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TNCC NOTES FOR WRITTEN EXAM LATEST |TEST newest update

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TNCC NOTES FOR WRITTEN EXAM LATEST |TEST BANK|100% COMPLETE Pass VERIFIED A+ Define central or transtentorial herniation. - ansA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Hemothorax. - ansAccumulation of blood in the pleural space. Define Minor Head Trauma. - ansGCS 13-15 Define Moderate Head Trauma - ansPostresuscitative state with GCS 9-13. Define Pneumothorax. - ansResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Severe Head Trauma. - ans Postresuscitative state with GCS score of 8 or less. Define tension pneumothorax. - Ans Life-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapse

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INTRAOPERATIVE NCLEX QUESTIONS AND
ANSWERS LATEST VERSION COMPLETE GRADED
A+
A break in sterile technique during surgery would occur when the scrub nurse touches

a. the mask with gloved hands

b. gloves hands to the gown at chest level

c. the drape at the incision site with gloved hands

d. the lower arms to the instruments on the instrument tray - ansA- The mask covering the face is not
considered sterile, and if in contact with sterile gloved hands, contaminates the gloves. The gown at
chest level and to 2 inches above elbows is considered sterile, as is the drape placed at the surgical
area.



A preoperative patient reveals that an uncle died during surgery because of a fever and cardiac arrest.
The perioperative nurse alerts the surgical team, knowing that if the patient is at risk for malignant
hyperthermia,

a. the surgery will have to be cancelled

b. specific precautions can be taken to safely anesthetize the patient

c. dantrolene (Dantrium) must be given to prevent hyperthermia during surgery

d. the patient should be placed on a cooling blanket during the surgical procedure - ansB- Although
malignant hyperthermia can result in cardiac arrest and death, if the patient is known or suspected to be
at risk for the disorder, appropriate precautions taken by the ACP can provide for safe anesthesia for the
patient. Because preventive measures are possible if the risk is known, it is critical that the preoperative
assessment include a careful family history of surgical events



At the end of the surgical procedure, the perioperative nurse evaluates the patient's response to the
nursing care delivered during the perioperative period. Which of the following criteria reflects an
outcome related to the patient's physical status?

a. the patient's right to privacy is maintained

b. the patient's care is consistent with the perioperative plan of care

c. the patient receives consistent and comparable care regardless of the setting

d. the patient's respiratory function is consistent with or improved from baseline levels established
preoperatively. - ansD- The Perioperative Nursing Data Set includes outcome statements that reflect
standards and recommended practices or perioperative nursing. Outcomes related to physiologic
responses include those of physiologic function, such as respiratory function; perioperative safety
includes the patient's freedom from any type of injury; and behavioral responses include knowledge
and actions of the patient and family, including the consistency of the patient's care with the
perioperative plan and the patient's right to privacy.

, INTRAOPERATIVE NCLEX QUESTIONS AND
ANSWERS LATEST VERSION COMPLETE GRADED
A+
Because of the rapid elimination of volatile liquids used for general anesthesia, the nurse should
anticipate that early in the anesthesia recovery period, the patient will need

a. warm blankets

b. analgesic medication

c. observation for respiratory depression

d. airway protection in anticipation of vomiting - ansB- The volatile liquid inhalation agents have very
little residual analgesia, and patients experience early onset of pain when the agents are
discontinued. They are associated with a low incidence of nausea and vomiting. Prolonged respiratory
depression is not common because of their rapid elimination. Hypothermia is not related to use of
these agents, but they may precipitate malignant hyperthermia in conjunction with neuromuscular
blocking agents.



During epidural and spinal anesthesia, the nurse should monitor the patient for

a. spinal headache

b. hypotension and bradycardia

c. loss of consciousness

d. downward extension of nerve block - ansB. During epidural and spinal anesthesia, a sympathetic
nervous system blockade may occur that results in hypotension, bradycardia, and nausea and vomiting. A
spinal headache may occur after, not during, spinal anesthesia, and unconsciousness and seizures are
indicative of IV absorption overdose. Upward extension of the effect of the anesthesia results in
inadequate respiratory excursion and apnea



During surgery, a patient has a nursing diagnosis of risk for perioperative positioning injury. A common
risk factor for this nursing diagnosis is

a. skin lesions

b. break in sterile technique

c. musculoskeletal deformities

d. electrical or mechanical equipment failure - ansC- Musculoskeletal deformities can be a risk factor
for positioning injuries and require special padding and support on the operating table. Skin lesions
and
break in sterile technique are risk factors for infection, and electrical equipment failure may lead to
other types of injuries.



Epidural block - ansInjection of anesthetic agent into space around the vertebrae

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