1. Which of the following indicates that an obese client is at risk for poor wound healing postoperatively?

A Risk for bleeding is increased. . B Ventilatory capacity is reduced. . C Fatty tissue has a poor blood supply. . D Resumption of normal physical activity is delayed. . The obese client is susceptible to poor wound healing and wound infection because of the structure of fatty tissue, which contains a poor blood supply. This slows delivery of the essential nutrients, antibodies, and en ymes needed for wound healing. Ventilatory capacity could affect postoperative healing but is not necessarily decreased by obesity. Risk for bleeding is not related to obesity!s effect on wound healing. "f the wound healing was poor, the resumption of normal activity could be delayed, but this delay would be caused by the poor wound healing, not vice versa. 2. The nurse asks each client preoperatively for the name and dose of all prescription and over#the#counter medications taken before surgery for which of the following reasons? A These medications may cause allergies to develop. . B These medications are automatically ordered postoperatively. . C These medications may increase the risks for anaesthetic and surgical complications. . D These medications should always be taken the morning of surgery with sips of water. . $ll medications must be reviewed to ensure that they will not increase the risks associated with anaesthesia and surgery. %edications routinely taken by the client before surgery will not cause allergies to develop during or after surgery. &ot all medications are automatically ordered postoperatively. %edications are taken as prescribed, or held as necessary, at the appropriate time, not 'ust in the morning. 3. $ client who smokes two packs of cigarettes per day is most at risk postoperatively for which of the following? A $telectasis, fever, and pneumonia . B (ypotension, confusion, and elevated glucose level

. C (ypotension, cardiac dysrhythmias, and fever . D )rinary infection, fever, and malignant hyperthermia . $fter surgery, clients who smoke have greater difficulty than nonsmokers in clearing the airways of mucous secretions, and the importance of postoperative deep breathing and coughing should be emphasi ed to such clients. )rinary infection, hypotension, confusion, and elevated glucose levels are not necessarily associated with smoking. 4. Family members should be included when the nurse teaches the client preoperative e*ercises so that they can do which of the following? A +oach the client postoperatively . B ,emonstrate the e*ercises to the client at home . C Relieve the nurse by getting the client to do the e*ercises every - hours . D .ractise the e*ercises with the client while the client waits to be taken to the operating room . /ften a family member serves as the client!s coach when the client performs postoperative e*ercises after returning from surgery. The coach may also help at home, but the client should be able to do his or her e*ercises correctly before surgery and should not need demonstration. .ractising e*ercises while waiting to be taken to the operating room may not be practical. The nurse is always responsible for ensuring that the e*ercises are initiated. 5. %aintaining normal glucose levels during the postoperative period reduces which complication? A "leus . B 0leeding . C Wound infection . D ,eep vein thrombosis . 1vidence indicates that maintaining normal glucose levels during the postoperative

period reduces the incidence of infections. 2lucose levels are not associated with ileus, bleeding, or deep vein thrombosis. 6. "n the postanaesthesia care unit 3.$+)4, the nurse notes that the client is having difficulty breathing because of an obstruction. What would be the nurse!s first action? A 5uction the pharyn* and bronchial tree. . B 2ive o*ygen through a mask at 67 89minute. . C $sk the client to use an incentive spirometer. . D .osition the client so that the tongue falls forward. . "n clients recovering from anaesthesia, the tongue causes the ma'ority of airway obstructions. +lients should remain lying on their sides until they are able to maintain their own airways. 5uctioning before removing a structural obstruction will not be helpful. 5upplemental o*ygen may be helpful after the obstruction is removed. +lients in this state will not be able to use the incentive spirometer. 7. 0ecause an older adult is at increased risk for respiratory complications after surgery, the nurse should do which of the following? A Withhold pain medications and ambulate the client every two hours. . B %onitor fluid and electrolyte status every shift and measure vital signs, including . temperature, every four hours. C /rient the client to the surrounding environment fre:uently and ambulate the client every . two hours. D 1ncourage the client to turn, breathe deeply, and cough fre:uently and ensure ade:uate pain . control. The nurse should encourage the client to perform coughing e*ercises every two hours while awake and should maintain pain control to promote deep, productive coughing. .ain medications should not be withheld from a client. +hecking vital signs every four hours is appropriate. 8. $ client with a greater than normal international normali ed ratio 3"&R4 or activated partial thromboplastin time 3$.TT4 is at risk postoperatively for which of the following? A 0leeding .

B "nfection . C 8ow urine output . D +ardiac dysrhythmias . 0oth "&R and $.TT are measures of clotting ability. $ client with a prolonged "&R or $.TT is at risk for bleeding. These tests do not measure urine output, infection, or cardiac rhythm. 9. When a nonbariatric client is breathing deeply and coughing, why should the client be in the sitting position? A 5itting is more comfortable. . B 5itting facilitates e*pansion of the thora*. . C 5itting helps the client to splint with a pillow. . D 5itting increases the client;s view of the room and is more rela*ing. . The thora* can e*pand better when the client is upright. This position may or may not be more comfortable for the client. The changed view of the room may or may not be of interest to the client. "t is easier for the client to splint when upright, but the primary purpose for having the client sit upright is to facilitate e*pansion of the thora*. 10. The nurse notes that a postsurgical client in the .$+) has a heart rate of 6<7 beats per minute and a respiratory rate of <- breaths per minute. The nurse also assesses 'aw muscle rigidity and rigidity of the limbs, abdomen, and chest. What does the nurse suspect, and what intervention is indicated? The nurse suspects infection and should notify the surgeon and anticipate administration of antibiotics. The nurse suspects pneumonia and should listen to breath sounds, notify the surgeon, and anticipate an order for chest radiography. The nurse suspects hypertension and should check blood pressure, notify the surgeon, and anticipate administration of antihypertensives. The nurse suspects malignant hyperthermia and should notify the surgeon or anaesthesiologist immediately, prepare to administer dantrolene sodium, and monitor vital signs fre:uently.

%alignant hyperthermia is a potentially lethal condition that can occur in clients receiving general anaesthesia. "t should be suspected when the client has une*pected tachycardia and tachypnea= elevated carbon dio*ide levels= 'aw muscle rigidity and rigidity of the limbs, abdomen, and chest= and hyperkalemia. The nurse will immediately administer dantrolene sodium ordered by the health care team. The other options are incorrect. 11. Through e*perience and knowledge, the nurse knows that the client will commonly e*perience the most severe postoperative pain at what time? A The third postoperative day . B The fourth postoperative day . C "mmediately after the surgery . D The first 6- to <> hours after surgery . .ostoperative pain generally decreases after the second or third day. "mmediately following surgery, the anaesthetic is still effective. +ommonly, the most severe pain is e*perienced 6- to <> hours after surgery. The nurse must keep in mind that all clients should be treated individually. 12. 5urgical procedures are classified in terms of seriousness, urgency, and purpose. The designation of a procedure as an ?emergency surgical procedure? relates to which of the following categories? A .urpose . B )rgency . C ,iagnostic . D 5eriousness . ?1mergency surgery,? ?elective surgery,? and ?urgent surgery? are designations based on urgency. The urgency classification describes a time factor. The seriousness of a surgical procedure is designated by the terms major and minor, which indicate e*tensive and minimal alteration of body parts, respectively. Diagnostic is one of seven descriptors indicating the purpose of a surgical procedure. The others are ablative, palliative, reconstructive or restorative, procurement for transplant, constructive, and cosmetic. 13. The $merican 5ociety of $nesthesiologists has assigned surgical classifications to

clients based on what characteristic? A .hysical status of the client . B Type of anaesthesia used . C .urpose and seriousness of the procedure . D 5eriousness and urgency of the procedure . The $merican 5ociety of $nesthesiologists has assigned classifications to clients based on the client!s physiological condition independent of the proposed surgical procedure. ,ifficulties during surgery occur more fre:uently for clients whose assigned classification reflects poor physical status. +lients in classes " and "" and stable clients in class """ are considered acceptable candidates for ambulatory or outpatient surgery. The surgical procedure itself is classified according to seriousness, urgency, and purpose. 14. /n admission to the ambulatory surgical unit, the client tells the nurse, ?" take napro*en for arthritic pain.? Why should the nurse inform the surgeon of this? A &onsteroidal anti#inflammatory drugs 3&5$",s4 do not interfere in any way. . B &5$",s may cause mild respiratory depression. . C &5$",s inhibit platelet aggregation and may prolong bleeding time. . D &5$",s impair cardiac conduction during anaesthesia. . &5$",s increase the client!s susceptibility to postoperative bleeding by inhibiting platelet aggregation and prolonging bleeding time. $ntidysrhythmics, not &5$",s, impair cardiac conduction during anaesthesia. &5$",s do not cause mild respiratory depression. 15. While assessing a client after surgery, the nurse notes dull breath sounds and dyspnea. What are the most appropriate nursing interventions? A +ontinue observations. . B .romote ade:uate fluid intake . C $pply antiembolism stockings and turn the client every 6@ hours.

. D 1ncourage deep breathing and coughing e*ercises and increase mobility. . ,ull breath sounds and dyspnea may suggest atelectasis. Therefore, it is important for the client to do deep breathing and coughing e*ercises and to increase mobility and activity. Turning the client is beneficial. 5udden chest pain is associated with pulmonary embolism. $ntiembolism stockings are used as a preventive measure for emboli. 2astrointestinal complications can be lessened or prevented by ade:uate fluid intake. 16. &ursing has made significant contributions in what areas promoting positive client outcomes after surgery? A ,iscovery of effective anaesthetics . B ,evelopment of the germ theory . C ,iscovery of multiple aseptic techni:ues . D ,emonstration of the benefits of preoperative education . &ursing knowledge has made important contributions to the perioperative care of the client. 5tructured preoperative teaching and return demonstrations of postoperative e*ercises have been shown to improve outcomes in such areas as pain management, pulmonary function, length of stay, and the client!s level of an*iety. The other contributions listed were not based specifically on nursing assessments but rather were more physician#driven. 17. When taking a medication history, the nurse preoperatively asks the client about allergies. Which of the following is the most appropriate way of asking the client about this issue? A A,o any medications make you sick?B . B A,o you have any medication allergies?B . C A(ave you ever had a problem with a medication or substance?B . D A(ave you ever had difficulty breathing after taking medication?B . ?(ave you ever had a problem with a medication or substance?? is a broad :uestion that may elicit more information from the client than the other styles of :uestion. The nurse

needs to distinguish allergies from unpleasant side effects. For e*ample, codeine may cause nausea, constipation, or hypotension 3side effects4 or skin rash 3an allergy4 in a client. The term allergy can be confusing to some clients. Therefore, the nurse will get more information from the client by asking about any problems instead of being so specific. 18. 5urgical procedure permitting, in what position should the client be placed during the immediately postanaesthetic stage of recovery? A (igh#Fowler;s . B 5emi#Fowler;s . C 5upine with pillow . D 5ide#lying, face down . .lacement in a side#lying position with the face slightly down 3recovery position4 protects the client from possible aspiration, and in this position, the client!s tongue falls forward. .lacement in a supine position may increase the possibility of aspiration. 0oth Fowler!s positions are appropriate only once the client!s vital signs and airway are stable and the surgical procedure allows this position. 19. The nurse conducts a nursing assessment immediately once the client arrives in the .$+). Which of the following assessments should the nurse perform immediately in the postanaesthesia stage? A $irway, family support, and safety . B Respirations, level of consciousness, and family support . C $n*iety, pain, and presence of coping mechanisms . D $irway, cardiovascular status, level of consciousness, and safety . +linical assessments to be completed immediately in the postanaesthetic phase include assessments for an ade:uate airway, cardiovascular status, level of consciousness, pain, and safety. $ssessments of an*iety, presence of coping mechanisms, and family support are important but not a priority at this specific point in time. 20. 1ncouraging the client to perform coughing e*ercises every - hours while awake is an appropriate measure for the ma'ority of postsurgical clients. $fter what surgical procedures may coughing e*ercises be contraindicated?

A $bdominal and spinal . B $bdominal and thoracic . C Thoracic, rectal, and eye . D 1ye, intracranial, and spinal . For clients who have had eye, intracranial, or spinal surgery, coughing may be contraindicated because of the potential increase in intraocular or intracranial pressure. +oughing e*ercises are recommended after other surgeries to promote removal of pulmonary secretions, if present. 21. %inimally invasive surgery has changed the preparation of clients for surgery and their time in hospital to recovery. "n response to these techni:ues, nurses now must focus on which of the following? (Select all that apply.) A Readiness for self#care . B .otential complications at home . C .ain control at home . D 2etting out of bed in hospital for the first time on day C . +lients who have minimally invasive surgery are often in hospital 'ust on the day of surgery or overnight. Therefore, they would not be attempting to mobili e for the first time on day C. With minimally invasive surgery, nurses must do e*tensive pre# and postoperative teaching to ensure that the client will be able to return home and provide self#care or have the support to help with care. +lients are taught, for e*ample, how to care for incision sites, manage pain, and what to do if complications arise.