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The goals of perioperative nursing are
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assist the patient and family through the surgery
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promote positive patient outcomes
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assist the patient to achieve his/her optimal level of function after the surgery
Frage 2
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what are the three phases of surgery?
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preoperative care
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intraoperative care
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postoperative care (next week)
Frage 3
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Role of the nurse in Pre-op admission clinic (PAC)
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patient interview
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nursing assessment
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preoperative teaching
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day of surgery prep
Frage 4
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In the patient interview what information should you obtain?
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determine pt expectations about surgery and anesthesia
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provide and clarify information about the surgical experience
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assess patient's emotional state and readiness for surgery
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determine if pt has enough information to make an informed decision
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may being some post op teaching
Frage 5
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Informed consent involves
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1. adequate disclosure of diagnosis
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understanding and comprehension of the information being provided
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must be given voluntarily
Frage 6
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Assess for ABCDE
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Airway
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breathing
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Circulation
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Diability
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Exposure
Frage 7
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What kind of allergies are you looking for?
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Medication
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foods
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Chemicals
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Tape
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Pollen
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perfumes
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latex
Frage 8
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For a pt about to undergo surgery ask about subjective health history
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have you had surgeries in the past? which ones? did you have any complications?
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Have you or any family members experienced any problems with anaesthesia
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Do you have any past hospitalizations?
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any chronic health conditions
Frage 9
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Health history assessment
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weight and height
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limitations in neck mobility
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history of drug or opiate abuse
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hx of ETOH use
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HX of smoking
Frage 10
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Conduct lab and diagnostic tests
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CBC
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electrolyte panel
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LFT
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Renal Panel
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Coagulation studies
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Type and cross match
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12 lead ECG
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Blood Glucose levels
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CXR
Frage 11
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What types of preoperative information is there?
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Sensory - sights, smells sounds
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Procedural - what to wear, what to eat, physical prep
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Process - flow of surgery, family needs
Frage 12
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An adult learner
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likes to have choices
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has a variety of learning styles and preferences
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needs to have abilities and achievements recognized
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does best in an environment where they feel safe, accepted and respected
Frage 13
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What are the steps involved in client education
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assessment of the need to learn
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assessment of readiness
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setting of objectives
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teaching - learning
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evaluation and re-teaching if necessary
Frage 14
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Check all that are involved in a surgical team
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2 RNs
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practical nurse
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Surgeon and assistant
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RN first assistant
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Anaesthetist
Frage 15
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What does SBAR-R stand for
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S: Situation
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B: background
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A: Assessment
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R: Recommendation
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Repeat - repeat back so it is said properly
Frage 16
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During the preoperative interview, a patient scheduled for an elective hysterectomy to treat benign tumours of the uterus tells the nurse that she does not know whether she can go through with the surgery because she knows she will die in surgery, as her mother did. What is the most appropriate response?
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“Tell me more about what happened to your mother.”
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“Think positively! Positive thoughts have been shown to influence a positive surgical outcome.
Frage 17
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Why is it especially important for the nurse to determine the patient’s current use of medications during the preoperative assessment?
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These medications may alter the patient’s perceptions about surgery.
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Other medications may cause interactions with anaesthetics, altering the potency and effect of the drugs.
Frage 18
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The nurse visits the patient to have him sign the operative permit as directed in the physician’s preoperative orders. The patient tells the nurse that the physician has not really told him what is involved in the surgical procedure. What should the nurse do?
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Explain what the planned surgical procedure entails before having the patient sign the consent form.
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Delay the patient’s signature on the consent form, and notify the physician that the informed-consent process is not complete.
Frage 19
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What does appropriate preoperative teaching for a patient scheduled for abdominal surgery include?
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How to breathe deeply and cough
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How to care for the wound
Frage 20
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An 82-year-old man is admitted to the hospital the evening before a prostatectomy for cancer of the prostate. He is alert and oriented but has difficulty seeing and hearing. His wife is at his bedside and answers most questions directed to the patient. What should the nurse do to accomplish preoperative teaching with the patient?
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Provide additional time for the patient to understand preoperative instructions and carry out procedures
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Ask the patient’s wife to wait in the hall in order to focus on preoperative teaching with the patient himself
Frage 21
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What are the physical environment and traffic control measures of the OR primarily designed to do?
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Protect the patient’s privacy.
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Prevent transmission of infection
Frage 22
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Which one of the following intraoperative patient positions would the nurse anticipate for the patient who is being prepared for abdominal surgery?
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Prone
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Supine
Frage 23
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The nurse notes that a preoperative patient is drowsy, but oriented, in the receiving area. In addition to checking her hospital number and identification band, what should the nurse check?
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Ask the patient to state her name, her doctor’s name, and the operative procedure planned.
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Ask the surgeon to identify the patient and the planned surgical procedure.
Frage 24
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The nurse from the general surgical unit brings the patient’s hearing aid to the surgical suite because the patient left the unit without it and it is needed to communicate with the patient. At the surgical suite, what areas can the general surgical unit nurse enter?
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Clean core
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Scrub sink areas
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Information or nursing station
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Corridors of the ORs
Frage 25
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Which assessment finding would the nurse expect to observe in a patient with malignant hyperthermia
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Decreased heart rate
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Low, irregular respirations
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Decreased temperature
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Ventricular dysrhythmias
Frage 26
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What is one of the most important goals of the registered nurse first assistant?
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Safety of the patient
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Documentation of the intraoperative care
Frage 27
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You are the clinic nurse doing a preoperative assessment on a patient who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the patient's medical history, you note that this patient had a kidney transplant 8 years ago. The patient is taking immunosuppressive drugs. What is this patient at increased risk for when having surgery?
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infection
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death
Frage 28
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An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults?
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Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
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older adults are more malnourished
Frage 29
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How should a nurse teach a patient to perform deep breathing and coughing to use postoperatively?
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The patient should take a deep breath in through the mouth and exhale all the air out through the mouth, take a short breath, and cough from deep in the lungs.
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The patient should do box breathing
Frage 30
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Which of the following clinical manifestations is often the earliest sign of malignant hyperthermia?
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Tachycardia
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bradycardia
Frage 31
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A client who had abdominal surgery 4 days ago reports that "something gave way" when he sneezed. The nurse observes a wound evisceration. Which nursing action is the first priority?
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Applying a sterile, moist dressing
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suturing the wound
Frage 32
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A postanesthesia care unit (PACU) nurse is caring for a patient with the following assessment data: pale, cool, moist skin; thready pulse of 122; blood pressure 78/60; urine output of 25 mL/h; temperature 99.2°F. What interventions by the nurse are appropriate? Select all that apply.
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Maintain a patent airway. • Frequently monitor neurological status. .
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• Apply oxygen per orders
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• Administer blood products per orders.
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apply warm blankets
Frage 33
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Which of the following terms refers to a protrusion of abdominal organs through the surgical incision?
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Eviseration
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desiccation
Frage 34
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Nursing assessment findings reveal a temperature of 96.2°F, pulse oximetry 90%, shivering, and client complains of chilling. The findings are indicative of which nursing diagnosis?
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Ineffective thermoregulation
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ineffective airway clearance
Frage 35
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The nurse is caring for a client during the immediate postoperative period and is assessing for signs of shock. What signs and symptoms indicate that the client may be in shock?
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weak and rapid pulse
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bounding and rapid pulse
Frage 36
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The client asks the nurse about ways to control pain other than taking pain medication. Which strategy should the nurse include when responding to the client? Select all that apply
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Listening to music •
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Watching television
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• Changing position
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yelling
Frage 37
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The primary objective in the immediate postoperative period is
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maintaining pulmonary ventilation.
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preventing infection
Frage 38
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In the transfer of accountability what is transferred?
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rights
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duties
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obligations
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charting
Frage 39
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What is included in the post operative report/handover?
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general patient information
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patient history
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intraoperative management
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post anasesthesia care plan
Frage 40
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Post operative orders (select all that apply)
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iv fluids
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resumption of diet and fluids
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positioning
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special wound care instructions
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oxygen therapy
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medications
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emergency contact
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number of nurse in PACU
Frage 41
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what is part of your initial assessment of a post surgical patient?
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ABCs
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LOC
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V/S
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O2 therapy
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Intake/output
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IV lines/fluid
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drains and tubes
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Surgical site
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pain
Frage 42
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When assessing neurological systems what should you look for?
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LOC
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orientation
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ability to follow commands
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shine a pen light in their eye
Frage 43
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what percent of patients have emergence delirium?
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10%
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5%
Frage 44
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a neurological scale used to give reliable and objective way of recording the conscious state of a patient is a
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glasgow coma scale
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orientation scale
Frage 45
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to prevent pulmonary complications what should you do?
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keep head of bed at 25-45 degrees at all times
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T and P q 2hs
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leg exercises
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teach splinting when coughing
Frage 46
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list potential cardiovascular complications after surgery
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hemorrhage
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hypovolemia
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hypotension
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syncope/arrhythmias
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deep vein thrombosis
Frage 47
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what are some interventions to prevent cardiac complications?
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IV management
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early ambulation
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t and p while in bed
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leg exercises
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anticoagulants
Frage 48
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what are some GI function risks for post surgery
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Nausea and vomitting
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abdominal distention
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paralytic ileus
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constipation
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acites
Frage 49
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Potential dysfunction in GU function
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Oliguria <30 ml/hr
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anuria (no urine)
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Urinary retention
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UTI
Frage 50
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when is the original dressing removed?
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by the surgeon
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by the nurse
Frage 51
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when is a surgical dressing changed?
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after 24 hours
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after 48 hours
Frage 52
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What are some of the benefits of discharge planning?
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patient satisfaction
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improved self care
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decreased LOS
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Decrease readmission rates
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decreased cost
Frage 53
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if a drug is equianlgesic it means
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dose of one drug is equivalent in pain relieving effects compared with another drug
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that the drugs work the same
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