NURS 320 Exam 5 CORRECT
QUESTIONS & ANSWERS
A - ANSWER A nurse is monitoring the status of a post-operative patient. The nurse
would become most concerned with which of the following signs that could indicate an
evolving complication?
A) Increasing restlessness
B) A pulse of 86
C) BP 110/70
D) Hypoactive bowel sounds in all four quadrants
A - ANSWER A postoperative patient asks a nurse why it is so important to cough and
deep breathe after surgery. When formulating a response, the nurse incorporates the
understanding that retained pulmonary secretions in a postoperative patient can lead to:
A) Pneumonia
B) Fluid imbalance
C) Pulmonary Embolism
D) CO2 retention
A - ANSWER A nurse has just assessed the condition of a postoperative patient who
was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which of the
following parameters most carefully during the next hour?
A) UOP of 20mL/hr
B) T of 99.6
C) BP of 100/70
D) Serous drainage on the dressing
A - ANSWER A nurse receives a telephone call from the PACU stating that a patient is
being transferred to the surgical unit. The nurse plans to do which of the following first
on arrival of the patient?
A) Assesses the patency of the airway
B) Check tubes or drains
C) Check the dressing
D) Assess the vital signs
B - ANSWER A patient who has undergone preadmission testing has had blood drawn
for serum laboratory studies including a CBC, coagulation studies, BMP, and creatinine.
Which of the following laboratory results should be reported to the surgeon's office by
the nurse, knowing that it could cause surgery to be postponed?
, A) Na 141 mEg/L
B) Hgb 8g/dL
C) PLT 210,000 mm
D) Creatinine 0.8mg/dL
D - ANSWER A patient with a perforated gastric ulcer is scheduled for surgery. The
patient cannot sign the operative consent form because of sedation from opioid
analgesics that have been administered. The nurse should take which appropriate
action in the care of this patient?
A) Obtain a court order for the surgery
B) Send the patient to surgery without the consent form being signed
C) Have the hospital chaplain sign the informed consent immediately
D) Obtain a telephone consent from a family member, following agency policy
C - ANSWER A nurse has conducted preoperative teaching for a patient scheduled for
surgery in 1 week. The patient has a history of arthritis and has been taking aspirin. The
nurse determines that the patient needs additional teaching if the patient states:
A) "Aspirin can cause bleeding after surgery."
B) "Aspirin can cause my ability to clot blood to be abnormal."
C) "I need to continue to take the aspirin until the day of surgery."
D) "I need to check with my physician about the need to stop the aspirin before the
scheduled surgery."
D - ANSWER The nurse is conducting preoperative teaching with a patient about the
use of an incentive spirometer. The nurse should include which piece of information in
discussions with the patient?
A) Inhale as deeply as possible
B) Keep a loose seal between the lips and the mouthpiece
C) After maximum inspiration, hold the breath for 15 seconds and exhale
D) The best results are achieved when sitting up or with the head of the bed elevated 45
to 90 degrees
Benner - ANSWER Theorist of caring;
The essence of nursing practice is caring
Caring creates possibilities
Helps patients recover from illness, give meaning to illness, and maintain or re-establish
a connection
Facilitates a nurse's ability to know the patient
How your patient feels care may be different from another patient's
Leininger - ANSWER Theorist of caring;
QUESTIONS & ANSWERS
A - ANSWER A nurse is monitoring the status of a post-operative patient. The nurse
would become most concerned with which of the following signs that could indicate an
evolving complication?
A) Increasing restlessness
B) A pulse of 86
C) BP 110/70
D) Hypoactive bowel sounds in all four quadrants
A - ANSWER A postoperative patient asks a nurse why it is so important to cough and
deep breathe after surgery. When formulating a response, the nurse incorporates the
understanding that retained pulmonary secretions in a postoperative patient can lead to:
A) Pneumonia
B) Fluid imbalance
C) Pulmonary Embolism
D) CO2 retention
A - ANSWER A nurse has just assessed the condition of a postoperative patient who
was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which of the
following parameters most carefully during the next hour?
A) UOP of 20mL/hr
B) T of 99.6
C) BP of 100/70
D) Serous drainage on the dressing
A - ANSWER A nurse receives a telephone call from the PACU stating that a patient is
being transferred to the surgical unit. The nurse plans to do which of the following first
on arrival of the patient?
A) Assesses the patency of the airway
B) Check tubes or drains
C) Check the dressing
D) Assess the vital signs
B - ANSWER A patient who has undergone preadmission testing has had blood drawn
for serum laboratory studies including a CBC, coagulation studies, BMP, and creatinine.
Which of the following laboratory results should be reported to the surgeon's office by
the nurse, knowing that it could cause surgery to be postponed?
, A) Na 141 mEg/L
B) Hgb 8g/dL
C) PLT 210,000 mm
D) Creatinine 0.8mg/dL
D - ANSWER A patient with a perforated gastric ulcer is scheduled for surgery. The
patient cannot sign the operative consent form because of sedation from opioid
analgesics that have been administered. The nurse should take which appropriate
action in the care of this patient?
A) Obtain a court order for the surgery
B) Send the patient to surgery without the consent form being signed
C) Have the hospital chaplain sign the informed consent immediately
D) Obtain a telephone consent from a family member, following agency policy
C - ANSWER A nurse has conducted preoperative teaching for a patient scheduled for
surgery in 1 week. The patient has a history of arthritis and has been taking aspirin. The
nurse determines that the patient needs additional teaching if the patient states:
A) "Aspirin can cause bleeding after surgery."
B) "Aspirin can cause my ability to clot blood to be abnormal."
C) "I need to continue to take the aspirin until the day of surgery."
D) "I need to check with my physician about the need to stop the aspirin before the
scheduled surgery."
D - ANSWER The nurse is conducting preoperative teaching with a patient about the
use of an incentive spirometer. The nurse should include which piece of information in
discussions with the patient?
A) Inhale as deeply as possible
B) Keep a loose seal between the lips and the mouthpiece
C) After maximum inspiration, hold the breath for 15 seconds and exhale
D) The best results are achieved when sitting up or with the head of the bed elevated 45
to 90 degrees
Benner - ANSWER Theorist of caring;
The essence of nursing practice is caring
Caring creates possibilities
Helps patients recover from illness, give meaning to illness, and maintain or re-establish
a connection
Facilitates a nurse's ability to know the patient
How your patient feels care may be different from another patient's
Leininger - ANSWER Theorist of caring;
