. Thepostanesthesiacareunit (PACU)nursetransportstheinpatientsurgicalpatient tothe medical-surgicalfloor. Before leaving the floor, the medical-surgical
... [Show More] nurse obtains a complete set of vital signs. What is the
rationale for this nursing action?
a. This isdone tocompletethe firstactionina head-to-toe assessment.
This isdonetocompare and monitor for vitalsignvariationduring
b. transport.
This isdonetoensure that the medical-surgicalnursechecks onthe
c. postoperative patient.
This is donetofollow hospitalpolicyandprocedure forcareof the
d. surgicalpatient.
ANS: B
Before the PACU nurse leaves the acute care area, the staff nurse assuming care for the patient takes a complete set of vital signs to compare with PACU findings. Minor vital sign variations normally occur after
transporting the patient. The PACU nurse reviews the patient’s information with the medical-surgical nurse, includingthesurgicaland PACU course,physicianorders,andthepatient’s condition. Whilevitalsigns mayor may
not be the first action in a head-to-toe assessment, this is not the rationale for this situation. While following policy or ascertaining that the floor nurse checks on the patient are good reasons for safe care, they are not the
best rationale for obtaining vital signs.
2. The nurseis caring forapatient who willundergo a removalof alung lobe. Which levelofcare will thepatient require immediately post procedure?
a. Acutecare—medical-surgicalunit
b. Acutecare—intensivecare unit
c. Ambulatorysurgery
d. Ambulatorysurgery—extendedstay
ANS: B
Patients undergoing extensive surgery and requiring anesthesia of long duration recover slowly. If a patient is undergoing major surgery such as a procedure on the lung, a stay in the hospital and specifically in the
intensive care unit is requiredto monitor forpotential risks to well-being. This patient wouldrequire more care than can be provided on a medical-surgical unit. It is not appropriate for this type of patient to go home after
the procedure or to stay in an extended stay area of an ambulatory surgery area because of the complexity and associated risks [Show Less]