QUESTIONS MEDSURG Chapter 18 - Preoperative Care

A 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. have the client void immediately before going into surgery b. avoid oral hygiene and rinsing with mouthwash c. verify that the client has not eaten for the last 24 hours d. report immediately any slight increase in blood pressure or pulse

a

A nurse is reviewing a physician's prescription sheet for a preoperative client that states that the client must be NPO after midnight. the nurse would telephone the physician to clarify that which of the following medications should be given to the client and not withheld? a. Prednisone b. Ferrous sulfate c. Cyclobenzaprine (Flexaril) d. Conjugated estrogen (Premarin)

a

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. Which of the following is the most appropriate action for the nurse to take? A. Offer the patient to use the urinal/bedpan after explaining the need to maintain safety. B. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. C. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. D. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

a

It is most important for the nurse's preoperative teaching for a pt scheduled for extracapsular cataract removal to include which of the following? a. postoperative activities and restriction b. the proper use of dark glasses c. signs and symptoms of a detached retina d. symptoms of eye hemorrhage

a, important to protect the suture lines from IOP, bend from the knees, avoid sneezing, coughing and blowing the nose, no straining during BM's, no vomiting, and do not lie down with eye in dependent position.

A patient who is scheduled for a hysterectomy reports using ginko biloba to improve her memory. Which of the following questions is the most important for the nurse to ask the patient? A. "how long have you been using it?" B. "have you been taking this herb during the past two weeks?" C. "how have you been able to tell if this herbal supplement is working?" D. "have you experienced any side effects from taking this herbal supplement?"

b

The nurse asks the patient who is scheduled for general anesthesia at an ambulatory surgical center when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. Which of the following would the nurse do first? A. ask the patient to void before surgery B. notify the surgeon and the anesthesia care provider C. tell the patient to come back tomorrow since he ate a meal D. proceed with the preoperative check list including site identification

b

The nurse is admitting a patient to the same-day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which of the following nursing actions would be most appropriate? A. Tell the patient that using kava to help sleep is often helpful. B. Inform the anesthesiologist of the patient's recent use of kava. C. Tell the patient that the kava should continue to help him relax before surgery. D. Inform the patient about the dangers of taking herbal medicines without consulting his health care provider.

b

A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a hx of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if the client states: 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 physician about the need to stop the aspirin before the scheduled surgery

c

A preoperative client expresses anxiety to a 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 to 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.

c

An 85 year old woman with a hip fracture is scheduled for surgery. She has Alzheimer's disease and is only oriented to her name. Which of the following should the nurse look for on the informed consent? A. The patient's mark witness by the surgeon B. The patient's explanation of the operative procedure C. A signature of the person who has legal guardianship of the patient D. The surgeon's note stating the surgery was explained to the patient

c

As the nurse is preparing a patient for surgery, the patient refuses to remove a wedding ring. Which of the following is the most appropriate action by the nurse? A. Insist the patient remove the ring for safety purposes. B. Explain that the hospital will not be responsible for the ring. C. Tape the ring securely to the finger and document this on the preoperative checklist. D. Note the presence of the ring in the nurse's notes of the chart and on the preoperative checklist.

c

Which of the following is the primary reason for accurately recording the patient's current medications during a preoperative assessment? A. Some medications may alter the patient's perceptions about surgery. B. Many anesthetics alter renal and hepatic function, causing toxicity of other drugs. C. Some medications may interact with anesthetics, altering the potency and effect of the drugs. D. Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

c

Which of the following preoperative patients likely faces the greatest risk of bleeding as a result of their medication? A. A woman who takes metoprolol (Lopressor) for the treatment of hypertension B. A man whose type 1 diabetes is controlled with insulin injections four times daily C. A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent D. A man who recently started taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia

c

While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that A. She must be NPO after breakfast. B. She needs to be NPO after midnight. C. She can drink clear liquids up to 2 hours before surgery. D. She can drink clear liquids up until she is moved to the OR.

c

Preoperative considerations for elderly patients include which of the following:(select all that apply): A. only use large print education materials B. speak louder for patients with hearing aids C. recognize that sensory deficits may be present D. provide warm blankets to prevent hypothermia E. teach important information early in the morning

c, 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 appropriate action in the care of this client? a. obtain a court order for the surgery b. send the client to surgery without the consent form being signed c. have the hospital chaplain sign the informed consent immediately d. obtain a telephone consent from a family member, following agency policy

d

A nurse is conducting a 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 45-90 degrees

d

A patient is scheduled for a laparoscopic cholesystectomy at an ambulatory surgery center. The nurse would expect: A. curative surgery for cancer of the pancreas B. palliative surgery for a resection of a tumor C. surgery with small incisions for removal of the liver D. removal of the gallbladder using a minimally invasive technique

d

A patient is to receive ranitidine (Zantac) preoperatively. He tells the nurse that he took his esomeprazole (Nexium) today (as ordered). The nurse explains that these medications will: A. calm the patient and relieve his anxiety B. provide sedation and amnesia before surgery C. prevent aspiration of stomach contents into his lungs D. work to decrease stomach acids and help avoid nausea after surgery

d

A priority nursing intervention to assist a preoperative patient in coping with fear of pain would be to: A. inform the patient that pain medication will be available B. teach the patient to use guided imagery to help manage pain C. describe the type of pain expected with the patient's particular surgery D. explain the pain management plan, including the use of a pain intensity scale

d

While assessing patient preoperatively, the nurse notices a history of a latex allergy. Which of the following would be an appropriate intervention? A. notify the surgeon so that the case can be canceled B. give the patient antihistamines to prevent anaphylactic shock C. question the patient about how their allergy developed D. notify the operating room staff so that latex-free supplies can be used

d

A 70-year-old woman has been admitted prior to a bilateral mastectomy and breast reconstruction. Which of the following elements should the nurse include in the patient's preoperative teaching (select all that apply)? A.Information about various options for reconstructive surgery B.Information about the risks and benefits of her particular surgery C.Information about risk factors for breast cancer and the role of screening D.Information about where in the hospital she will be taken postoperatively E.Information about performing postoperative deep breathing and coughing exercises

d, e