Or Exam
Or Exam
Or Exam
Situation 1 – Concerted work efforts among members of the surgical team is essential to the
success of the surgical procedure.
1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is
a need for sterile supply which is not in the sterile field, who hands out these items by opening its
outer cover?
a. Circulating nurse
b. Anesthesiologist
c. Surgeon
d. Nursing aide
2. The OR team performs distinct roles for one surgical procedure to be accomplished within a
prescribed time frame and deliver a standard patient outcome. While the surgeon performs the
surgical procedure, who monitors the status of the client like urine output, blood loss?
a. Scrub nurse
b. Surgeon
c. Anesthesiologist
d. Circulating nurse
3. Surgery schedules are communicated to the OR usually a day prior to the procedure by the
nurse of the floor or ward where the patient is confined. For orthopedic cases, what department is
usually informed to be present in the OR?
a. Rehabilitation department
b. Laboratory department
c. Maintenance department
d. Radiology department
4. Minimally invasive surgery is very much into technology. Aside from the usual surgical team
who else to be present when a client undergoes laparoscopic surgery?
a. Information technician
b. Biomedical technician
c. Electrician
d. Laboratory technician
5. In massive blood loss, prompt replacement of compatible blood is crucial. What department
needs to be alerted to coordinate closely with the patient’s family for immediate blood component
therapy?
a. Security Division
b. Chaplaincy
c. Social Service Section
d. Pathology department
Situation 2 – You are assigned in the Orthopedic Ward where clients are complaining of pain in
varying degrees upon movement of body parts.
6. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain.
Which of the following observation would prompt you to call the doctor?
7. There is an order of Demerol 50 mg I.M. now and every 6 hours p r n. You injected Demerol at
5 pm. The next dose of Demerol 50 mg I.M. is given:
8. You continuously evaluate the client’s adaptation to pain. Which of the following behaviors-
indicate appropriate adaptation?
9. Pain in Ortho cases may not be mainly due to the surgery. There might be other factors such as
cultural or psychological that influence pain. How can you alter these factors as the nurse?
a. Explain all the possible interventions that may cause the client to worry.
b. Establish trusting relationship by giving his medication on time
c. Stay with the client during pain episodes
d. Promote client’s sense of control and participation in pain control by listening to his concerns
10. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is
your nursing priority care in such a case?
a. Instruct client to observe strict bed rest
b. Check for epidural catheter drainage
c. Administer analgesia through epidural catheter as prescribed
d. Assess respiratory rate carefully
Situation 3 – Records are vital tools in any institution and should be properly maintained for
specific use and time.
11. The patient’s medical record can work as a double-edged swords. When can the medical record
become the doctor’s/nurse worst enemy?
13. In the hospital, when you need-the medical record of a discharged patient for research, you
will request permission through:
a. Doctor in charge
b. The hospital director
c. The nursing Service
d. Medical records section
14. You readmitted a client who was in another department a month ago. Since you will need the
previous chart, from whom do you request the old chart?
15. Records Management and Archives Offices of the DOH is responsible for implementing its
policies on record,
15. Records Management and Archives Offices of the DOH is responsible for implementing its
policies on record, disposal. You know that your institution is covered by this policy it;
Situation 4 – In the OR, there are safety protocols that should be followed. The OR nurse should
be well versed with all these to safeguard the safety and quality to patient delivery outcome.
16. Which of the following should be given highest priority when receiving patient in the OR?
17. Surgeries like I and D (incision and drainage) and debridement are relatively short procedures
but considered ‘dirty cases’. When are these; procedures best scheduled?
a. Last case
b. In between cases
c. According to availability of anesthesiologist
d. According to the surgeon’s preference
18. OR nurses should be aware that maintaining the client’s safety is the overall goal of nursing
care during the intraoperative phase. As the circulating nurse, you make certain that throughout the
procedure…
19. Another nursing check that should not be missed before the induction of general anesthesia is:
20. Some different habits and hobbies affect postoperative respiratory function. If your client
smokes 3 packs of cigarettes a day for the part 10 years, you will anticipate increased risk for:
a. perioperative anxiety and stress
b. delayed coagulation time
c. delayed wound healing
d. postoperative respiratory dysfunction
Situation 5 – Nurses hold a variety of roles when providing care to a perioperative patient.
21. Which of the following role would be the responsibility of the scrub nurse?
22. As a perioperative nurse, how can you best meet the safety need of the client after
administering preoperative narcotic?
a. Put side rails up and ask client not to get out of bed
b. Send the client to ORD with the family
c. Allow client to get up to go to the comfort room
d. Obtain consent form
23. It is the responsibility of the pre-op, nurse to do skin prep for patients undergoing surgery. If
hair at the operative site is not shaved, what should be done to make suturing easy and lessen
chance of incision infection?
a. Draped
b. Pulled
c. Clipped
d. Shampooed
24. It is also the nurse’s function to determine when infection is developing in the surgical
incision. The perioperative nurse should observe for what signs of impending infection?
25. Which of the following nursing intervention is done when examining the incision wound and
changing the dressing?
Situation 6 – Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and
he appears to be in acute respiratory distress.
27. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what its
indication the nurse will say is:
28. You will give health instructions to Carlo, a case of bronchial asthma. The health instruction
will include the following EXCEPT:
29. The asthmatic client asked you what breathing technique he can best practice when asthmatic
attack starts. What will be the best position?
30. As a nurse you are always alerted to monitor status asthmaticus who will likely and initially
manifest symptoms of:
a. metabolic alkalosis
b. respiratory acidosis
c. respiratory alkalosis
d. metabolic acidosis
31. As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems?
32. Over dosage of medication or anesthetic can happen even with the aid of technology like
infusion pump, sphygmomanometer, and similar devices/machines. As a staff, how can you
improve the safety of using infusion pumps?
33. JCAHO’s universal protocol for surgical and invasive procedures to ...
prevent wrong site, wrong person, and wrong procedures/surgery includes the following EXCEPT:
34. You identified a potential risk of pre and postoperative clients. To reduce the risk of patient
harm resulting from fall, you can implement the following EXCEPT:
a. Assess potential risk of fail associated with the patient’s the following EXCEPT: medication
regimen
b. Take action to address any identified risks through Incident Report (IR)
c. Allow client to walk with relative to the OF?
d. Assess and periodically reassess individual client’s risk for falling
35. As a nurse you know you can improve on accuracy of patient’s identification by 2 patient
identifiers, EXCEPT:
a. identify the client by his/her wrist tag and verify with family members
b. identify client by his/her wrist tag and call his/her by name
c. call the client by his/her case and bed number
d. call the patient by his/her name and bed number
36. If you are the nurse in charge for scheduling surgical cases, what important information do you
need to ask the surgeon?
37. In the OR, the nursing tandem for every surgery is:
38. While team effort is needed in the OR for efficient and quality patient care delivery, we should
limit the number of people in the room for infection control. Who comprise this team?
39. When surgery is on-going, who coordinates the activities outside, including the family?
a. Orderly/clerk
b. Nurse supervisor
c. Circulating nurse
d. Anaesthesiologist
a. Electricity
b. Inadequate supply
c. Leg work
d. Communication
Situation 11 -After an abdominal surgery, the circulating and scrub nurses have critical
responsibility about sponge and Instrument count.
51. When is the first sponge/instrument count reported?
52. What major supportive layer of the abdominal wall must be sutured with long tensile strength
such as cotton or nylon or silk suture?
a. Fascia
b. Muscle
c. Peritoneum
d. Skin
53. Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who
is prone to keloid formation and has a low threshold of pain, what needle would you prepare?
a. Round needle
b. A traumatic needle
c. Reverse cutting needle
d. Tapered needle
54. Another alternative “suture” for skin closure is the use of:
a. Staple
b. Therapeutic glue
c. Absorbent dressing
d. invisible suture
55. Like any nursing interventions, counts should be documented. To whom does the scrub nurse
report any discrepancy of country so that immediate ‘and appropriate action in instituted?
a. Anesthesiologist
b. Surgeon
c. Or nurse supervisor
d. Circulating nurse
Situation 12 – As a nurse, you should be aware and prepared of the different roles you play.
56. What role do you play, when you hold all clients’ information entrusted to you in the strictest
confidence?
a. Patient’s advocate
b. Educator
c. Patient’s Liaison
d. Patient’s arbiter
57. As a nurse, you can help improve the effectiveness of communication among healthcare givers
58. As a nurse, your primary focus in the workplace is the client’s safety. However, personal safety
is also a concern. You can communicate hazards to your co-workers through the use of the
following EXCEPT:
a. Formal training
b. Posters
c. Posting IR in the bulletin board
d. Use of labels and signs
59. As a nurse, what is one of the best way to reconcile medications across the continuum of care?
60. As a nurse, you protect yourself and co-workers from misinformation and misrepresentations
through the following EXCEPT:
a. Provide information to clients about a variety of services that can help alleviate the client’s pain
and other conditions
b. Advising the client, by virtue of your expertise, that which can contribute to the client’s well-
being
c. Health education among clients and significant others regarding the use of chemical disinfectant
d. Endorsement thru trimedia to advertise your favorite disinfectant solution
61. A one-day postoperative abdominal surgery client has been complaining of severe throbbing
abdominal pain described as 9 in a 1-10 pain rating. Your assessment reveals bowel sounds on all
quadrants and the dressing is dry and intact. What nursing intervention would you take?
62. Pentoxicodone 5 mg IV every 8 hours was prescribed for post abdominal pain. Which will be
your priority nursing action?
63. The client complained of abdominal and pain. Your nursing intervention that can alleviate pain
is:
64. Surgical pain might be minimized by which nursing action in the OR:
Situation 14 – You were on duty at the medical ward when Zeny came in for admission for
tiredness, cold intolerance, constipation, and weight gain. Upon examination, the doctor’s
diagnosis was hypothyroidism.
67. As the nurse, you should anticipate to administer which of the following medications to Zeny
who is diagnosed to be suffering from hypothyroidism?
a. Levothyroxine
b. Lidocaine
c. Lipitor
d. Levophed
68. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would
probably include which of the following?
69. Myxedema coma is a life threatening complication of long standing and untreated
hypothyroidism with one of the following characteristics.
a. Hyperglycemia
b. hypothermia
c. hyperthermia
d. hypoglycemia
70. As a nurse, you know that the most common type of goiter is related to a deficiency
a. thyroxine
b. thyrotropin
c. iron
d. iodine
Situation 15 – Mrs. Pichay is admitted to your ward. The MD ordered “Prepared for thoracentesis
this pm to remove excess air from the pleural cavity.”
71. Which of the following nursing responsibility is essential in Mrs. Pichay who will undergo
thoracentesis?
72. Mrs. Pichay, who is for thoracentesis, is assisted by the nurse to any of the following positions,
EXCEPT:
a. straddling a chair with arms and head resting on the back of the chair
b. lying on the unaffected side with the bed elevated 30-40 degrees
c. lying prone with the head of the bed lowered 15-30 degrees
d. sitting on the edge of the bed with her feet supported and arms and head on a padded overhead
table
73. During thoracentesis, which of the following nursing intervention will be most crucial?
74. To prevent leakage of fluid in the thoracic cavity, how wilt you position the client after
thoracentesis?
75. Chest x-ray was ordered after thoracentesis. When you client asks what is the reason for
another chest x-ray, you will explain:
Situation 16 – In the hospital, you are aware that we are helped by the .use of a variety of
equipment/devices to enhance quality patient care delivery;
76. You are initiate an IV line to your patient, Kyle, 5, who is febrile. What IV administration set
will you prepare?
77. Kyle is diagnosed to have measles. What will your protective personal attire include?
a. Gown
b. Eyewear
c. Face mask
d. Gloves
78. What will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake?
79. Before bedtime, you want to ensure Kyle’s safety in ‘bed. You will do which of the following:
80. Kyle’s room is fully mechanized. What do you teach the watcher and Kyle to alert the nurse
for help?
Situation 17 – Tony, 11 years old, has ‘kissing tonsils’ and is scheduled for tonsillectomy and
adenoidectomy or T and A.
81. You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if
Tony will be put to sleep. Your teaching will focus on:
a. spinal anesthesia
b. anesthesiologist’s preference
c. local anesthesia
d. general anesthesia
82. Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food
prepared and give their children after surgery. You as the nurse will say:
83. The RR nurse should monitor for the most common postoperative complication of:
a. hemorrhage
b. endotracheal tube perforation
c. esopharyngeal edema
d. epiglottis
84. The PACU nurse will maintain postoperative T and A client in what position?
85. Tony is to be discharged in the afternoon of the same day after tonsillectomy and
adenoidectomy. You as the RN will make sure that the family knows to:
Situation 18 – Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered that an
A-V shunt was surgically created.
86. Which of the following action would be of highest priority with regards to the external shunt?
a. Recommend protein of high biologic value like eggs, poultry and lean meat
b. Encourage client to include raw cucumbers, carrot, cabbage, and tomatoes
c. Allowing the client cheese, canned foods, and other processed food
d. Bananas, cantaloupe, orange and other fresh fruits can be included in the diet
88. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome.
He asked you how this can be prevented. Your response is:
89. You are assisted by a nursing aide with the care of the client with renal failure. Which
delegated function to the aide would you particularly check?
90. A renal failure patient was ordered for creatinine clearance. As the nurse you will collect
Situation 19 – Fe is experiencing left sharp pain and occasional hematuria. She was advised to
undergo IVP by her physician.
91. Fe was so anxious about the procedure and particularly expressed her low pain threshold.
Nursing health instruction will include:
a. assure the client that the pain is associated with the warm sensation during the administration of
the Hypaque by IV
b. assure the client that the procedure painless
c. assure the client that contrast medium will be given orally
d. assure the client that x-ray procedure like IVP is only done by experts
92. What will the nurse monitor and instruct the client and significant others, post IVP?
93. Post IVP, Fe should excrete the contrast medium. You instructed the family to include more
vegetables in the diet and
94. The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To
increase the chance of passing the stones, you instructed her to force fluids and do which of the
following?
a. Balanced diet
b. Ambulance more
c. Strain all urine
d. Bed rest
a. Colelithiasis
b. Nephrolithiasis
c. Ureterolithiasis
d. Urolithiasis
Situation 20 – At the medical-surgical ward, the nurse must also be concerned about drug
interactions.
96. You have a client with TPN. You know that in TPN, like blood transfusion, there should be no
drug incorporation. However, the MD’s order read; incorporate insulin to present TPN. Will you
follow the order?
98. One patient has a ‘runaway’ IV of 50% dextrose. To prevent temporary excess of insulin
transient hyperinsulin reaction, what solution should you prepare in anticipation of the doctors
order?
100. In insulin administration, it should be understood that our body normally releases insulin
according to our blood glucose level. When is insulin and glucose level highest?
a. After excitement
b. After a good night’s rest
c. After an exercise
d. After ingestion of food
Answers
Here are the answers for the exam. Unfortunately, rationales are not given. If you need
clarifications or disputes, please direct them to the comments section and we’ll be glad to give you
an explanation.
A. Circulating Nurse
C. Anesthesiologist
D. Radiology department
B. Biomedical technician
C. Social Service Section
B. Left foot is cold to touch and pedal pulse is absent
C. At 11 pm
C. The client can distract himself during pain episodes
D. Promote client’s sense of control and participation in control by listening to his concerns
D. Assess respiratory rate carefully
D. When the medical record is inaccurate, incomplete, and inadequate
D. Department of Health (DOH)
B. The hospital director
D. Medical records section
C. It obtained permit to operate from DOH
B. Verify patient identification and informed consent
A. Last case
C. strap made of strong non-abrasive materials are fastened securely around the joints of the knees
and ankles and around the 2 hands around an arm board.
D. check baseline vital signs
D. postoperative respiratory function
C. Account for the number of sponges, needles, supplies, used during the surgical procedure.
A. Put side rails up and ask the client not to get out of bed
C. Clipped
A. Localized heat and redness
A. Observe the dressing and type and odor of drainage if any
D. Administer bronchodilator by nebulizer
A. Relax smooth muscles of the bronchial airway
D. Practice respiratory isolation
D. Lean forward 30-40 degrees with each exhalation
C. respiratory alkalosis
D. Implement a regular maintenance and testing of alarm systems
A. Check the functionality of the pump before use
C. Take a video of the entire intra-operative procedure
C. Allow client to walk with relative to the OR
C. call the client by his/her case and bed number
B. Who is your assistant and anesthesiologist, and what is your preferred time and type of
surgery?
D. Scrub and circulating nurses
B. Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologist
C. Circulating Nurse
D. Communication
A. Apply liberal amount of mineral oil to the area
C. Eat balanced meals at regular intervals
A. Increased weight
A. Increase the irrigating solution flow rate when abdominal cramps is felt
B. Sensation of pressure
C. General population
B. Appropriate location
B. An equal chance of selection
B. Convenience
C. Stratified sampling
B. Before peritoneum is closed
D. Skin
B. Atraumatic needle
A. Staple
B. Surgeon
A. Patient’s advocate
B. Using standardized list of abbreviations, acronyms, and symbols
C. Posting IR in the bulletin board
C. Endorse in writing
D. Endorsement thru trimedia to advertise your favorite disinfectant solution
A. Medicate client as prescribed
D. Monitor VS, more importantly RR
D. Turn to sides frequently and avoid too much talking
B. Appropriate preparation for the scheduled procedure
D. Inadequate anesthetic
D. encourage to drink 6-8 glasses of water
A. Levothyroxine
A. Activity intolerance related to tiredness associated with disorder
B. Hypothermia
D. iodine
D. Ascertain if chest x-rays and other tests have been prescribed and completed
D. Orthopneic position
C. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the
chest
B. Turn on the unaffected side
A. to rule out pneumothorax
D. Microset
C. Face mask
C. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and
output
B. Put the side rails up
C. Call system
D. general anesthesia
D. soft diet when fully awake
A. hemorrhage
B. Prone with the head on pillow and turned to the side
B. offer soft foods for a week to minimize discomfort while swallowing
A. Avoid taking BP or blood sample from the arm with the shunt
A. Recommend protein of high biologic value like eggs, poultry and lean meats
C. initial hemodialysis shall be done 30 minutes only so as not to rapidly remove the waste from
the blood than from the brain
A. Monitoring and recording I and O
C. 24 hour urine specimen
A. assure the client that the pain is associated with the warm sensation during the administration
of the Hypaque by IV
A. Report signs and symptoms for delayed allergic reaction
A. increase fluid intake
B. Ambulate more
D. Urolithiasis
B. Yes, because insulin is chemically stable with TPN and can enhance blood glucose level
D. Use volumetric chamber
B. Isotonic solution
D. Referring to manufacturer’s guidelines
D. After ingestion of food
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