After the surgery, the patient is transferred to the PACU. Functions of the nurse in the PACU are to

observe the amount of drainage from the surgical site.

assist the patient to maintain a patent airway.

keep the family posted on the patient's condition.

maintain safety for the patient while unconscious.

stimulate the patient to hasten return of consciousness.

Answer and Explanation

Correct Answer : B,D

A. Observe the amount of drainage from the surgical site. While the nurse in the PACU should monitor for complications, the primary focus is on the patient’s immediate recovery, such as airway management and vital signs. Drainage is important but is usually addressed once the patient is stable.

B. Assist the patient to maintain a patent airway. The primary role in the PACU is to monitor and maintain the patient’s airway. Ensuring that the patient is breathing properly is the most critical priority immediately postoperatively.

C. Keep the family posted on the patient's condition. While family communication is important, it is not the primary function of the nurse in the PACU, as the focus should be on monitoring the patient’s immediate condition post-surgery.

D. Maintain safety for the patient while unconscious. The nurse in the PACU must ensure that the patient is safe while unconscious, including monitoring for complications from anesthesia and ensuring that the patient’s vital signs remain stable.

E. Stimulate the patient to hasten return of consciousness. While it is important to help the patient regain consciousness, this should be done gently. The nurse should not aggressively stimulate the patient, as anesthesia will wear off naturally over time.

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Correct Answer is C

Explanation

A. That vomiting might be an expected symptom. Vomiting can occur post-surgery, particularly if anesthesia was used, but this is not an expected or desired symptom. The education plan should focus on advising the patient about managing nausea if it occurs, rather than presenting vomiting as an expected outcome.

B. Limiting wine intake for 12 hours. Alcohol intake should be avoided after surgery, but the specific restriction may vary depending on the procedure and type of anesthesia used. The recommendation is usually to avoid alcohol for at least 24 hours, not just 12 hours. Therefore, this is not an ideal choice for the education plan.

C. Not driving or making important decisions for 24 hours. After same-day surgery, the effects of anesthesia can last for several hours, impairing the patient's cognitive and motor abilities. It is important to educate the patient to avoid driving or making significant decisions for at least 24 hours after surgery to prevent accidents and errors.

D. Reporting temperatures greater than 99°F. A temperature greater than 99°F may not be a significant concern post-surgery. Generally, a fever above 100.4°F (38°C) would be more concerning. The patient should be instructed to report a higher fever, but a temperature of 99°F alone is usually not an alarming sign.

A. spray the surgical area with an antimicrobial solution. B. shave the entire surgical site. C. scrub the surgical area for 1 minute with antibacterial solution. D. instruct the patient in the use of an antimicrobial soap in the shower.

Correct Answer is A

Explanation

A. Spray the surgical area with an antimicrobial solution. Spraying an antimicrobial solution on the surgical area is a common method of skin preparation to reduce the risk of infection during surgery. It is important to follow specific guidelines set by the facility or surgical team.

B. Shave the entire surgical site. Shaving the surgical site is not typically recommended anymore because it can cause micro-abrasions that increase the risk of infection. Hair clipping is preferred if hair removal is necessary.

C. Scrub the surgical area for 1 minute with antibacterial solution. Scrubbing the area with an antibacterial solution may be part of the preparation, but it is typically done by the surgical team or after following specific guidelines for cleaning, not as a general preoperative action.

D. Instruct the patient in the use of an antimicrobial soap in the shower. This is another common preoperative practice, but the nurse's role may be to instruct the patient rather than carry out the preparation directly.

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After the surgery, the patient is transferred to the PACU. Functions of the nurse in the PACU are to

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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