Med Surg 2 Chap 4

The nurse is aware that the older adult is a greater surgical risk because the older adult has: (Select all that apply.) a. fewer physiologic reserves. b. more probability of a chronic illness. c. more vulnerability to fluid loss. d. less tolerance for pain. e. less psychological stamina.

ANS: A, B, C The older adult does have less physiologic reserves, more probability for a chronic illness, and more vulnerability to fluid loss. There is no indication that the older adult has less tolerance for pain or less psychological stamina.

The LPN/LVN is in the patient's room while the charge nurse is obtaining the patient's signature on the surgical consent form. The patient states, "I didn't really understand what my surgeon explained, but I trust him completely." Which response by the charge nurse is correct? a. "I need to contact your surgeon so your questions can be answered." b. "I can answer any questions that you might have regarding your surgery." c. "As long as you are comfortable, then you may sign the consent form." d. "Maybe we should call your surgeon to be sure it is okay to sign the consent."

ANS: A An informed consent means that the surgeon has supplied information regarding the procedure itself, as well as the risks and benefits, and that the patient understands this information. The nurse's responsibility is witnessing the signing of the form and ensuring the patient understands what the surgeon has discussed, not providing information if the patient has no understanding of the procedure.

The presurgical patient asks why it is that her height and weight are recorded. The nurse replies that the information is essential for: a. calculating anesthesia dose. b. predicting blood loss. c. assessing respiratory volume. d. anticipating fluid needs.

ANS: A Height and weight are used to calculate anesthesia dosages.

The nurse clarifies that the difference between regional anesthesia and procedural sedation anesthesia is that procedural sedation anesthesia uses: a. IV sedation and regional anesthesia. b. general anesthesia and IV sedation. c. alternative medicine herbs and regional anesthesia. d. IV sedation and local anesthesia.

ANS: A Procedural sedation anesthesia uses both IV sedation and regional anesthesia.

The nurse is reviewing the presurgical patient's lab reports and notes an elevated aspartate aminotransferase (AST) and bilirubin. The nurse is most concerned that this patient is at risk for: a. excessive bleeding during or after surgery. b. an increased serum albumin level. c. postsurgical respiratory infection. d. delayed wound healing.

ANS: A The AST and bilirubin are liver studies. Elevated levels may indicate a dysfunctional liver. The liver is directly involved with clotting factors; therefore, this patient would be at risk for excessive bleeding. The serum albumin level would most likely be decreased if the liver is not functioning properly. Postsurgical wound infection and delayed wound healing risks are not directly related to liver function.

A(n) ________________ allows a patient to donate her own blood to be used during or after surgery.

ANS: autologous transfusion An autologous transfusion is one in which the patient has donated her own blood to be used during or after surgery.

The nurse determines that the patient demonstrates an understanding of preoperative teaching with which responses? (Select all that apply.) a. "I will need to sign a consent form before I am given my medications prior to my surgery." b. "The surgeon will want me to ambulate as soon as possible after my surgery." c. "My nurse will want me to take the deepest breaths I can tolerate following my surgery." d. "I may experience some constipation if I am taking much pain medication after my surgery." e. "The general anesthesia will prevent me from having pain for the first 24 hours after surgery."

ANS: A, B, C, D Consent forms must be signed before preoperative pain medications are administered; early ambulation is common with most surgeries; deep breaths prevent postoperative respiratory complications; and constipation is common with the use of narcotic analgesics. General anesthesia does not prevent pain 24 hours after surgery, so this statement demonstrates the need for further preoperative teaching.

The nurse reinforces that the purpose of preoperative medication is to: (Select all that apply.) a. reduce anxiety. b. decrease mucus secretion. c. counteract nausea. d. synergize anesthesia. e. enhance ventilation.

ANS: A, B, C, D Preoperative medications are given to reduce anxiety, decrease mucus production, counteract nausea, and enhance anesthesia. Many preoperative medications depress ventilation.

MULTIPLE RESPONSE 20. The patient questions the nurse about robotics surgery. The nurse correctly responds, "Robotics: (Select all that apply.) a. gives the surgeon greater magnification than the human eye." b. allows the surgeon to be more precise than normal." c. allows for a smaller incision." d. increases healing time." e. procedures generally cause less postoperative pain."

ANS: A, B, C, E Robotics have 12 times magnification of the operative site, steady "hands," and use a smaller incision, which results in less postoperative pain. Healing time is decreased with robotics.

The nurse recognizes a need for further instruction about the emotional preparation for surgery when a patient says: a. "I'm going to hug my surgeon tomorrow." b. "My fate is in the hands of my surgeon. I'm frightened about the outcome." c. "I'll be ready for a cheeseburger when I get back." d. "I know I may have some pain, but this gallbladder will be gone when I wake up."

ANS: B This response demonstrates the patient's fear and insecurity, which warrant further discussion. Providing additional information or answering patient questions may help alleviate the patient's emotional unpreparedness for surgery. The plan for a cheeseburger indicates a potential need to further review nutrition in the postoperative period. The other responses demonstrate positive statements regarding the upcoming postsurgical period.

The patient received a preoperative dose of lorazepam (Ativan) 20 minutes ago. The safety precaution the nurse should take in regard to this drug is to: a. monitor respiratory status. b. raise bed rails. c. elevate the head of the bed 30 degrees. d. take seizure precautions.

ANS: B Raising the bed rails is a safety precaution against the dizziness and hypotension caused by this drug.

The patient refuses to take off her diamond wedding band prior to going to the operating room. The nurse should first: a. record in the chart that the patient refused to remove jewelry. b. tape the ring to finger, covering the ring. c. request that the patient sign a waiver to release the hospital from responsibility. d. alert the surgery team to the presence of the jewelry.

ANS: B Taping the ring will protect the ring and secure it to the finger. Care must be taken not to wrap the tape too tightly. The nurse will also need to document the presence of the ring on the preoperative checklist or in the nurse's notes. There is no need for a signature on a waiver. Most facilities have policies in which the patient signs a release of responsibility for valuables. There is no need to notify the surgical team of the presence of the ring.

The nurse warns the patient that, in order to retard the growth of microorganisms, the operating room is kept at a temperature of _____ to _____ degrees. a. 60; 65 b. 66; 70 c. 71; 74 d. 75; 77

ANS: B The operating suite is kept at a temperature of 66 to 70 degrees to discourage microbial growth.

The nurse is caring for a postsurgical patient whose surgical procedure lasted 3 hours. The nurse anticipates that the patient will experience: a. thrombophlebitis. b. muscle spasms. c. joint pain. d. hyperthermia.

ANS: C Long-term immobility places the patient at risk for pressure damage to skin and underlying tissues. Joint complaints are common after a long surgery. Thrombophlebitis, muscle spasms, and hyperthermia are complications that are not expected to occur.

The nurse working in a surgeon's office is providing preoperative teaching to a patient who is scheduled for a needle breast biopsy. Which statement by the patient demonstrates a need for further preoperative teaching? (Select all that apply.) a. "This procedure will help the doctor determine if I have breast cancer." b. "I will most likely have general anesthesia since this is a painful procedure." c. "The surgeon will need to perform this procedure within the next 24 to 48 hours." d. "I will have less breast pain after having this procedure performed." e. "I will not require any further treatment after this procedure is performed."

ANS: B, C, D, E A needle breast biopsy is a diagnostic procedure that is used to determine if cancer cells are present. This procedure typically requires only a local or regional anesthetic; procedures that must be performed within 24 to 48 hours are considered urgent procedures for immediate life-threatening conditions; indicating that less pain will be experienced describes a palliative procedure; and indicating that less breast pain will occur describes a curative procedure.

The nurse instructs the presurgical patient that hypothermia may occur during surgery due to: (Select all that apply.) a. warm atmosphere of the operating room. b. infusion of cool IV fluids. c. inhalation of cool anesthetic gases. d. exposure of body surfaces. e. lowered metabolism.

ANS: B, C, D, E The operating room is kept cool to inhibit growth of organisms. All other options listed are potential causes of hypothermia in the operating room.

Prior to administering the preoperative medication of Demerol and atropine, the nurse should confirm that: a. a family member is present. b. underwear is removed. c. a consent form is signed. d. bed rails are up.

ANS: C Consent forms must be signed prior to giving any sedative or preoperative drug. Removal of underwear and the raising of the side rails can be done after the administration of the drug. The family member does not have to present.

The patient has just been given medication to reverse neuromuscular blocking agents. The nurse is aware that the patient is in the general anesthetic stage of: a. induction. b. introduction. c. emergence. d. maintenance.

ANS: C Emergence is the stage of surgery in which surgery is completed and the patient is prepared to return to consciousness, and neuromuscular blocking agents are reversed.

1. The nurse is caring for a patient who has received epoetin alfa (Epogen) 2 to 3 weeks prior to a scheduled surgery. The nurse understands that this patient will likely: a. require an antibiotic immediately prior to surgery. b. have difficulty with blood clotting following surgery. c. not require a blood transfusion during surgery. d. develop an electrolyte imbalance during surgery.

ANS: C Epoetin alfa (Epogen) is given to increase red blood cell production prior to surgery with the goal of having a bloodless surgery. Epoetin alfa (Epogen) will not affect the need for an antibiotic preoperatively, nor will it cause difficulty with clotting or cause an electrolyte imbalance.

13. The nurse explains that the National Patient Safety Goals protocol requires that: a. a licensed caregiver accompany the patient to the operating room. b. side rails should be raised and head of bed elevated 30 degrees. c. surgical site be verified and marked. d. all prosthetic devices be identified.

ANS: C The National Patient Safety Goals require that the patient be identified, the surgical consent be signed and correct, and the surgical site be marked

Noting that the Asian patient was given atropine as a preoperative drug, the nurse will closely monitor for: a. oliguria. b. hyperventilation. c. hypotension. d. tachycardia.

ANS: D Asians often metabolize atropine differently from other populations. The drug can greatly accelerate the heart rate in the Asian patient.

The nurse is planning care for four postoperative patients. The nurse determines that the patient who is most likely to develop postoperative complications is the patient who is: a. 36 years old with a history of controlled diabetes. b. 52 years old with a history of hypothyroidism. c. 45 years old with a history of a myocardial infarction (MI). d. 79 years old with mild osteoarthritis.

ANS: D Patients over the age of 75 are 3 times more likely to experience surgical complications. The elderly patient is less able to adjust and compensate for the stress of surgery, as physiologic reserves (cardiac, respiratory, renal) have already declined with age.

The nurse explains that the person responsible for verifying that the consent form is signed and that the surgical site is marked is the: a. scrub nurse. b. surgeon. c. anesthesiologist. d. circulating nurse.

ANS: D The circulating nurse is responsible for confirming a signature on the consent form and marking the site for surgery.

The nurse is performing a preoperative assessment on a patient scheduled for surgery today. The patient reports a history of drinking 2 glasses of wine daily, smoking cigarettes for 20 years, completing a round of corticosteroids for asthma control 2 days ago, and taking the last dose of passion flower extract yesterday. The nurse's best action is: a. supply the patient with information on a smoking cessation class. b. warn the patient regarding the dangers of drinking alcohol on a daily basis. c. provide the patient with information regarding the use of herbal medications. d. notify the physician immediately regarding the recent use of corticosteroids.

ANS: D The use of corticosteroids reduces the body's response to infection and delays healing. Surgery may need to be delayed until the patient has been off the drug approximately 7 days. Providing the patient with information regarding smoking cessation is advisable but is not a priority at this time. Drinking 2 glasses of wine daily may not be a problem if not contraindicated by the patient's health status. Passion flower extract does not interfere with the surgery and poses no apparent problems.

The nurse reminds the patient that in laparoscopic surgery, with the small incision and less tissue trauma, there is less pain because of the diminished ______________.

ANS: inflammatory response There is less trauma, therefore less inflammatory response, which reduces pain

The _____________ functions within the sterile area of the operating room and maintains sterile technique

ANS: scrub nurse scrub person The scrub nurse is a licensed nurse or surgery technician who functions in the sterile area of the operating room and maintains sterility throughout the operative procedure.

During the course of surgery, a patient exhibits tachycardia, diaphoresis, and rising body temperature. The priority intervention by the circulating nurse is to: a. continue to monitor the patient for any further changes in condition. b. note the patient's oxygen saturation and blood pressure. c. ask the scrub nurse to verify the assessment findings. d. alert the anesthesiologist and surgeon immediately

ANS: D These are signs of malignant hyperthermia, along with arrhythmias, muscle rigidity, and hypotension. The anesthesiologist and surgeon should be notified immediately because malignant hyperthermia is a medical emergency

The nurse is aware that the 82-year-old patient returning from surgery will need special attention relative to: a. combating thirst. b. maintaining respiratory status. c. stabilizing blood pressure. d. maintaining core body temperature.

ANS: D Thirst, respiratory status, and blood pressure are all important considerations when caring for the postsurgical patient; however, maintaining core body temperature is a major concern with the older adult postsurgical patient.