Who among the following patients can sign their own informed consent?*1 pointA. A 17-year old prodigy who graduated as summa cum laudeB. A 25-year old man who cannot speakC. A 90-year old woman who is on life saving medicationsD. A 37-year old intoxicated chief of surgery152. You are reviewing the charts of your patient who is to undergo appendectomy later today. Which among the following chart entries will alert you to call their surgeon?*1 pointA. A nothing-per-orem order since 12:00 MNB. A signed informed consentC. Medications include: phenothiazine, vancomycin, and atropine sulfateD. Medical history of taking multivitamin supplements containing vitamins A, C, D, B complex, and gingko biloba.153. Who among the following members of the surgical team is deemed to be following the principles of asepsis?*1 pointA. A circulating nurse who is preparing the mayo tableB. A circulating nurse who is wearing her surgical cap in the wardC. A surgeon who only wears their mask inside the OR theatreD. A scrub nurse who prefers wearing scrubs one size smaller to prevent breaks in asepsis154. 8 hours post-operation, a patient in the PACU suddenly presents with new-onset disorientation, began pulling her IV lines, and screams at the nurse for trapping her in the ward. Medical history reveals that the patient has no history of psychiatric illnesses. What is the appropriate nursing action?*1 pointA. Call the surgeon-in chargeB. Put restraintsC. Administer PRN diazepamD. Reorient the client to person, place, and time155. You are monitoring your patient who is admitted to the PACU 1 hour ago and you noted a 4 x 4 cm, bright red drainage on the dressing of the patient’s operative site. What is your appropriate initial action?*1 pointA. Inspect the wound to get further assessment dataB. Document findings and continue monitoringC. Call the surgeon-in-chargeD. Check the patient’s platelet count156. Your 75-year old post-cholecystectomy patient asks you why you keep on insisting that they walk around the unit. You will answer that the benefits of early ambulation includeI.         Preventing postoperative pneumoniaII.         Preventing postoperative atelectasisIII.         Preventing development of deep vein thrombosisIV.         Preventing development of deliriumV.         Preventing development of postoperative ileusVI.         Preventing development of contractures*1 pointA. I, III, V, VIB. I, II, III, V, VIC. III, IV, V, VID. All of the above157. What intervention written by your staff nurse for a patient who is at risk for developing deep vein thromboembolism will alert you to intervene?*1 pointA. Ensuring activity by asking the patient to dangle the legs before getting out of bed to walkB. Using thigh-high anti-embolism stockingsC. Administering low-dose heparin, as scheduledD. Giving 2500 mL of fluids per day158. A patient who is admitted to the PACU 2 hours ago suddenly presses the call button stating that she vomited. You went to the bedside and confirmed that the patient vomited. What is your initial nursing action?*1 pointA. Elevate the head of bed to semi-Fowler’sB. Assess the patient’s abdomenC. Administer PRN antiemeticsD. Call the surgeon in-charge

1. To determine who among the following patients can sign their own informed consent, we need to consider their age, cognitive abilities, and legal capacity.

A. A 17-year old prodigy who graduated as summa cum laude: In most jurisdictions, a 17-year old is considered a minor and may not have the legal capacity to sign their own informed consent. However, there may be exceptions for mature minors or emancipated minors, depending on local laws and regulations. Further assessment is needed.

B. A 25-year old man who cannot speak: If the 25-year old man has the cognitive ability to understand the information provided and communicate his consent through alternative means (such as sign language or written communication), he may be able to sign his own informed consent.

C. A 90-year old woman who is on life-saving medications: Age alone does not determine the ability to sign informed consent. If the 90-year old woman has the cognitive capacity to understand the information provided and make an informed decision, she can sign her own informed consent.

D. A 37-year old intoxicated chief of surgery: If the 37-year old chief of surgery is intoxicated to the point where he cannot understand the information provided or make an informed decision, he cannot sign his own informed consent. In this case, a substitute decision-maker or legal guardian may need to provide consent on his behalf.

2. To identify which chart entry will alert you to call the surgeon for a patient undergoing appendectomy:

A. A nothing-per-orem order since 12:00 MN: This entry indicates that the patient has been fasting since midnight, which is a standard requirement before surgery. It does not necessarily require a call to the surgeon.

B. A signed informed consent: This entry indicates that the patient has provided their consent for the surgery. It does not require a call to the surgeon unless there are specific concerns or issues related to the consent.

C. Medications include: phenothiazine, vancomycin, and atropine sulfate: This entry may require a call to the surgeon as it indicates the patient's current medication regimen, which may have implications for the surgery or anesthesia.

D. Medical history of taking multivitamin supplements containing vitamins A, C, D, B complex, and gingko biloba: This entry does not necessarily require a call to the surgeon unless there are specific concerns related to the multivitamin supplements and their potential interactions with anesthesia or surgery.

3. To determine which member of the surgical team is following the principles of asepsis:

A. A circulating nurse who is preparing the mayo table: The mayo table is a sterile field, and the circulating nurse should follow aseptic techniques while preparing it. Therefore, this nurse is deemed to be following the principles of asepsis.

B. A circulating nurse who is wearing her surgical cap in the ward: While wearing a surgical cap is important for maintaining a sterile environment in the operating room, it is not necessary in the ward. Therefore, this nurse may not necessarily be following the principles of asepsis.

C. A surgeon who only wears their mask inside the OR theatre: Wearing a mask inside the operating room is essential for maintaining a sterile environment. Therefore, this surgeon is deemed to be following the principles of asepsis.

D. A scrub nurse who prefers wearing scrubs one size smaller to prevent breaks in asepsis: While wearing properly fitting scrubs is important for maintaining a sterile environment, wearing scrubs one size smaller may not necessarily prevent breaks in asepsis. Therefore, this nurse may not necessarily be following the principles of asepsis.

4. When a patient in the PACU suddenly presents with new-onset disorientation, begins pulling IV lines, and screams at the nurse, the appropriate nursing action is to reorient the client to person, place, and time. This can help address the patient's confusion and agitation. Restraints should only be used as a last resort if the patient's safety or the safety of others is at risk and after other interventions have been attempted. Calling the surgeon-in-charge may be necessary if the patient's condition worsens or if there are concerns about their post-operative recovery.

5. When monitoring a patient in the PACU and noting a 4 x 4 cm, bright red drainage on the dressing of the patient's operative site, the appropriate initial action is to inspect the wound to gather further assessment data. This will help determine the source and severity of the bleeding. Depending on the findings, further interventions such as notifying the surgeon-in-charge or taking additional measures to control bleeding may be necessary.

6. The benefits of early ambulation for a post-cholecystectomy patient include:

I. Preventing postoperative pneumonia II. Preventing postoperative atelectasis III. Preventing the development of deep vein thrombosis IV. Preventing the development of delirium V. Preventing the development of postoperative ileus VI. Preventing the development of contractures

Therefore, the appropriate answer is D. All of the above.

7. An intervention written by a staff nurse for a patient at risk for developing deep vein thromboembolism that would alert you to intervene is administering low-dose heparin as scheduled. This intervention is aimed at preventing the formation of blood clots and reducing the risk of deep vein thrombosis.

8. When a patient in the PACU suddenly presses the call button and reports vomiting, the initial nursing action is to assess the patient's abdomen. This will help determine if there are any signs of complications such as distention or tenderness. Elevating the head of the bed to semi-Fowler's position may also be appropriate to help alleviate any discomfort or prevent aspiration. Administering PRN antiemetics may be considered based on the assessment findings. Calling the surgeon-in-charge may be necessary if there are concerns about the patient's condition or if further interventions are required.