1. How does palliative surgery differ from any other type of surgery? A.

The main purpose is cosmetic in nature rather than functional repair or comfort. B. There are fewer risks associated with palliative surgery than with any other type of surgery. C. The outcomes of palliative surgery cannot be ensured to produce the desired effect or restoration of functional ability. D. Palliative surgery is performed to provide temporary relief of distressing symptoms rather than to cure a problem or condition. ANS: D The purpose of palliative surgery is to improve the client's quality of life by reducing or eliminating distressing symptoms. It does not cure a health problem and, often, does not prolong life. Although the exact outcomes of palliative surgery cannot be ensured, neither can the outcomes of any other type of surgery. 2. The client tells the nurse during the preoperative history that he is a three-pack a day cigarette smoker. This information alerts the nurse to which potential complication during the intraoperative and postoperative periods? A. A decreased tolerance to pain B. A decreased clotting ability C. An increased risk for atelectasis and hypoxia D. An increased risk for excessive scar tissue formation ANS: C Smoking increases the level of circulating carboxyhemoglobin, which decreases oxygen delivery to the tissues. In addition, cigarette smoking damages the cilia of mucous membranes, decreasing transport of secretions and increasing the risk of pulmonary infection and atelectasis. 3. The client receiving preoperative medication tells the nurse that all of the following medications (drugs or herbs) were ingested yesterday. Which one should the nurse report to the surgical team? A. Acetaminophen (Tylenol) B. Vitamin C C. Motherwort

D. Diphenhydramine (Benadryl) Motherwort interferes with coagulation, increasing the client's risk for bleeding during and after the surgical procedure. 4. When the nurse brings the preoperative medication to the client about to have abdominal surgery, she tells the nurse that she does not need the injection because she had a good night's sleep last night. What is the nurse's best first action? A. Tell the client that her surgeon has ordered the medication; therefore, she should go ahead and take the medication because the surgeon knows what is best. B. Tell the client that the preoperative medication is ordered to reduce the risk of some problems during surgery rather than to ensure adequate rest. C. Appropriately discard the preoperative medication and notify the surgeon. D. Document the client's statement and notify the charge nurse.

ANS: B The preoperative medication is prescribed to prevent a vagal response during intubation and surgery, reduce the amount of anesthetic needed during induction, and reduce anxiety. 7. Which nursing action or statement is most likely to reduce anxiety in a client being brought to the surgical suite? A. Asking the client if he or she has talked with the hospital chaplain B. Asking the client what specific surgery he or she is having done today C. Asking the client if he or she wants family members to be with them in the holding area D. Explaining to the client that the surgical area is the most technologically advanced in the city ANS: C Most anxious clients would feel some relief by having one or more familiar persons waiting with them until surgery begins. In addition, asking the client what he or she wants allows the client to have more control over the situation. Asking the client if he or she has visited with the hospital chaplain and telling the client about the advanced technology can imply to the client that the procedure is dangerous. Although the client must be asked what procedure he or she is having (to ascertain

that the client does know what is to be done), this question may make the client worry about the competency of the staff.

8. All of the members of the surgical team must perform a "surgical scrub" except which of the following? A. Anesthetist/anesthesiologist B. Surgical technologist C. Scrub nurse D. Surgeon ANS: A The anesthetist or anesthesiologist does not enter the sterile field. Caps, masks, scrub clothing, and scrub jackets are worn to prevent shedding of microorganisms, but sterile gloves and surgical scrubbing are not needed. 9. In the operating room, the client tells the circulating nurse that he is going to have the cataract in his left eye removed. The nurse notes that the consent form indicates that surgery is to be performed on the right eye. What is the nurse's best first action? A. Assume that the client is a little confused because he is older and has received midazolam intramuscularly. B. Check to see if the client has received any preoperative medications. C. Notify the surgeon and anesthesiologist. D. Ask the client his .

ANS: D Ensuring proper identification of the client is a responsibility of all members of the surgical team. Especially in a specialty surgical setting, where many people undergo the same type of surgery each day, such as cataract removal, it is possible that the client and the record do not match. The nurse identifies the client and the client's consent form before the physicians are notified.

10. The anesthetized client with an open abdomen suddenly develops malignant hyperthermia. What intervention should the nurse be prepared to initiate or assist with? A. Discontinue mechanical ventilation. B. Administer intravenous potassium chloride. C. Administer intravenous calcium chloride. D. Administer intravenous dantrolene (Dantrium). ANS: D Dantrolene is a skeletal muscle relaxant and can help lower body temperature by reducing metabolic heat production by the muscles. Clients become hyperkalemic and hypercalcemic; therefore, neither of these electrolytes should be administered. The client's gas exchange is severely compromised. If the client is not already receiving mechanical ventilation, it is initiated. 11. What is the priority nursing diagnosis for the client under general anesthesia during surgery? A. Acute Pain related to surgical procedure B. Risk for Infection related to surgical wound C. Risk for Impaired Skin Integrity related to prolonged static position D. Disturbed Body Image related to presence of surgical wound or scar ANS: C The problem that nursing is most responsible for with this client is ensuring maintenance of skin integrity. 13. Who is responsible for accompanying the surgical client to the postanesthesia recovery area after surgery and for giving a report of the client's intraoperative experience to the PACU nurse? A. The surgeon and scrub nurse B. The surgeon and circulating nurse C. The anesthesiologist and scrub nurse D. The anesthesiologist and circulating nurse ANS: D

The anesthesiologist (or certified registered nurse anesthetist) and the circulating nurse are responsible for accompanying the client to the postoperative recovery area and giving a report of the client's intraoperative experience. 14. The client is admitted to the postanesthesia care unit (PACU) after surgery that took place with the client in the lithotomy position. Which change in assessment findings alerts the nurse to a possible complication of this surgical position? A. The electrocardiogram (ECG) shows tall, peaked T waves and wide QRS complexes. B. The client only arouses in response to light shaking. C. The pulse pressure has increased from 28 to 40 mm Hg. D. The dorsalis pedis pulses are not palpable bilaterally. ANS: D The lithotomy position can compromise the client's peripheral circulation in the lower extremities. 15. Which client is at greatest risk for respiratory complications after surgery under general anesthesia? A. 65-year-old woman taking a calcium channel blocker for hypertension B. 55-year-old man with chronic allergic rhinitis C. 45-year-old woman with diabetes mellitus type 1 D. 35-year-old man who smokes two packs of cigarettes daily ANS: D Cigarette smoking greatly increases the risk for pulmonary problems following general anesthesia because the cilia of the mucous membranes may be absent or hypoactive, the lining of the airways may be hypertrophied, and the alveoli may be less compliant. Age and gender are not significant in this case.