1. The nursing student is preparing an elderly patient for surgery. The patient is scheduled for a general anesthetic.

Which side effect should the nurse monitor the patient for? A) Hypothermia B) Pulmonary edema C) Cerebral ischemia D) Increased ability to resist stress 2. You are the circulating nurse. Which task are you solely responsible for? A) Monitoring the patient and documents B) Estimating the patient's blood loss C) Setting up the sterile tables D) Keeping track of drains and sponges 3. A 21-year-old patient is positioned on the OR bed prior to knee surgery. The anesthesiologist administers the anesthetic. What is the next step in the care of this patient? A) Grounding B) Hanging IV fluids C) Giving blood D) Intubating 4. You are the circulating nurse in an operating room that has several surgeries scheduled. You would know to monitor which patient during the intraoperative period because he or she is at increased risk for hypothermia? A) A 72-year-old woman B) A 17-year-old boy C) A 45-year-old woman D) A 12-year-old girl 5. The anesthetist is coming to the unit to see a patient prior to surgery that is scheduled for tomorrow morning. What information, obtained during the admission assessment, should be given to the anesthetist during the visit? A) Last bowel movement B) Latex allergy C) Number of pregnancies D) Difficulty falling asleep

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6. Surgical asepsis is a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the operating room? A) Reusable shoe covers B) Mask covering the nose and mouth C) Goggles D) Gloves 7. As an OR nurse, you have an increased awareness regarding asepsis. You know that a basic guideline for maintaining surgical asepsis is what? A) Sterile surfaces or articles may touch other sterile surfaces. B) Sterile supplies can be used on another patient if the packages are intact. C) The outer lip of a sterile solution is considered sterile. D) The scrub nurse may pour a sterile solution from a nonsterile bottle. 8. Your patient is a 35-year-old female who has been administered general anesthesia. The patient is in stage II (the excitement stage) of anesthesia. Which intervention might you need to implement during this stage? A) Rub the patient's back B) Restrain the patient C) Encourage the patient to express feelings D) Stroke the patient's hand 9. What is the best rationale for intubation during a surgical procedure? A) The tube provides an airway for ventilation. B) The tube protects the esophagus. C) The patient may receive an anti-emetic through the tube. D) The patient's heart rate can be monitored with the tube. 10. You are the circulating nurse in an outpatient surgery center. Your patient is scheduled to receive moderate sedation. You know that a patient receiving this form of anesthesia should what? A) Never be left unattended by the nurse B) Receive an anti-emetic C) Remember most of the procedure D) Be able to maintain his or her own airway

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11. A nurse is caring for a patient following surgery under a spinal anesthetic. What interventions can the nurse implement to prevent a spinal headache? A) Have the patient sit in a chair B) Ambulate the patient C) Limit fluids D) Keep the patient lying flat 12. You are the nurse caring for a patient who will receive a transsacral block. In what surgeries would a transsacral block be useful for pain control? A) Thoracotomy B) Inguinal hernia repair C) Breast reduction D) Closed reduction of a right humerus 13. You are the circulating nurse caring for a 78-year-old patient who is scheduled for a total hip replacement. Which of the factors should you consider during the preparation of the patient in the operating room? A) The patient should be placed in Trendelenburg position. B) The patient must be firmly restrained at all times. C) Pressure points should be assessed and well padded. D) The preoperative shave should be done by the circulating nurse. 14. The operating room nurse is taking the patient into the OR when the patient informs the operating nurse that his grandmother spiked a 104F temperature in the operating room and nearly died 15 years ago. What relevance does this information have regarding your patient? A) The patient may be nervous. B) The patient may be at risk for developing malignant hyperthermia. C) The grandmother's surgery has no relevance to the patient's surgery. D) The patient may be at risk for hypothermia. 15. You note a colleague making an inappropriate remark about the patient's weight. The patient is unconscious at the time. What should you do? A) Ignore the comment because the patient is unconscious. B) Discourage the comments. C) Report the comment to the supervisor. D) Realize humor is needed in the workplace.

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16. You are caring for a male patient who has had spinal anesthesia. The patient is under a physician's order to lie flat postoperatively. When the patient asks to go to the bathroom, you encourage him to comply with the physician's order. What is the rationale for complying with this order? A) Hypotension B) Respiratory depression C) A headache D) Pain at the lumbar injection site 17. You are packing a patient's abdominal wound with sterile, half-inch Iodoform gauze. You drop some of the gauze onto the patient's abdomen 2 inches (5 cm) away from the wound. What should you do? A) Apply povidone-iodine (Betadine) to that section of the gauze and continue packing the wound. B) Pick up the gauze and continue packing the wound after irrigating the abdominal wound with Betadine solution. C) Continue packing the wound and inform the physician that an antibiotic is needed. D) Discard the gauze packing and repack the wound with new Iodoform gauze. 18. You are the nurse performing wound care on a 68-year-old male patient. Which of the following practices violates surgical asepsis? A) Holding sterile objects above the waist B) Considering a 1 inch (2.5 cm) edge around the sterile field as being contaminated C) Pouring solution onto a sterile field cloth D) Opening the outermost flap of a sterile package away from the body 19. A patient is scheduled for surgery the next day. What is the best approach to this surgery? A) A surgical approach B) A medical approach C) An interdisciplinary approach D) A nursing approach 20. What is the basis of the collaboration of the surgical team that results in the best outcome for the patient? A) Historical precedence B) Patient request C) Physician need D) Evidence-based practice

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21. Which of the following events subjects the surgical patient to possible injury in the intraoperative phase of the surgical experience? (Mark all that apply.) 22. You are a circulating nurse in the day surgery center. You know that each patient has the potential for complications intraoperatively. What are these complications? (Mark all that apply.) 23. You are preparing to take your patient into the operating room. As the circulating nurse, one of your responsibilities is to review the patient's record. What are you reviewing the record for? A) Progress notes B) History and physical C) Admission papers signed by patient D) Intake and output record 24. You are the circulating nurse for several surgeries today. What would be one of your major goals for each of these patients? A) Latex-allergy symptoms treated rapidly B) Surgery unsuccessful C) Maintenance of the patient's dignity D) Complications treated rapidly 25. The circulating nurse meets the patient in a warm and friendly manner. The nurse discusses what the patient can expect in surgery. What basic communication skills does the nurse use? A) Talk slowly and softly B) Use medically acceptable terms C) Give pre-operative medications first D) Touch 26. What position used for surgery can cause irreparable nerve damage? A) Trendelenburg B) Prone C) Dorsal recumbent D) Lithotomy

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27. The patient's surgery is nearly finished. The surgeon has decided to use tissue adhesives to close the surgical wound. As the nurse, you know that this puts the patient at increased risk for what? A) Hypothermia B) Anaphylaxis C) Infection D) Malignant hyperthermia 28. As a circulating nurse, you are the advocate of each of your patients. What does patient advocacy in the operating room entail? A) Use of safety straps B) Maintaining adequate pain medication C) Maintaining patient's privacy D) Decreasing risk of infection 29. The nurse is caring for a patient who is scheduled to have a needle biopsy of the pleura. The patient tells the anesthesiologist he wants a local conduction block. Which local conduction block can be used to block the nerves leading to the chest? A) Transsacral block B) Brachial plexus block C) Peudental block D) Paravertebral block 30. Which nursing diagnosis would a circulating nurse use on her intraoperative patients who have a general anesthetic? (Mark all that apply.) 31. As a nurse, you know that one of the risks for a surgical patient is vomiting. What can aspirated vomitus lead to? A) Choking B) Hypoxia C) Malignant hyperthermia D) Hypothermia 32. You are a new nurse in the operating room. Your preceptor is teaching you about malignant hyperthermia. Which symptom is often the earliest sign of malignant hyperthermia? A) Increased temperature B) Oliguria C) Tachycardia D) Hypotension

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33. As a perioperative nurse, you know that the 2009 National Patient Safety Goals all pertain to the perioperative areas. Which of the 2009 National Patient Safety Goals has the most direct relevance to the operating room? A) Improve safety of using medications B) Reduce the risk of patient harm resulting from falls C) Reduce the risk of health careassociated infections D) Reduce the risk of surgical fires 34. You have a 72-year-old female patient who is scheduled for a left total knee replacement. Which complication is this patient at increased risk for because of her aging cardiovascular system? A) Hypovolemia B) Hypopnea C) Hyperkalemia D) Hyperphosphatemia 35. The nurse knows that elderly patients are at higher risk for complications and adverse outcomes during the intraoperative period. What is the best rationale for this phenomenon? A) The elderly patient has more boney prominences than a younger person. B) The elderly patient has reduced ability to adjust rapidly to emotional and physical stress. C) The elderly patient has impaired thermoregulatory mechanisms, which increase susceptibility to hyperthermia. D) The elderly patient has an impaired ability to decrease his or her metabolic rate. 36. As an intraoperative nurse, you know that the patient's emotional state can influence the outcome of his or her surgical procedure. How would you best reinforce the patient's ability to influence their outcome? A) Teach the patient guided imagery B) Assess the patient's coping strategies C) Incorporate cultural, ethnic, and religious considerations as appropriate D) Give him or her anti-anxiety medication

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37. As an intraoperative nurse, you know that maintaining an aseptic environment in the operating room is essential. When moving around surgical areas, what distance must be kept from the sterile field? A) 2 feet B) 18 inches C) 1 foot D) 6 inches 38. As an intraoperative nurse, what is your responsibility to your patient in relation to malignant hyperthermia? (Mark all that apply.) 39. Your patient is asleep on the operating table. As the circulating nurse, you are aware of the potential environmental hazards to your patient. What is an environmental hazard in the operating room? A) Lasers B) Needlestick injuries C) Exposure to sterile fluids D) Exposure to bodily fluids 40. A part of the intraoperative nurse's role is being a patient advocate. What is an advocacy activity of the intraoperative nurse? A) Checking the patient's armband against his or her medical record B) Respecting the patient's cultural values C) Dehumanizing the patient D) Maintaining the patient's privacy while he or she is awake 41. Your patient is a 25-year-old obstetric patient. You know that she is at increased risk for what? A) Infection B) Hypothermia C) Anesthesia awareness D) Moderate sedation

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Answer Key
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. A A D A B B A B A A D B C B B C D C C D Reflexes Malignant hypothermia B C D A B C D Disturbed sensory perception B C D A B C C Recognize the signs and symptoms A B C

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