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NLE ENHANCEMENT PROGRAM
MEDICAL SURGICAL: PERI-OPERATIVE NURSING POST TEST
Prepared by: Ranniel P. Olorvida, EMT, RN
Instructions:
a. Choose the best answer and shade the corresponding letter on the answer sheet.
b. Avoid erasures or any form of alteration.
c. Use a pencil to shade your answers.

PERI-OPERATIVE NURSING
1. A client is scheduled for insertion of an inferior vena cava (IVC) filter. Nurse Patricia consults the physician about withholding which
regularly scheduled medication on the day before the surgery?
a. Potassium Chloride c. Furosemide
b. Warfarin Sodium d. Docusate
2. After a Pneumonectomy of the right lung nurse Silvia was assigned as the PACU nurse in charge of the client. When ordered to properly
position the client, nurse Silvia is correct when she places the client:
A. On left side lying for lung expansion C. With the right side dependent
B. On low fowlers to prevent aspiration D. Supine position with head turned to side
3. Assessment is one of the most important activity a peri-operative nurse does to make sure no or minimal complications would be
experienced by the client during the entire surgical experience. To properly assess latex allergy, the nurse asks the client if he/she is
allergic to which of the following?
A. Turon C. Kiwi shoe polish
B. Cashew nut cake D. Crab and mango salad
4. The med. Tech. working at the hospital laboratory is enraged that the specimen delivered to her has no label attached to it. The one liable for
the negligent act is:
A. The Scrub Nurse. C. The Surgeon.
B. The Circulating Nurse. D. The anesthesiologist.
5. Upon removing the surgical attire of the scrub nurse, he/she should remember that the first thing he/she should remove is:
A. The mask B. The gloves C. The cap D. The gown
6. Upon receiving the client who underwent general anesthesia in the PACU how would the PACU nurse position the client to avoid
hypopharyngeal obstruction?
A. Flat with head turned to side with pillow support C. Flat with head turned to side without pillow support
B. Supine with head elevated without pillow support D. Supine with head elevated with pillow support
7. Management for Evisceration include all of the following except:
A. Applying direct strong pressure in the site C. Notify physician immediately
B. Covering site with warm saline soaked gauze D. All are correct actions
8. Surgical conscience means:
A. Strict adherence to aseptic technique with honesty
B. Reporting if vital functioning is already unstable
C. Feeling guilty when wrong instrument is handed
D. Honest assessment of client history before transferring to OR table
9. Which of the following is a sign of bleeding in clients who underwent thyroidectomy?
A. Frequent swallowing C. Dark red color of dressing
B. Wet nape D. Facial pallor
10. Nurse Karen is caring for clients in the OR. The nurse is aware that the last physiologic function that the client loss during the 4 TH stage of
induction of anesthesia is:
A. Consciousness C. Respiratory movement
B. Gag reflex D. Corneal reflex
11. Which intervention should the nurse implement first when beginning preoperative teaching?
A. Assessing the client’s knowledge base related to the surgical procedure
B. Using a standardized preoperative teaching plan for consistency
C. Describing the possible risks of the surgical procedure
D. Having the client read the printed instructional booklet
12. Which statement best explains the scientific rationale for performing urinary catheterization on a client following an abdominal
hysterectomy if she is unable to void within 8 hours?
A. Temporary atony may result from surgical manipulation in the area
B. The bladder is removed along with the uterus
C. Infection from surgery interferes with the client’s ability to void
D. Surgically induced menopause impairs the client urinary function
13. The phases of the peri-operative period, as usually identified, include which of the following?
A. pre-anesthetic phase C. preliminary work-up phase
B. pre-operative phase D. healing phase
14. When assessing the client in the immediate post-anesthetic period, the nurse will pay special attention to tissue perfusion. This will be best
assessed by doing which of the following things?
A. Looking at lip color and checking capillary refill. C. Feeling the feet for warmth.
B. Pressing on the skin of a fleshy part of the body. D. Taking the carotid pulse.
15. The nurse is assigned to a client who has just had an appendectomy. The nurse inspects the client's dressings and the bedclothes
underneath the client. The nurse is most likely checking the linens under the client for which of the following things?
A. excessive perspiration C. excessive bleeding
B. wrinkles D. any objects left in the bed
16. The family of a client who has just received surgery involving the intestines asks when oral fluids and food can be given. You should tell the
family that the physician will most likely start fluids at which of the following times?

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 A. when peristalsis returns C. when the client has hunger signs
B. four hours after surgery D. twenty-four hours after surgery
17. The post-surgical client has been NPO this shift; however, the physician orders clear liquids. Which of the following actions would be best on
the part of the nurse?
A. Push fluids to 200 cc per hour. C. Offer small sips of water initially.
B. Encourage client to drink as much as possible. D. Suggest apple juice or orange juice.
18. In the pre-operative period, the nurse taught the client some leg exercises. Now, in the immediate post-operative period, the nurse asks the client
to do these exercises every two hours when awake. A family member wants to know the reason for these leg exercises. How should the nurse
reply?
A. "Leg exercises compress veins and prevent thrombi and emboli."
B. "These exercises will make it easier to get up out of bed later."
C. "The leg exercises will improve the quality of respirations."
D. "Contractures will be prevented by doing these leg exercises."
19. A client asks the nurse, "Why must I do deep-breathing exercises?" How should the nurse reply? [Hint]
A. "The doctor has ordered this, and you must do it."
B. “All our clients have to do deep breathing after surgery."
C. "Insurance won't pay if you don't do these exercises."
D. "Deep breathing helps prevent pneumonia and atelectasis."
20. When cleaning a sutured wound and applying a sterile dressing, the nurse must do which of the following? [Hint]
A. Hold the forceps with the tips down at all times.
B. Use at least three gauze swabs to clean the wound.
C. Cut the gauze to fit the wound or around drains.
D. Clean in circular motion inward to wound or incision.
21. The client has been reportedly smoking for 20 years. He is for exploratory laparotomy therefor must stop smoking. Preferably smoking
should be halted for:
A. 24 hours before surgery C. 2 weeks before the surgery
B. 2 months before the surgery D. 4-8 months before the surgery
22. The nurse is preparing a client for surgery. What is the most effective method for obtaining an accurate blood pressure reading from the
client?
A. Obtain a cuff that covers the upper one third of the client’s arm
B. Position the cuff approximately 4 inches above the antecubital arm
C. Use a cuff that is wide enough to cover the upper two thirds of the client’s arm
D. Identify the Korotkoff sounds, and take a systolic reading at 10 mmHg after the first sound
23. Which of the following is most dangerous complication during induction of spinal anesthesia?
A. Tachycardia C. Hyperthermia
B. Hypotension D. Bradypnea
24. Which of the following characterizes excitement stage of anesthesia?
A. Occurs from the administration of anesthesia to the loss of consciousness
B. Extends from the loss of consciousness to the loss of lid reflex, characterized by struggling and talking
C. From the loss of lid reflex to the loss of most reflexes
D. From the loss of most reflexes to respiratory and circulatory failure
25. Which of the following nursing actions should be given highest priority when admitting the patient into the operating room?
A. Level of consciousness
B. Vital signs
C. Patient identification and correct operative consent
D. Positioning and skin preparation
26. Which of the following postop findings should the nurse report to the M.D.?
A. The patient pushes out the oral airway with his tongue C. VS are as follows: BP=110/70;PR=95;RR=19,Temp=36.8C
B. Urine output is 20ml/hr for the past two hours D. Wound drainage is serosanguinous
27. Which of the following is the earliest sign of poor respiratory function?
A. Cyanosis C. Restlessness
B. Fast thready pulse D. Faintness
28. The best time to provide preoperative teaching on deep breathing, coughing and turning exercises is:
A. Before administration of preoperative medications
B. The afternoon or evening prior to surgery
C. Several days prior to surgery
D. Upon admission of the client in the recovery room
29. The following are the appropriate nursing actions before administration of preoperative medications EXCEPT:
A. Ascertain the consent has been signed C. Instruct patient to empty his bladder
B. Ensure that NPO has been maintained D. Provide bedpan
30. Which of the following nursing actions would help the patient decrease anxiety during the preoperative period?
A. Explaining all procedures thoroughly in chronological order
B. Spending time listening to the patient and answering questions
C. Encouraging sleep and limiting interruptions
D. Reassuring the patient that the surgical staff are competent professional
31. The following ensure validity of informed written consent EXCEPT:
A. The patient is of legal age with proper mental disposition
B. The consent has been secured within 24hours before the surgery
C. If the patient is unable to write, secure the consent from a relative
D. The consent is secured before administration of any medication that alter the level of consciousness
32. Which of the following drugs is administered to minimize respiratory secretions preop?
A. Valium (Diazepam) C. Phenergan (Promethazine)
B. Nubain ( Nalbuphine HCL) D. Atropine Sulfate
33. The most important factor in the prevention of postop infection is:
A. Proper administration of antibiotics C. Practice of strict aseptic techniques
B. Fluid intake of 2-3L/day D. Frequent change of wound dressings
34. Which of the following primarily prevents postop complications?
A. Adequate fluid intake C. Well-balanced diet
B. Early ambulation D. Administration of antimicrobials
35. Nursing measures for post-op thrombophlebitis include the following EXCEPT:
A. Maintain bedrest C. Massage the painful extremities
B. Elevate affected leg with pillow support D. Apply antiembolic stockings

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 36. Modified radical mastectomy involves:
A. Removal of the entire breast, axillary lymph nodes, pectoralis muscle
B. Removal of the lump of the breast
C. Removal of the entire breast, axillary and neck lymph nodes, including pectoralis muscles
D. Removal of the entire breast but nipple remains intact
37. Which of the following is not appropriate nursing intervention after modified radical mastectomy?
A. Place in semi fowler’s position and elevate arm on the affected side with pillow support
B. Check behind the client for bleeding
C. Monitor output from wound suction drainage
D. Immobilize the arm on affected side in adduction
38. A fluid challenge is begun with a post-op gastric surgery client. Which assessment will give the best indication of client response to this
treatment?
A. CVP readings and hourly urine output C. Lung sounds and arterial blood gases
B. Blood pressure and apical rate checks D. Electrolytes, BUN, creatinine results
39. A client is scheduled for a subtotal gastrectomy. In anticipation of clarifying information for client education, the nurse knows that vagotomy
is done as part of the surgical treatment for peptic ulcers in order to:
A. Decrease secretion of hydrochloric acid C. Increase blood supply to the jejunum
B. Improve the tone of the GI muscles D. Prevent the transmission of pain impulses
40. Prior to having a subtotal gastrectomy, a client is told about the dumping syndrome. The nurse explains that it is:
A. The body’s absorption of toxins produced by liquefaction of dead tissue
B. Formation of an ulcer at the margin of the gastrojejunal anastomosis
C. Obstruction of venous flow from the stomach into the portal system
D. Rapid emptying of food and fluid from the stomach into the jejunum
41. Upon induction of spinal anesthesia, the client experienced CSF Leakage. The nurse in charge notified the anesthesiologist for a proper
intervention to this complication. What would is the expected nursing action that would be done to the client with CSF Leakage?
A. Blood Patching C. Maintain fetal position to avoid further leakage
B. Position client flat on bed for 6-8 hours D. A and B are appropriate actions
42. Proper assessment during induction of general anesthesia is crucial to avoid endangering the patient’s life. Upon examination of the client’s
pupils the nurse notes that the pupils are constricted but reacts to light. The nurse knows that the client is now on which stage of
anesthesia?
A. 1st stage B. 2nd stage C. 3rd stage D. 4th stage
43. Which of the following statements by the client about induction of anesthesia needs further education?
A. “I may experience drowsiness and feeling of detachment as the anesthesia is being administered via IV”
B. “A complication during Epidural anesthesia is CSF Leakage because of dural puncture but the anesthesiologist can perform blood
patching to manage it.”
C. “the 2nd stage of anesthesia induction can be avoided if the anesthesiologist slows down the rate of administration”
D. All are correct statements
44. Malignant hyperthermia is the one of the most dangerous complication the client may experience during intra-op phase. You know that
malignant hyperthermia is:
A. Increasing rate of metabolism brought about by abnormality in Ca+ action
B. Elevated temperature due to anesthesia effect on the hypothalamus
C. Extreme muscle rigidity that is due to interaction between pre-op meds and anesthesia
D. Activation of inflammatory response as defense mechanism on anesthesia induction
45. Which of the following actions in the OR is done incorrectly?
A. The Surgeon applies the dressing after surgery
B. The circulating touches the back part of the scrub nurse’s gown
C. Dropping the needed supply on the sterile field by the scrub nurse to avoid contamination
D. Scrub nurse touching the sleeves of the gown on the stockinette
46. Among the OR Team who does intubation when the client experiences Respiratory distress?
A. Scrub Nurse C. Assistant Surgeon
B. Surgeon D. Anesthesiologist
47. The client is now experiencing no bowel movement 2 days’ post op. as a nurse who conduct assessment you know that this may indicate:
A. Constipation C. Evisceration
B. Paralytic Ileus D. Blocked GIT
48. A client with appendicitis decided to have an appendectomy. Being a knowledgeable nurse you understand that the purpose of this surgery
is classified into what category?
A. Diagnostic B. Ablative C. Palliative D. Constructive
49. Upon thorough assessment of the client about to undergo surgery you would pay particular attention to risk related assessment findings.
Which of the following would alarm the nurse and would warrant postponement of client’s surgery?
A. Client reported smoking 4 weeks before surgery C. Client have uncontrolled hypertension
B. Client have allergies to seafood D. Client who took an anxiolytic with pre-op meds
50. You are about to give your health teaching for the client who will undergo exploratory laparotomy. What activity should the nurse avoid?
A. Give health teaching the night/day before surgery
B. Give health education as soon as the client is admitted
C. BGive health teaching when the client is very anxious to lessen her fear of the unknown
D. Give health education by not providing too detailed explanation

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