1. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and coughing exercises.

The nurses best response would be: A.Pain will become less each day. B.This is a normal reaction after surgery. C.With a pillow, apply pressure against the incision. D.I will give you the pain medication the physician ordered. Answer: (C) With a pillow, apply pressure against the incision. Applying pressure against the incision with a pillow will help lessen the intra-abdominal pressure created by coughing which causes tension on the incision that leads to pain. 2. The nurse needs to carefully assess the complaint of pain of the elderly because older people A.are expected to experience chronic pain B.have a decreased pain threshold C.experience reduced sensory perception D.have altered mental function Answer: (C) experience reduced sensory perception Degenerative changes occur in the elderly. The response to pain in the elderly maybe lessened because of reduced acuity of touch, alterations in neural pathways and diminished processing of sensory data. 3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than before the medication was administered. The nurses best A.The patient is having an allergic reaction to the drug. B.The patient needs a higher dose of this drug C.This is normal side-effect of AtSO4 D.The patient is anxious about upcoming surgery Answer: (C) This is normal side-effect of AtSO4 Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate. 4. Anas postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question? A.Put the client in modified Trendelenberg's position. B.Administer oxygen at 100%. C.Monitor urine output every hour. D.Administer Demerol 50mg IM q4h Answer: (D) Administer Demerol 50mg IM q4h Administering Demerol, which is a narcotic analgesic, can depress respiratory and cardiac function and thus not given to a patient in shock. What is needed is promotion for adequate oxygenation and perfusion. All the other interventions can be expected to be done by the nurse. 5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach? A."Good evening, Mr. Pablo. Wasn't it a pleasant day, today?" B."Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts. C.Mr. Pablo, you'll wear out the hospital floors and yourself at this rate." D."Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" The client is showing signs of anxiety reaction to a stressful event. Recognizing the clients anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns. 6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take? A.Call the physician immediately. B.Administer the prescribed antiemetic. C.Check the patency of the nasogastric tube for any obstruction. D.Change the patients position. Answer: (C) Check the patency of the nasogastric tube for any obstruction.

Nausea is one of the common complaints of a patient after receiving general anesthesia. But this complaint could be aggravated by gastric distention especially in a patient who has undergone abdominal surgery. Insertion of the NGT helps relieve the problem. Checking on the patency of the NGT for any obstruction will help the nurse determine the cause of the problem and institute the necessary intervention. 7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: A.Reassure him that the nurses will not hurt him B.Let him perform his own activities of daily living C.Handle him gently when assisting with required care D.Complete A.M. care quickly as possible when necessary Answer: (C) Handle him gently when assisting with required care Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the bone to appoint at which normal activities and even position changes can lead to fracture. During nursing care, the patient needs to be supported and handled gently. 8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood pressure is 120/80, respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action is most appropriate? A.Notify his physician. B.Take his vital signs again in 15 minutes. C.Take his vital signs again in an hour. D.Place the patient in shock position. Answer: (B) Take his vital signs again in 15 minutes. Monitoring the clients vital signs following surgery gives the nurse a sound information about the clients condition. Complications can occur during this period as a result of the surgery or the anesthesia or both. Keeping close track of changes in the VS and validating them will help the nurse initiate interventions to prevent complications from occurring. 9. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2-story building. When assessing the client, the nurse would be most concerned if the assessment revealed: A.Reactive pupils B.A depressed fontanel C.Bleeding from ears D.An elevated temperature Answer: (C) Bleeding from ears The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function, increased intracranial pressures, fractures and bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily contribute to increased intracranial pressure and brain herniation 10. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD? A.I exercise every other day. B.My father died of Myasthenia Gravis. C.My cholesterol is 180. D.I smoke 1 1/2 packs of cigarettes per day. Answer: (D) I smoke 1 1/2 packs of cigarettes per day. Smoking has been considered as one of the major modifiable risk factors for coronary artery disease. Exercise and maintaining normal serum cholesterol levels help in its prevention.