Priorities for the Preoperative Patient

Which gauge catheter should the nurse use when initiating intravenous (IV) access for a preoperative patient? 1) 18 2) 20 3) 22 4) 24

ANS: 1 Feedback 1 An 18-gauge catheter is used when initiating IV access for a perioperative patient as this is the gauge preferred for the administration of blood products. 2 This is not an appropriate gauge for the nurse to use when initiating IV access for a perioperative patient. 3 This is not an appropriate gauge for the nurse to use when initiating IV access for a perioperative patient. 4 This is not an appropriate gauge for the nurse to use when initiating IV access for a perioperative patient.

Which identifier should the nurse use during the initial time-out to determine the right patient? 1) Date of birth 2) Maiden name 3) Medical record number 4) Photo placed in the medical record

ANS: 1 Feedback 1 Date of birth is an identifier the nurse should use to determine the right patient during the initial time-out conducted during the preoperative period. 2 The patient's first and last name, not maiden name, are identifiers the nurse should use to determine the right patient during the initial time-out conducted during the preoperative period. 3 The patient's social security number, not medical record number, is an identifier the nurse should use to determine the right patient during the initial time-out conducted during the preoperative period. 4 A photo placed on the patient's identification band, not medical record, is an identifier the nurse should use to determine the right patient during the initial time-out conducted during the preoperative period.

Which is the priority nursing action when providing patient care during the preoperative phase of care? 1) Ensuring NPO status 2) Monitoring vital signs 3) Obtaining informed consent 4) Completing a preoperative checklist

ANS: 4 Feedback 1 While ensuring NPO status is important, this is not the priority nursing action. 2 While monitoring vital signs is important, this is not the priority nursing action. 3 The health-care provider, not the nurse, is responsible for obtaining informed consent. 4 The priority nursing action during the preoperative period is to complete the preoperative checklist prior to the patient being transferred to the surgical suite.

The nurse is conducting a medication assessment for a preoperative patient. Which action by the nurse is appropriate for the patient who is prescribed amiodarone? 1) Obtaining a baseline ECG 2) Monitoring blood pressure 3) Assessing for hyperglycemia 4) Tapering the drug two days prior to surgery

ANS: 1 Feedback 1 The prescribed drug is an antiarrhythmic; therefore, the most appropriate nursing action is to obtain a baseline ECG. 2 This nursing action is appropriate for a patient who is prescribed an antihypertensive drug. 3 This nursing action is appropriate for a patient who is prescribed a corticosteroid drug. 4 The nursing action is appropriate for a patient who is prescribed an anticoagulant drug.

Which should the nurse ask the patient to verify during the initial time-out, the "pause for cause"? 1) "What is the name of your surgeon?" 2) "Which procedure are you having done today?" 3) "Is the information on your identification band correct?" 4) "Which side of the body is your procedure going to be completed on?" 5) "Have you signed your informed consent for the scheduled procedure?"

ANS: 1, 2, 3, 4 Feedback 1. This is correct. This question is included in the initial time-out, the "pause for cause." 2. This is correct. This question is included in the initial time-out, the "pause for cause." 3. This is correct. This question is included in the initial time-out, the "pause for cause." 4. This is correct. This question is included in the initial time-out, the "pause for cause." 5. This is incorrect. This question is not included in the initial time-out. This information is included in the preoperative checklist.

The nurse is preparing an older adult patient for surgery. Which topics should the nurse focus on when preparing this patient's preoperative teaching? Select all that apply. 1) Level of hearing 2) Transportation needs of the patient after discharge 3) Teaching on deep breathing and coughing 4) Plans for discharge care 5) Actions to prevent pressure ulcers

ANS: 1, 3, 4, 5 Feedback 1. This is correct. For the older patient, make sure the patient can hear the information to be presented or provide information through alternative means. 2. This is incorrect. Transportation needs of the patient after discharge would not be part of the preoperative teaching plan. 3. This is correct. Older adults are at greater risk for pneumonia and other postoperative complications and should have teaching related to deep breathing and coughing. 4. This is correct. The older patient is going to need assistance once discharged and should have the necessary medical equipment such as walkers and raised toilet seats, assistance with transportation, or extended care. 5. This is correct. The older patient is at risk for pressure ulcer formation because of poor nutritional status, diabetes, cardiovascular illness, or history of steroid use.

When providing preoperative teaching for the patient who is scheduled for coronary artery bypass surgery in the morning, the nurse would include which topics? Select all that apply. 1) Location of incisions 2) Discharge information 3) Postoperative drains to expect 4) Postoperative pain management 5) Coughing and deep breathing exercises

ANS: 1, 3, 4, 5 Feedback 1. This is correct. The location of incisions is included in the preoperative teaching session. 2. This is incorrect. Discharge information is not included in the preoperative teaching session. 3. This is correct. Drains to expect after the surgical procedure is information included in the preoperative teaching session. 4. This is correct. Postoperative pain management is information included in the preoperative teaching session. 5. This is correct. Coughing and deep breathing exercises is information included in the preoperative teaching session.

The nurse performs preoperative teaching for a patient requiring a surgical intervention. Which actions by the patient indicate appropriate understanding of the information provided? Select all that apply. 1) Demonstrating how to turn and get out of bed 2) Having no anxiety about the impending surgery 3) Demonstrating proper performance of leg exercises 4) Demonstrating proper coughing and deep breathing 5) Asking questions about and voicing understanding of information provided

ANS: 1, 3, 4, 5 Feedback 1. This is incorrect. The nurse evaluates the patient's understanding through the questions asked and the return demonstration of skills performed. 2. This is incorrect. Although preoperative teaching can help to reduce anxiety, it is unlikely to completely eliminate fear. 3. This is correct. The nurse evaluates the patient's understanding through the questions asked and the return demonstration of skills performed. 4. This is correct. The nurse evaluates the patient's understanding through the questions asked and the return demonstration of skills performed. 5. This is correct. The nurse evaluates the patient's understanding through the questions asked and the return demonstration of skills performed.

Which laboratory test should the nurse include in the plan of care for a patient who may require a blood transfusion during the surgical procedure? 1) Urinalysis 2) Type and crossmatch 3) Basic metabolic panel 4) Arterial blood gas analysis

ANS: 2 Feedback 1 A urinalysis is not anticipated for a patient who may require a blood transfusion during a surgical procedure. 2 A type and crossmatch is anticipated for a patient who may require a blood transfusion during a surgical procedure. This will allow for type specific blood to be available for the patient if a transfusion is required. 3 A basic metabolic panel is not anticipated for a patient who may require a blood transfusion during a surgical procedure. 4 An arterial blood gas analysis is not anticipated for a patient who may require a blood transfusion during a surgical procedure.

The nurse is completing the preoperative checklist on the night shift in preparation for the patient's surgery, scheduled for 0800. Which tasks could the nurse complete at this time? 1) Documenting the time of last voiding 2) Checking the medical record for the history, physical, and signed informed consent 3) Administering preoperative medication 4) Removing the prosthesis

ANS: 2 Feedback 1 The nurse on day shift preparing to send the patient to surgery would document time of last voiding and administration of preoperative medication. 2 The nurse on night shift could check the medical record to ensure that a history and physical have been completed, and that the consent for surgery is signed. 3 The nurse on day shift preparing to send the patient to surgery would document time of last voiding and administration of preoperative medication. 4 Many patients prefer to wait until just before going to surgery before removing dentures, contact lenses, and other prostheses.

The nurse is conducting a medication assessment for a preoperative patient. Which action by the nurse is appropriate for the patient who is prescribed metoprolol? 1) Obtaining a baseline ECG 2) Monitoring blood pressure 3) Assessing for hyperglycemia 4) Tapering the drug two days prior to surgery

ANS: 2 Feedback 1 This nursing action is appropriate for a patient who is prescribed an antiarrhythmic. 2 The prescribed drug is an antihypertensive; therefore, the most appropriate nursing action is to monitor the patient's blood pressure. 3 This nursing action is appropriate for a patient who is prescribed a corticosteroid drug. 4 The nursing action is appropriate for a patient who is prescribed an anticoagulant drug.

A patient is informed that a surgical procedure is to be scheduled in two weeks. Which teaching points should the nurse focus to prepare the patient for the surgery? Select all that apply. 1) Maintaining a patent airway 2) Deep breathing and coughing 3) Caring for the surgical incision 4) Managing constipation 5) Managing pain

ANS: 2, 3, 4, 5 Feedback 1. This is incorrect. Maintaining a patent airway is a nursing action that is performed during the postoperative phase of surgical care. 2. This is correct. In the preoperative phase, when the patient is alert and oriented, the nurse should focus teaching on deep breathing and coughing exercises, care of the surgical incision, managing constipation, and managing pain. 3. This is correct. In the preoperative phase, when the patient is alert and oriented, the nurse should focus teaching on deep breathing and coughing exercises, care of the surgical incision, managing constipation, and managing pain. 4. This is correct. In the preoperative phase, when the patient is alert and oriented, the nurse should focus teaching on deep breathing and coughing exercises, care of the surgical incision, managing constipation, and managing pain. 5. This is correct. In the preoperative phase, when the patient is alert and oriented, the nurse should focus teaching on deep breathing and coughing exercises, care of the surgical incision, managing constipation, and managing pain.

The nurse is preparing a patient for emergency surgery to repair liver and colon lacerations caused by a motor vehicle crash. Which information about this type of surgery will the nurse use to guide the patient's care? Select all that apply. 1) An organ is going to be removed. 2) This is an emergency surgery. 3) The patient will be hospitalized longer. 4) The patient is at risk for blood loss. 5) The patient is at risk for hypothermia.

ANS: 2, 3, 4, 5 Feedback 1. This is incorrect. The suffix -ectomy indicates removal of an organ. The patient is having surgery to repair lacerations. No organ is identified for removal. 2. This is correct. Emergency surgery is performed when a condition is life-threatening. 3. This is correct. Surgery to control internal hemorrhage from lacerations is an example of emergency surgery. An open procedure usually requires a longer hospital stay. 4. This is correct. Open procedures place the patient at a higher risk for blood loss. 5. This is correct. If there is a large surgical opening, the patient cannot be adequately covered and will be exposed to cold surgical suite air, and can develop hypothermia.

The nurse is conducting a medication assessment for a preoperative patient. Which action by the nurse is appropriate for the patient who is prescribed dexamethoasone? 1) Obtaining a baseline ECG 2) Monitoring blood pressure 3) Assessing for hyperglycemia 4) Tapering the drug two days prior to surgery

ANS: 3 Feedback 1 This nursing action is appropriate for a patient who is prescribed an antiarrhythmic. 2 This nursing action is appropriate for a patient who is prescribed an antihypertensive drug. 3 The prescribed drug is a corticosteroid; therefore, the most appropriate nursing action is to assess the patient for hyperglycemia. 4 The nursing action is appropriate for a patient who is prescribed an anticoagulant drug.

The nurse is conducting a medication assessment for a preoperative patient. Which action by the nurse is appropriate for the patient who is prescribed phenobarbital? 1) Obtaining a baseline ECG 2) Monitoring blood pressure 3) Maintaining the drug during the perioperative period 4) Assessing blood glucose levels closely during the perioperative period

ANS: 3 Feedback 1 This nursing action is appropriate for a patient who is prescribed an antiarrhythmic. 2 This nursing action is appropriate for a patient who is prescribed an antihypertensive drug. 3 The prescribed drug is a medication used to control seizures; therefore, this drug should be maintained during the perioperative period. 4 The nursing action is appropriate for a patient who is prescribed insulin for diabetes management.

Which parameter for NPO status is appropriate when providing care to a pediatric patient in the preoperative period? 1) Ensuring nothing by mouth for six hours prior to the surgical procedure 2) Ensuring no solid foods by mouth for six hours prior to the surgical procedure 3) Allowing formula to be included in the child's intake for up to six hours prior to the surgical procedure 4) Allowing breast milk to be included in the child's intake for up to six hours prior to the surgical procedure

ANS: 3 Feedback 1 This parameter is not appropriate for the pediatric patient. 2 This parameter is not appropriate for the pediatric patient. Solid foods are allowed up to up eight hours prior to surgery. 3 The pediatric patient can have formula for up to six hours prior to surgery. 4 This parameter is not appropriate for the pediatric patient. Breast milk is allowed for up to four hours prior to surgery.

The nurse is preparing a patient, diagnosed with asthma, for surgery. Which should the nurse include in the plan of care for this patient? 1) Monitoring blood pressure every hour 2) Assessing bowel sounds twice per shift 3) Monitoring pulse oximetry continuously 4) Assessing deep tendon reflexes every hour

ANS: 3 Feedback 1 This parameter is not required when planning this patient's care. 2 This parameter is not required when planning this patient's care. 3 A patient diagnosed with asthma, who is scheduled for surgery, may have difficulty being weaned from the mechanical ventilator. This patient would require continuous pulse oximetry and arterial blood gas analysis in the plan of care. 4 This parameter is not required when planning this patient's care.

The nurse is reviewing the medical records for patients who are scheduled for surgery the next day. Which patient may not provide consent to receive blood products? 1) A Hispanic Catholic patient. 2) An African-American Baptist patient. 3) A Caucasian Jehovah's Witness patient. 4) A Native American patient with no religious affiliation.

ANS: 3 Feedback 1 This patient is likely to provide consent to receive blood products. 2 This patient is likely to provide consent to receive blood products. 3 A patient who is a Jehovah's Witness is not likely to provide consent to receive blood products during the perioperative period. 4 This patient is likely to provide consent to receive blood products.

Which is the priority action by the nurse when a patient discloses a medication allergy during the health history prior to a surgical procedure? 1) Asking the patient to describe the reaction that occurs 2) Documenting the information on the patient's medical record 3) Placing an alert bracelet on the patient prior to leaving the unit 4) Verifying the information with the patient's family members at the bedside

ANS: 3 Feedback 1 While it is important to determine the type of reaction the patient experiences, this is not the priority nursing action. 2 While it is important to document the information in the patient's medical record, this is not the priority nursing action. 3 The nurse should immediately place an alert bracelet on the patient and communicate this information with the surgical team. 4 It is not necessary to verify the information with the patient's family members at the bedside.

Which risk factor should the nurse include in the preoperative plan of care for a patient who smokes? 1) Angina pain 2) Gastrointestinal upset 3) Cognitive impairment 4) Respiratory depression

ANS: 4 Feedback 1 A patient who smokes is not at a greater risk for angina pain during the perioperative period. 2 A patient who smokes is not at a greater risk for gastrointestinal upset during the perioperative period. 3 A patient who smokes is not at a greater risk for cognitive impairment during the perioperative period. 4 A patient who smokes is at a greater risk for respiratory depression during the perioperative period.

The nurse administers the preoperative medication to the patient one hour before elective surgery, and then discovers the preoperative consent is not signed. Which action by the nurse is the most appropriate? 1) Have the patient sign the consent quickly, before the medication begins taking effect. 2) Have a family member or medical power of attorney sign the consent. 3) Send the patient to the holding area without a signed consent. 4) Notify the health-care provider that surgery will need to be canceled.

ANS: 4 Feedback 1 The nurse cannot have the patient sign the consent once the preoperative medication has been administered, because it affects the patient's ability to reason. 2 Emergency surgery, in some facilities, may be performed if a family member or medical power of attorney signs the consent when the patient is unable to do so, but elective surgery requires the patient's signature if she is capable of making a reasoned decision. 3 The nurse cannot send the patient to the holding area without a signed consent form. 4 The nurse will notify the health-care provider, who will need to cancel surgery until the preoperative medication is excreted and no longer affecting the patient's ability to make informed decisions, at which time the consent can be signed.

Which should the nurse teach the patient regarding NPO status prior to a surgical procedure? 1) Nothing by mouth for 12 hours prior to surgery 2) Nothing solid by mouth for six hours prior to surgery 3) No clear liquids by mouth for four hours prior to the surgery 4) No clear liquids by mouth for two hours prior to the surgery

ANS: 4 Feedback 1 This is not the guideline regarding NPO status prior to a surgical procedure. 2 This is not the guideline regarding NPO status prior to a surgical procedure. 3 This is not the guideline regarding NPO status prior to a surgical procedure. 4 The guidelines for NPO status prior to a surgical procedure is nothing solid by mouth for eight hours prior to the procedure and no clear liquids by mouth for two hours prior to the procedure. NPO status is meant to decrease the patient's risk for aspiration.

The nurse is conducting a medication assessment for a preoperative patient. Which action by the nurse is appropriate for the patient who is prescribed warfarin? 1) Obtaining a baseline ECG 2) Monitoring blood pressure 3) Assessing for hyperglycemia 4) Tapering the drug two days prior to surgery

ANS: 4 Feedback 1 This nursing action is appropriate for a patient who is prescribed an antiarrhythmic. 2 This nursing action is appropriate for a patient who is prescribed an antihypertensive drug. 3 This nursing action is appropriate for a patient who is prescribed a corticosteroid drug. 4 The prescribed drug is an anticoagulant; therefore, the most appropriate nursing action is to teach the patient to taper the drug for 48 hours prior to the surgical procedure.

The nurse is conducting a medication assessment for a preoperative patient. Which action by the nurse is appropriate for the patient who is prescribed insulin? 1) Obtaining a baseline ECG 2) Monitoring blood pressure 3) Holding the drug during the perioperative period 4) Assessing blood glucose levels closely during the perioperative period

ANS: 4 Feedback 1 This nursing action is appropriate for a patient who is prescribed an antiarrhythmic. 2 This nursing action is appropriate for a patient who is prescribed an antihypertensive drug. 3 This nursing action is inappropriate as insulin should be administered throughout the perioperative period. 4 The prescribed drug is administered to control the patient's blood glucose level; therefore, the nurse should monitor the patient's blood glucose level closely during the perioperative period.

Which information should the nurse collect during the health history that is conducted during the preoperative period? 1) Caretaker after discharge 2) Oral intake over the last day 3) Date of last sexual encounter 4) Previous response to anesthesia

ANS: 4 Feedback 1 While the support system and living conditions should be assessed it is unnecessary to determine a specific caregiver after discharge. 2 Last oral intake, not intake over the previous day, is information collected. 3 The date of the patient's last sexual encounter is not needed. 4 The patient's previous response to anesthesia should be determined at this time.