W8 Introduction to Surgical Nursing Flashcards
(272 cards)
1
Q
What are the phases of the surgical journey that require a systematic and person-centred approach?
A
Preoperative phase, Intraoperative phase, Postoperative phase
Each phase requires specific assessments and management strategies.
2
Q
What are the requirements for a preoperative nursing assessment?
A
Implementation of patient support and education, Completion of the preoperative theatre checklist
Essential for ensuring patient safety and preparedness.
3
Q
What is required for a complete nursing handover during the intraoperative phase?
A
Comprehensive communication of patient status and surgical details
Critical for continuity of care.
4
Q
What should be identified to determine a patient’s readiness for discharge from the post anaesthesia care unit?
A
Patient’s recovery status and vital signs
Ensures patient safety post-surgery.
5
Q
What are common types of anaesthetics?
A
General anaesthesia, Regional anaesthesia, Local anaesthesia
Each type has specific indications and nursing considerations.
6
Q
What is the role of the nurse in postoperative complications?
A
Prevention, identification, and intervention
Nurses play a crucial role in monitoring and managing complications.
7
Q
Define effective postoperative pain assessment.
A
Using appropriate pain scales and patient feedback
Essential for tailoring pain management strategies.
8
Q
List pharmacological options for managing postoperative pain.
A
- Paracetamol
- Ibuprofen
- Morphine
- Fentanyl
- Oxycodone
- Ondansetron
- Metoclopramide
Each medication has specific indications and side effects.
9
Q
What are the nursing care considerations for a patient with Patient Controlled Analgesia (PCA)?
A
Monitoring usage, assessing pain levels, educating the patient
Ensures effective and safe pain management.
10
Q
What aspects of surgical wounds should be assessed and managed?
A
- Dressings
- Surgical drains
- Removal of sutures
Proper management is crucial for preventing infection and promoting healing.
11
Q
What is the definition of elective surgery?
A
Planned surgery that is not an emergency
Examples include cataract surgery and skin cancer removal.
12
Q
What is the definition of emergency surgery?
A
Surgery that is required immediately due to urgent medical conditions
Examples include appendicitis and trauma cases.
13
Q
How many patients underwent surgical operations in Australian hospitals in 2022?
A
Approximately 3 million
This represents about 25% of all hospital admissions.
14
Q
What does ‘perioperative’ refer to?
A
The period before, during, and after surgery
Encompasses the entire surgical patient journey.
15
Q
What is the current trend regarding the locations for performing surgery?
A
Surgery is performed in various locations beyond the Operating Room
Includes day procedure units and interventional radiology suites.
16
Q
A
17
Q
What is the preoperative phase?
A
The time period between the decision to have surgery and the beginning of the surgical procedure
18
Q
What are the three key understandings a nurse must have for effective preoperative care?
A
- The patients’ diagnosis
- Pathophysiology of the disorder
- The surgical plan, potential complications, and specific, safe postoperative assessment
19
Q
What is the goal of the nursing assessment on the day of surgery?
A
To ensure a safe and person-centred surgical journey by identifying risk factors and maintaining patient safety
20
Q
What are the overall goals of preoperative nursing care?
A
- Establish baseline data to compare intraoperatively and postoperatively
- Confirm correct patient identification and type/location of planned procedure
- Determine patient’s psychological readiness for surgery
- Identify physiological factors that may result in risk
- Identify medications that may cause drug interactions
- Identify cultural or religious factors affecting surgical experience
- Ensure patient understands the surgical process
21
Q
What does the Enhanced Recovery After Surgery (ERAS) Protocol provide?
A
Standardised information/education, pre and post-op nutritional support, VTE prophylaxis
22
Q
What information is included in a patient’s medical and surgical history?
A
- Past hospitalisations
- Previous medical diagnoses
- Previous surgeries including outcomes and complications
- Previous pregnancies and outcomes
- Medications
- Social history
23
Q
What are some risk factors to identify during preoperative care?
A
- Comorbidities (cardiac, endocrine, renal, hepatic, respiratory)
- Allergies (medications, food, etc.)
- Smoking and vaping history
- Obesity
- Age
- Alerts to anaesthesia team
24
Q
What is a critical component of assessing readiness for surgery?
A
Providing information on the surgical process and determining supports needed postoperatively
25
Fill in the blank: Surgery can elicit a physiological and psychological ______ response.
stress
26
What factors can influence a patient's stress response to surgery?
* Age
* Past experiences of poor anesthesia or surgical complications
* Current health status and co-morbidities
* Mental health disorders
* Socioeconomic factors
27
How can a nurse acknowledge a patient's fears and concerns related to surgery?
* Using appropriate language
* Escalating medical concerns to the surgical team
* Determining ongoing support needs
* Providing targeted education
* Ensuring a support person for discharge
* Being kind and compassionate
28
What should a nurse assess regarding a patient's level of understanding?
Health literacy and the need for an interpreter if required
29
True or False: It is important for the patient to have a support person or carer for discharge.
True
30
What should be confirmed regarding the consent form?
* It is signed
* Dated
* Legible
* Patient can state what they are having done in their own words
* Patient is of sound mind to give consent freely
31
What varies depending on the facility and type of surgery?
Preparation for surgery.
32
What must be confirmed by the pre-admission nurse before planned surgery?
Date and time of arrival, where to present, expected routine, what to bring, and responsible person for discharge.
33
How many name bands must be applied for patient identification?
Two name bands.
34
Where is one name band typically placed?
On the non-dominant wrist.
35
What is the purpose of patient name bands?
Provides identification when the patient is unconscious and draped.
36
What should be assessed with the name bands?
Peripheral skin integrity and oedema.
37
What might a red name band indicate?
Allergies.
38
What vital sign is a critical early warning sign and must be accurately counted?
Respiratory rate (RR).
39
What is the importance of temperature assessment before surgery?
* Identify potential sepsis
* Establish baseline for detecting perioperative hypothermia
* Recognize anaesthetic-related hyperthermia.
40
What must be assessed pre-operatively in all patients?
Blood Glucose Level (BGL).
41
Why is chewing gum before surgery a concern?
It stimulates gastric acid secretion, increasing aspiration risk.
42
What must patients wear before surgery?
Hospital gown only.
43
What risks are associated with underwire bras in surgery?
CPR risk.
44
What must be done with all jewellery before surgery?
Taped down to the skin.
45
What must be removed from patients before surgery?
All makeup and nail enhancements.
46
What types of medications must be documented?
* Over-the-counter (OTC) medications
* Herbal supplements
* Dangerous medications.
47
What allergies must be documented?
Medications, tapes, and food.
48
What is a special consideration for patients with a previous mastectomy?
Risk of lymphoedema in affected limb.
49
What must be marked with a pink armband?
Patients with previous mastectomy/lymph node removal.
50
What must be screened in all women of childbearing age?
Pregnancy.
51
What can diathermy cause if metal prostheses are near the grounding pad?
Burns.
52
Why is weight important for patients pre-operatively?
For accurate medication dosing.
53
What should be assessed to prevent damage when inserting airway devices?
Dentition.
54
When should hearing aids and glasses be documented and removed?
Just before surgery, not on the ward.
55
How many full sheets of patient labels should be brought to the operating room?
At least two (2).
56
What must be done if unsure about pre-operative issues?
Contact the Floor Coordinator of the Operating Suite.
57
What is the purpose of the pre-operative interview?
To gather patient information in a quiet, private space.
58
What must be completed fully during the pre-operative interview?
All steps, including EMR fields.
59
What is another term for fasting before surgery?
Nil By Mouth (NBM).
60
What does NBM aim to reduce the risk of?
Vomiting and aspiration.
61
What might happen if NBM instructions are not followed?
The procedure may be cancelled or postponed.
62
What are traditional NBM orders for a morning procedure?
NBM from midnight the night before.
63
What can a patient usually have for breakfast before an afternoon procedure?
A light, early breakfast, then be NBM by 0600 hours.
64
What type of fluids are permitted up to 2 hours prior to surgery?
Maximum 200mls clear, unsweetened fluids.
65
What must be followed regarding medications before surgery?
Only medications permitted by the surgeon/anaesthetist.
66
67
What is the ISBAR handover in the context of the intraoperative phase?
A formal handover process used when transporting a patient to the operating suite
## Footnote
ISBAR stands for Introduction, Situation, Background, Assessment, Recommendation.
68
What is the purpose of the Holding Bay in the operating suite?
To prepare and receive patients prior to surgery, ensuring safety and comfort
## Footnote
Patients may receive a warm blanket and have their blood pressure checked.
69
What are the two distinct zones in the perioperative environment?
* Semi-Restricted Zone
* Restricted Zone
70
What is a Semi-Restricted Zone?
An area where patients are handed over prior to surgery and includes the PACU
## Footnote
Access is typically limited to staff and patient support persons in scrubs or everyday clothing.
71
What is a Restricted Zone?
Includes operating rooms, scrub bays, and sterile stock areas
## Footnote
Marked by a big red line on the floor indicating restricted access.
72
What is the role of the Holding Bay Nurse?
To receive the patient safely, document handover, and provide care
## Footnote
This includes answering questions and ensuring patient comfort.
73
Who comprises the Anaesthesia Team?
* Anaesthetic Consultant
* Anaesthetic Registrar
* Anaesthesia Nurse
74
What are the primary functions of the anaesthesia nurse?
* Assist the anaesthetist
* Provide compassionate patient care
75
What is the role of the Operating Theatre Technician?
Responsible for non-sterile equipment and assisting patient transfer
## Footnote
They manage devices like diathermy machines and laparoscopic towers.
76
What do the Instrument and Circulating Nurses do?
* Ensure sterile equipment is available
* Maintain an aseptic field
* Coordinate perioperative care
77
What is the hierarchy among surgeons in the operating room?
* Consultant
* Registrar
* Intern
78
What is the responsibility of the Post Anaesthetic Care Unit (PACU) Nurse?
Manage the patient's airway and assess their recovery from anaesthesia
## Footnote
They provide reassurance and psychological support post-surgery.
79
What is the role of Central Sterilising Services Technicians?
To clean and sterilise surgical instruments
## Footnote
They hold significant medico-legal responsibilities.
80
What is General Anaesthesia (GA)?
A state where the patient is kept unconscious, with analgesia and sedation provided
## Footnote
Advanced airway management may include LMA or ETT.
81
What is a Central Neural Blockade?
Injection of local anaesthetic into the spinal cord to induce loss of sensation
## Footnote
It is vital to check dermatomes and assess for Bromage Score.
82
What is a Peripheral Nerve Block?
Injection of local anaesthetic into a nerve bundle for loss of sensation
## Footnote
Often used for procedures like total knee replacement.
83
What are common intraoperative risks associated with airway management?
* Laryngeal trauma/spasm
* Broken teeth
* Loss of airway
84
What are potential complications related to breathing during surgery?
* Paradoxical breathing
* Lung atelectasis
* Aspiration of gastric contents
85
What are some circulation-related complications that may occur during surgery?
* Cardiac arrhythmias
* Thrombosis
* Hypovolaemia
86
What are some risks associated with dressings, drains, and drips?
* Unknown allergy to dressing
* IVC displacement
* Blood transfusion reaction
87
What are some surgery-specific complications?
* Pressure injury
* Infection
* Nerve and tissue damage
88
What are staff-specific risks during the intraoperative phase?
* Medication error
* Staff injury
* Retained surgical items
89
90
What is the postoperative phase?
The final phase of the surgical journey, beginning immediately after surgery and continuing until discharge.
91
What is the PACU?
Post Anaesthetic Care Unit, designed for focused nursing care immediately following surgery.
92
What are common conditions of patients upon arrival at PACU?
* Compromised state (no/slow reflexes) * Abnormal vital signs * Sedated/unconscious
93
What is key to preventing adverse events post surgery?
* Close observation and monitoring * Regular reassessments * Early recognition of deterioration * Prompt escalation and intervention * Administration of medications
94
What does DRABCD stand for in primary assessment?
* Danger * Response * Airway * Breathing * Circulation * Disability
95
What is included in a secondary assessment?
* Systems or head-to-toe assessment * Localised pain * Nausea * Loss of function * Evidence of blood loss * Checking for abnormalities
96
What is the purpose of a focused assessment?
To specifically assess the surgical site and related functions based on the type of surgery performed.
97
What criteria must patients meet to be considered 'ward ready'?
* Patent airway * Normal breathing * Appropriate level of consciousness * No severe pain
98
What is the typical frequency of reassessments in the first 4 hours postoperative?
* Every 30 minutes until stable * Hourly for the next 4 hours * Every 4 hours for the next 24 hours
99
What does the Wong Baker scale assess?
Pain in paediatric patients or those with intellectual dysfunction.
100
What types of surgical drains are commonly used?
* Penrose * Jackson Pratt (JP) * Redivac * Hemovac
101
What should be assessed in the management of surgical drains?
* Condition of the dressing * Suction requirements * Signs of infection * Type of drainage fluid
102
What is the significance of adequate pain management postoperatively?
It prevents adverse psychological and physiological effects, both short and long term.
103
What tools are used for pain assessment?
* PQRST * FLACC * Wong Baker scale
104
Fill in the blank: The PACU has a higher level of nursing and medical supervision than _______.
general wards
105
What should be included in the handover to the bedside nurse?
* Written and verbal handover * Patient's current status * Clarification of any concerns
106
What are signs of infection in a surgical wound?
* Fever * Tachycardia * Increased pain * Purulent drainage * Erythema
107
What is the purpose of administering antiemetics and analgesia in PACU?
To manage nausea and pain, usually via IV route.
108
What is the AVPU tool used for?
Assessing the level of consciousness.
109
What are the first steps in managing surgical wound care?
* Inspect skin around the incision * Assess for swelling, bruising, and tenderness
110
What does a patient need to do before being discharged from PACU?
Meet discharge criteria specific to the ward they are being transferred to.
111
What are common nursing interventions for postoperative patients?
* Ensuring patient comfort * Monitoring vital signs * Reassessing pain levels * Checking for nausea
112
What is the process for removing surgical drains?
* Follow surgeon's orders * Inspect the tip for tears * Document removal in patient notes
113
True or False: Pain is whatever the person experiencing it says it is.
True
114
What is the significance of documenting drainage in the fluid balance chart?
To maintain accurate records of fluid output and ensure proper patient management.
115
What is the process for removing sutures or staples?
Remove sutures/staples as per surgeon's orders, including education on pain, wound care, and signs of infection.
## Footnote
May include removing alternate sutures/staples or removal within a specific timeframe.
116
What equipment is needed for suture/staple removal?
* Dressing trolley
* Dressing pack
* Normal saline/chlorhexidine (without alcohol)
* Stitch cutter or staple remover
* Steri strips
* Dressing to cover incision post-procedure
117
What should be done after removing all sutures/staples?
* Gently clean the suture line with normal saline/chlorhexidine
* Allow the area to dry
* Apply steri strips across the suture line
118
What is postoperative nausea and vomiting (PONV)?
A complex and distressing complication of surgery that can affect up to 30% of patients, often rated worse than pain.
## Footnote
It can lead to serious consequences like aspiration risk and electrolyte imbalance.
119
What are the pharmacological management options for PONV?
* Ondansetron
* Droperidol
* Dexamethasone
* Metoclopramide
120
What are nonpharmacological management strategies for PONV?
* Cool face flannel over the eyes
* Reassurance
* Ice chips (if allowed)
* Vomit (emesis) bag within reach
121
What nursing management should be done post-vomiting?
* Wash patient's face and hands
* Allow patient to rinse mouth or brush teeth
* Offer a sip of water (small amounts)
* Perform abdominal assessment
122
What is paralytic ileus?
Temporary impairment of gastric and bowel motility that can occur after surgery.
## Footnote
Results from factors like handling of intestines during surgery or prolonged opioid use.
123
What nursing management is recommended for paralytic ileus?
* Patient should remain NBM until peristalsis returns
* Perform abdominal assessment
* Encourage early ambulation
* Position patient on their right side
124
What complications may arise from spinal, epidural, and caudal anaesthesia?
* Severe headache
* Respiratory depression
* Hypotension
* Sensory response issues
* Motor response issues
125
What are some potential postoperative respiratory complications?
* Hypoxaemia
* Pneumonia
* Atelectasis
126
What are some potential postoperative cardiovascular complications?
* Hypovolaemic shock
127
What are some gastrointestinal complications after surgery?
* Constipation
* Abdominal distention
* Intestinal obstruction
128
What neurological complications can occur postoperatively?
* Postoperative delirium
* Headache
129
What urinary complications can occur postoperatively?
* Retention
* Oliguria (urine output < 0.5ml/kg/hr)
130
What are some surgical site complications after surgery?
* Wound infection
* Wound dehiscence
* Compartment syndrome
131
What is shoulder tip pain and what causes it?
Referred pain due to phrenic nerve irritation, often from carbon dioxide used during laparoscopic surgery.
## Footnote
Affects up to 80% of patients and can last more than 72 hours.
132
What is intrathecal morphine (ITM)?
Administration of morphine directly into cerebrospinal fluid to manage postoperative pain, especially in abdominal surgeries.
133
What complications can arise from ITM administration?
* Respiratory depression
* Pruritus
* Nausea and vomiting
134
What are transversus abdominis plane (TAP) blocks?
An effective strategy for managing postoperative pain by injecting local anaesthetic into the transversus abdominis muscle.
135
What signs indicate local anaesthetic systemic toxicity (LAST)?
* Changes to CNS (e.g., visual disturbances)
* Changes to CVS (e.g., hypotension)
136
What information should be included in discharge planning?
* Symptoms to follow up on
* Medications and their uses
* Wound care instructions
* Activities to avoid
* Dietary requirements
* Ongoing nursing support
* Interprofessional referrals
137
What are the most common reasons patients seek help postoperatively?
* Ongoing pain
* Wound infection
* Advice regarding medications
138
What are the phases of the peri-operative journey that medications are used in?
* Pre-operative
* Intra-operative
* Post-operative
## Footnote
This includes medications for analgesia, sedation, and prevention of nausea.
139
What are the reasons for administering pre-operative medications?
* Provision of analgesia
* Prevention of nausea and vomiting
* Promote sedation and amnesia
* Decrease anaesthetic requirements
* Facilitate induction of anaesthesia
* Relieve apprehension and anxiety
* Prevent autonomic reflex response
* Decrease respiratory and gastrointestinal secretions
## Footnote
These reasons help improve patient outcomes during surgery.
140
Which medications are commonly used to promote sedation and amnesia?
* Benzodiazepines
* Opioids (covered in analgesia chapter)
## Footnote
Common benzodiazepines include diazepam and midazolam.
141
What types of medications are used to decrease respiratory and gastrointestinal secretions?
* Antiemetics
* Anticholinergics
* H2 Receptor antagonists
## Footnote
These medications minimize risks associated with anaesthesia.
142
Name four antiemetic medications commonly used to manage postoperative nausea and vomiting.
* Ondansetron
* Metoclopramide
* Droperidol
* Dexamethasone
## Footnote
These are frequently administered to patients post-surgery.
143
What is the most common anti-cholinergic medication used preoperatively?
Atropine
## Footnote
Atropine is used to manage excessive salivary and bronchial secretions.
144
Which class of medications is used to decrease gastric acid secretion?
* H2 receptor antagonists
* Proton pump inhibitors (PPI)
## Footnote
Ranitidine is a commonly used H2 receptor antagonist, though its registration has been suspended.
145
What is the primary use of opioids in pain management?
To provide analgesia for both acute and persistent pain
## Footnote
Nociceptive pain responds better to opioids than neuropathic pain.
146
What are the three primary opioid receptors in the body?
* mu (μ)
* delta (δ)
* kappa (Ǩ)
## Footnote
These receptors are found in the CNS and some other tissues.
147
List five common opioid analgesics.
* Morphine
* Fentanyl
* Oxycodone
* Codeine
* Tramadol
## Footnote
Each of these opioids has unique properties and indications.
148
What are common side effects of opioid analgesics?
* Rash
* Constipation
* Nausea
* Respiratory depression
## Footnote
Targin is noted for reducing constipation due to its combination with naloxone.
149
True or False: Fentanyl is administered in milligrams.
False
## Footnote
Fentanyl is ordered and administered in micrograms.
150
What should be monitored in patients receiving opioid medications?
* Respiratory rate
* Level of sedation
## Footnote
Accurate monitoring is crucial to prevent overdose.
151
Fill in the blank: The medication _______ is combined with oxycodone to reduce constipation.
Naloxone
## Footnote
This combination helps manage one of the common side effects of opioid use.
152
What is the significance of monitoring postoperative patients' temperature?
It can indicate changes due to muscle relaxants and environmental factors in the theatre
## Footnote
Temperature changes can impact blood pressure and heart rate.
153
List some adverse effects associated with opioid analgesics.
* Blurred vision
* Drowsiness
* Hallucinations
* Bradycardia
* Tolerance
* Dependence
## Footnote
These side effects necessitate careful monitoring and management.
154
155
What is nausea?
The uneasy sensation of the stomach which often results in vomiting
156
What is vomiting?
The forceful expulsion of the contents of the stomach through the mouth
157
What type of process is vomiting?
A complex process involving multiple nerve pathways and neurotransmitters
158
What is the role of efferent nerves in vomiting?
They send impulses from the emetic centre to the upper GIT, diaphragm, and abdominal muscles
159
What triggers the strong contractions of the abdominal muscles during vomiting?
Impulses sent from the emetic centre
160
What is the chemoreceptor trigger zone (CTZ)?
Sensory nerve cells located in the brain that coordinate responses with the vomit centre
161
What is the protective mechanism of vomiting?
To rid the body of a toxic substance
162
What can severe vomiting result in?
Fluid and electrolyte disturbances
163
Why can nausea and vomiting be distressing for patients?
Especially during the postoperative phase
164
Name a medication used to treat nausea and vomiting.
Prochlorperazine (stemetil)
165
What type of medication is promethazine?
An antihistamine with anticholinergic activity
166
What is cyclizine used for?
To treat severe PONV in the first 48 hours post-surgery
167
What is Patient-Controlled Analgesia (PCA)?
A method used in the postoperative period to provide immediate analgesia
168
What kind of medications does PCA commonly use?
Schedule 8 analgesic medications (opioids) like morphine, fentanyl, tramadol
169
What is a loading dose in PCA?
A prescribed dose after PCA setup to ensure immediate therapeutic action
170
What is a bolus dose?
The amount of opioid delivered when the demand button is pressed
171
What is the lockout interval in PCA?
The time from the end of one dose delivery until the PCA pump will respond to another demand
172
What is the purpose of a continuous infusion rate in PCA?
To maintain a stable analgesic level
173
What does the hourly limit in PCA refer to?
The maximum dose that the PCA will deliver in any one hour
174
What does a high number of PCA demands compared to doses delivered indicate?
The patient needs reassessment
175
Who are not suitable candidates for PCA?
Patients with cognitive impairment or those under the age of 5
176
What is elective surgery?
A carefully planned procedure booked in advance as a result of a specialist review
177
What is emergency surgery?
An unplanned, unexpected procedure performed under anaesthesia, usually urgent
178
What does the suffix '-ectomy' mean?
Excision or removal of
179
What does the suffix '-lysis' mean?
Destruction of
180
What does the suffix '-orrhaphy' mean?
Repair or suture of
181
What does the suffix '-oscopy' mean?
Looking into
182
What does the suffix '-ostomy' mean?
Creation of an opening
183
What does the suffix '-otomy' mean?
Cutting into or incision of
184
What does the suffix '-plasty' mean?
Repair or reconstruction of
185
What is laparoscopic surgery?
Minimally invasive procedure performed through small incisions with a camera
186
What is open surgery?
Invasive procedure performed through a large incision
187
What is endoscopy?
A procedure performed by introducing a long flexible instrument into a hollow organ
188
Q1: Which medication is most likely to cause respiratory depression in the postoperative period?
A. Paracetamol
B. Ibuprofen
C. Morphine
D. Ondansetron
Q1: Which medication is most likely to cause respiratory depression in the postoperative period?
A. Paracetamol
B. Ibuprofen
C. Morphine ✅
D. Ondansetron
189
Q2: What does the term 'laparoscopic surgery' refer to?
A. Open abdominal surgery through a large incision
B. Surgery performed with robotic assistance
C. Minimally invasive surgery using small incisions and a camera
D. Surgical procedure on the spine
Q2: What does the term 'laparoscopic surgery' refer to?
A. Open abdominal surgery through a large incision
B. Surgery performed with robotic assistance
C. Minimally invasive surgery using small incisions and a camera ✅
D. Surgical procedure on the spine
190
Q3: Which of the following signs is NOT typically associated with surgical wound infection?
A. Purulent drainage
B. Erythema around the wound
C. Low body temperature
D. Swelling and pain at the site
Q3: Which of the following signs is NOT typically associated with surgical wound infection?
A. Purulent drainage
B. Erythema around the wound
C. Low body temperature ✅
D. Swelling and pain at the site
191
Q4: Which phase of the surgical journey includes preparing a patient and completing the theatre checklist?
A. Preoperative phase
B. Intraoperative phase
C. Postoperative phase
D. Discharge phase
Q4: Which phase of the surgical journey includes preparing a patient and completing the theatre checklist?
A. Preoperative phase ✅
B. Intraoperative phase
C. Postoperative phase
D. Discharge phase
192
Q5: Which tool is most appropriate for assessing postoperative pain in a non-verbal patient?
A. Wong-Baker scale
B. FLACC scale
C. Numeric rating scale
D. PQRST method
Q5: Which tool is most appropriate for assessing postoperative pain in a non-verbal patient?
A. Wong-Baker scale
B. FLACC scale ✅
C. Numeric rating scale
D. PQRST method
193
Q6: What is a key safety consideration when a patient wears nail polish before surgery?
A. Risk of skin irritation
B. Risk of flammability
C. Interference with pulse oximetry readings
D. Risk of infection
Q6: What is a key safety consideration when a patient wears nail polish before surgery?
A. Risk of skin irritation
B. Risk of flammability
C. Interference with pulse oximetry readings ✅
D. Risk of infection
194
Q7: Which assessment is critical before giving spinal anaesthesia?
A. Bowel sounds
B. Dermatome level
C. Wound drainage
D. Blood glucose level
Q7: Which assessment is critical before giving spinal anaesthesia?
A. Bowel sounds
B. Dermatome level ✅
C. Wound drainage
D. Blood glucose level
195
Q8: Which medication combination reduces opioid-induced constipation?
A. Oxycodone + Naloxone
B. Morphine + Ondansetron
C. Fentanyl + Diazepam
D. Codeine + Tramadol
Q8: Which medication combination reduces opioid-induced constipation?
A. Oxycodone + Naloxone ✅
B. Morphine + Ondansetron
C. Fentanyl + Diazepam
D. Codeine + Tramadol
196
Q9: Which of the following is a correct feature of a Jackson Pratt drain?
A. Open drainage onto gauze
B. Uses high-pressure suction
C. Closed system collecting fluid in a bulb
D. Inserted without an incision
Q9: Which of the following is a correct feature of a Jackson Pratt drain?
A. Open drainage onto gauze
B. Uses high-pressure suction
C. Closed system collecting fluid in a bulb ✅
D. Inserted without an incision
197
198
Q10: Which vital sign must be accurately counted and never estimated before surgery?
A. Heart rate
B. Temperature
C. Respiratory rate
D. Blood pressure
Q10: Which vital sign must be accurately counted and never estimated before surgery?
A. Heart rate
B. Temperature
C. Respiratory rate ✅
D. Blood pressure
199
Q11: Which scale uses Face, Legs, Activity, Cry, and Consolability to assess pain?
A. Wong-Baker scale
B. FLACC scale
C. Numeric pain scale
D. Sedation score
Q11: Which scale uses Face, Legs, Activity, Cry, and Consolability to assess pain?
A. Wong-Baker scale
B. FLACC scale ✅
C. Numeric pain scale
D. Sedation score
200
Q12: Which of the following is a postoperative complication that may present with hiccups and gas pain?
A. Pneumothorax
B. Paralytic ileus
C. Wound dehiscence
D. Pulmonary embolism
Q12: Which of the following is a postoperative complication that may present with hiccups and gas pain?
A. Pneumothorax
B. Paralytic ileus ✅
C. Wound dehiscence
D. Pulmonary embolism
201
202
Q13: When assessing surgical wound infection, which of the following is NOT a typical finding within the first 48 hours?
A. Redness
B. Swelling
C. Purulent drainage
D. Infection symptoms
Q13: When assessing surgical wound infection, which of the following is NOT a typical finding within the first 48 hours?
A. Redness
B. Swelling
C. Purulent drainage
D. Infection symptoms ✅
203
Q14: What is the primary reason for the Nil By Mouth (NBM) order before surgery?
A. Prevent patient discomfort
B. Minimize risk of aspiration
C. Control blood glucose levels
D. Enhance drug absorption
Q14: What is the primary reason for the Nil By Mouth (NBM) order before surgery?
A. Prevent patient discomfort
B. Minimize risk of aspiration ✅
C. Control blood glucose levels
D. Enhance drug absorption
204
Q15: Which medication is a dopamine antagonist used for managing PONV?
A. Ondansetron
B. Metoclopramide
C. Dexamethasone
D. Cyclizine
Q15: Which medication is a dopamine antagonist used for managing PONV?
A. Ondansetron
B. Metoclopramide ✅
C. Dexamethasone
D. Cyclizine
205
Q16: Which nursing action should be taken first upon receiving a post-op patient from PACU?
A. Start fluid chart
B. Check pain score
C. Assess DRABCD
D. Reposition patient
Q16: Which nursing action should be taken first upon receiving a post-op patient from PACU?
A. Start fluid chart
B. Check pain score
C. Assess DRABCD ✅
D. Reposition patient
206
Q17: What is the correct response if a patient presses their PCA frequently with minimal doses delivered?
A. Ignore unless they complain
B. Check sedation score
C. Notify the buddy nurse
D. Reset the PCA pump
Q17: What is the correct response if a patient presses their PCA frequently with minimal doses delivered?
A. Ignore unless they complain
B. Check sedation score
C. Notify the buddy nurse ✅
D. Reset the PCA pump
207
Q18: Which opioid is administered in micrograms and has a quick onset?
A. Morphine
B. Fentanyl
C. Tramadol
D. Codeine
Q18: Which opioid is administered in micrograms and has a quick onset?
A. Morphine
B. Fentanyl ✅
C. Tramadol
D. Codeine
208
Q19: What is a potential risk of central neural blockade like spinal anaesthesia?
A. Bronchospasm
B. Opioid tolerance
C. Local Anaesthetic Systemic Toxicity
D. Air embolism
Q19: What is a potential risk of central neural blockade like spinal anaesthesia?
A. Bronchospasm
B. Opioid tolerance
C. Local Anaesthetic Systemic Toxicity ✅
D. Air embolism
209
Q20: Which assessment tool is best for a verbal patient describing their pain experience?
A. AVPU scale
B. PQRST
C. FLACC scale
D. Sedation score
Q20: Which assessment tool is best for a verbal patient describing their pain experience?
A. AVPU scale
B. PQRST ✅
C. FLACC scale
D. Sedation score
210
Q21: Which postoperative complication can be caused by prolonged opioid use and abdominal surgery?
A. Atelectasis
B. Paralytic ileus
C. Wound dehiscence
D. Delirium
Q21: Which postoperative complication can be caused by prolonged opioid use and abdominal surgery?
A. Atelectasis
B. Paralytic ileus ✅
C. Wound dehiscence
D. Delirium
211
Q22: Which medication can cause QT prolongation and must be used cautiously in PONV management?
A. Ondansetron
B. Metoclopramide
C. Dexamethasone
D. Prochlorperazine
Q22: Which medication can cause QT prolongation and must be used cautiously in PONV management?
A. Ondansetron ✅
B. Metoclopramide
C. Dexamethasone
D. Prochlorperazine
212
Q23: What is a Bromage score used to assess?
A. Sedation level
B. Pain severity
C. Motor block from spinal anaesthesia
D. Respiratory effort
Q23: What is a Bromage score used to assess?
A. Sedation level
B. Pain severity
C. Motor block from spinal anaesthesia ✅
D. Respiratory effort
213
Q24: Which intraoperative medication is a dissociative anaesthetic?
A. Propofol
B. Ketamine
C. Fentanyl
D. Isoflurane
Q24: Which intraoperative medication is a dissociative anaesthetic?
A. Propofol
B. Ketamine ✅
C. Fentanyl
D. Isoflurane
214
Q25: What nursing action is appropriate if a surgical drain is not draining and has no suction?
A. Leave it and reassess later
B. Flush the tubing
C. Check for kinks and patency, and notify the team
D. Clamp the drain completely
Q25: What nursing action is appropriate if a surgical drain is not draining and has no suction?
A. Leave it and reassess later
B. Flush the tubing
C. Check for kinks and patency, and notify the team ✅
D. Clamp the drain completely
215
Q26: Which type of drain is most likely to increase the risk of infection?
A. Jackson Pratt
B. Penrose
C. Hemovac
D. Redivac
Q26: Which type of drain is most likely to increase the risk of infection?
A. Jackson Pratt
B. Penrose ✅
C. Hemovac
D. Redivac
216
Q27: Which postoperative complication is characterised by urine output < 0.5ml/kg/hr?
A. Polyuria
B. Retention
C. Oliguria
D. Incontinence
Q27: Which postoperative complication is characterised by urine output < 0.5ml/kg/hr?
A. Polyuria
B. Retention
C. Oliguria ✅
D. Incontinence
217
Q28: Which medication is often given to reverse opioid-induced respiratory depression?
A. Naloxone
B. Flumazenil
C. Atropine
D. Ondansetron
Q28: Which medication is often given to reverse opioid-induced respiratory depression?
A. Naloxone ✅
B. Flumazenil
C. Atropine
D. Ondansetron
218
Q29: What type of medication is ranitidine?
A. Opioid
B. H2 receptor antagonist
C. Antiemetic
D. Benzodiazepine
Q29: What type of medication is ranitidine?
A. Opioid
B. H2 receptor antagonist ✅
C. Antiemetic
D. Benzodiazepine
219
Q30: Which phase of anaesthesia involves regaining consciousness and returning to baseline function?
A. Induction
B. Maintenance
C. Emergence
D. Sedation
Q30: Which phase of anaesthesia involves regaining consciousness and returning to baseline function?
A. Induction
B. Maintenance
C. Emergence ✅
D. Sedation
220
Q31: Why must a patient remove all jewellery before surgery?
A. For x-ray clarity
B. To avoid pressure injury
C. To prevent burns from diathermy equipment
D. To prevent hypothermia
Q31: Why must a patient remove all jewellery before surgery?
A. For x-ray clarity
B. To avoid pressure injury
C. To prevent burns from diathermy equipment ✅
D. To prevent hypothermia
221
Q32: What must be documented when a surgical drain is removed?
A. Only the type of dressing applied
B. The tip of the drain is intact
C. The time the wound was last assessed
D. The patient’s pain score
Q32: What must be documented when a surgical drain is removed?
A. Only the type of dressing applied
B. The tip of the drain is intact ✅
C. The time the wound was last assessed
D. The patient’s pain score
222
Q33: Which opioid also inhibits reuptake of noradrenaline and serotonin?
A. Oxycodone
B. Tapentadol
C. Tramadol
D. Codeine
Q33: Which opioid also inhibits reuptake of noradrenaline and serotonin?
A. Oxycodone
B. Tapentadol
C. Tramadol ✅
D. Codeine
223
Q34: Which is a non-pharmacological nursing intervention for postoperative pain?
A. Increasing opioid dose
B. Administering antiemetics
C. Repositioning and applying ice packs
D. Increasing IV fluids
Q34: Which is a non-pharmacological nursing intervention for postoperative pain?
A. Increasing opioid dose
B. Administering antiemetics
C. Repositioning and applying ice packs ✅
D. Increasing IV fluids
224
Q35: What is the purpose of the 'lockout interval' in PCA use?
A. Prevent overdose
B. Allow sleep
C. Reduce cost of medication
D. Monitor pain trends
Q35: What is the purpose of the 'lockout interval' in PCA use?
A. Prevent overdose ✅
B. Allow sleep
C. Reduce cost of medication
D. Monitor pain trends
225
Q36: Why are accurate vital signs important preoperatively?
A. To meet documentation policy
B. They form a baseline for postoperative comparison
C. So the patient feels reassured
D. For anaesthetist curiosity
Q36: Why are accurate vital signs important preoperatively?
A. To meet documentation policy
B. They form a baseline for postoperative comparison ✅
C. So the patient feels reassured
D. For anaesthetist curiosity
226
Q37: What does AVPU stand for in neurological assessment?
A. Awake, Verbal, Pain, Unconscious
B. Alert, Vitals, Pain, Urine
C. Assess, Verify, Position, Understand
D. Airway, Vitals, Pulse, Understanding
Q37: What does AVPU stand for in neurological assessment?
A. Awake, Verbal, Pain, Unconscious ✅
B. Alert, Vitals, Pain, Urine
C. Assess, Verify, Position, Understand
D. Airway, Vitals, Pulse, Understanding
227
Q38: What is the most appropriate initial action when a postoperative patient is confused?
A. Restrain the patient
B. Administer sedation
C. Assess oxygenation and vital signs
D. Call security
Q38: What is the most appropriate initial action when a postoperative patient is confused?
A. Restrain the patient
B. Administer sedation
C. Assess oxygenation and vital signs ✅
D. Call security
228
Q39: Which medication is a benzodiazepine used in preoperative sedation?
A. Morphine
B. Atropine
C. Midazolam
D. Ranitidine
Q39: Which medication is a benzodiazepine used in preoperative sedation?
A. Morphine
B. Atropine
C. Midazolam ✅
D. Ranitidine
229
Q40: What information must be confirmed before proceeding with surgery?
A. Type of anaesthesia
B. Patient's weight
C. Consent is signed, dated, and accurate
D. Time the patient last ate
Q40: What information must be confirmed before proceeding with surgery?
A. Type of anaesthesia
B. Patient's weight
C. Consent is signed, dated, and accurate ✅
D. Time the patient last ate
230
Q1: Which of the following describes general anaesthesia?
A. The patient remains fully conscious but sedated
B. The patient is unconscious with airway support
C. A local nerve is blocked with no sedation
D. The patient is only given analgesia
Q1: Which of the following describes general anaesthesia?
A. The patient remains fully conscious but sedated
B. The patient is unconscious with airway support ✅
C. A local nerve is blocked with no sedation
D. The patient is only given analgesia
231
Q2: Which airway devices are commonly used during general anaesthesia?
A. Nasal cannula or face mask
B. Endotracheal tube (ETT) or laryngeal mask airway (LMA)
C. Nasopharyngeal airway
D. Simple oxygen mask
Q2: Which airway devices are commonly used during general anaesthesia?
A. Nasal cannula or face mask
B. Endotracheal tube (ETT) or laryngeal mask airway (LMA) ✅
C. Nasopharyngeal airway
D. Simple oxygen mask
232
Q3: Which complication is most associated with spinal or epidural anaesthesia?
A. Aspiration pneumonia
B. Urinary retention
C. Severe headache from CSF leakage
D. Bronchospasm
Q3: Which complication is most associated with spinal or epidural anaesthesia?
A. Aspiration pneumonia
B. Urinary retention
C. Severe headache from CSF leakage ✅
D. Bronchospasm
233
Q4: What is the Bromage score used to assess?
A. Respiratory function
B. Motor block level
C. Pain intensity
D. Nausea risk
Q4: What is the Bromage score used to assess?
A. Respiratory function
B. Motor block level ✅
C. Pain intensity
D. Nausea risk
234
Q5: Local Anaesthetic Systemic Toxicity (LAST) may present as:
A. Increased bowel sounds and urination
B. Visual disturbances and hypotension
C. Tachycardia and diaphoresis
D. Coughing and wheezing
Q5: Local Anaesthetic Systemic Toxicity (LAST) may present as:
A. Increased bowel sounds and urination
B. Visual disturbances and hypotension ✅
C. Tachycardia and diaphoresis
D. Coughing and wheezing
235
Q6: What does "P" stand for in the PQRST pain assessment tool?
A. Pulse
B. Position
C. Precipitating factors
D. Posture
Q6: What does "P" stand for in the PQRST pain assessment tool?
A. Pulse
B. Position
C. Precipitating factors ✅
D. Posture
236
Q7: In the FLACC scale, what does the "C" for Cry assess?
A. The patient’s pain description
B. Quality of tears
C. Frequency and intensity of crying
D. Cause of the crying
Q7: In the FLACC scale, what does the "C" for Cry assess?
A. The patient’s pain description
B. Quality of tears
C. Frequency and intensity of crying ✅
D. Cause of the crying
237
Q8: Which pain scale is best used for a non-verbal or unconscious patient?
A. Wong-Baker
B. PQRST
C. Numeric rating scale
D. FLACC
Q8: Which pain scale is best used for a non-verbal or unconscious patient?
A. Wong-Baker
B. PQRST
C. Numeric rating scale
D. FLACC ✅
238
Q9: A patient says the pain is "sharp, radiating down the leg, 8/10." What tool is being used?
A. FLACC
B. PQRST
C. Wong-Baker
D. Abbey Pain Scale
Q9: A patient says the pain is "sharp, radiating down the leg, 8/10." What tool is being used?
A. FLACC
B. PQRST ✅
C. Wong-Baker
D. Abbey Pain Scale
239
Q10: Before transferring a patient from PACU to the ward, the nurse must ensure:
A. Pain score is zero
B. The family is present
C. The patient meets discharge criteria
D. The surgeon has signed the discharge papers
Q10: Before transferring a patient from PACU to the ward, the nurse must ensure:
A. Pain score is zero
B. The family is present
C. The patient meets discharge criteria ✅
D. The surgeon has signed the discharge papers
240
Q12: What must the nurse do if unsure about the patient’s stability before accepting PACU handover?
A. Accept and monitor closely
B. Delay handover and inform the nurse in charge
C. Ask PACU to keep the patient longer
D. Administer PRN medication
Q12: What must the nurse do if unsure about the patient’s stability before accepting PACU handover?
A. Accept and monitor closely
B. Delay handover and inform the nurse in charge ✅
C. Ask PACU to keep the patient longer
D. Administer PRN medication
240
Q11: Which of the following indicates a patient is not ready for ward transfer from PACU?
A. Patent airway and normal vitals
B. Pain well managed with PCA
C. Ongoing severe nausea and vomiting
D. Alert and oriented
Q11: Which of the following indicates a patient is not ready for ward transfer from PACU?
A. Patent airway and normal vitals
B. Pain well managed with PCA
C. Ongoing severe nausea and vomiting ✅
D. Alert and oriented
241
Q13: Which opioid is the standard for comparing other opioids in pain management?
A. Codeine
B. Fentanyl
C. Oxycodone
D. Morphine
Q13: Which opioid is the standard for comparing other opioids in pain management?
A. Codeine
B. Fentanyl
C. Oxycodone
D. Morphine ✅
242
Q14: Which medication reduces the constipation side effect of oxycodone?
A. Ondansetron
B. Naloxone
C. Tramadol
D. Tapentadol
Q14: Which medication reduces the constipation side effect of oxycodone?
A. Ondansetron
B. Naloxone ✅
C. Tramadol
D. Tapentadol
243
Q15: Why should antiemetics be ordered alongside opioid analgesics?
A. They increase sedation
B. Opioids commonly cause nausea and vomiting
C. They decrease blood pressure
D. They reduce fever
Q15: Why should antiemetics be ordered alongside opioid analgesics?
A. They increase sedation
B. Opioids commonly cause nausea and vomiting ✅
C. They decrease blood pressure
D. They reduce fever
244
Q16: Which antiemetic acts on the chemoreceptor trigger zone (CTZ) and is commonly used postoperatively?
A. Ibuprofen
B. Ondansetron
C. Diazepam
D. Atropine
Q16: Which antiemetic acts on the chemoreceptor trigger zone (CTZ) and is commonly used postoperatively?
A. Ibuprofen
B. Ondansetron ✅
C. Diazepam
D. Atropine
245
Q17: What is a major nursing consideration for fentanyl administration via IV?
A. Liver function monitoring
B. Rapid onset and respiratory depression
C. Causes hypertension
D. Oral administration only
Q17: What is a major nursing consideration for fentanyl administration via IV?
A. Liver function monitoring
B. Rapid onset and respiratory depression ✅
C. Causes hypertension
D. Oral administration only
246
Q18: Which medication class is used preoperatively to reduce secretions?
A. NSAIDs
B. Antiemetics
C. Anticholinergics
D. Beta blockers
Q18: Which medication class is used preoperatively to reduce secretions?
A. NSAIDs
B. Antiemetics
C. Anticholinergics ✅
D. Beta blockers
247
Q19: What does the lockout interval on a PCA device ensure?
A. Constant infusion
B. Patient can't overdose
C. Battery saving
D. Nurse control of dosage
Q19: What does the lockout interval on a PCA device ensure?
A. Constant infusion
B. Patient can't overdose ✅
C. Battery saving
D. Nurse control of dosage
248
Q20: A patient presses the PCA button 15 times in an hour, but only 5 doses are delivered. What should the nurse do?
A. Restrict use
B. Inform the doctor for review
C. Reset the machine
D. Increase the lockout time
Q20: A patient presses the PCA button 15 times in an hour, but only 5 doses are delivered. What should the nurse do?
A. Restrict use
B. Inform the doctor for review ✅
C. Reset the machine
D. Increase the lockout time
249
Q21: Which patient is not suitable for PCA?
A. Alert post-op adult
B. Paediatric patient under 5
C. Adult with chronic pain
D. Patient recovering from laparotomy
Q21: Which patient is not suitable for PCA?
A. Alert post-op adult
B. Paediatric patient under 5 ✅
C. Adult with chronic pain
D. Patient recovering from laparotomy
250
Q22: What is the most critical safety check when accepting a patient with a PCA?
A. Pain score
B. Lockout settings and sedation level
C. Food intake
D. Family education
Q22: What is the most critical safety check when accepting a patient with a PCA?
A. Pain score
B. Lockout settings and sedation level ✅
C. Food intake
D. Family education
251
Q23: What type of drainage would you expect to see 48 hours after surgery?
A. Frank blood
B. Serosanguinous
C. Green bile
D. Thick pus
Q23: What type of drainage would you expect to see 48 hours after surgery?
A. Frank blood
B. Serosanguinous ✅
C. Green bile
D. Thick pus
252
Q24: Which is an open drainage system with higher infection risk?
A. Jackson-Pratt
B. Redivac
C. Penrose
D. Hemovac
Q24: Which is an open drainage system with higher infection risk?
A. Jackson-Pratt
B. Redivac
C. Penrose ✅
D. Hemovac
253
Q25: What should the nurse do immediately after removing a surgical drain?
A. Discard tubing
B. Leave wound open
C. Inspect tip of the drain
D. Start oral fluids
Q25: What should the nurse do immediately after removing a surgical drain?
A. Discard tubing
B. Leave wound open
C. Inspect tip of the drain ✅
D. Start oral fluids
254
Q26: A patient has increased pain and warmth around their incision. What is the most likely concern?
A. Wound healing well
B. Nerve regeneration
C. Surgical site infection
D. Dehydration
Q26: A patient has increased pain and warmth around their incision. What is the most likely concern?
A. Wound healing well
B. Nerve regeneration
C. Surgical site infection ✅
D. Dehydration
255
Q27: What is a key nursing assessment for a wound with a drain?
A. Sutures count
B. Presence of haematuria
C. Drain site patency and fluid characteristics
D. Pain score only
Q27: What is a key nursing assessment for a wound with a drain?
A. Sutures count
B. Presence of haematuria
C. Drain site patency and fluid characteristics ✅
D. Pain score only
256
Q28: What is the most common serious adverse effect associated with paracetamol overdose?
A. Kidney failure
B. Gastric bleeding
C. Liver toxicity
D. Respiratory depression
Q28: What is the most common serious adverse effect associated with paracetamol overdose?
A. Kidney failure
B. Gastric bleeding
C. Liver toxicity ✅
D. Respiratory depression
257
Q29: Why is paracetamol considered a key component in multimodal analgesia postoperatively?
A. It causes minimal sedation
B. It replaces opioids entirely
C. It increases opioid potency
D. It reduces inflammation better than NSAIDs
Q29: Why is paracetamol considered a key component in multimodal analgesia postoperatively?
A. It causes minimal sedation ✅
B. It replaces opioids entirely
C. It increases opioid potency
D. It reduces inflammation better than NSAIDs
258
Q30: What is the primary nursing consideration when administering ibuprofen postoperatively?
A. Monitor for drowsiness
B. Assess for constipation
C. Monitor renal function and GI symptoms
D. Avoid with antibiotics
Q30: What is the primary nursing consideration when administering ibuprofen postoperatively?
A. Monitor for drowsiness
B. Assess for constipation
C. Monitor renal function and GI symptoms ✅
D. Avoid with antibiotics
259
Q31: Which of the following is a contraindication for ibuprofen use?
A. History of mild anxiety
B. Hypertension
C. Active peptic ulcer disease
D. Postoperative nausea
Q31: Which of the following is a contraindication for ibuprofen use?
A. History of mild anxiety
B. Hypertension
C. Active peptic ulcer disease ✅
D. Postoperative nausea
260
Q32: Morphine primarily binds to which type of opioid receptor to relieve pain?
A. Alpha
B. Beta
C. Mu
D. Delta
Q32: Morphine primarily binds to which type of opioid receptor to relieve pain?
A. Alpha
B. Beta
C. Mu ✅
D. Delta
261
Q33: A key nursing action when caring for a patient receiving morphine is to:
A. Check temperature hourly
B. Monitor blood glucose
C. Assess respiratory rate and sedation regularly
D. Limit fluid intake
Q33: A key nursing action when caring for a patient receiving morphine is to:
A. Check temperature hourly
B. Monitor blood glucose
C. Assess respiratory rate and sedation regularly ✅
D. Limit fluid intake
261
Q34: What is a common gastrointestinal side effect of morphine that requires proactive nursing management?
A. Diarrhoea
B. Constipation
C. Nausea only
D. Gastric ulcers
Q34: What is a common gastrointestinal side effect of morphine that requires proactive nursing management?
A. Diarrhoea
B. Constipation ✅
C. Nausea only
D. Gastric ulcers
262
Q35: Why is fentanyl dosed in micrograms rather than milligrams?
A. It has a shorter half-life
B. It is much more potent than morphine
C. It is only given as an infusion
D. It is a weaker opioid
Q35: Why is fentanyl dosed in micrograms rather than milligrams?
A. It has a shorter half-life
B. It is much more potent than morphine ✅
C. It is only given as an infusion
D. It is a weaker opioid
263
Q36: A patient on fentanyl is found to have a respiratory rate of 8. What is the nurse’s priority action?
A. Reassure the patient
B. Administer a stool softener
C. Escalate for review and prepare naloxone
D. Increase fluid intake
Q36: A patient on fentanyl is found to have a respiratory rate of 8. What is the nurse’s priority action?
A. Reassure the patient
B. Administer a stool softener
C. Escalate for review and prepare naloxone ✅
D. Increase fluid intake
264
Q37: Which oxycodone formulation may reduce constipation risk while maintaining analgesia?
A. Oxycodone with metoclopramide
B. Oxycodone CR (controlled release)
C. Oxycodone with naloxone (e.g. Targin)
D. Oxycodone syrup
Q37: Which oxycodone formulation may reduce constipation risk while maintaining analgesia?
A. Oxycodone with metoclopramide
B. Oxycodone CR (controlled release)
C. Oxycodone with naloxone (e.g. Targin) ✅
D. Oxycodone syrup
265
Q38: A patient taking oxycodone reports ongoing moderate pain. What is the nurse’s best next action?
A. Document and wait for the next dose
B. Provide reassurance
C. Assess last dose time and escalate for review
D. Stop medication and switch to paracetamol
Q38: A patient taking oxycodone reports ongoing moderate pain. What is the nurse’s best next action?
A. Document and wait for the next dose
B. Provide reassurance
C. Assess last dose time and escalate for review ✅
D. Stop medication and switch to paracetamol
266
Q39: What is the mechanism of action of ondansetron?
A. Dopamine receptor blocker
B. 5-HT3 serotonin receptor antagonist
C. GABA receptor modulator
D. Histamine blocker
Q39: What is the mechanism of action of ondansetron?
A. Dopamine receptor blocker
B. 5-HT3 serotonin receptor antagonist ✅
C. GABA receptor modulator
D. Histamine blocker
267
Q40: What is a common but less serious side effect of ondansetron?
A. Hypotension
B. Sedation
C. Headache
D. Constipation
Q40: What is a common but less serious side effect of ondansetron?
A. Hypotension
B. Sedation
C. Headache ✅
D. Constipation
268
Q41: What is a key contraindication for metoclopramide administration?
A. Type 2 diabetes
B. Irritable bowel syndrome
C. Parkinson’s disease
D. GERD
Q41: What is a key contraindication for metoclopramide administration?
A. Type 2 diabetes
B. Irritable bowel syndrome
C. Parkinson’s disease ✅
D. GERD
269
Q42: What is the most serious extrapyramidal side effect associated with metoclopramide?
A. Constipation
B. Bradycardia
C. Dystonia
D. Tachycardia
Q42: What is the most serious extrapyramidal side effect associated with metoclopramide?
A. Constipation
B. Bradycardia
C. Dystonia ✅
D. Tachycardia
270
Q43: In postoperative patients, metoclopramide helps with nausea by:
A. Relaxing the GI tract
B. Increasing GI motility and dopamine blockade
C. Blocking serotonin receptors
D. Neutralizing stomach acid
Q43: In postoperative patients, metoclopramide helps with nausea by:
A. Relaxing the GI tract
B. Increasing GI motility and dopamine blockade ✅
C. Blocking serotonin receptors
D. Neutralizing stomach acid
