MSNCB Perioperative Nursing 2 — Questions and Answers
Question 1: A patient scheduled for surgery reports taking warfarin daily. Which preoperative action is most appropriate?
- Administer vitamin K and proceed with surgery
- Notify the surgeon and anesthesiologist immediately (Correct answer)
- Document the finding and continue preoperative preparation
- Hold the next dose and proceed as scheduled
Correct answer: Notify the surgeon and anesthesiologist immediately
Warfarin increases bleeding risk and the surgical team must be informed so they can decide whether to delay, reverse anticoagulation, or adjust the plan.
Question 2: Which assessment finding would most concern the perioperative nurse during a patient's preoperative evaluation?
- Blood pressure 128/82 mmHg
- 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 intraoperative dysrhythmias and should be corrected before elective surgery.
Question 3: The scrub nurse passes an instrument to the surgeon during an open abdominal procedure. What technique should be used?
- Place the instrument on the sterile field for the surgeon to pick up
- Hand it directly handle-first so the surgeon can grasp it safely (Correct answer)
- Pass it tip-first to allow the surgeon to immediately use it
- Toss it gently to avoid breaking sterile field
Correct answer: Hand it directly handle-first so the surgeon can grasp it safely
Instruments are passed handle-first so the surgeon can grasp them safely without risk of injury from sharp tips.
Question 4: A patient in the PACU has a respiratory rate of 8 breaths per minute and is difficult to arouse. What is the priority nursing action?
- Administer oxygen via nasal cannula and document findings
- Stimulate the patient and prepare to administer naloxone (Correct answer)
- Elevate the head of the bed to 30 degrees
- Notify the family of the patient's condition
Correct answer: Stimulate the patient and prepare to administer naloxone
Signs of opioid-induced respiratory depression require immediate stimulation and readiness to administer naloxone to reverse the effect.
Question 5: Which action best prevents surgical site infection (SSI) in the perioperative setting?
- Shaving the surgical site the night before surgery
- Administering prophylactic antibiotics within 60 minutes before incision (Correct answer)
- Applying a topical antiseptic to the skin postoperatively
- Keeping the OR temperature above 75°F at all times
Correct answer: Administering prophylactic antibiotics within 60 minutes before incision
Evidence-based guidelines recommend prophylactic antibiotic administration within 60 minutes prior to skin incision to reduce SSI risk.
Question 6: During a surgical count, the circulating nurse and scrub nurse discover a discrepancy. What is the correct action?
- Document the discrepancy and close the incision
- Notify the surgeon immediately and conduct a thorough search (Correct answer)
- Recount once more and proceed if results differ by only one item
- Complete the procedure and order an X-ray postoperatively
Correct answer: Notify the surgeon immediately and conduct a thorough search
Any count discrepancy must be immediately reported to the surgeon and a systematic search performed before the incision is closed.
Question 7: A patient refuses a blood transfusion for religious reasons but consents to the scheduled surgery. How should the perioperative nurse respond?
- Obtain consent from the patient's next of kin to override the refusal
- Document the refusal, notify the team, and respect the patient's decision (Correct answer)
- Administer blood only if the patient becomes hemodynamically unstable
- Contact hospital administration to seek a court order
Correct answer: Document the refusal, notify the team, and respect the patient's decision
Competent adult patients have the right to refuse treatment, including blood transfusions; this decision must be respected and clearly documented.
MSNCB Perioperative Nursing 2
A patient scheduled for surgery reports taking warfarin daily.
Which preoperative action is most appropriate?