1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Nursing Management: Postoperative Care Chapter 20

2 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. 1.A patient becomes restless and agitated in the postanesthesia care unit (PACU) as he begins to regain consciousness. The first action the nurse should take is 1.turn the patient to a lateral position. 2.orient the patient and tell him that the surgery is over. 3.administer the ordered postoperative pain medication. 4.check the patient’s oxygen saturation with pulse oximetry.

3 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. 2.While in the PACU, the patient’s blood pressure drops from an admission pressure of 126/82 to 106/78 with a pulse change from 70 to 94. The nurse administers oxygen and then 1.increases the rate of the IV fluids. 2.notifies the anesthesia care provider. 3.performs neurovascular checks on the lower extremities. 4.uses a cardiac monitor to assess the patient’s heart rhythm.

4 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. 3.The nurse is preparing to discharge a patient from the ambulatory surgery center following an inguinal hernia repair. The nurse delays release of the patient upon discovering that the patient 1.had IV morphine 45 minutes ago. 2.has an oxygen saturation of 92%. 3.has not voided since before surgery. 4.had one episode of vomiting 30 minutes ago.