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CHAPTER 19: POSTOPERATIVE CARE LEWIS: MEDICAL-SURGICAL NURSING, 10TH EDITION QUESTIONS AND ANSWERS WITH SOLUTIONS 2024 $12.49   Add to cart
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CHAPTER 19: POSTOPERATIVE CARE LEWIS: MEDICAL-SURGICAL NURSING, 10TH EDITION QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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CHAPTER 19: POSTOPERATIVE CARE LEWIS: MEDICAL-SURGICAL NURSING, 10TH EDITION QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

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  • August 31, 2024
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  • 2024/2025
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CHAPTER 19: POSTOPERATIVE CARE
LEWIS: MEDICAL-SURGICAL NURSING,
10TH EDITION QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
On admission of a patient to the postanesthesia care unit (PACU), the blood pressure (BP) is 122/72.
Thirty minutes after admission, the BP falls to 114/62, with a pulse of 74 and warm, dry skin. Which
action by the nurse is most appropriate?



a. Increase the IV fluid rate.

b. Continue to take vital signs every 15 minutes.

c. Administer oxygen therapy at 100% per mask.

d. Notify the anesthesia care provider (ACP) immediately. - ANSWER ANS: B

A slight drop in postoperative BP with a normal pulse and warm, dry skin indicates normal response to
the residual effects of anesthesia and requires only ongoing monitoring. Hypotension with tachycardia
and/or cool, clammy skin would suggest hypovolemic or hemorrhagic shock and the need for notification
of the ACP, increased fluids, and high-concentration oxygen administration



In the postanesthesia care unit (PACU), a patient's vital signs are blood pressure 116/72, pulse 74,
respirations 12, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse
take first?



a. Place the patient in a side-lying position.

b. Encourage the patient to take deep breaths.

c. Prepare to transfer the patient to a clinical unit.

d. Increase the rate of the postoperative IV fluids. - ANSWER ANS: B

The patient's borderline SpO2 and sleepiness indicate hypoventilation. The nurse should stimulate the
patient and remind the patient to take deep breaths. Placing the patient in a lateral position is needed
when the patient first arrives in the PACU and is unconscious. The stable blood pressure and pulse
indicate that no changes in fluid intake are required. The patient is not fully awake and has a low SpO2,
indicating that transfer from the PACU to a clinical unit is not appropriate

, An experienced nurse orients a new nurse to the postanesthesia care unit (PACU). Which action by the
new nurse, if observed by the experienced nurse, indicates that the orientation was successful?



a. The new nurse assists a nauseated patient to a supine position.

b. The new nurse positions an unconscious patient supine with the head elevated.

c. The new nurse turns an unconscious patient to the side upon arrival in the PACU.

d. The new nurse places a patient in the Trendelenburg position when the blood pressure drops. -
ANSWER ANS: C

The patient should initially be positioned in the lateral "recovery" position to keep the airway open and
avoid aspiration. The Trendelenburg position is avoided because it increases the work of breathing. The
patient is placed supine with the head elevated after regaining consciousness



An older patient is being discharged from the ambulatory surgical unit following left eye surgery. The
patient tells the nurse, "I do not know if I can take care of myself with this patch over my eye." Which
action by the nurse is most appropriate?



a. Refer the patient for home health care services.

b. Discuss the specific concerns regarding self-care.

c. Give the patient written instructions regarding care.

d. Assess the patient's support system for care at home. - ANSWER ANS: B

The nurse's initial action should be to assess exactly the patient's concerns about self-care. Referral to
home health care and assessment of the patient's support system may be appropriate actions but will be
based on further assessment of the patient's concerns. Written instructions should be given to the
patient, but these are unlikely to address the patient's stated concern about self-care



The nasogastric (NG) tube is removed on the second postoperative day, and the patient is placed on a
clear liquid diet. Four hours later, the patient complains of sharp, cramping gas pains. What action by the
nurse is the most appropriate?



a. Reinsert the NG tube.

b. Give the PRN IV opioid.

c. Assist the patient to ambulate.

d. Place the patient on NPO status. - ANSWER ANS: C

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