CPNRE Perioperative Nursing Care — Questions and Answers
Question 1: A client is scheduled for elective surgery in 2 hours. The PN notes the client drank a full glass of water 30 minutes ago. What is the most appropriate action?
- Notify the surgeon and anesthesiologist immediately (Correct answer)
- Document the finding and proceed with pre-op preparation
- Reassure the client that a small amount of water is acceptable
- Administer a prescribed antiemetic to reduce aspiration risk
Correct answer: Notify the surgeon and anesthesiologist immediately
NPO (nothing by mouth) status is critical to prevent aspiration during anesthesia. Any oral intake within the pre-operative window must be reported to the surgeon and anesthesiologist immediately, as the case may need to be postponed.
Question 2: During the pre-operative checklist, the PN confirms the client has signed the surgical consent form. Which of the following best describes the PN's role regarding informed consent?
- Witness the signature and document, but do not provide information about surgical risks
- Explain the procedure, risks, and alternatives to ensure understanding
- Obtain the signature once the surgeon has explained the procedure (Correct answer)
- Ensure the consent is signed at least 24 hours before the procedure
Correct answer: Obtain the signature once the surgeon has explained the procedure
Informed consent is the surgeon's legal responsibility to explain. The PN's role is to witness the signature after the surgeon has already obtained informed consent, and to notify the surgeon if the client has unanswered questions or expresses doubt.
Question 3: A client returns from the operating room following general anesthesia. The PN notes oxygen saturation of 91% and the client is difficult to arouse. What is the priority action?
- Reposition the client to a semi-Fowler's position and apply supplemental oxygen (Correct answer)
- Document findings and notify the charge nurse at the next opportunity
- Administer IV fluids to raise blood pressure
- Wait 10 minutes and reassess as this is expected post-anesthesia
Correct answer: Reposition the client to a semi-Fowler's position and apply supplemental oxygen
Airway and oxygenation are the priority in the post-anesthetic period. Repositioning to semi-Fowler's opens the airway and applying supplemental oxygen addresses the desaturation. Obtundation and low O2 sat warrant immediate intervention and escalation.
Question 4: Which of the following pre-operative findings should the PN report to the surgeon before the scheduled procedure?
- Blood pressure of 138/86 mmHg in a client with a history of hypertension
- Serum potassium of 2.9 mEq/L (Correct answer)
- Heart rate of 78 beats per minute
- Temperature of 37.1°C
Correct answer: Serum potassium of 2.9 mEq/L
Hypokalemia (K+ < 3.5 mEq/L) increases the risk of serious cardiac dysrhythmias under anesthesia. This is an abnormal lab finding that must be reported and may result in surgery being delayed until corrected.
Question 5: A post-operative client reports pain of 8/10 and is prescribed morphine 2–4 mg IV q4h PRN. The PN checks vital signs and finds RR 10/min, SpO2 93%, and BP 110/70 mmHg. What should the PN do?
- Administer 2 mg morphine as the lowest dose is safest
- Withhold the morphine, reposition the client, apply oxygen, and notify the physician (Correct answer)
- Administer 4 mg morphine and monitor closely for the next 15 minutes
- Document the pain score and reassess in 30 minutes
Correct answer: Withhold the morphine, reposition the client, apply oxygen, and notify the physician
A respiratory rate of 10/min and SpO2 of 93% indicate opioid-induced respiratory depression. Administering more opioid is contraindicated. The PN should withhold the dose, stimulate and reposition the client, apply oxygen, and notify the prescriber immediately.
Question 6: Which nursing intervention is the highest priority in preventing post-operative pulmonary complications such as atelectasis and pneumonia?
- Administering prophylactic antibiotics as prescribed
- Encouraging early ambulation and deep breathing exercises (Correct answer)
- Keeping the client on strict bedrest for the first 24 hours
- Providing high-flow supplemental oxygen continuously
Correct answer: Encouraging early ambulation and deep breathing exercises
Early ambulation and deep breathing exercises (including incentive spirometry) promote lung expansion, clear secretions, and prevent atelectasis. These are the cornerstone interventions for post-operative pulmonary complication prevention.
CPNRE Perioperative Nursing Care
A client is scheduled for elective surgery in 2 hours.
The PN notes the client drank a full glass of water 30 minutes ago.
What is the most appropriate action?