Pre and post operative care of children undergoing surgery
Time: 15:00
What is the most effective method for psychologically preparing a preschool-age child for surgery?
[a] Providing a detailed, scientific explanation of the procedure a week in advance.
[b] Showing the child a video of the actual surgery.
[c] Using play therapy with dolls or puppets to demonstrate what will happen.
[d] Explaining the procedure only to the parents to avoid scaring the child.
What is the highest priority nursing assessment for a child in the immediate post-anesthesia care unit (PACU)?
[a] Assessing the surgical dressing for drainage.
[b] Monitoring for the return of bowel sounds.
[c] Checking the patient's pain level using an appropriate scale.
[d] Ensuring airway patency and adequate respiratory function.
A 4-year-old child returns from surgery. Which pain assessment tool is most appropriate for the nurse to use?
[a] A numeric rating scale (0-10).
[b] The Wong-Baker FACES Pain Rating Scale.
[c] The CRIES scale.
[d] The FLACC scale.
A nurse is reviewing pre-operative NPO guidelines. For an elective surgery, what is the generally accepted minimum fasting time for clear liquids in a healthy child?
[a] 8 hours.
[b] 6 hours.
[c] 4 hours.
[d] 2 hours.
Early signs of post-operative hemorrhage in a young child include:
[a] Bradycardia and hypertension.
[b] A strong, bounding pulse and warm, flushed skin.
[c] Tachycardia, pallor, and frequent swallowing (if oral/throat surgery).
[d] A decreased respiratory rate and a stable blood pressure.
The nurse must verify that a valid informed consent is signed before surgery. The person who legally provides this consent is the:
[a] Child, if they are over 12 years old.
[b] Anesthesiologist.
[c] Parent or legal guardian.
[d] Surgeon.
An 8-year-old child verbally agrees to a procedure after the parents have given permission. This is known as obtaining:
[a] Informed consent.
[b] Assent.
[c] Medical clearance.
[d] Patient compliance.
A child is scheduled for an elective tonsillectomy. Which pre-operative finding would be most likely to cause the surgery to be postponed?
[a] A history of a milk allergy.
[b] The child expresses fear about the surgery.
[c] A fever of 38.8°C (101.8°F) and a productive cough.
[d] A loose primary (baby) tooth.
Which intervention is an effective non-pharmacological method to manage post-operative pain in an infant?
[a] Explaining the procedure in a calm voice.
[b] Using guided imagery.
[c] Offering a pacifier dipped in sucrose or swaddling.
[d] Using a patient-controlled analgesia (PCA) pump.
To prevent post-operative atelectasis in a 5-year-old child, the nurse should encourage the child to:
[a] Take shallow breaths to avoid pain.
[b] Remain on strict bed rest for 24 hours.
[c] Drink plenty of cold liquids.
[d] Blow bubbles or a pinwheel.
Before advancing a child's diet from clear liquids to solid foods post-operatively, the nurse must first assess for:
[a] The child's hunger level.
[b] The presence of bowel sounds.
[c] The last dose of pain medication.
[d] The parent's permission.
What is the primary reason for obtaining an accurate pre-operative weight for a child?
[a] To assess their nutritional status.
[b] To determine the size of the hospital gown needed.
[c] To ensure accurate calculation of anesthesia and medication dosages.
[d] To predict the amount of post-operative weight loss.
The nurse's most therapeutic response to an anxious parent in the pre-operative holding area is to:
[a] Tell the parent not to worry because the surgeon is excellent.
[b] Suggest the parent wait in the cafeteria to reduce their anxiety.
[c] Distract the parent by asking about their insurance information.
[d] Provide clear, simple explanations of what to expect and answer their questions honestly.
A child who has not voided for 7 hours after surgery complains of lower abdominal pain. The nurse's first action should be to:
[a] Notify the surgeon immediately.
[b] Prepare for an in-and-out catheterization.
[c] Palpate the bladder and use non-invasive measures like running water.
[d] Increase the rate of the intravenous fluids.
Pre-operative assessment of a child should always include asking about allergies, especially to:
[a] Pollen and dust mites.
[b] Latex and medications.
[c] Pet dander and mold.
[d] Gluten and dairy.
Which clinical sign in a post-operative child would indicate a potential surgical site infection?
[a] A small amount of serosanguineous drainage on the dressing.
[b] A pain score of 3 out of 10.
[c] A low-grade temperature of 37.8°C (100.0°F) on the first post-op day.
[d] Purulent drainage and increased redness around the incision.
A child received an opioid analgesic for post-operative pain. The nurse should prioritize monitoring for which adverse effect?
[a] Hypertension.
[b] Tachycardia.
[c] Respiratory depression.
[d] Increased urine output.
When giving discharge instructions to the parents of a child who had surgery, the most important information to include is:
[a] The name of the anesthesiologist.
[b] The cost of the procedure.
[c] Signs and symptoms that require a call to the surgeon.
[d] A list of suggested television shows for the child to watch.
The primary purpose of administering a pre-operative sedative like midazolam to a child is to:
[a] Provide post-operative pain relief.
[b] Prevent nausea and vomiting.
[c] Reduce anxiety and ease separation from parents.
[d] Dry up oral secretions.
A nurse inspects a post-operative dressing and notes a small area of fresh bloody drainage. The initial action should be to:
[a] Remove the dressing immediately to inspect the wound.
[b] Notify the surgeon STAT.
[c] Reinforce the dressing and outline the drainage with a pen, noting the date and time.
[d] Apply a pressure dressing over the existing one.
The nurse knows that maintaining adequate hydration is critical post-operatively in children because they:
[a] Have a lower percentage of body water than adults.
[b] Are less likely to experience post-operative nausea.
[c] Have mature kidney function that conserves water efficiently.
[d] Have a higher metabolic rate and greater insensible fluid losses.
Which pre-operative teaching point is most appropriate for an adolescent preparing for surgery?
[a] Focus on playing with dolls to explain the procedure.
[b] Address concerns about body image and privacy, and involve them in decision-making.
[c] Explain that they will not feel any pain after the surgery.
[d] Keep information minimal to avoid causing anxiety.
The nurse must ensure which of the following is completed and on the chart before a child is transported to the operating room?
[a] The child's favorite toy.
[b] A copy of the child's birth certificate.
[c] A signed consent form, history and physical, and pre-op checklist.
[d] The parents' insurance card.
A child vomits shortly after arriving in the PACU. After ensuring the airway is clear, the nurse should position the child:
[a] In a supine position to promote rest.
[b] In a side-lying position to prevent aspiration.
[c] In a high-Fowler's position to reduce nausea.
[d] In the Trendelenburg position.
A key component of post-operative care related to temperature regulation in infants is to:
[a] Keep the infant uncovered to allow for heat dissipation.
[b] Administer antipyretics for any temperature over 37°C (98.6°F).
[c] Use cooling blankets to prevent hyperthermia.
[d] Prevent hypothermia using warm blankets or a radiant warmer.
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