Chapter 17: Surgical Care

32. A nurse discovers on the preoperative assessment that a patient has a condition that would require increased amounts of general anesthesia. The condition is _____.

ANS: alcoholism Individuals who use alcohol excessively usually require greater amounts of anesthesia.

22. A patient scheduled for a liver biopsy has given a nurse a list of medications routinely taken at home. Which medication should the nurse question? a. Aspirin b. Multivitamin c. Furosemide d. Acetaminophen

ANS: A Aspirin Aspirin is an anticoagulant, which can increase the risk of postoperative bleeding. Drugs that have been taken for a long time may require dose adjustments because of the effects of surgery or the effect of additional drugs, which may be held or modified.

8. A nurse is performing a postoperative assessment on a patient who has just returned from a hernia repair. The patient's blood pressure is 90/60 mm Hg, and the apical pulse is 108 beats/min. What should be the nurse's first action? a. Check the dressing for bleeding. b. Notify the registered nurse (RN). c. Document the vital signs. d. Increase the rate of infusion of intravenous fluids.

ANS: A Check the dressing for bleeding A decrease in blood pressure and tachycardia could indicate postoperative bleeding. The first action of the nurse should be to check the dressing and then report to the RN.

5. A nurse is caring for a postoperative patient who has had spinal anesthesia. Which assessment is a priority for this patient? a. Complaints of a headache b. Pulse rate of 78 beats/min c. Voided 300 mL d. Blood pressure of 126/78 mm Hg

ANS: A Complaints of a headache One complication of spinal anesthesia is postspinal headache, which is caused by the leaking of cerebrospinal fluid at the puncture site.

15. A nurse is doing an assessment of a patient who has returned from a cardiac catheterization and had conscious sedation. Which finding should the nurse report? a. Difficulty arousing the patient b. Blood pressure of 124/72 mm Hg c. Oxygen saturation of 96% d. Patient complaints of the need to void

ANS: A Difficulty arousing the patient Conscious sedation uses intravenous drugs to reduce pain intensity or awareness without a loss of reflexes. A complication may be excessive sedation approaching that of general anesthesia. The patient should be easily aroused.

26. Why should a nurse assess a patient's limbs and position the limbs frequently after a regional anesthesia? a. Pain is not perceived, although motion is possible. b. Rashes and skin eruptions would indicate an allergy. c. Permanent paralysis is a concern. d. Contracture deformities may occur.

ANS: A Pain is not perceived, although motion is possible. After a regional anesthesia, movement is possible, but pain is not perceived immediately after surgery, which leaves the patient susceptible to injury.

19. A nurse is assisting in the transfer of a postoperative patient from the postanesthesia care unit to the surgical nursing unit. What action should the nurse implement to ensure the safety of the patient? a. Put the side rails up after moving the patient from the stretcher to the bed. b. Ask the patient to move from the stretcher to the bed. c. Move the patient rapidly from the stretcher to the bed. d. Uncover the patient before transferring from the stretcher to the bed.

ANS: A Put the side rails up after moving the patient from the stretcher to the bed The patient will probably still be experiencing residual effects of anesthesia; the side rails should be up to prevent the patient from falling out of bed.

29. A patient has an extensive bowel preparation of oral laxatives and enemas for a colon resection. What rationales should the nurse list when asked about the rigorous preparation? (Select all that apply.) a. Reduces possibility of fecal contamination of the operative site b. Flattens the colon c. Decreases postoperative distention d. Avoids postoperative constipation e. Decreases straining at stool

ANS: A, C, D, E Reduces possibility of fecal contamination of the operative site Decreases postoperative distention Avoids postoperative constipation Decreases straining at stool Preoperative bowel prep reduces the risk for infection from bowel contents and decreases postoperative distention, constipation, and straining at stool.

28. Patients with preoperative disorders put them at risk during recovery. What disorders should a nurse be aware may pose this hazard? (Select all that apply.) a. Diabetes b. Warfarin therapy c. Fungal skin infection d. Hepatitis C e. Chronic obstructive pulmonary disease (COPD)

ANS: A, D, E Diabetes Hepatitis C Chronic obstructive pulmonary disease (COPD) Diabetes, hepatitis C, and COPD all complicate recovery related to blood-clotting deficiencies, respiratory problems, or disturbance in the healing process. Warfarin therapy is not a disorder and should have been discontinued well before surgery, and fungal skin infections do not pose a threat.

9. A postoperative patient who has no previous medical conditions is difficult to arouse when transferred to the surgical unit from the postanesthesia care unit. A nurse monitors the pulse oximeter and gets a reading of 85%. What should be the nurse's next action? a. Assess the pulse oximeter reading again in 1 hour. b. Arouse the patient, have him cough, and encourage deep breathing. c. Administer a dose of pain medication. d. Suction fluid from the oral cavity.

ANS: B Arouse the patient, have him cough, and encourage deep breathing If the pulse oximeter reading is less than 90%, the patient should be aroused and encouraged to take deep breaths. The patient's respirations may not be adequate as a result of the effects of anesthesia.

4. Which technique should a nurse implement when changing a postoperative dressing? a. Enteric isolation b. Aseptic technique c. Clean technique d. Respiratory isolation

ANS: B Aseptic technique The aseptic technique is important to reduce the risk of infection.

21. A patient has just returned to the surgical unit after varicose vein stripping and ligation. What is the best technique for a nurse to evaluate pain relief? a. Check the patient's record for the last dose of pain medication administered. b. Ask the patient to rate the severity of the pain on a scale of 1 to 10. c. Ask the family if they think that the patient is having pain. d. Tell the patient to ask for pain medicine when it is needed.

ANS: B Ask the patient to rate the severity of the pain on a scale of 1 to 10. Having the patient rate the pain provides a system for evaluating response to the pain medication. Pain is controlled better if treated before it becomes severe, and the patient may not ask for pain medicine soon enough.

3. A patient who had a hysterectomy yesterday has not been allowed food or drink by mouth (NPO). The physician has now ordered the patient's diet to be clear liquids. What should the nurse assess prior to providing this patient with clear liquids? a. Feelings of hunger b. Bowel sounds c. Positive Homans sign d. Gag reflex

ANS: B Bowel sounds The absence of bowel sounds would contraindicate a diet of clear liquids.

24. What should a nurse suggest to a patient to prevent the effects of postoperative immobility on the gastrointestinal system? a. Avoid taking antibiotics. b. Increase her fluid intake. c. Avoid high-fiber foods. d. Limit her activity for the first 3 to 4 days.

ANS: B Increase her fluid intake. The intake of oral fluids and ingestion of a normal diet help stimulate peristalsis.

27. A patient who received Penthrane as an inhaled anesthesia complains of a sore throat and a raspy voice. What should the nurse explain as the probable cause of these discomforts? a. Drying effect of the anesthesia b. Insertion of an endotracheal tube c. Postsurgical dehydration d. Possible upper respiratory infection

ANS: B Insertion of an endotracheal tube Inhalant anesthesia is administered via an endotracheal tube that is inserted after the patient is unconscious.

16. What is the goal of palliative surgery? a. Remove and study tissue to make a diagnosis. b. Relieve symptoms or improve function without correcting the basic problem. c. Remove diseased tissue or correct defects. d. Correct serious defects that only affect appearance.

ANS: B Relieve symptoms or improve function without correcting the basic problem Palliative surgery is performed only to relieve symptoms or to improve function. It is not curative.

31. What are the responsibilities of a circulating nurse? (Select all that apply.) a. Assisting the surgeon with the procedure b. Setting up the surgical room c. Scrubbing in to handle instruments d. Maintaining patient safety e. Documenting nursing care

ANS: B, D, E Setting up the surgical room Maintaining patient safety Documenting nursing care The circulating nurse is in charge of the operating room, monitors asepsis, provides supplies, and documents patient care. The first assistant helps the surgeon with the procedure and the scrub nurse handles the instruments.

30. A nurse carefully monitors an obese patient after a hysterectomy for the peculiar postoperative complications. Which postoperative complications are associated with obesity? (Select all that apply.) a. Nausea b. Wound infection c. Hypertension d. Hemorrhage e. Respiratory difficulties

ANS: B, E Wound infection Respiratory difficulties Obese patients are especially prone to postoperative respiratory complications of pneumonia and atelectasis. Obese patients are at increased risk for infection because of the amount of adipose tissue.

2. A nurse is caring for a postoperative patient. What should the nurse ask when assessing for the complication of malignant hyperthermia? a. "Do you think you might have a fever?" b. "Do you currently have an infection?" c. "Has anyone in your family ever had problems with general anesthesia?" d. "Have you ever had any type of malignancy?"

ANS: C "Has anyone in your family ever had problems with general anesthesia?" Malignant hyperthermia is a life-threatening complication that occurs in response to certain drugs. Susceptibility to this response is inherited.

17. What information should a nurse ask a patient during the preoperative assessment? a. Current address and telephone number b. Food preferences c. Allergies, medications, and past medical conditions d. Bathing and sleep patterns

ANS: C Allergies, medications, and past medical conditions If an emergency should arise, any allergies can be promptly managed. Knowledge of the patient's medications can enable the nurse to anticipate possible drug interactions. Past medical conditions may increase surgical risks or require special attention during the perioperative period.

14. When obtaining a patient's signature on the surgical consent form, the patient seems confused about the procedure to be performed. What is the most appropriate response by the nurse? a. Tell the patient to talk to the physician after he or she gets to the surgical department. b. Ask the patient to go ahead and sign the consent. c. Ask the patient what the physician told him and then call the physician if necessary. d. Encourage the patient to ask his family what the physician told them.

ANS: C Ask the patient what the physician told him and then call the physician if necessary The patient may not understand some of the medical terms used by the physician, and the nurse may be able to explain them. If the patient needs further information, notify the physician. The physician is responsible for explaining the procedure and the risks to the patient.

7. During a nurse's preoperative assessment, the nurse notices that a patient is extremely anxious. The patient's blood pressure is 142/92 mm Hg, the heart rate is 104 beats/min, and respirations are 32 breaths/min. What nursing action should be implemented? a. Give the preoperative medicine early to help calm the patient. b. Call the surgical department and cancel the surgery. c. Notify the anesthesiologist or surgeon. d. Instruct the patient on possible postoperative complications.

ANS: C Notify the anesthesiologist or surgeon When significant fear is associated with surgical complications, sometimes surgery is postponed until the anxiety level is reduced.

23. A patient scheduled for a bronchoscopy is placed on an NPO status after midnight before the procedure. The patient is complaining of being thirsty and requests some water on the morning of the procedure. What action should the nurse implement? a. Deny any oral fluid per order. b. Allow 8 oz of tap water. c. Offer limited ice chips. d. Administer only carbonated drinks.

ANS: C Offer limited ice chips Patients are given nothing by mouth from midnight before the scheduled procedure to reduce the risk of vomiting and aspiration during or after the procedure. Recent practice allows small amounts of fluid or ice chips during the day of surgery.

13. Which modification should the nurse implement when caring for a postoperative patient after cataract surgery? a. Early ambulation is not necessary. b. Remove the dressing immediately. c. Omit instructions relative to coughing. d. Omit use of an incentive spirometer for deep breathing.

ANS: C Omit instructions relative to coughing There are only a few instances in which coughing is contraindicated. They include surgeries for hernias, cataracts, and brain surgery.

25. A postanesthesia care nurse is evaluating a patient for possible transfer to the surgical unit. Which assessment should prevent the patient's transfer? a. Blood pressure of 126/78 mm Hg b. Pulse rate of 82 beats/min c. Pulse oximeter reading of 85% d. Respirations of 22 breaths/min

ANS: C Pulse oximeter reading of 85% The pulse oximeter reading should be 95% to 100%. The patient should not be transferred from the recovery room until the vital signs are stable, respiratory and circulatory functions are adequate, pain is minimal, the patient is easily awakened, no complications have been experienced, and the gag reflex is present.

12. The suprapubic area of a postoperative patient is distended. The patient states that he has not voided since surgery approximately 9 hours ago. What should be the nurse's first action? a. Notify the head nurse or physician. b. Insert a catheter and document insertion. c. Seat the patient on the side of the bed to try to void. d. Prepare the patient to return to surgery.

ANS: C Seat the patient on the side of the bed to try to void. The patient should be encouraged to try to void in a natural position before other measures are taken. Seated on the bedside or on a bedside commode may make urination easier.

18. Which member of the surgical team administers anesthetics and monitors the patient's status throughout the procedure? a. Surgeon b. Circulating nurse c. Perfusionist d. Anesthesiologist

ANS: D The anesthesiologist and nurse anesthetist have special training and are the members of the surgical team that administer anesthesia and are responsible for closely monitoring the patient during surgery.

6. What should a nurse ensure that a postoperative patient implement to best prevent deep vein thrombosis (DVT)? a. Splint the incision. b. Cough and deep breathe every 2 hours. c. Regularly remove antiembolism stockings. d. Ambulate frequently.

ANS: D Ambulate frequently. DVT is best prevented by early and frequent ambulation of the patient.

11. A nurse should include the proper use of an incentive spirometer in teaching a preoperative patient. What postoperative assessment of this patient would reveal that the incentive spirometry teaching has been effective? a. Adventitious breath sounds b. Expiratory wheezing c. Thick, green respiratory secretions d. Clear breath sounds

ANS: D Clear breath sounds An incentive spirometer is used to promote lung expansion, which opens airways, reduces atelectasis, and stimulates coughing to clear secretions.

20. A patient who has just undergone a colon resection complains to a nurse that he felt something pop under his dressing while trying to get out of bed. The nurse removes the dressing and finds that dehiscence of the wound has occurred. What nursing action should be implemented first? a. Replace the dressing; dehiscence is normal. b. Call the physician. c. Pull the wound edges together and replace the dressing. d. Cover the wound with sterile dressings saturated with normal saline.

ANS: D Cover the wound with sterile dressings saturated with normal saline The first action of the nurse should be to cover the wound with saline-saturated dressings to prevent damage of the exposed organs from drying and then to call the physician.

1. A postoperative patient is complaining of incisional pain. An order has been given for morphine every 4 to 6 hours as needed (PRN). What should the nurse assess first? a. Assess for the presence of bowel sounds. b. Assess pupillary reaction. c. Ask the patient's family if she is having pain. d. Determine when the patient last received pain medication.

ANS: D Determine when the patient last received pain medication Verifying the time of the last dose decreases the risk of a dose of medication being given too soon.

10. A nurse has completed giving discharge instructions to a patient after a hernia repair. What verbalization by the patient should lead the nurse to determine that the patient understands the instructions? a. Go back to work tomorrow. b. Do not change the dressing until he sees his physician in 2 weeks. c. Ignore changes in the size of his abdomen. d. Report fever, redness, swelling, or increased pain at the incision site.

ANS: D Report fever, redness, swelling, or increased pain at the incision site The patient should report any signs and symptoms of infection (e.g., fever, redness, swelling, pain).