A registered nurse working in a PACU (post-anesthesia-care-unit) is responsible for conducting assessments on immediate post-operative clients.
What is the purpose of these assessments?
To use intra-operative data as a baseline for patient outcome comparison.
To prevent complications from anesthesia and surgery, and to monitor and stabilize the patient they are caring for post-anesthesia.
To focus on cardiovascular data and findings for future cases.
To determine and report the length of time each patient recovers from anesthesia.
The Correct Answer is B
Choice A rationale:
While comparing intra-operative data to post-operative outcomes can be valuable for research and quality improvement purposes, it's not the primary purpose of immediate post-operative assessments in the PACU.
The focus in the PACU is on the patient's immediate well-being and stabilization, not on long-term data analysis.
Choice B rationale:
Preventing complications:
Early detection of potential complications is crucial for timely intervention and prevention of adverse events.
Assessments identify changes in vital signs, respiratory status, pain levels, level of consciousness, surgical site integrity, and other indicators of potential complications.
Monitoring and stabilizing the patient:
Nurses closely monitor patients' physiological responses to anesthesia and surgery, ensuring vital signs remain within acceptable ranges and managing any deviations.
They assess pain levels and administer analgesics as needed, promote respiratory function, maintain fluid and electrolyte balance, and address any other post-operative concerns.
Choice C rationale:
While cardiovascular data is indeed crucial in the PACU, it's not the sole focus of assessments.
Nurses assess a comprehensive range of body systems to ensure overall patient stability and recovery.
Choice D rationale:
Determining recovery time is important, but it's secondary to ensuring patient safety and stability.
Assessments prioritize identifying and addressing potential complications, promoting recovery, and ensuring a safe transition from the PACU.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
Choice A rationale:
Oral route anesthetic blocks are not considered regional anesthesia. They are a form of systemic anesthesia, meaning they affect the entire body.
Oral anesthetics are absorbed through the gastrointestinal tract and distributed throughout the bloodstream to reach their target sites in the central nervous system.
They produce a general depressant effect on the brain and spinal cord, leading to sedation, unconsciousness, and analgesia. Examples of oral anesthetics include benzodiazepines, barbiturates, and propofol.
Choice B rationale:
Inhalation anesthetic blocks are also a form of systemic anesthesia.
They are administered through inhalation of vaporized gases or volatile liquids.
These anesthetics rapidly cross the alveolar-capillary membrane in the lungs and enter the bloodstream, where they are transported to the brain and other tissues.
They produce a dose-dependent depression of the central nervous system, resulting in loss of consciousness, analgesia, and muscle relaxation.
Examples of inhalation anesthetics include nitrous oxide, sevoflurane, and isoflurane.
Choice C rationale:
Spinal anesthetic blocks are a type of regional anesthesia that involves injecting a local anesthetic directly into the subarachnoid space of the spinal cord.
This blocks nerve transmission in the spinal cord, resulting in loss of sensation and motor function in the lower half of the body.
Spinal anesthesia is commonly used for surgeries below the waist, such as cesarean deliveries, hip replacements, and knee surgeries.
Choice D rationale:
Epidural anesthetic blocks are another type of regional anesthesia that involves injecting a local anesthetic into the epidural space, which is the area surrounding the spinal cord.
This blocks nerve transmission in the spinal nerves, resulting in loss of sensation and motor function in a specific region of the body.
Epidural anesthesia is commonly used for labor and delivery, as well as for surgeries on the abdomen, pelvis, and lower extremities.
Choice E rationale:
Nerve anesthetic blocks (also known as peripheral nerve blocks) involve injecting a local anesthetic around a specific nerve or group of nerves.
This blocks nerve transmission in the targeted area, resulting in loss of sensation and motor function in a specific part of the body.
Nerve blocks can be used for a variety of surgical procedures, as well as for pain management.
Correct Answer is D
Explanation
Choice A rationale:
Sterile dressing changes each morning are not directly related to the finding in question. While maintaining sterile dressings is important for postoperative wound care, it's not the primary intervention based on the specific finding you've presented. I'll need more information about the finding to determine the most appropriate rationale for this choice.
Choice B rationale:
Administering pain medications as needed is a common postoperative intervention, but it's not always the most crucial one depending on the patient's condition and the specific finding. It's important to assess the patient's pain level and administer medications accordingly, but pain management shouldn't overshadow other essential interventions.
Choice C rationale:
Conducting a head-to-toe assessment each shift is a comprehensive assessment, but it may not be necessary for every postoperative patient in every situation. The frequency and extent of assessments should be tailored to the patient's individual needs and the specific findings.
Choice D rationale:
Monitoring respirations and breath sounds is often the most critical postoperative intervention, as it allows for early detection of respiratory complications such as pneumonia, atelectasis, or pulmonary embolism. These complications can be life threatening, so prompt identification and intervention are essential.
Specific reasons why monitoring respirations and breath sounds is essential based on the finding (which you haven't provided) could include:
Evidence of respiratory distress or compromise
Changes in breathing patterns or sounds
Decreased oxygen saturation levels
Increased work of breathing
Risk factors for respiratory complications (e.g., type of surgery, underlying lung disease)
I'm ready to provide a more comprehensive rationale for each choice once you share the specific finding that prompted this question.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today