Chapter 17 Preoperative Nursing Practice Questions
In order to prevent the possibility of venous stasis, a nurse is teachning a surgical pt how to perform leg exercises. Which of the pt's following statement indicates a sound understanding of leg exercises? *a.* "I'll practice these now and try to start them as soon as I can after my surgery." *b.* "I'll make sure to do these, as long as my doctor doesn't tell me to stay on bedrest after my operation. *c.* "I'm pretty sure my stomach muscles are strong enough to lift both my legs off the bed at the same time" *d.* "I'll try to do these lying on my stomach so that I can bend my knees more fully."
Answer: A
The nurse is preparing a pt for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is are that which type of anesthesia is commonly used for this procedure? *a.* conscious sedation *b.* spinal anesthesia *c.* epidural anesthesia *d.* nerve block
Answer: A
The nurse is preparing to send a patient to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the pt. What is the nurses best action to the request? *a.* Inform the physician that it is his or her responsibility to obtain the signature *b.* inform the physician that the nurse manager will need to obtain the signature *c.* call the house officer to obtain the signature *d.* obtain the signature and ask another nurse to cosign the signature
Answer: A
The nurse is providing teaching to a patient regarding pain control after surgery. What time does the nurse inform the patient is the best time to request pain medication? *a.* before the pain becomes severe *b.* after the pain becomes severe and relaxation techniques have failed *c.* when the patient experiences pain rating of "10" on a 1-10 pain scale *d.* when there is no pain, but it is time for the medication to be administered
Answer: A
Upon assessment, a pt reports that he drinks 5-6 beers every evening after work. Based upon this information, the nurse is aware that the pt may require which of the following? *a.* larger doses of anethetic agents and larger doses of post op analgesics *b.* lower does of anesthetic agents and lower does of post op analgesics *c.* larger does of anesthetic agents and lower does of post op analgesics *d.* lower doses of anesthetic agents and larger doses of post op analgesics
Answer: A
Which of the following patients most likely requires special preoperative assessment and treatment as a result of his or her existing medication regimen? *a.* a woman who take daily anticoagulants to treat atrial fib. *b.* a woman who takes a daily thyroid supplement to treat her longstanding hypothyroidism. *c.* a man who regularly treats his rehumatoid arthritis with OTC NSAIDs. *d.* a man who takes an angiotensin converting enzyme inhibitor because he has hypertension
Answer: A
A postoperative client asks the nurse why it is so important to deep-breathe and cough after surgery. When formulating a response, the nurse incorporates the understanding that retained pulmonary secretions in a postoperative client can lead to which condition? *A.* Pneumonia *B.* Hypoxemia *C.* Fluid imbalance *D.* Pulmonary embolism
Answer: A >Postoperative respiratory problems are atelectasis, pneumonia and pulmonary emboli. Pneumonia is the inflammation of lung tissue that causes productive cough, dyspnea, and lung crackles and can be caused by the retention of pulmonary secretions.
The nurse is reviewing a prescription sheet for preoperative client that states that he client must be NPO after midnight. The nurse would telephone the physician to clarify that which medication should be given to the client and not withheld? *A.* Prednisone *B.* Ferrous sulfate *C.* Cyclobenzaprine (Flexeril) *D.* Conjugated estrogen (Premarin)
Answer: A >Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the ability of the body to withstand stress. When stress is severe corticosteroids are essential to life. Before and during surgery, dosages may be increased temporarily. These last few medications may be withheld before surgery without undue effects on the client.
The nurse receives a telephone call from the postanesthesia care unit stating that a client is being transferred to the surgical unit. The nurse plans to take which action first on arrival of the client? *A.* Assess the patency of the airway *B.* Check tubes or drains for patency *C.* Check the dressing to assess for bleeding *D.* Assess the vital signs to compare with preoperative measurements
Answer: A >The first action of the nurse is to assess the patency of the airway snd respiratory function. If the airway is not patent, the nurse must take immediate measures for the survival of the client. The nurse then takes vital signs followed by checking of the dressing and tubes or drains.
The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? *A.* Urine output of 20ml/hour *B.* Temperature of 37.6 C *C.* Blood pressure of 114/70 *D.* Serous drainage on the surgical dressing
Answer: A >Urine output should be maintained at a minimum of 30mL/hour for an adult. An output of less than that for each of 2 consecutive hours should be reported to the health care provider.
The telemetry unit nurse is reviewing lab results for an operative procedure later in the day. The nurse notes on the lab report that the pt has a serum potassium level of 6.5 mEq/L. The nurse informs the physician of this lab result because the nurse recognizes this increases the pts risk for which of the following? *a.* infection *b.* cardiac problems *c.* bleeding and anemia *d.* fluid imbalances
Answer: B
Following a successful coronary artery bypass graft, a 71 year old male pt has been transferred to the PACU. What is the priority for the pt's nursing care during this stage of recovery? *a.* protecting and maintaining airway *b.* positioning the pt to prevent skin breakdown *c.* treating the pts pain *d.* preventing incisional infection and monitoring for s/s of infection
Answer: A
A 54 year old female pt has been scheduled for a bunionectomy which will be conducted on an ambulatory basis. Which of the following characteristics applies to this type of surgery? *a.* the pt will be admitted the day of surgery and return home the same day *b.* the surgery is classified as urgent rather than elective *c.* the surgery will be conducted using moderate sedation rather than general anesthesia *d.* the pt must be previously healthy with low surgical risks
Answer: A
A patient is returning to the floor after orthopedic surgery is complaining of nausea. the nurse is aware that an appropriate intervention is to do which of the following? *a.* avoid strong smelling foods *b.* hold all meds *c.* provide clear liquids with a straw *d.* avoid oral hygiene until nausea subsides
Answer: A
A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse recognizes that this type of surgery is categorized as which of the following? *a.* constructive surgery *b.* transplantation surgery *c.* palliative surgery *d.* reconstructive surgery
Answer: A
A client who has had abdominal surgery complains of feeling as though "something gave way" in the incisional site. The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing interventions should the nurse take? Select all that apply *A.* Contact the surgeon *B.* Instruct the client to remain quiet *C.* Prepare the client for wound closure *D.* Document the findings and actions taken *E.* Place a sterile saline dressing and icepacks over the wound *F.* Place the client in a prone position without a pillow under the head.
Answer: A,B,C,D >Wound dehiscence is the separation of the wound edges. Wound evisceration is protrusion of the internal organs through an incision. If wound dehiscence or evisceration occurs, the nurse should call for help, stay with the client, and ask another nurse to contact the surgeon and obtain needed supplies to care for the client. The nurse places the client in a low fowlers position and the client is kept quite and instructed not to cough. Protruding organs are covered with a sterile saline dressing. Ice is not applied because of its vasoconstrictive effect. The treatment for evisceration is usually immediate wound closure under local or general anesthesia. The nurse also documents the findings and actions taken.
A 51 year old woman with a dx of breast cancer has been scheduled for a unilateral mastectomy. Which of the following categorizations of surgical procedures are represented in this case? *a.* diagnostic *b.* constructive *c.* reconstructive *d.* palliative *e.* ablative
Answer: A,E
The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebtitis. When should the nurse teach the correct technique for leg exercises to a patient? *A.* upon transfer from post anesthetic care unit to the post surgical unit *B.* prior to surgery *C.* when early signs of venous stasis are evident *D.* in post anesthetic recovery
Answer: B
The nurse assess a client's surgical incision for signs of infection. Which finding by the nurse would be interpreted as a normal finding at the surgical site? *A.* Red, hard skin *B.* Serous drainage *C.* Purulent drainage *D.* Warm tender skin
Answer: B >Serous drainage is an expected finding at a surgical site. The other options indicate signs of wound infection. Wound infection usually appears 3 to 6 days after surgery.
A client who has undergone preadmission testing, has had blood drawn for serum lab studies, including a complete blood count, coagulation studies and electrolytes and creatine levels. Which lab result should be reported to the surgeon's office by the nurse, knowing that it could cause surgery to be postponed? *A.* Sodium, 141mEq/L *B.* Hemoglobin, 8.0 g/dL *C.* Platelets, 210,000/mm3 *D.* Serum creatine, 0.8 mg/dL
Answer: B >The complete blood count includes the hemoglobin analysis. All these values are within normal range except for hemoglobin. If a client has a low hemoglobin level, the surgery likely could be postponed by the surgeon
A PACU nurse has received a semiconscious patient form the operating room and reviews the chart for orders related to positioning of the patient. There are no specific orders on the chart related to specific orders for the patient's position. in this situation, in what position will the nurse place the patient? *a.* supine *b.* prone *c.* side-lying *d.* trendelenburg
Answer: C
A pt has presented to a clinic for a presurgical consult, during which the pt has expressed concern about having to fast before surgery. Current recommendations for preop fasting include which of the following? *a.* pts generally must eat or drink nothing after midnight the night before surgery *b.* new recommendations allow eating and drinking until just prior to anesthetic being administered *c.* pts can usually eat or drink up to 2 hours prior to surgery *d.* preop fasting is still often recommended, even though it is medically unnecessary
Answer: C
The nurse has entered the room of a patient who is postop day one and found the patient grimacing and guarding her incision. The patient refuses the nurse's offer of PRN anlgesia and on discussion, states that this refusal is motivated by his fear of becoming addicted to pain meds. How should the nurse respond to the patient's concerns? *a.* "Actually people who are not addicted to drugs before thier surgery never develop a tolerance or addiction during recovery." *b.* "The hospital has excellent resources for dealing with any addiction that might result from the pain med you take." *c.* "Research has shown that there is very little risk of patients becoming addicted to painkillers after they have surgery." *d.* "You should remind yourself that treating your pain is important now, and that dealing with any resulting dependency can come later."
Answer: C
The operating room is aware that which of the following patients are at a greater risk related to a surgical procedure? *a.* an 8 year old boy *b.* a 48 year old man *c.* an 83 year old woman *d.* a 34 year old woman
Answer: C
The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid. The nurse determines that the client needs additional teaching if the client makes which statement? *A.* "Aspirin can cause bleeding after surgery." *B.* "Aspirin can cause my ability to clot blood to be abnormal." *C.* "I need to continue to take the aspirin until the day of surgery." *D.* "I need to check with my HCP about the need to stop the aspirin before the scheduled surgery."
Answer: C >Anticoagulants altered normal clotting factors and increase the risk of bleeding after surgery. Aspirin has properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. However, the client should always check with his or her health care provider regarding when to stop taking the aspirin when a surgical procedure is scheduled.
A preoperative client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse? *A.* "If it's any help, everyone is nervous before surgery." *B.* "I will be happy to explain the entire surgical procedure with you." *C.* "Can you share with me what you've been told about your surgery?" *D.* "Let me tell you about the care you'll receive after surgery and the amount of pain you can anticipate".
Answer: C >Explanations should begin with the information that the client knows. By providing the client with individualized explanations of care and procedures, the nurse can assist the client in handling anxiety and fear for a smooth preoperative experience. Clients who are calm and emotionally prepared for surgery withstand anesthesia better and experience fewer postoperative complications.
The nurse is developing a plan of care for a client scheduled for surgery. The nurse should include which activity in the nursing care plan for the client on the day of surgery? *A.* Avoid oral hygiene and rinsing with mouthwash *B.* Verify that the client has not eaten for the last 24 hours *C.* Have the client void immediately before going into surgery *D.* Report immediately any slight increase in BP or pulse
Answer: C >The nurse would assist the client to void immediately before surgery so that the bladder will be empty. Oral hygiene is allowed, but the client should not swallow any water. The client usually has a restriction of food and fluids for 6 to 8 hours before surgery instead of 24 hours. A slight increase in BP and pulse is common during the preoperative period due to anxiety.
A pt had an open cholecystectomy 36 hours earlier, and the nurse's assessment this morning confirms that the pt has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding? *a.* increase the rate of the pts IV infusion *b.* contact the physician to come assess the pt *c.* administer a cleansing enema *d.* monitor the pt closely and promote fluid intake
Answer: D
Upon admission for an appendectomy, the pt provides the nurse with a document that specifies instructions his healthcare team should follow in the event he is unable to communicate these wishes post op. What is the document best known as? *a.* informed consent *b.* pt's bill of rights *c.* insurance card *d.* advance directive
Answer: D
Which of the following nursing interventions is most likely to prevent respiratory complications such as pneumonia and atelectasis in a post surgical patient? *a.* control of anxiety and agitation *b.* adequate nutrition and fluids *c.* adequate pain control *d.* use of incentive spirometry
Answer: D
A client with a perforated gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse should take which most appropriate action in the care of this client? *A.* Obtain a court order for the surgery. *B.* Have the charge nurse sign the informed consent immediately *C.* Send the client to surgery without the consent form being signed *D.* Obtain a telephone consent from a family member, following agency policy
Answer: D >Every effort should be made to obtain permission from a responsible family member to perform surgery if the client is unable to sign the consent form. A telephone consent must be witnessed by two persons who hear the family member's oral consent. The two witnesses then sign the consent with the name of the family member, noting that an oral consent was obtained. Consent is not informed if it is obtained from a client who is confused, unconscious, mentally incompetent, or under the influence of sedatives. In an emergency the client may not be able to sign and family members may not be available. In this situation, a health care provider is permitted legally to perform surgery without consent, but tin this case it is not an emergency. Agency policies regarding informed consent should always be followed.
The nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse should include which piece of information in discussions with the client? *A.* Inhale as rapidly as possible *B.* Keep a loose seal between the lips and the mouthpiece *C.* After maximum inspiration, hold the breath for 15 seconds and exhale. *D.* The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees
Answer: D >For optimal lung expansion with the incentive spirometer, the client should assume the semi-Fowlers or high fowlers position. The mouthpiece should be covered completely and tightly while the client inhales slowly, with a constant flow through the unit. The breath should be held for 5 seconds before exhaling slowly.