CDC – Medical-Surgical Nursing (Part A)
SURGICAL TEAMSituation: Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure.
The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover?
A. Circulating Nurse
The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. While the surgeon performs the surgical
procedure, who monitors the status of the client like urine output, blood loss? C. Anaesthesiologist
Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. For orthopedic cases, what department is usually informed to be present in the OR?
A. Rehabilitation depaartment
Minimally invasive surgery is very much into technology. Aside from the usual surgical team, who else has to be present when a client undergoes laparoscopic surgery?
D. Laboratory technician
In massive blood loss, prompt replacement of compatible blood is crucial. What department needs to be alerted to coordinate closely with the patient’s family for immediate blood component therapy?
B. Chaiplaincy PAIN MANAGEMENT
Situation: You are assigned in the Orthopedic Ward where clients are complaining of pain in varying degrees upon movement of body parts.
Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Which of the following observation would prompt you to call the doctor?
B. Left foot is cold to touch and pedal pulse is absent
There is an 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:
B. When the patient is in severe pain
You continuously evaluate the client’s adaptation to pain. Which of the following behaviors indicate appropriate adaptation?
C. The client can distract himself during pain episodes
Pain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence pain. How can you alter these factors as the nurse?
D. Promote client’s sense of control and participation in control by listening to his concerns
In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case?
D. Assess respiratory rate carefully MEDICAL RECORDS & DOCUMENTATION
Situation: Records are vital tools in any institution and should be properly maintained for specific use and time.
The patient’s medical record can work as a double edged sword. When can the medical record become the doctor’s/nurse’s worst enemy?
D. When the medical record is inaccurate, incomplete, and inadequate
Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency?
D. Department of Health (DOH)
In the hospital, when you need the medical record of a discharged patient for research you will request permission through:
You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you request the old chart?
D. Medical records section
Records Management and Archives Office of the DOH is responsible for implementing its policies on record disposal. You know that your institution is covered by this policy if:
C. It obtained permit to operate from DOH
Situation: As a nurse, you should be aware and prepared of the different roles you play.
What role do you play when you hold all client’s information entrusted to you in the strictest confidence?
A. Patient’s advocate
As a nurse, you can help improve the effectiveness of communication among healthcare givers by: B. Using standardized list of abbreviations, acronyms, and symbols
As a nurse, your primary focus in the workplace is the client’s safety. However, personal safety is also a concern. You can communicate hazards to your co-workers through the use of the following EXCEPT:
C. Posting IR in the bulletin board
As a nurse, what is one of the best way to reconcile medications across the continuum of care? B. Communicate a complete list of the patient’s medication to the next provider of
service
PERIOPERATIVE NURSING
Situation: In the OR, there are safety protocols that should be followed. The OR nurse should be well versed with all these to safeguard the safety and quality of patient delivery outcome.
Which of the following should be given highest priority when receiving patient in the OR? B. Verify patient identification and informed consent
Surgeries like I and D (incision and drainage) and debridement are relatively short procedures but considered ‘dirty cases’. When are these procedures best scheduled?
A. Last case
OR nurses should be aware that maintaining the client’s safety is the overall goal of nursing care during the intraoperative phase. As the circulating nurse, you make certain that throughout the procedure…
C. 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.
Another nursing check that should not be missed before the induction of general anesthesia is: D. Check basline vital signs
Some lifetime habits and hobbies affect postoperative respiratory function. If your client smokes 3 packs of cigarettes a day for the past 10 years, you will anticipate increased risk for:
D. Postoperative respiratory function
Situation: Nurses hold a variety of roles when providing care to a perioperative patient.
Which of the following role would be the responsibility of the scrub nurse?
C. Account for the number of sponges, needles, supplies, used during the surgical procedure.
As a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic?
A. Put side rails up and ask the client not to get out of bed
It is the responsibility of the pre-op nurse to do skin prep for patients undergoing surgery. If hair at the operative site is not shaved, what should be done to make suturing easy and lessen chance of incision infection?
C. Clipped
It is also the nurse’s function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection?
A. Localized heat and redness
Which of the following nursing interventions is done when examining the incision wound and changing the dressing?
C. Wash hands
Situation: Joint Commission on Accreditation of Hospital Organization (JCAHO) patient safety goals and requirements include the care and efficient use of technology in the OR and elsewhere in the healthcare facility.
As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems? D. Implement a regular maintenance and testing of alarm systems
Overdosage of medication or anesthetic can happen even with the aid of technology like infusion pumps, sphygmomanometer and similar devices/machines. As a staff, how can you improve the safety of using infusion pumps?
A. Check the functionality of the pump before use
JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedure/surgery includes the following, EXCEPT:
C. Take a video of the entire intra-operative procedure
You identified a potential risk of pre-and postoperative clients. To reduce the risk of patient harm resulting from fall, you can implement the following, EXCEPT:
A. Assess potential risk of fall associated with the patient’s medication regimen
As a nurse, you know you can improve on accuracy of patient’s identification by 2 patient identifiers, EXCEPT:
C. call the client by his/her case and bed number Situation: Team efforts is best demonstrated in the OR.
If you are the nurse in charge for scheduling surgical cases, what important information do you need to ask the surgeon?
B. Who is your assistant and anesthesiologist, and what is your preferred time and type of surgery?
In the OR, the nursing tandem for every surgery is: D. Scrub and circulating nurses
While team effort is needed in the OR for efficient and quality patient care delivery, we should limit the number of people in the room for infection control. Who comprise this team?
B. Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologist
When surgery is on-going, who coordinates the activities outside, including the family? A. Orderly/ Clerk
The breakdown in teamwork is often times a failure in: D. Communication
Situation: After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument count.
When is the first sponge/instrument count reported? B. Before peritoneum is closed
What major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture?
C. Peritoneum
Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has low threshold of pain, what needle would you prepare?
C. Reverse cutting needle
Another alternative “suture” for skin closure is the use of ____________ A. Staple
Like any nursing interventions, counts should be documented. To whom does the scrub nurse report any discrepancy of counts so that immediate and appropriate action is instituted?
ASTHMA
Situation: Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory distress.
Which of the following nursing actions should be initiated first? D. Administer bronchodilator by nebulizer
Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what is its indication, the nurse will say:
A. Relax smooth muscles of the bronchial airway
You will give health instructions to Carlo, a case of bronchial asthma. The health instruction will include the following, EXCEPT:
D. Practice respiratory isolation
The asthmatic client asked you what breathing techniques he can best practice when asthmatic attack starts. What will be the best position?
A. Sit in high-Fowler’s position with extended legs
As a nurse, you are always alerted to monitor status asthmaticus who will likely and initially manifest symptoms of:
B. respiratory acidosis OSTOMY CARE
Situation: Colostomy is a surgically created anus. It can be temporary or permanent, depending on the disease condition.
Skin care around the stoma is critical. Which of the following is not indicated as a skin care barriers? A. Apply liberal amount of mineral oil to the area
What health instruction will enhance regulation of a colostomy (defecation) of clients? B. Eat fruits and vegetables in all three meals
After ileostomy, which of the following condition is NOT expected? D. Establishment of regular bowel movement
The following are appropriate nursing interventions during colostomy irrigation, EXCEPT: A. Increase the irrigating solution flow rate when abdominal cramps is felt
What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained?
B. Sensation of pressure
NURSING RESEARCH
Situation: As a beginner in research, you are aware that sampling is an essential elements of the research process.
What does a sample group represent? C. General population
What is the most important characteristic of a sample? D. Representativeness
Random sampling ensures that each subject has: B. An equal chance of selection
Which of the following methods allows the use of any group of research subject? B. Convenience
You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from each barangay. What should be the appropriate method for you to use in this care?
A. Cluster sampling
Situation: You are assigned at the surgical ward and clients have been complaining of post pain at varying degrees. Pain as you know, is very subjective.
A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10 pain rating. Your assessment revelas bowel sounds on all quadrants and the dressing is dry and intact. What nursing intervention would you take
C. Encourage deep breathing and turning
Pentoxidone 5 mg IV every 8 hours was prescribed for post abdominal pain. Which will be your priority nursing action?
C. Avoid overdosing to prevent dependence/ tolerance
The client complained of abdominal distention and pain. Your nursing intervention that can alleviate pain is:
D. Turn to sides frequently and avoid too much talking
Surgical pain might be minimized by which nursing action in the O.R. A. Skill of surgical team and lesser manipulation
One very common cause of postoperative pain is: D. Inadequate anesthetic
HYPOTHYROIDISM
Situation: You were on duty at the medical ward when Zeny came in for admission for tiredness, cold intolerance, constipation, and weight gain. Upon examination, the doctor’s diagnosis was hypothyroidism.
Your independent nursing care for hypothyroidism includes: C. Providing a cool, quiet, and comfortable environment
As the nurse, you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from hypothyroidism?
A. Levothyroxine
Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following?
A.Activity intolerance related to tiredness associated with disorder
Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following characteristics.
D. Hypoglycemia
As a nurse, you know that the most common type of goiter is related to a deficiency of: D. iodine
THORACENTESIS
Situation: Mrs. Pichay is admitted to your ward. The MD ordered “Prepare for thoracentesis this pm to remove excess air from the pleural cavity.”
Which of the following nursing responsibilities is essential in Mrs. Pichay who will undergo thoracentesis?
B. Ensure that informed consent has been signed
Mrs. Pichay who is for thoracentesis is assigned by the nurse to which of the following positions? C. Dorsal Recumbent position
During thoracentesis, which of the following nursing intervention will be most crucial? B. Maintain strict aseptic technique
To prevent leakage of fluid in the thoracic cavity, how will you position the client after thoracentesis?
C. Turn on the affected side
Chest x-ray was ordered after thoracentesis. When your client asks what is the reason for another chest x-ray, you will explain:
A. to rule out pneumothorax SAFETY DEVICES
Situation: In the hospital, you are aware that we are helped by the use of a variety of equipment / devices to enhance quality patient care delivery.
You are to initiate an IV line to your patient, Kyle, 5, who is febrile. What IV administration set will you prepare?
D. Microset
Kyle is diagnosed to have measles. What will your protective personal attire include? C. Face mask
What will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake?
C. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output
Before bedtime, you went to ensure Kyle’s safety in bed. You will do which of the following: B. Put the side rails up
Kyle’s room is fully mechanized. What do you teach the watcher and Kyle to alert the nurses for help?
C. Call system TONSILLECTOMY
Situation: Tony, 11 years old, has ‘kissing tonsils’ and is scheduled for tonsillectomy and adenoidectomy or T and A.
You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if Tony will be put to sleep. Your teaching will focus on:
A. Spinal anesthesia
Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food to prepare and give their children after surgery. You as the nurse will say:
D. Soft diet when fully awake
The RR nurse should monitor for the most common postoperative complication of: A. hemorrhage
The PACU nurse will maintain postoperative T and A client in what position? B. Prone with the head on pillow and turned to the side
Tony is to be discharged in the afternoon of the same day after tonsillectomy and adenoidectomy. You as the RN will make sure that the family knows to:
B. offer soft foods for a week to minimize discomfort while swallowing CHRONIC RENAL FAILURE
Situation: Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered so that an A-V shunt was surgically created.
Which of the following action would be of highest priority with regards to the external shunt? A. Avoid taking BP or blood sample from the arm with the shunt
Diet therapy for Rudy, who has acute renal failure is low-protein, low potassium and low sodium. The nutrition instructions should include:
B. Encourage client to include raw cucumbers, carrot, cabbage, and tomatoes
Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. He asked you how this can be prevented. Your response is:
C. initial hemodialysis shall be done 30 minutes only so as not to rapidly remove the waste from the blood than from the brain
You are assisted by a nursing aide with the care of the client with renal failure. Which delegated function to the aide would you particularly check?
C. Obtaining vital signs
A renal failure patient was ordered for creatinine clearance. As the nurse you will collect… C. 24 hour urine specimen
INTRAVENOUS PYELOGRAPHY
Situation: Fe is experiencing left sharp pain and occasional hematuria. She was advised to undergo IVP by her physician.
Fe was so anxious about the procedure and particularly expressed her low pain threshold. Nursing health instruction will include:
A. assure the client that the pain is associated with the warm sensation during the administration of the Hypaque by IV
What will the nurse monitor and instruct the client and significant others post IVP? C. Increase fluid intake
Post IVP, Fe should excrete the contrast medium. You instructed the family to include more vegetables in the diet and:
A. increase fluid intake
The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To increase the chance of passing the stones, you instructed her to force fluids and do which of the following?
A. Balanced diet
The presence of calculi in the urinary tract is called D. Urolithiasis
INTRAVENOUS THERAPY
Situation: At the medical-surgical ward, the nurse must also be concerned about drug interactions.
You have a client with TPN. You know that in TPN like blood transfusion, these should be no drug incorporation. However the MD’s order read; incorporate insulin to present TPN. Will you follow the order?
B. Yes, because insulin is chemically stable with TPN and can enhance blood glucose level
The RN should also know that some drugs have increased adsorption when infused in the PVC container. How will you administer drugs such as insulin, nitroglycerine hydralazine to promote better therapeutic drug effects?
D. Use volumetric chamber
One patient had a ‘runaway’ IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction what solution you prepare in anticipation of the doctor’s order?
A. Any IV solution available to KVO
How can nurses prevent drug interaction including adsorption? D. Referring to manufacturer’s guidelines
In insulin administration, it should be understood that our body normally releases insulin according to our blood glucose level. When is insulin and glucose level highest?
