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Critical Care Nursing 6th Edition Urden Stacy Lough Test Bank

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Critical Care Nursing 6th Edition Urden Stacy Lough Test Bank

ISBN13: 9780323057486

ISBN10: 0323057489

Critical Care Nursing 6th Edition Urden Stacy Lough Test Bank

ISBN13: 9780323057486

ISBN10: 0323057489

 

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Urden, Stacy, Lough: Critical Care Nursing, 6th Edition

 

Chapter 15: Perianesthesia Management

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which stage of general anesthesia begins with the initiation of an anesthetic agent and ends with loss of consciousness?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV

 

 

ANS: A

Stage I, commonly called the stage of analgesia, begins with the initiation of an anesthetic agent and ends with the loss of consciousness. This stage has been described as the lightest level of anesthesia and represents mild sensory and mental depression. Patients can open their eyes on command, breathe normally, and maintain protective reflexes.

 

DIF:   Cognitive Level: Knowledge        REF:  {General Anesthesia}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Which stage of general anesthesia is known as surgical anesthesia?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV

 

 

ANS: C

Stage III is the stage of surgical anesthesia. It is defined as lasting from the onset of regular pattern of breathing to cessation of breathing. This is the goal for anesthesia, because the response to surgical incision is absent. Patients experience a depression in all elements of nervous system function.

 

DIF:   Cognitive Level: Knowledge        REF:  {General Anesthesia}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Which of the following antagonizes the effects of benzodiazepines?
a. Naloxone
b. Neostigmine
c. Fentanyl
d. Flumazenil

 

 

ANS: D

Flumazenil antagonizes the sedative, amnesic, anxiolytic, and muscle-relaxant effects of benzodiazepines. It does not reverse benzodiazepine-induced respiratory or cardiac depression. It is specific for the benzodiazepine receptors and therefore does not reverse the effects of barbiturates or opiates.

 

DIF:   Cognitive Level: Knowledge        REF:  {Benzodiazepine Antagonists}

OBJ:  Nursing Process Step: Evaluation TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. The effects of nitrous oxide include
a. anesthesia, analgesia, and amnesia.
b. vasodilation, analgesia, and myocardial depression.
c. respiratory and cardiovascular depression.
d. bronchodilation, myocardial excitation, and muscle tremors.

 

 

ANS: A

The effects of nitrous oxide include anesthesia, analgesia, and amnesia.

 

DIF:   Cognitive Level: Comprehension

REF:  {Pharmacologic Management: Inhalation Anesthetics}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Which of the following benzodiazepines has a slow onset of action and long duration?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Lorazepam (Ativan)
d. Droperidol (Inapsine)

 

 

ANS: C

Lorazepam (Ativan) has a slow onset of action and long duration.

 

DIF:   Cognitive Level: Comprehension

REF:  {Pharmacologic Management: Inhalation Anesthetics}

OBJ:  Nursing Process Step: Planning     TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. The duration of action of naloxone is
a. 30 minutes to 1 hour.
b. 1 to 4 hours.
c. 4 to 6 hours.
d. 6 to 10 hours.

 

 

ANS: B

The duration of action of naloxone is 1 to 4 hours. If long-acting opioids are used, the patient must be monitored for respiratory insufficiency because the depressant effects of the opioids may return. Often a low-dose, continuous intravenous drip of naloxone is effective.

 

DIF:   Cognitive Level: Knowledge        REF:  {Opioid Antagonists}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. What is the principal depolarizing skeletal muscle relaxant?
a. Succinylcholine
b. Pancuronium
c. Mivacurium
d. Rocuronium

 

 

ANS: A

The principal depolarizing skeletal muscle agent is succinylcholine (Anectine). Once the succinylcholine attaches to the receptor, a brief period of depolarization occurs, which is manifested by transient muscular fasciculations. Succinylcholine has a rapid onset, 30 to 60 seconds, and a short duration of action, 5 to 10 minutes.

 

DIF:   Cognitive Level: Knowledge        REF:  {Neuromuscular Blocking Agents}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Postoperatively, dysrhythmias occur in patients
a. during the first minute.
b. during the first 2 minutes.
c. during the first 5 minutes.
d. at any time.

 

 

ANS: D

Electrocardiographic (ECG) monitoring is essential in the immediate postoperative recovery period. Dysrhythmias of any type may occur at any time and in any patient during the postoperative period.

 

DIF:   Cognitive Level: Knowledge        REF:  {Cardiovascular Function}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Oral intake is prohibited after anesthesia until
a. the patient is ambulatory.
b. the patient is strong enough to hold a cup of water.
c. all nausea has ceased.
d. laryngeal and pharyngeal reflexes are fully regained.

 

 

ANS: D

Oral intake is prohibited after anesthesia until the patient regains laryngeal and pharyngeal reflexes. These reflexes are demonstrated by the patient’s ability to gag and swallow effectively. In addition, the management of postoperative nausea and vomiting remains critical.

 

DIF:   Cognitive Level: Knowledge        REF:  {Fluid and Electrolyte Balance}

OBJ:  Nursing Process Step: Planning     TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. The stir-up regimen consists of
a. deep breathing exercises, suctioning, warming, and nausea management.
b. incentive spirometry, abdominal breathing, warming, drinking, and pain management.
c. incentive spirometry, coughing, suctioning, warming, mobilization, and eating.
d. deep breathing exercises, coughing, positioning, mobilization, and pain management.

 

 

ANS: D

The basics of the regimen are aimed at the prevention of complications, primarily atelectasis and venous stasis. Five major activities—deep-breathing exercises, coughing, positioning, mobilization, and pain management—constitute the stir-up regimen.

 

DIF:   Cognitive Level: Application        REF:  {Stir-Up Regimen}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. In the postanesthesia care unit, the patient should be stimulated to take three to four deep breaths every
a. 1 to 2 minutes.
b. 3 to 5 minutes.
c. 5 to 10 minutes.
d. 30 to 60 minutes.

 

 

ANS: C

The major factor contributing to postoperative pulmonary complications is low lung volumes resulting from a shallow, monotonous, sighless breathing pattern caused by general anesthesia, pain, and opioids. Therefore the patient must be stimulated to take three or four deep breaths every 5 to 10 minutes.

 

DIF:   Cognitive Level: Knowledge        REF:  {Deep Breathing Exercises}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. The sustained maximal inspiration (SMI) maneuver is performed by having the patient take
a. a deep breath and hold it for 3 to 5 seconds before exhaling.
b. a slow deep breath and then forcefully exhale.
c. a deep breath and, at the peak of inspiration, expand the chest and take in a little more air.
d. in a slow deep breath, then exhale slowly.

 

 

ANS: A

The SMI maneuver is a method to enhance the lung volumes of postoperative patients. The patient inhales as close to lung capacity as possible and, at the peak of inspiration, the patient holds that volume for 3 to 5 seconds before exhalation.

 

DIF:   Cognitive Level: Knowledge        REF:  {Deep-Breathing Exercises}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. The coughing maneuver in which a patient takes a deep breath and then performs multiple coughs on exhalation of that breath is known as the
a. serial cough.
b. cascade cough.
c. sustained maximal cough.
d. deep cough.

 

 

ANS: B

The patient is instructed to take a rapid, deep inhalation to the volume of air in the lungs and dilate the airways, allowing air to pass behind the retained secretions. On exhalation, the patient performs multiple coughs. With each cough the length of the airways increases, enhancing the effectiveness of the cough.

 

DIF:   Cognitive Level: Knowledge        REF:  {Coughing}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Initial management of laryngospasm includes
a. intubating the patient and providing manual ventilation with 100% oxygen.
b. hyperextending the patient’s head and administering positive-pressure ventilations on 100% oxygen.
c. administering 10 mg succinylcholine.
d. administering nebulized racemic epinephrine.

 

 

ANS: B

Management involves hyperextension of the patient’s head and positive-pressure mask ventilation on 100% oxygen. If complete obstruction is unrelieved, a small dose of succinylcholine (10 to 20 mg) may be needed to relax the vocal cords to allow for ventilation. Endotracheal intubation is required if the laryngospasm persists or if refractory hypoxemia develops.

 

DIF:   Cognitive Level: Application        REF:  {Laryngospasm}

OBJ:  Nursing Process Step: Planning     TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Which of the following is a consequence of postoperative hypothermia?
a. Decreased blood viscosity
b. Metabolic alkalosis
c. Decreased systemic vascular resistance
d. Decreased metabolic processes

 

 

ANS: D

Significant hypothermia slows metabolic processes, leading to reduced drug biotransformation and impaired renal transport. This may prolong drug effects and delay emergence.

 

DIF:   Cognitive Level: Comprehension  REF:  {Hypothermia}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Patients who shiver
a. are always hypothermic.
b. are always hyperthermic.
c. may be normothermic.
d. always shiver because of pain.

 

 

ANS: C

The normothermic patient may shiver or complain of feeling cold, so warm blankets may provide psychological comfort. Shivering may be a result of either the compensatory response to hypothermia or the effects of anesthetic agents, and it can produce a 500% increase in the metabolic rate.

 

DIF:   Cognitive Level: Comprehension  REF:  {Shivering, General Comfort Management}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Snoring, stridor, nostril flaring, and intercostal retractions are clinical manifestations of
a. angina.
b. airway obstruction.
c. pain.
d. sedation.

 

 

ANS: B

Clinical manifestation of airway obstruction includes snoring, stridor, flaring of the nostrils, retractions at the intercostal spaces and suprasternal notch, abnormal use of accessory muscles, asynchronous movements of the chest and abdomen, increased pulse rate, decreased oxygen saturation level, and decreased breath sounds.

 

DIF:   Cognitive Level: Knowledge        REF:  {p. 263}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. What medication may be used to treat laryngeal edema?
a. Racemic epinephrine
b. Succinylcholine
c. Albuterol
d. Morphine

 

 

ANS: A

Management consists of placing the patient in the upright position; using cool, humidified oxygen; and administering nebulized racemic epinephrine. Reintubation is performed only if the patient’s symptoms cannot be controlled with an inhalation treatment within 30 minutes, hypercarbia persists, or the patient appears to be in respiratory distress.

 

DIF:   Cognitive Level: Knowledge        REF:  {Laryngeal Edema}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. What medication may be used to treat laryngospasm?
a. Racemic epinephrine
b. Succinylcholine
c. Albuterol
d. Morphine

 

 

ANS: B

If complete obstruction is unrelieved by positive-pressure ventilation, a small dose of succinylcholine (10 to 20 mg) may be needed to relax the vocal cords to allow for ventilation.

 

DIF:   Cognitive Level: Knowledge        REF:  {p. 263}

OBJ:  Nursing Process Step: Planning     TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. What medication is a first-line therapy in treating bronchospasm?
a. Racemic epinephrine
b. Methylprednisolone
c. Albuterol
d. Morphine

 

 

ANS: C

The first line of therapy consists of inhaled bronchodilators. These inhalants cause fewer cardiovascular side effects than systemically administered drugs. Common inhalant medications used are isoetharine, metaproterenol, albuterol, and beclomethasone.

 

DIF:   Cognitive Level: Knowledge        REF:  {Bronchospasm}

OBJ:  Nursing Process Step: Planning     TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. What is the most common cause of hypoxemia?
a. Laryngeal edema
b. Laryngospasm
c. Bronchospasm
d. Ventilation/perfusion mismatching

 

 

ANS: D

The most common cause of hypoxemia is ventilation-perfusion mismatching. When functional residual capacity falls below closing capacity, dependent alveoli occlude, leading to increased mismatching. Impairment of hypoxic pulmonary vasoconstriction by inhalation agents and some vasoactive drugs potentiates this effect.

 

DIF:   Cognitive Level: Knowledge        REF:  {Hypoxemia}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Which anesthetic agent has the most significant hypotensive effect and the least negative inotropic effect?
a. Halothane
b. Enflurane
c. Isoflurane
d. Epithane

 

 

ANS: C

Halothane causes a drop in blood pressure primarily because of a reduction in heart rate and myocardial contractility. It produces only a slight reduction in systemic vascular resistance. Enflurane not only decreases contractility but also reduces systemic vascular resistance. Isoflurane has the most significant hypotension action and the least negative inotropic effects of the three agents.

 

DIF:   Cognitive Level: Knowledge        REF:  {Effects of Anesthesia on Cardiac Function}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. All of the following dysrhythmias are common in the postanesthetic period EXCEPT
a. ventricular tachycardia.
b. ventricular fibrillation.
c. supraventricular tachydysrhythmias.
d. sinus bradycardia.

 

 

ANS: A

In the immediate postanesthetic period, patients are predisposed to a variety of cardiac dysrhythmias. The most common dysrhythmias are sinus tachycardia, sinus bradycardia, premature ventricular contractions, supraventricular tachydysrhythmias, and ventricular tachycardia.

 

DIF:   Cognitive Level: Knowledge        REF:  {Dysrhythmias}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Which of the following is a common cause of postoperative hypertension?
a. Administration of morphine
b. Fluid overload
c. Bladder distention
d. Tachycardia

 

 

ANS: B

Most commonly, postoperative hypertension is related to fluid overload, heightened sympathetic nervous system activity, or preexisting hypertension. Postoperative hypertension, even as a transient episode, may have significant cardiovascular and intracranial consequences, and therefore aggressive diagnosis and treatment are indicated.

 

DIF:   Cognitive Level: Comprehension  REF:  {Postoperative Hypertension}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. How large of an increase in the body’s metabolic demand can shivering can produce?
a. 400%
b. 250%
c. 100%
d. 500%

 

 

ANS: D

Shivering can produce a 500% increase in the metabolic rate.

 

DIF:   Cognitive Level: Knowledge        REF:  {p. 268}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. The most definitive test for detecting malignant hyperthermia (MH) susceptibility is a(n)
a. creatine phosphokinase (CPK) test.
b. ionized calcium test.
c. core temperature reading.
d. skeletal muscle biopsy.

 

 

ANS: D

The most definitive test for detecting MH susceptibility is a biopsy of skeletal muscle. The skeletal muscle of the MH-susceptible patient has an increased isometric tension when exposed to caffeine or halothane. Measurement of blood CPK is usually about 70% reliable in determining susceptibility to MH.

 

DIF:   Cognitive Level: Knowledge        REF:  {Malignant Hyperthermia}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. What is the most effective treatment of postoperative nausea and vomiting?
a. Prevention
b. Droperidol given immediately when nausea is reported
c. Phenergan given immediately when nausea is reported
d. Metoclopramide given immediately when nausea is reported

 

 

ANS: A

The most effective treatment of postoperative nausea and vomiting is prevention. Avoidance of gastric insufflation is paramount. In addition, the swallowing of blood during oral, pharyngeal, or nasal surgery should be prevented. Distention is decompressed intraoperatively.

 

DIF:   Cognitive Level: Knowledge        REF:  {Nausea and Vomiting}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. An electrolyte disturbance that can cause delayed arousal in the postoperative patient is
a. hypercalcemia.
b. hyponatremia.
c. hyperkalemia.
d. hypermagnesemia.

 

 

ANS: B

Severe electrolyte disturbances are most commonly seen after excessive water absorption during transurethral prostate surgery. The subsequent dilution hyponatremia may manifest as sedation, coma, or hemiparesis. Dilution hyponatremia may also be seen after the inappropriate release of antidiuretic hormone.

 

DIF:   Cognitive Level: Comprehension  REF:  {Delayed Arousal}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Nursing management of the postoperative patient who is nauseated and vomiting includes
a. withholding all pain medication until the nausea has subsided.
b. removing the nasogastric tube.
c. inserting an oral airway.
d. increasing intravenous fluids.

 

 

ANS: D

Nursing management of the postoperative patient who is nauseated and vomiting includes increasing intravenous fluids.

 

DIF:   Cognitive Level: Application        REF:  {p. 273}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

  1. Mr. N is a 72-year-old patient transferred to the postanesthesia care unit from the operating room after the induction of halothane anesthesia. Mr. N has no significant history. On admission, Mr. N appeared comatose and extremely diaphoretic, with severe muscle rigidity and tremors. His vital signs were heart rate, 145 beats/min, sinus tachycardia; blood pressure, 85/50 mm Hg; respiratory rate, 35 breaths/min; temperature, 103.8° F. Arterial blood gases on 100% oxygen by ventilator were PaO2, 70%; PaCO2, 35 mm Hg; pH, 7.21; HCO3, 16 mm Hg; and SaO2, 90%. Fluid resuscitation and vasoactive therapy were started. Initial abnormal laboratory results were blood urea nitrogen, 66 mg/dL; sodium, 155 mEq/L; potassium, 5.5 mEq/L; glucose, 68 mg/dL; creatinine, 2.4 mg/dL; and creatine phosphokinase, 1896 U/L. The nurse would anticipate a diagnosis of
a. noncardiogenic pulmonary edema.
b. sepsis.
c. malignant hyperthermia.
d. emergency delirium.

 

 

ANS: C

Clinical manifestations of malignant hyperthermia include hypoxemia; metabolic acidosis; respiratory acidosis; hyperkalemia; myoglobinuria; elevated creatine phosphokinase; tachycardia; tachypnea; ventricular dysrhythmias; cyanosis; skin mottling; fever or hot, flushed skin; rigidity; profuse sweating; and unstable blood pressure.

 

DIF:   Cognitive Level: Application        REF:  {p. 270}

OBJ:  Nursing Process Step: Diagnosis   TOP:  Perianesthesia

MSC: NCLEX: Physiologic Integrity

 

COMPLETION

 

  1. The _____ _____ consists of deep breathing exercises, coughing, positioning, mobilization, and pain management.

 

ANS:

stir-up regimen

This process is the key to successful recovery from anesthesia.

 

DIF:   Cognitive Level: Comprehension  REF:  {p. 256}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. _____ _____ is characterized by muscle rigidity and temperature elevations as high as 46° C.

 

ANS:

Malignant hyperthermia

Malignant hyperthermia is a true anesthetic emergency that usually occurs within minutes of induction but can occur as long as 3 days later.

 

DIF:   Cognitive Level: Application        REF:  {p. 270}

OBJ:  Nursing Process Step: Application          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

MATCHING

 

Match the stage of anesthesia with the correct definition.

a. Stage I
b. Stage II
c. Stage III
d. Stage IV

 

 

  1. Stage of delirium, loss of consciousness, and eyelid reflexes

 

  1. Begins with analgesia initiation and ends with loss of consciousness

 

  1. Circulatory failure occurs

 

  1. Decreased nervous system function and skeletal muscle relaxation

 

  1. ANS: B                    DIF:   Cognitive Level: Comprehension  REF:  {pp. 249-250}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: A                   DIF:   Cognitive Level: Comprehension  REF:  {pp. 249-250}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: D                   DIF:   Cognitive Level: Comprehension  REF:  {pp. 249-250}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: C                    DIF:   Cognitive Level: Comprehension  REF:  {pp. 249-250}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

Match each anesthetic agent with its pharmacologic category.

a. Halothane
b. Thiopental
c. Lorazepam
d. Fentanyl
e. Vecuronium

 

 

  1. Barbiturate

 

  1. Benzodiazepines

 

  1. Inhalation anesthetic

 

  1. Neuromuscular blocking agents

 

  1. Opioids

 

  1. ANS: B                    DIF:   Cognitive Level: Comprehension  REF:  {pp. 252-254}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: C                    DIF:   Cognitive Level: Comprehension  REF:  {pp. 252-254}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: A                   DIF:   Cognitive Level: Comprehension  REF:  {pp. 252-254}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: E                    DIF:   Cognitive Level: Comprehension  REF:  {pp. 252-254}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

  1. ANS: D                   DIF:   Cognitive Level: Comprehension  REF:  {pp. 252-254}

OBJ:  Nursing Process Step: Assessment          TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. Management of an airway obstruction begins with immediate recognition and treatment. Place these nursing interventions in the appropriate order for initial care of the postanesthesia patient suffering from airway obstruction.
a. Positive-pressure mask ventilation
b. Head tilt-chin lift maneuver (nonreactive patient)
c. Insertion of oropharyngeal or nasopharyngeal airway
d. Intubation with mechanical intubation
e. Stimulation of the patient

 

 

ANS: A, B, C, D, E

Initially, stimulation may be all that is necessary to relieve the obstruction. In the nonreactive patient, use the head tilt–chin lift maneuver to displace the tongue and open the airway. If unsuccessful, an oropharyngeal or nasopharyngeal airway is inserted. The patient can also be turned on his or her side to a lateral position, which facilitates the displacement of the tongue and drainage of secretions. If the obstruction is still unrelieved, positive-pressure mask ventilation, intubation, tracheotomy, or cricothyrotomy may be required.

 

DIF:   Cognitive Level: Analysis             REF:  {Airway Obstruction}

OBJ:  Nursing Process Step: Intervention         TOP:              Perianesthesia Management

MSC: NCLEX: Physiologic Integrity

 

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