoperative recovery.
5. A patient having surgery has a degree of risk associated with the surgery. The
nurse would evaluate which patient-related factors as contributing to a high degree
of risk associated with surgery? Select all that apply.
a) Type of institution where surgery is performed
b) Involvement of vital organs
c) Average nutritional status
d) Low likelihood of procedure complications
e) A history of respiratory disease and diabetes - ✔✔b) Involvement of vital organs
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,e) A history of respiratory disease and diabetes
6. A patient has just entered the postanesthesia care unit (PACU) from surgery. For
which priority needs should the nurse immediately assess the postoperative patient?
a) Vital signs, level of consciousness, presence of pain
b) Skin coloring, surgical incision, limb movements
c) Skin temperature, blood pressure, mental status
d) Temperature, emotional status, wound drainage - ✔✔a) Vital signs, level of
consciousness, presence of pain
7. The nurse in the postanesthesia care unit (PACU) is assessing a postoperative
patient. Which indicators suggest to the nurse an alteration in tissue perfusion?
Select all that apply.
a) Pallor or cyanosis
b) Difficulty with mobility
c) Pain in the incision area
d) Fluid loss
e) Decreased urinary output - ✔✔a) Pallor or cyanosis
d) Fluid loss
e) Decreased urinary output
8. After surgery, the nurse encourages the patient to move from side to side at least
every 2 hours. The patient questions this activity. How does the nurse explain the
purpose of this intervention?
a) Assist peristalsis to return more quickly
b) Lessen muscle weakness
c) Increase patient's ability to sleep
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, d) Let the lungs alternatively achieve maximum expansion - ✔✔d) Let the lungs
alternatively achieve maximum expansion
9. The nurse is creating a plan of care for a postoperative patient. The nursing
diagnosis in acute pain. What would be appropriate outcomes for this patient? Select
all that apply.
a) Balanced fluid intake and output
b) Seeks help as needed
c) Absence of nonverbal signs of pain
d) Performs leg exercises as instructed
e) Verbally rates pain as 3 on a 1 to 10 scale - ✔✔c) Absence of nonverbal signs of
pain
e) Verbally rates pain as 3 on a 1 to 10 scale
10. The patient has been in the postanesthesia care unit (PACU) for one hour. The
patient is now groggy but able to respond to voice commands. While assessing the
patient, for what reason would the nurse check the bedclothes underneath the
patient?
a) Determine drainage from tubes or drains
b) Assess for fluid balance
c) Detect for possible hemorrhage
d) Monitor perspiration - ✔✔c) Detect for possible hemorrhage
11. A 65-year-old was diagnosed and treated for right lower lobe pneumonia 4 days
ago. Today, the patient came to the ED reporting abrupt onset of chest pain that is
worse with inspiration. The nurse knows that the symptoms are consistent with:
a) Pleurisy
b) Stable angina
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