4110 Nursing Process in the Perioperative Setting - Final Exam Review (Qns & Ans) - OSU 2, Exams of Nursing

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4110 Nursing Process in the

Perioperative Setting

Final Exam Review

(Questions & Solutions)

1. Multiple Choice Question: A 56‑year‑old woman scheduled for elective hysterectomy presents in the preoperative holding area. Which nursing process phase is most critical at this time to ensure that care is individualized and evidence‑based?

• A. Diagnosis (NANDA formulation)
• B. Assessment (including psychosocial and cultural factors)
• C. Implementation of post‑op pain protocols
• D. Evaluation of surgical outcomes Correct ANS : B. Assessment (including psychosocial and cultural factors) Rationale: Preoperative assessment is the cornerstone of the nursing process. It involves gathering comprehensive data—including physiological, psychosocial, and cultural factors—that informs the formulation of nursing diagnoses, individualized care plans, and promotes patient- centered, evidence-based practice.

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2. Fill-in-the-Blank Question: The systematic process of collecting data, formulating diagnoses, planning interventions, implementing care, and evaluating outcomes is known as the __________. Correct ANS : nursing process

values Correct ANS s: A, B, D, E Rationale: A thorough preoperative assessment requires collecting historical data (A), exploring patient concerns (B), formulating nursing diagnoses (D), and establishing baselines (E). Implementation of postoperative protocols (C) is part of later phases.

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5. Multiple Choice Question: During the intraoperative phase, which nursing role is pivotal to ensuring patient safety and adherence to sterile technique?

• A. Registered Nurse First Assistant (RNFA)
• B. Circulating Nurse
• C. Scrub Nurse
• D. Patient Care Coordinator Correct ANS : C. Scrub Nurse Rationale: The scrub nurse plays a critical role in maintaining asepsis by managing surgical instruments and assisting the surgeon directly. While the circulating nurse supports overall OR functioning and the RNFA assists with technical procedures, maintaining sterility is the primary mandate of the scrub nurse.

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6. Fill-in-the-Blank

Question: In the intraoperative environment, adherence to __________ practice is vital for sustained patient safety and the minimization of surgical site infections. Correct ANS : evidence-based Rationale: Evidence-based practice ensures that intraoperative protocols—including hand hygiene, instrument sterilization, and surgical technique—are informed by the latest research and guidelines to reduce infection risks.

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7. True/False Question: True or False: Intraoperative nursing management focuses solely on physical safety and does not involve monitoring patient emotional responses. Correct ANS : False Rationale: While physical safety (e.g., asepsis, hemodynamic monitoring) is paramount intraoperatively, addressing patient anxiety (often preinduction, even if sedated intraoperatively) and preserving dignity by maintaining clear communication with the surgical team and family when possible are integral to holistic care.

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8. Multiple Response Question:

complications, such as deep vein thrombosis, in addition to vigilant monitoring. These interventions are evidence-based and essential for ensuring rapid recovery and reduced morbidity.

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10. Fill-in-the-Blank Question: Effective postoperative care planning incorporates both evidence-based guidelines and patient-specific factors, which is essential for __________ patient outcomes. Correct ANS : optimizing Rationale: Optimizing patient outcomes through personalized, evidence-based interventions leads to reduced complications and shorter hospital stays. It reflects a holistic approach during the postoperative phase.

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11. True/False Question: True or False: Postoperative pain management should be based solely on patient self-report. Correct ANS : False Rationale: While patient self-report is important, multidimensional pain assessments that include physiological and behavioral indicators provide a more comprehensive evaluation of pain, particularly in patients who may have impaired communication.

12. Multiple Response Question: In postoperative nursing care, which components are used to evaluate the effectiveness of interventions? (Select all that apply)

• A. Monitoring vital signs and laboratory results
• B. Assessing pain levels and comfort
• C. Reviewing wound healing and surgical site integrity
• D. Evaluating patient satisfaction and psychological well-being
• E. Relying solely on the surgeon's notes Correct ANS s: A, B, C, D Rationale: Effective evaluation in the postoperative phase includes objective measures (vital signs, labs, wound assessment) and subjective assessments (pain, satisfaction). Sole reliance on the surgeon’s notes (E) is insufficient for holistic care.

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13. Multiple Choice Question: A patient care coordinator in the perioperative setting is responsible for ensuring the efficient flow of information among team members. Which of the following actions is most indicative of this role?

• A. Directly administering medications in the OR
• B. Coordinating interdisciplinary rounds and communicating vital information to the care team
• C. Solely handling administrative paperwork
• D. Providing technical assistance with surgical instruments

Rationale: Accurate and comprehensive documentation is critical throughout all phases of care. Intraoperative records should reflect both procedural events and any deviations from the preoperative baseline that may affect postoperative outcomes.

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16. Multiple Response Question: Which interventions demonstrate evidence-based strategies in the preoperative teaching of surgical patients? (Select all that apply)

• A. Using multimedia educational tools tailored to patient learning styles
• B. Discussing potential risks, benefits, and alternatives of surgery
• C. Providing a standardized lecture, regardless of patient questions
• D. Including family members in instructional sessions
• E. Assessing the patient’s baseline understanding and tailoring education accordingly Correct ANS s: A, B, D, E Rationale: Effective preoperative teaching involves tailoring education to the patient’s learning preferences, discussing all aspects of the surgical procedure, including family members, and personalizing the content based on the patient’s baseline knowledge. A “one-size-fits-all” lecture (C) does not meet the standards of evidence-based practice.

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17. Multiple Choice Question: In the context of the nursing process for a patient undergoing elective

surgery, which step is primarily about anticipating potential complications and planning for their prevention?

• A. Assessment
• B. Nursing diagnosis
• C. Planning
• D. Implementation Correct ANS : C. Planning Rationale: The planning phase involves developing tailored care plans, including anticipation and prevention of complications (e.g., infection, thromboembolism), based on the patient’s data gathered during assessment. This phase is key in preparing for both expected and unexpected events.

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18. Fill-in-the-Blank Question: 

During the intraoperative phase, continuous __________ monitoring is vital to detect any early signs of compromise in the patient’s physiologic status. Correct ANS : hemodynamic Rationale: Continuous hemodynamic monitoring (including parameters like blood pressure, heart rate, and oxygen saturation) allows for the early detection of instability, enabling immediate intervention to prevent further deterioration.

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in context but is not an independent outcome measure.

21. Multiple Choice Question: A patient care coordinator notices a delay in the turnover process in the operating room that is affecting patient flow. Which action best demonstrates leadership in evidence‑based practice?

• A. Ignoring the delay as it is a routine occurrence
• B. Conducting a root cause analysis and proposing process improvements
• C. Delegating the issue to another nurse
• D. Waiting for the next scheduled meeting to discuss the problem Correct ANS : B. Conducting a root cause analysis and proposing process improvements Rationale: An evidence-based leader uses quality improvement tools—such as root cause analysis—to identify and address inefficiencies, thereby optimizing patient outcomes and coordinating effective perioperative care.

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22. Fill-in-the-Blank Question: In preoperative evaluation, a thorough __________ assessment ensures that all preexisting conditions and potential risk factors are identified prior to surgery. Correct ANS : health history Rationale:

A detailed health history assessment captures comorbidities, past surgical experiences, medication use, and psychosocial factors— information critical for risk stratification and individualized perioperative planning.

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23. True/False Question: True or False: Intraoperative documentation must include dynamic changes in the patient’s condition as well as all communication exchanges between the surgical team and the patient care coordinator. Correct ANS : True Rationale: Accurate intraoperative documentation is crucial for continuity of care. Recording dynamic changes and team communication supports effective decision-making and ensures that any deviations from baseline are promptly addressed.

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24. Multiple Response Question: Which of the following are examples of evidence-based interventions to decrease postoperative complications? (Select all that apply)

• A. Early removal of invasive lines when clinically appropriate
• B. Implementation of standardized protocols for pain control
• C. Initiation of Early Mobility Programs (EMPs)
• D. Routine postponement of nutrition until the seventh postoperative day
• E. Strict adherence to infection control practices

Question: The use of structured clinical pathways and standardized __________ facilitates coordinated care and minimizes variability in the preoperative, intraoperative, and postoperative phases. Correct ANS : protocols Rationale: Standardized protocols help ensure that evidence-based practices are implemented consistently across all phases of care, improving patient outcomes and reducing the likelihood of errors.

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27. True/False Question: True or False: Intraoperative nursing roles extend beyond technical skills to include advocacy and communication to ensure that any concerns regarding patient safety are addressed immediately. Correct ANS : True Rationale: In addition to technical proficiency, intraoperative nurses serve as advocates for patient safety. Effective communication enables the timely resolution of issues that could compromise patient well-being during surgery.

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28. Multiple Response Question: Which aspects of a patient’s psychosocial context should be addressed

during the preoperative phase? (Select all that apply)

• A. Level of health literacy and understanding of the procedure
• B. Family support and involvement
• C. Past experiences with surgical procedures
• D. Financial concerns related to surgery
• E. The patient’s favorite leisure activities Correct ANS s: A, B, C, D Rationale: Psychosocial assessment includes evaluating health literacy, family dynamics, previous surgical experiences, and financial issues that may affect admission and discharge planning. Although leisure activities might provide insight into stress relief, they are not primary concerns in surgical planning.

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29. Multiple Choice Question: 

During postoperative care, which evidence-based measure is most effective for preventing deep vein thrombosis (DVT) in high-risk surgical patients?

• A. Early ambulation and use of compression devices
• B. Extended bed rest with passive range-of-motion exercises
• C. Routine administration of high-dose anticoagulants without monitoring
• D. Application of superficial heat to the lower limbs Correct ANS : A. Early ambulation and use of compression devices Rationale: Early mobilization combined with mechanical prophylaxis (e.g.,

Rationale: Addressing patient anxiety often involves providing education and setting realistic expectations. This helps alleviate fear of the unknown and empowers the patient. Fill-in-the-Blank: During the preoperative assessment, the nurse should prioritize identifying and addressing patient risk factors. One critical risk factor that significantly increases the chance of postoperative complications is __. Correct ANS : smoking Rationale: Smoking impairs wound healing and increases the risk of respiratory complications. True/False: The circulating nurse in the operating room is primarily responsible for maintaining the sterile field. Correct ANS : False Rationale: The scrub nurse maintains the sterile field. The circulating nurse's role is to advocate for the patient and coordinate the team. Multiple Response: Which of the following are essential components of informed consent in the preoperative phase? (Select all that apply.) a) Explanation of the procedure's risks. b) The patient's signature. c) The surgeon's credentials. d) Alternative treatment options.

Correct ANS : a) Explanation of the procedure's risks, b) The patient's signature, d) Alternative treatment options. Rationale: Informed consent ensures the patient understands the procedure, its risks, and alternative options before agreeing to treatment. Multiple Choice: A patient in the intraoperative phase experiences a sudden drop in blood pressure. The initial nursing action should be to: a) Administer intravenous fluids. b) Notify the anesthesiologist immediately. c) Increase the oxygen flow rate. d) Check the patient's pulse oximetry reading. Correct ANS : b) Notify the anesthesiologist immediately. Rationale: Rapid intervention by the anesthesia provider is crucial in managing intraoperative hypotension. Fill-in-the-Blank: During the intraoperative phase, the nurse must meticulously document all events. This includes the time of incision, the medications administered, and the __. Correct ANS : patient's response Rationale: Thorough documentation ensures accurate records and supports continuity of care. True/False: