1. A patient with appendicitis was prescribed with Tramadol 50 mg IVTT every 8 hours.

What is the nurse’s

best response? Select all that applies.
Check for the doctor’s order and give the medication as prescribed.
Assess for history of allergies to tramadol.
Recheck with the attending physician the current medication prescription
Refuse to give the medication since it is above the maximum adult dose.

2. Which of the following physical examination results would help you diagnose an appendicitis? Select all that
applies
Pain in the right upper quadrant pain or McBurney’s sign
Pain in the right lower quadrant pain or McBurney’s sign
Right lower quadrant pain elicited by palpation of the left lower quadrant
RLQ pain with extension of the right hip or with flexion of the right hip against resistance or Rovsing’s Sign

3. During your rounds in the morning, a patient who is scheduled for ORIF tomorrow at 8:00 AM requested that
she may be allowed to eat because she is hungry. Reviewing on the nursing endorsement, you found this
doctor’s order “DAT, NPO postmidnight prior to surgery.” What is the nurse’s best response?
“No ma’am dili pwede ayaw pag buot2x”
“Ma’am mananghid sa ta sa imong doctor kay siya ray nakahibaw.”
“Sige ma’am manawag ko sa dietary section aron mapahatdan ka og food.’
“Ma’am, dili lang sa ta pwede mo kaon aron dili mobuto atong appendix”

4. Upon health assessment, the patient scheduled for surgery was noted to have latex allergy. What is the best
initial nursing response?
Notify the surgical team as well as OR
Instruct the patient to take maintenance of Benadryl
Instruct the patient to avoid foods like banana, kiwi and avocado
Note in the nurse’s notes for proper documentation

5. As a nurse, which statement is incorrect regarding an informed consent signed by a patient?

The nurse is responsible for obtaining the consent for surgery
Patients under 18 years of age may need a parent or legal guardian to sign a consent form
The nurse can witness the client signing the consent form
 It is the nurse's responsibility to ensure the patient has been educated by the physician about the procedure
before informed consent is obtained

6. What is the usual amount of a soaked regular napkin?

5-10 mL
10-15 mL
15 – 20 mL
20 – 25 mL

7. A client came in for abnormal vaginal bleeding secondary to a possible endometrial CA. She was ordered
with tranexamic 500mg/capsule 1 capsule TID PO. Which among the following is true about this drug?
It is given to the client to minimize vaginal bleeding
This drug is an anti-coagulant which prevents lysis of fibrin
This medication is not for endometrial CA and should be referred back to the medical team
This medication should be given IVTT considering the etiology of the patient’s case.

8. Which among the following situations would require CP clearance? Select all that apply.
A 65-year old female patient who is scheduled for hip surgery
A 40-year old male client who is scheduled for herniorrhaphy without co-morbidity.
A 24-year old female client scheduled for a surgery with mitral valve prolapse
A 50-year old male client with controlled asthma scheduled for ORIF

9. Which of the following results would compel the nurse to notify the surgical team prior to operation? Select
all that apply
Serum sodium level of 148 mEq/L
Creatinine level of 1.3 mg/dL
CXR: costophrenic angles are sharply pointed
ECG: sinus tachycardia

10. A patient is scheduled for TAHBSO with BLND. The patient asked you what it means. The best response
you can give is:
 This means total abdominal hysterectomy bilateral salphingo-ophorectomy with bilateral lymphnode
dissection
This means total abdominal hysterectomy bilateral salpingo-oophorostomy with bilateral lymphnode
dissection
This means total abdominal hysterectomy bilateral salpingo-oophorectomy with bilateral lymphnode
dissection
This means total abdominal hysterotomy bilateral salphingectomy with bilateral lymphnode dissection

11. A patient came in with multiple loose bowel movement and was diagnosed with mechanical bowel
obstruction after a CT of the abdomen. He was placed on NPO since day 1. Today, day 5, he was
scheduled for exploratory laparotomy. Upon reviewing the doctor’s order, the patient was not ordered bowel
preparation. What is true about bowel preparation considering this situation? Select all that apply.
Doing bowel prep may result to intestinal complication
Bowel prep is not required since the patient is already loosing too much fluids
Bowel prep should have been ordered to prevent infection intra-op
Patient should be placed continuously in NPO

12. An order for skin test is required prior to administration of anti-biotics. Which of the following is/are true in
the conduct of skin test.
Withdraw 0.9 mL of the reconstituted antibiotic followed by 0.1 mL of the sterile water for injection
Withdraw 0.1 mL of the reconstituted antibiotic followed by 0.9 mL of the sterile water for injection
Withdraw 0.5 mL of the reconstituted antibiotic followed by 0.5 mL of the sterile water for injection
Withdraw 0.9 mL sterile water for injection followed by 0.1 mL of the reconstituted antibiotic

13. Which of the following is/are goal/s of care to be included in the pre-operative teaching for a patient who is
to undergo a total laryngectomy? Select all that applies
Set alternative means of communication
Timely wound healing
Monitoring for bleeding
Establishing a patent airway

14. Chlorhexidine bath is not advisable. Select all that applies

Dilute chlorhexidine with water then apply to skin
 Use Gauze/wash cloth prior to skin application
Rinse immediately after application
Directly apply chlorhexidine and rinse immediately

15. What is the purpose of giving ranitidine to a patient pre-operatively?

Decrease the risk for aspirating gastric acid contents
Increase the oxygen carrying capacity of the blood
Decrease GI upset
Decrease the risk of DVT post-op

16. Which of the following is an important pre-op teaching for a patient scheduled for abdominal surgery to
prevent DVT?
Leg exercises
Splinting, coughing exercises
Wearing of abdominal binder
Diet adjustments

17. The preoperative phase encompasses which period of time?

Entry to the operating suite until admission to post-anesthesia care
Entry into the operating suite until discharge from the hospital
The decision to have surgery until admission to post-anesthesia care
The decision to have surgery until entry to the operating suite

18. Which of the following nursing actions would help the patient decrease anxiety during the
preoperative period?
Explaining all procedures thoroughly in chronological order
Spending time listening to the patient and answering questions
Encouraging sleep and limiting interruptions
Reassuring the patient that the surgical staff are competent professional

19. You are observing your patient use the incentive spirometry. What demonstrations by the patient let you know
the patients understands how to use the device properly?
The patient uses the incentives spirometry a day
The patient blows on the mouth piece rapidly
 The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level
The patient rapidly inhales on the devices and exhale.

20. Which of the following is the primary purpose of placing an NGT left open to drain for a patient with mechanical
bowel obstruction? Select all that apply.
For bowel rest
For bowel decompression
For feeding purposes
For administration of pre-operative medications
For fluid replacement
1. The following are signs and symptoms of malignant hyperthermia. Select all that apply.
a. Muscle rigidity or spasm
b. Elevated temperature
c. Elevated Blood pressure
d. Hypoxemia

2. Which of the following technique/s observe/s sterility in the operating theatre? Select all that apply.
a. Gloves come in contact with the bottom of the round basin at the sterile back table
b. The cuff of the scrub’s gown comes in contact with the sterile table
c. The gloved hands of the scrub nurse come in contact with the gloved hands of the surgeon during the
passing of instruments
d. The scrub nurse touched her/his mask with her gloved hands

3. The circulating nurse in the OR sees the surgeon don gown and gloves using appropriate sterile procedure. The
surgeon then folds the hands together and places them down below the hips. What action by the nurse is most
appropriate?
a. Ask the surgeon to change the sterile gown.
b. Do nothing; this is acceptable sterile procedure.
c. Inform the surgeon that the sterile field has been broken.
d. Obtain a new pair of sterile gloves for the surgeon to put on.

4. A client is in stage 2 of general anesthesia. What action by the nurse is most important?
a. Keeping the room quiet and calm
b. Being prepared to suction the airway
c. Positioning the client correctly
d. Warming the client with blankets

5. The circulating nurse noted that client’s oxygen saturation is 90% and the heart rate is 110 beats/min. What is
the nurse’s initial action?
a. Assess the clients end-tidal carbon dioxide level.
b. Document the findings.
c. Inform the anesthesia provider of these values.
d. Prepare to administer dantrolene sodium (Dantrium).

6. A client in the operating room has developed malignant hyperthermia. The client’s potassium is 6.5 mEq/L.
What action by the nurse takes priority?
a. Administer 10 units of regular insulin.
b. Administer nifedipine (Procardia).
c. Assess urine for myoglobin or blood.
d. Monitor the client for dysrhythmias.
Post-operative Phase Examination:

Following a abdominal surgery, the nurse instructs the patient about postoperative coughing and deep-breathing
exercises. Which technique should the nurse use to engage the patient in prevention of pneumonia and atelectasis?

Begin coughing and deep breathing 2 days post-op.

Take a deep breath, hold it for 10 seconds, and exhale slowly.
Support the incision when doing these exercises.
Prepare analgesics at the bedside

The nurse assesses the patient post TAHBSO and determines that he may be at risk for altered peripheral tissue
perfusion in the lower extremities. Which activity should the nurse include in patient teaching to prevent decreased
perfusion to his extremities while he is on bed rest?
Monitor the passage of flatus to be reported immediately to the doctor
Flex and rotate the ankles several times every hour while awake.
Rest periods should be included in between activities
Encourage turning side to side post-operatively

The patient post BKA right complained of phantom limb pain. Which of the following is/are measure/s that can be
applied in this particular situation? Choose all that applies.
Advise the patient that the leg was already removed and the pain is just his imagination
Allow the patient to verbalize and report the assessment finding to the attending physician
Administer pain medication as ordered
Perform non-pharmacologic therapies as appropriate

The nurse wants to detect a paralytic ileus promptly in a patient after a total abdominal hysterectomy. Which method
is best for the nurse to use to assess for this postoperative complication?
Auscultate the bowel sounds every few hours.
Palpate the suprapubic region for distention.
Evaluate the patient's postoperative appetite.
Administer stool softeners for prophylaxis.

Post-op day 2, you are evaluating your patient for signs of infection. Which of the following signs and symptoms
would be most indicative of infection?
Presence of NGT, FNC and T-tube
An axillary temperature of 37.9 degrees Celsius
Slight redness around the incision site
WBC count of 12.0 × 109/L