PERIOPERATIVE NURSING
Have the client void immediately before surgery.
* Definition of perioperative nursing except:
Period in the health care continuum that focuses
merely on the time of surgery until the recovery of
the patient.
* Appendectomy is classified as:
Ablative
* Inflamed gallbladder -- category of surgery based on
urgency:
Urgent
* Pneumonectomy within 24-30 hours -- category of
surgery based on urgency:
Urgent
* Removing her gallbladder (Cholecystectomy):
Ablative
* Palliative surgery to correct an intestinal obstruction:
Done to relieve symptoms or improve function
PRE-OP
* Right to information regarding the operation -- achieved
through:
informed consent
* Not part of an informed consent for surgery:
A guarantee of the results of the planned surgery
* True about informed consent:
The client must be fully informed regarding
treatment, tests, surgery and the risks and benefits
prior to giving informed consent
* Explain the procedure and obtain informed consent:
Surgeon
* Emergency surgery -- client cannot sign the consent
form because of sedation form narcotic -- appropriate
action
Obtain telephone consent from a family member
and have the consent witnessed by two persons.
* Criteria for valid consent are:
Voluntary, Informed, and Competent
* Patient seems confused about the procedure to be
performed -- appropriate response by the nurse is to:
Ask the patient what the physician told him and
then call if necessary
* Thumb mark of a comatose patient in the informed
consent is considered:
A not valid signature
* Procedure or practice requires surgical asepsis:
IV catheter insertion
* Cleansing enema – position:
Left Sim’s position
* Administered three enemas and the client is still
passing brown liquid stool – next action:
Notify physician
* Transfer to the operating room -- actions in the care of
this client at this time:
Ensure that the client has voided
* Nursing care plan for the client on the day of surgery:
* The worst of all fears among clients undergoing
surgery is:
Fear of the unknown
* Preoperative assessment -- patient is extremely
anxious.
Notify the surgeon
* Appropriate response to a crying client for surgery:
Stand by her side and quietly ask her to describe
her feelings
* Client expresses anxiety to a nurse about surgery --
response by the nurse:
“Can you share with me what you’ve been told
about your surgery?”
* Statement about a person’s character is evident in the
OR team:
it reflects the moral values and beliefs that are
used as guides to personal behavior and actions
* Intervention will allay anxiety and pain among surgical
patients:
Assess the client for concerns especially those
that can potentially cause pain
* Demonstrates knowledge of the psychological
response to the operation and other invasive procedure
when she asks about:
How is the post operative pain over the site like?
* Clients are at risk for latex allergies if they are allergic
to all of the following, except:
Apples
* Allergy to latex – assess allergy to:
Bananas
* Diagnosed with latex allergy -- instructs the client to
avoid:
The use of condoms
* Allergy to latex -- asks the medical supply personnel to
deliver:
Cotton pads and silk tape
* Latex allergy -- intervention to be included in the plan:
Apply a cloth barrier to the client’s arm under a
blood pressure cuff when taking the blood pressure.
* Erythema and itching around her mouth after blowing
up a balloon -- likely due to:
A latex allergy
* Preoperative teaching for a client scheduled for surgery
 needs additional teaching if the client states:
“I need to continue to take the aspirin as
prescribed until the day of the surgery.”
* Tonsillectomy -- most essential for the nurse to ask the
mother:
“Does your child have any bleeding tendencies?”
* Best time to provide preoperative teaching:
During the preadmission visit & the afternoon or
evening before surgery
* Given highest priority when receiving patient in the OR:
Verify patient identification and informed consent
* The nurse notices that the band was missing 
immediate action of the nurse is to:
Place a new identification band on the client’s
wrist before the client can be transported to the OR
* Given sulfasuxidine and neomycin, primarily to:
reduce the bacterial content of the colon
* Check for the medical clearance  clearance primarily
covers:
Cardio-pulmonary system
* Tonsillectomy  assessment findings needs to be
reported:
Presence of loose tooth
* Refuses to remove her plain gold wedding band before
going to surgery best action to take:
Cover the wedding band with adhesive tape and
tape it to her finger
* Primary objective of preoperative skin prep is to:
Prevent postoperative infection by reducing the
number of microorganisms of the skin.
* If hair at the operative site is not shaved  done to
make suturing easy and lessen chance of incision
infection:
Clipped
* Adrenalectomy -- priority nursing action preoperatively
is to monitor:
Vital signs
* Single most important procedure for preventing
hospital-acquired infections:
Handwashing
* Complete scrub should last for how many minutes:
10-15 minutes
* JCAHO’s universal protocol EXCEPT:
Take a video of the entire intra-operative
procedure
* Meet the safety need of the client after administering
preoperative narcotic:
Put side rails up and ask the client not to get out
of bed
INTRAOP
* Pre-operative drug is use to decrease salivation and
prevent aspiration:
Atropine sulfate & scopolamine
* Nursing check that should not be missed before the
induction of general anesthesia is:
Check baseline vital signs
* Color of the tank which contains 'laughing gas’:
Blue
* MAJOR advantage of regional anesthesia is that the
client:
Remains conscious
* Spinal anaesthesia -- the client will experience a loss
of:
Motor and sensory function
* Fentanyl epidural analgesia  nursing priority care:
Assess respiratory rate carefully
* Norcuron (vercuronium bromide) – important to
monitor:
Respiration
* Third stage of anesthesia, the client is:
Already unconscious, has relaxed muscles and
the surgery is started.
* General anethesia and is in stage II of anesthesia --
intervention to implement during this stage:
Restrain the patient
* Tonsillectomy and adenoidectomy:
General anesthesia
* Closely assess to a client  halothane (Fluothane):
Respiratory depression
* 2 general types of General Anesthesia (GA):
Intravenous and inhalation
* Spinal anesthesia  highest priority:
Complaints of headache
* Epidural anesthesia -- following administration of the
anesthesia, the nurse should:
Priority: Monitor the client for respiratory
depression
2nd priority: hypotension (common side effect)
* Inherited muscle disorder chemically induced by
anethesia/anesthetic agents:
Malignant hypethermia
* Malignant hyperthermia is a potential postoperative
complication  gathering information on the patient’s
medical history, the nurse should ask:
“Has anyone in your family ever had problems
with general anaesthesia?”
* Drug should be available to reverse malignant
hyperthermia crisis:
dantrolene (Dantrium)
* Maintaining the client’s safety -- circulating nurse:
Strap made of strong non-abrasive materials are
fastened securely around the joints of the knees and
ankles and around the 2 hands around an arm
board.
* Behavior in the OR is so tightly controlled is:
To prevent the cross-contamination of infection
between OR staff and patient
* Traffic patterns in the OR suite should:
Prevent transmission of pathogenic
microorganisms
* Conversation while in the operation is ongoing is
minimized because:
It enhances the spread of microorganism to the
incision site
* In the OR, "Surgical Conscience" means.
Honest adherence to surgical aseptic techniques
all the time
* Clear advantage of single-use items is:
 Transmission of infection during processing is
avoided
* Surgeries like I and D (incision and drainage)  “dirty
cases” -- best scheduled:
Last case
PRINCIPLES OF STERILE TECHNIQUE
* Principles of sterile technique include all of the
following except:
The circulating nurse can have a direct contact
with the sterile field.
* When donning gloves:
Pick up the right glove with the left hand covered
with cuff by grasping the fingers, lifting straight up,
and placing on the right palm side down.
* Counting of instruments  counting process:
From the field, on the back table and outside the
field. (FBO)
* Principles of sterile technique are strictly applied and
doubt might occur when:
Change table levels according to the height level
of the surgeon.
* Indicates the scrub nurse has broken sterile technique:
When the surgical hair cap is touched.
* According to AORN, surgical attire intended only for
use within the surgical suite should be worn within the:
Restricted area only
* Restricted area:
Head cap, scrub suit, mask, OR shoes
* NOT considered a piece of personal protective
equipment (PPE):
Sterile gauze
* Personal protective equipment -- worn at all times in
the restricted zone:
Masks covering the nose and mouth
* Items that come in contact with the intact skin should
be:
Disinfected
* Spaulding’s classification system -- Gastroscopes,
bronchoscopes, colonoscopes are:
Semi- critical items
* Instruments introduced directly into the blood stream or
into any normally sterile cavity or area of the body 
classified as:
Critical
* Instruments that do not touch the patient or have
contact only to intact skin is classified as:
Non critical
* Classification of endoscopic instruments:
Sterile instruments
* Items that enter sterile tissue or vascular system are
categorized as critical items and should be:
Sterilized
* Missing instruments -- appropriate approach to this
happening:
“a place for everything and everything in its
place”
* 2 interventions of the surgical team when an instrument
was confirmed missing:
X-RAY and incidence report
* Correctly remove a hair that was found on top of the
drape:
By using a haemostat
* Improve the effectiveness of clinical alarm systems:
Implement a regular maintenance and testing of
alarm system
* Improve the safety of using infusion pumps:
Check the functionality of the pump before use
* Ensure quality of these instruments, which criterion is
evaluated:
Integrity and functionality after each use &
processing
* Decontamination -- done through:
1. Wiping instruments used in the sterile field
2. pre-rinsing
3. washing
4. rinsing
5. disinfecting /sterilizing
6. wiping for safe handling
* Done before using a disinfectant on the instrument:
Rinse with sterile water.
* Black striped autoclave/steam chemical indicator tape
communicates that the instrument tray:
Is sterile
* Color of the stripe produced after autoclaving:
Black
* Ideal setting of the autoclave machine:
121 degrees Celsius for 15 minutes
* Considerations for selecting chemical agents for
disinfection:
Material compatibility and efficiency
* Not an advantage of steam sterilization:
Items need not to be cleaned or freed from the
grease and oil.
* Liquid sterilizer versus autoclave machine – true:
They are both capable of sterilizing the
equipments; however, it is necessary to soak
supplies in the liquid sterilizer for a longer period of
time
* Types of sterilization -- not included:
Sterilization by boiling
* 2 organizations that endorsed that sterility are affected
by factors other than the time itself are:
AORN and JCAHO
* Functionality and integrity of instruments 
responsibility of the:
Bio-med technician
* Orthopedic cases -- department is usually informed to
be present in the OR:
Radiology department
* Does NOT belong to the sterile OR team:
X-ray technician
* Comprise the surgical team:
Surgeon, assistants, scrub nurse, circulating
nurse, anaesthesiologist
* Nursing tandem for every surgery is:
Scrub and circulating nurses
* Monitors the activities of each OR suite:
Circulating nurse
* Responsible for the operating room condition, verifying
the consent, coordinating the team, and availability of
the supplies from non-sterile field:
Circulating nurse
* Hands out these items not in the sterile field by
opening its outer cover:
Circulating Nurse
* Coordinates the activities outside, including the family:
Circulating Nurse
* Circulating nurse must do the following, except:
Passing an instrument to the surgeon.
* Count and identify the number of sponges, sharps and
instruments use in a surgical procedure:
Scrub nurse
* Responsibility of the scrub nurse:
Account for the number of sponges, needles,
supplies, used during the surgical procedure.
* Counting during the pre-incision phase, the
operative phase and closing phase -- counts the
sponges, needle and instruments:
Scrub nurse and the circulating nurse
* Daily monitoring the standards of safe, nursing practice
in the operating suite: OR nurse supervisor
* Monitor the status of the client like urine output, blood
loss:
Anaesthesiologist
* Administers anesthetics and monitors the patient’s
status throughout the procedure:
Anesthesiologist
* Report any discrepancy of counts to the:
Surgeon
* Nurse in charge for scheduling surgical cases --
important information needed to be asked:
Who are your assistant and anesthesiologist, and
what is your preferred time and type of surgery?
* First sponge/instrument count reported after an
abdominal surgery:
Before peritoneum is closed
* Sutured with long tensile strength such as cotton or
nylon or silk suture:
Fascia
* Closure of the abdominal layers begins with the
peritoneum followed by;
Muscle, fascia, subcutaneous tissue, skin
* Prone to keloid formation and has low threshold of pain
– needle:
Atraumatic needle
* Another alternative “suture” for skin closure is the use
of:
Staple
POST-OP
IMMEDIATE
* In the PACU, the nurse will monitor his vital signs:
Every 15 minutes
* Continue with postoperative assessment activities
Every 15 minutes for the first half hour, every 30
minutes for 2 hours, every hour for 4 hours, and
then every 4 hours as needed.
AIRWAY
* Post-anesthesia -- transferred to the surgical unit -- first
on arrival of the client:
Assess the patency of the airway.
* Positioning a client for surgical procedure -- priority
care:
Access to the airway
* MOST effective in promoting adequate respiratory
function in an unconscious client recently admitted to the
PACU with no contraindications to movement:
Extending client’s chin while on his side and
pillow at the back
* Endoscopic examinations -- anesthetized with
xylocaine (Lidocaine) spray --interventions for post-
endoscopic examination include:
Keeping patient NPO until gag reflex returns
* General anesthesia in PACU -- signs that may indicate
his artificial airway should be removed is:
Gagging
* Following a pneumonectomy, deep tracheal suction
should be done with extreme caution because:
The bronchial suture line maybe traumatized
* Inhalation anesthesia -- experienced severe shivering
postoperatively:
Provide oxygen as prescribed
* Unconscious on admission to the post-anesthesia care
unit (PACU) -- position the client:
In a lateral position
* Spleenectomy -- nursing priority assessment:
The quality of the client’s respiration
* Assessment would prevent the patient’s transfer to
ward:
Pulse oximeter reading is 80% (Abnormal)
* Pulse oximeter and gets a reading of 85% -- next
action should be to:
Awaken the patient and have him cough and
deep breathe
BREATHING
* Incentive spirometer:
 The best results are achieved when the head of Splinting the patient’s chest with both hands
the bed is elevated 45-90 degrees. during the exercises

* Incentive spirometry has been effective if the patient * Smokes 3 packs of cigarettes a day for the past 10
has: years -- increased risk for:
Clear breath sounds Postoperative respiratory complications

* Breathing technique: * Incentive spirometer -- accurate understanding of the

Inhale through the mouth and hold the breath for technique:
5 seconds and exhale through the mouth Slow, deep breaths to elevate the spirometer ball

CIRCULATION * Become MOST concerned  indicate an evolving

*Open reduction and internal fixation (ORIF) -- complication:
observation would prompt you to call the doctor: Increasing restlessness
Left foot is cold to touch and pedal pulse is
absent * Monitor and promote the respiratory status of postop
client, the nurse would do:
* Avoid dangling of foot -- done primarily to prevent: Instruct the client and monitor the use of the
Nerve and muscle damage incentive spirometer.

SAFETY * Retained pulmonary secretions in a postoperative

* Transferred out a post-op client to her room -- client may lead:
instruction to prevent accidents: Pneumonia
Make sure the side rails are up
* Inserted vaginally to prevent postoperative bleeding:
DRAINAGE Vaginal packing
* Action would the nurse avoid in the care of the drain:
Curl the drain tightly and tape firmly to the body. * Most common postoperative complication of
tonsillectomy:
* Interpreted as a normal finding at the surgical site: Hemorrhage
Serous drainage
* Blood pressure is 90/60 mmHg and apical pulse is 122.
* Facilitate drainage of secretions from the operative The nurse’s first action would be to:
site, the nurse should: Check the dressing for bleeding
Turn the client to the operative side every 2-3
hours * Homan’s Sign:
Pain with dorsiflexion of the foot
NUTRITION
* Tonsillectomy and adenoidectomy -- food to prepare * Contributing factors would the nurse recognize as
and give: important:
Soft diet when fully awake Recent pelvic surgery

* Purpose of NGT IMMEDIATELY after an operation is: * Indicative of a developing thrombophlebitis would be:
For gastric decompression Tender, painful area on the leg

ELIMINATION * Prevent deep vein thrombosis (DVT) -- ensure that the

* Hasn’t voided since before surgery, which took place 8 patient:
hour ago  nurse do first: Ambulates frequently
Assess the client for bladder fullness
* Sign alerts the nurse to wound evisceration:
* Nurse plans to monitor which of the following Pink serous drainage
parameters most carefully:
Urinary output of 20 ml/hr. * Wound has eviscerated. The nurse assesses his
respiratory status because:
Coughing increases the risk of evisceration
POSITIONING
* Unconscious on admission to the post-anesthesia care * Dehiscence of the wound occurred  first action
unit (PACU) -- position the client: should be to:
In a lateral position Cover the wound with sterile dressings saturated
with normal saline
* Postoperative T and A (Tonsillectomy &
Adenoidectomy) position: * Signs of impending infection:
Prone with the head on pillow and turned to the Localized heat and redness
side
* Sterile surgical dressing, the nurse must first:
* Position who just underwent pneumonectomy: Wash hands
On the side of surgery
* Risk of developing wound infection:
COMPLICATIONS AND MGNT Clients who are undernourished
* Reduce pain during the deep breathing and coughing
exercises by * Normal finding at the surgical site:
Serous drainage
 * Pain is related to the destruction of peripheral nerves
and central nervous system:
PAIN Neuropathic
DEFINITION
* 5th vital sign is: * Radiating pain refers to:
Pain Pain that extends to nearby tissues

* Whatever the person says it is and existing whenever
the experiencing person says it does. The author of this
statement is:
McCaffery
* Pain receptors that stimulate transmission during
actual tissue damage:
Nociceptors
* Important responsibility related to pain that is
subjective in nature:
Believe what the patient says about the pain
* Principles of pain treatment  first consideration:
The client must be believed about perceptions of
own pain.
* Visceral pain involves pain in:
Abdominal cavity
ASSESSMENT
* Pain -- she should initially:
Assess pain as automatic as she assesses the
pulse and blood pressure.
* Has difficulty specifying the location of pain – how:
Ask the client to point to the painful area by just
one finger
* In assessing pain, what should a nurse do if a patient
says there is no pain?
Reassess the client appropriately to rule out
denial.

* Whatever the person says it is, existence whenever the
experiencing person says it does, thus, nurse should:
Consider the patient as the best authority on the
existence of the pain.
* Pain in the elder persons requires careful assessment
because they:
Experienced reduce sensory perception
* TRUE Statement on pain is:
Patient’s reaction to pain varies
* Myth about pain:
It is better to wait until a client has pain before
giving medication because client can validate its
existence.
* Willing to endure severe pain rather than be treated for
it. This is known:
Pain tolerance
* Gate control theory of pain explains that a pain is
perceived as stimulation of receptors in the:
Small nerve fibers
TYPES AND CLASSIFICATION
* MOST appropriately describe pain sensation that has
periods of remission and exacerbation:
Chronic
* To get accurate information about the quality of pain --
statements would be MOST APPROPRIATE?
“Tell me what your pain feels like”
* Older adults -- risk of underrated pain. Nursing
assessment and management of pain should address
the following beliefs EXCEPT:
Older patients seldom tend to report pain than
the younger ones (this is not a belief/myth, this is
true)
* Older persons require careful patient assessment
because older people:
Are more sensitive to drugs
* Components of a thorough pain assessment is most
significant:
Intensity
*In pain assessment -- reliable indicator:
Patient’s description of the pain sensation
* Triggering factor -- The nurse charts this as an
example of a/an:
Aggravating factor
* Assesses the quality off pain:
In your own words, tell me what your pain feels
like

* The following describes chronic pain except: * Maximum amount of pain a person can tolerate:
Less than 6 months Pain tolerance

* Indication of acute pain: GOAL

Increase vital signs + diaphoresis
* Above the knee amputation  sensation of pain in the
left foot:
Phantom pain
* “How can I have pain in my right shoulder if I have a
gallbladder problem?” The nurse describes this pain as:
Referred pain
* Priority nursing intervention -- terminally ill patient
diagnose with metastatic cancer is:
Alleviating and relieving pain
* Desired nursing outcome for Mr. Alindog base on the
nursing diagnosis Risk of powerlessness related to
perceived lack of control over a situation:
Client will return to functional status report
stabilization of or improvement on comfort level.

* Pain that originates from the skin and subcutaneous * Primary goal in caring for clients with chronic pain:
tissue is known as: Reduce the client’s perception of pain
Cutaneous
NON-PHARMACOLOGIC MGNT * Levels of pain:
* Appropriate non-pharmacologic intervention for pain 0 -no pain at all
includes all of the following EXCEPT: 1-3 -mild
Type of opioid being used 4-5 -moderate
* Indicate appropriate adaptation: 6-7 -severe
The client can distract himself during pain 8-9 -very severe
episodes 10 -worst possible pain

* Describes a non-pharmacologic approach to pain GOD BLESS YOU ALL!!!!!

control:
Imagery is the use of the patient’s imagination to
help control pain

* Backrub in relieving pain:

Stimulation of large diameter cutaneous fibers to
block the pain impulses from the spinal cord to the
brain

PHARMACOLOGIC MGNT
* The WHO analgesic ladder provides the health
professional with:
General pain management choices based on level
of pain

WHO
* Step 1 of the World Health Organization (WHO)
analgesic ladder:
NSAIDS, acetaminophen (Tylenol)

* Order of Demerol 50 mg I.M. now and every 6 hours p

r n. You injected Demerol at 5 pm. The next dose of
Demerol 50 mg I.M. is given:
At 11 pm

* Not included in step three:

Hydrocodone (step 2)

* Pain as 9 out of 0 to 10 pain rating scale, which 10

could be the worst possible pain  severe pain:
Morphine, non-narcotic, TCAs

*Pentoxidone 5 mg IV every 8 hours -- priority nursing

action;
Monitor VS, more importantly RR

* Kept available for the client being treated with opioids

analgesics:
naloxone (Narcan)

* Patient-controlled anesthesia (PCA) pump will allow

the patient: Administer their own analgesic

ADDITIONAL BULLETS:
* Breathing technique:
Inhale through the mouth and hold the breath for
5 seconds and exhale through the mouth

* Common Nursing Diagnosis in Severe Pain:

Powerlessness

* Common Side Effects of Narcotic

C- onstipation
P- ruritus (allergic reactions)
R- espiratory Depression)

* Record the instruments:

Circulating Nurse

* Burning and shooting pain:

Musculoskeletal and Neuropathic pain in origin