Ch. 14: Preoperative Patient Care
During a preoperative assessment, which statement by a patient requires further investigation by the nurse to assess surgical risks? 1 "I am taking vitamins." 2 "I drink a glass of wine a night." 3 "I had a heart attack 4 months ago." 4 "I don't like latex balloons."
"I had a heart attack 4 months ago." Cardiac problems increase surgical risks, and the risk for a myocardial infarction (MI) during surgery is higher in patients who have heart problems. The type of vitamins the patient takes should be assessed, but this is not the highest risk. Moderate alcohol consumption is not considered high-risk behavior. A dislike for latex is not the same as a latex allergy (however, it might be a good idea to ask why the patient doesn't like latex balloons).
Which of a nursing student's statements regarding informed consent prior to surgery indicates a need for further teaching? 1 "Informed consent enables a patient to understand the nature of and reason for surgery." 2 "Informed consent enables a patient to understand the risks associated with the use of anesthesia." 3 "Informed consent protects the surgeon and the health care facility from lawsuits related to unauthorized surgery or uninformed patients." 4 "Informed consent does not designate who is performing the surgery or whether others will be present during the procedure."
"Informed consent does not designate who is performing the surgery or whether others will be present during the procedure." Informed consent means a patient has sufficient information to understand who will be performing the surgery and whether others will be present during the procedure (e.g., students). It enables a patient to understand the nature of and reason for surgery and the associated risks with the use of anesthesia. It protects the surgeon and the health care facility from lawsuits related to unauthorized surgery or uninformed patients.
Which statement by the novice nurse best demonstrates an understanding of preoperative teaching? 1 "The surgeon and I will conduct a time out before the procedure." 2 "I'll tell you more about being discharged when you recover from surgery." 3 "Let me tell you about your procedure so you can sign the consent." 4 "Please sign both consents for anesthesia and blood products."
"Please sign both consents for anesthesia and blood products." Separate consents may be required for the surgical procedure and receiving blood products. All team members including the scrub technicians, anesthesia staff, and any other participating members should be a part of the time out procedure. Discharge planning begins before surgery during the preoperative period. The surgeon is responsible for explaining the procedure to the patient; the nurse's role is to clarify and to witness the signature.
The nurse is educating a family member of a patient who is having surgery. Which statement by the family member indicates a need for further teaching? 1 "The best place for us to wait is the designated surgical waiting area." 2 "The type of anesthesia used is what determines the length of the patient's stay in the postanesthesia care unit (PACU)." 3 "After the surgery, the patient will be taken to the PACU for 1 to 2 hours." 4 "After the patient leaves the admission area, there is a preparation time of a half hour to an hour prior to actual surgery."
"The type of anesthesia used is what determines the length of the patient's stay in the postanesthesia care unit (PACU)." Educating family members can help reduce anxiety and fear about a patient's surgical procedure. The type of anesthesia used influences the length of the patient's stay in the PACU, but so does the type of surgery, any complications, and patient response. During the procedure, the family members should wait in the designated area according to the facility's policy and surgeon's preference; often this is a surgical waiting area where the health care team can quickly find them. The patient's PACU stay is usually 1 to 2 hours. After the patient leaves the admission area, there is usually additional preparation time of 30 minutes to an hour before the actual surgery.
The nurse is providing patient education regarding external pneumatic compression devices. Which statement by the patient demonstrates effective teaching? 1 "You will apply these before my surgery." 2 "These are to supply blood to my other organs." 3 "If I get cold, these are to help me keep me warm." 4 "They will vibrate periodically to help my leg pain."
"These are to supply blood to my other organs." External pneumatic compression devices are often applied before surgery and are used throughout the perioperative process in order to prevent venous thromboembolism (VTE) and deep vein thrombosis (DVT). These devices help circulate blood from the lower extremities so that blood flow does not stagnate and ultimately clot; they do not help supply blood to the patient's other organs. External pneumatic compression devices do not create heat for the patient's comfort. The device works by periodically inflating to 35-55 mg/Hg and not by vibration.
Which teaching by the nurse during the preoperative period best informs the patient regarding the primary purpose of the device shown in the image? (an incentive spirometer) 1 "You will need to hold your breath for at least 3 to 5 seconds at a time." 2 "This device will help you keep your lungs expanded after surgery." 3 "We will try to set goals everyday by watching the ball move up and down." 4 "Make sure to seal your lips tight around the mouth piece."
"This device will help you keep your lungs expanded after surgery." Using the incentive spirometer will encourage lung expansion, thus decreasing atelectasis. Information regarding holding the breath 3 to 5 seconds at a time, setting daily goals, and sealing the lips tightly around the mouth piece are all directions on how to use the device, but do not describe its function.
A patient is scheduled for abdominal surgery. Which operative stage is most suitable for inserting the patient's nasogastric tube? 1 After the surgery 2 One hour before surgery 3 Two hours before surgery 4 After the induction of anesthesia
After the induction of anesthesia A nasogastric (NG) tube is placed after the induction of anesthesia in the patient undergoing abdominal surgery. At this stage, the insertion is less disturbing to the patient and is easier to perform. The NG tube is not placed after the surgery because the purpose of the NG tube is to decompress or empty the stomach during the surgery. The NG tube is not placed 1 or 2 hours before surgery because it is disturbing to the patient and is difficult to perform.
Why are prophylactic antibiotics discontinued within 24 hours after a gastric surgery? Select all that apply. 1 Antimicrobial resistance 2 Risk for clostridium infection 3 Risk outweighs the benefits of the drug 4 Adequate secretion of gastric acids in the body 5 Increased bowel movements after the gastric surgery
Antimicrobial resistance Risk for clostridium infection Risk outweighs the benefits of the drug Prophylactic antibiotics are discontinued within 24 hours after surgery because they do not effectively prevent infections at that point. Prolonged prophylactic antibiotic therapy increases the risk for clostridium difficile infection. Development of resistance to antimicrobial therapy also can occur. Therefore, the risks of continued administration 24 hours after surgery outweigh the benefits. Prophylactic antibiotics do not stimulate the production of gastric acids and do not increase bowel movements.
A 78-year-old patient is about to undergo cardiac surgery. Which assessment data has the highest priority? 1 White blood cell 7000/mm 3 2 Blood glucose 218 mg/dL 3 Informed consent was signed by power of attorney (POA) 4 Patient reports taking beta blocker with a sip of water this morning
Blood glucose 218 mg/dL Surgical care improvement project (SCIP) core measures report that infection is increased in those who are having cardiac surgery with a blood glucose greater than 200 mg/dL. A normal white blood cell count is 5000 to 10000/mm 3, so a finding of 7000/mm 3 would not hinder the surgical process. A power of attorney has the legal right to sign and make decisions on the behalf of the patient. Surgical care improvement project (SCIP) core measures recommend that those who are currently on beta-blocker therapy receive them throughout the perioperative period.
A health care provider has ordered a potassium intravenous drip for a patient with a potassium level of 3.2 mEq/L. Which surgical procedure would the nurse most likely expect to administer this medication for? 1 Hysterectomy 2 Cataract removal 3 Bowel resection 4 Joint replacement
Bowel resection Bowel preparation usually involves repeated enemas and laxatives that can cause fluid and electrolyte imbalances such as hypokalemia, which if not corrected prior to surgery can cause arrhythmias and slow recovery from anesthesia. All other surgeries listed do not routinely require bowel preparation and are not as likely to require emergent potassium replacement.
The nurse is caring for a perioperative patient. How does the nurse intervene in managing the perioperative temperature of the patient? 1 By measuring the temperature after the surgical procedure 2 By measuring the temperature 15 minutes prior to anesthesia administration 3 By measuring the temperature within 15 minutes after anesthesia administration 4 By measuring the temperature simultaneously at the time of anesthesia administration
By measuring the temperature within 15 minutes after anesthesia administration Temperature is monitored within 15 minutes after administering anesthesia. The purpose of perioperative temperature management is to prevent prolonged hypothermia, which is associated with impaired wound healing, altered drug metabolism, coagulation problems, and higher incidence of surgical site infections. Measuring the temperature after the surgical procedure is not a preventive approach to overcoming temperature variations. Measuring the temperature 15 minutes prior to or simultaneously during anesthesia does not show the core temperatures, making it difficult to interpret the body temperature.
After examining a patient's respiratory status, the nurse anticipates a chronic lack of oxygen. Which evaluation criterion leads the nurse to this conclusion? 1 Patient's posture 2 Clubbing of fingertips 3 Abnormal breath sounds 4 Abnormal respiratory rate
Clubbing of fingertips Clubbing of the fingertips, as evidenced by swelling at the base of the nails, is caused by a chronic lack of oxygen, or cyanosis. Assessing the patient's posture helps indicate whether the patient is in respiratory distress. Breath sounds are assessed to evaluate the rhythm of respiration. Respiratory rate is assessed when evaluating overall respiratory status.
A patient with back pain is scheduled for spinal surgery. What examinations does the nurse anticipate in the preoperative order set for this patient? Select all that apply. 1 Computed tomography (CT) scan 2 Creatinine level 3 Magnetic resonance imaging (MRI) 4 X-ray imaging 5 International normalized ratio (INR)
Computed tomography (CT) scan Magnetic resonance imaging (MRI) A CT scan and MRI examination will be helpful in identifying the exact location of the patient's problem. Creatinine level provides information about kidney function. An x-ray shows the size and shape of the heart, lungs, and major blood vessels as well as provides information about the presence of pneumonia or tuberculosis. It also provides baseline data in case of complications. The INR provides information about blood coagulation.
A patient with kidney impairment has been treated with scopolamine. What are the possible side effects of the drug? Select all that apply. 1 Confusion 2 Depression 3 Restlessness 4 Hallucination 5 Apprehension 6 Disorientation
Confusion Restlessness Apprehension Disorientation Kidney impairment decreases the excretion of drugs. As a result, the response to scopolamine may be prolonged, and may lead to confusion, restlessness, apprehension, and disorientation. Drugs such as barbiturates and benzodiazepines result in depression and hallucinations.
Which clinical manifestations in a patient indicate poor fluid or nutritional status? Select all that apply. 1 Pallor 2 Dull hair 3 Cyanosis 4 Brittle nails 5 Muscle wasting 6 Skin turgor changes
Dull hair Brittle nails Muscle wasting Skin turgor changes Dull hair is a direct result of lack of nutrients in the diet. Brittle nails are caused by poor nutrition or stress. Common causes for muscle wasting are improper intake of nutrients and low activity levels. A decrease in skin turgor would be a late sign of dehydration. In this case when the skin is pulled up for a few seconds, it does not return to its original state, due to reduced elasticity in the skin. Pallor is pale skin, which is caused by reduced oxyhemoglobin in an anemic condition. Cyanosis is blueness of the skin caused by an increase in deoxygenated hemoglobin levels.
Which supplements are often prescribed to a patient before surgery to increase red blood cell formation? Select all that apply. 1 Iron 2 Kava 3 Folic acid 4 Vitamin C 5 Vitamin B 12
Iron, folic acid, vitamin B 12, and vitamin C may be prescribed to the patient before surgery to help red blood cell formation. These components help in the absorption of iron and production of hemoglobin and red blood cells. Kava is an herb that should be avoided because long-term use can damage the eyes, skin, liver, and spinal cord.
During the perioperative phase, a patient is advised to perform coughing and splinting. What may be the reasons behind this practice? Select all that apply. 1 It expels secretions. 2 It prevents atelectasis. 3 It keeps the lungs clear. 4 It prevents pneumonia. 5 It helps in strengthening accessory muscles.
It expels secretions. It prevents atelectasis. It keeps the lungs clear. It prevents pneumonia. Coughing and splinting helps to expel secretions and prevents atelectasis by keeping the lungs clear. It also helps in preventing pneumonia, which is a common pulmonary complication after surgery. Coughing and splinting exercises do not strengthen accessory muscles.
What should the nurse assess for in a patient whose potassium levels are high? 1 Alkalosis 2 Malnutrition 3 Kidney impairment 4 Excessive use of diuretics
Kidney impairment Kidney impairment can be the underlying cause of elevated potassium, and this must be checked prior to surgery. Malnutrition, alkalosis, and excessive use of diuretics would lead to decreased potassium levels.
Which preoperative drug is administered to a patient when rapid emptying of stomach is needed? 1 Ranitidine 2 Lorazepam 3 Alprazolam 4 Metoclopramide
Metoclopramide Metoclopramide is a prokinetic drug; it stimulates the muscles of the stomach, and thereby hastens emptying of solid and liquid meals from the stomach into the intestine. Ranitidine is a histamine H 2antagonist that inhibits stomach acid production. It is administered preoperatively to reduce aspiration pneumonia. Lorazepam and alprazolam are the drugs used for treating anxiety.
A patient scheduled for surgery at the ambulatory health care clinic is asked to maintain "NPO status" after midnight, on the night before surgery. What does the instruction about NPO status indicate? 1 Anesthesia will be administered during surgery. 2 No food should be consumed after midnight, on the night before surgery. 3 Regular vitamins may be taken with a sip of water if required. 4 Cigarette smoke should be avoided at least 2 hours before surgery.
No food should be consumed after midnight, on the night before surgery.
The nurse is caring for a patient who is scheduled for back surgery. The patient's medical history includes gastroesophageal reflux disease (GERD). During transport to the operating room, the patient complains of burning chest pain which he rates as "8" on a pain scale of 0 to 10. Which nursing action is most appropriate? 1 Cancel the surgery 2 Administer pain medication 3 Notify the surgeon and anticipate a cardiology consult 4 Position the patient upright and reassess after 5 minutes
Notify the surgeon and anticipate a cardiology consult The nurse should always inform the surgeon of any potential changes in the patient condition. Although the patient has a history of gastroesophageal reflux disease, the patient could also be displaying cardiac symptomology that may place the patient in danger during the surgery. Further assessment will likely require a cardiology consultation. Cancellation of the surgery may be necessary, however, further assessment is needed. Prior to administration of medication, further assessment is needed to determine the cause of the patient's chest pain. Sitting the patient upright may be appropriate; however, delaying treatment may place the patient in danger if the patient is experiencing a cardiac event.
A nurse is preparing an 82-year-old patient to undergo a graft for an abdominal aortic aneurysm. Which assessment is important for the nurse to report to the surgeon? 1 Patient has chronic obstructive pulmonary disease. 2 Patient reports correct month and day, but not year. 3 Patient states, "I can't get warm! I'm always cold!" 4 Patient has history of deep vein thrombosis.
Patient reports correct month and day, but not year. A patient's consent is needed prior to any procedure. Establishing a patient's baseline mental status is imperative to patient-centered care. If a patient has altered mental status, alternate sources such as next of kin or power of attorney should be consulted in order for informed consent to be obtained before the patient can undergo surgery. Normal assessment findings in elderly patients are an increase in chronic illnesses and difficulty with thermoregulation related to a decrease in adipose tissue. A history of deep vein thrombosis does not exclude a patient from a surgical procedure and will receive venous thromboembolism (VTE) prophylaxis.
The nurse is teaching deep breathing, coughing, and splinting to a patient scheduled for chest surgery. What does the nurse inform the patient? 1 Perform deep breathing exercise in the supine position after surgery. 2 Perform these exercises every 5 hours after surgery. 3 Squeeze the rib cage to force air out of the base of the lungs. 4 Place a folded blanket or pillow over the incision when coughing.
Place a folded blanket or pillow over the incision when coughing. The patient should be taught to use a folded blanket or pillow as a splint over the incision area when coughing; splinting provides support, promotes a feeling of security, and reduces pain during coughing. Deep breathing exercises may be performed in Fowler's or semi-Fowler's position after surgery. Deep breathing, coughing, and splinting exercises are performed every 1 or 2 hours after surgery unless contraindicated. During the expansion breathing exercise, the patient should squeeze the rib cage to force air out of the base of the lungs.
A patient with hemorrhoids is being prepared for surgery the next day. Which therapy can help the patient in evacuating the bowels? 1 Enema 2 Dandelion 3 IV preparation 4 Potent laxatives
Potent laxatives Potent laxatives may help this patient with evacuating the bowels. Enemas are not the best solution because they may cause severe anorectal discomfort for the patient with hemorrhoids, as well as other side effects. Although some people may use dandelion, an herb, to increase bowel movements, there is no scientific evidence that it is effective. Herbal drugs are also avoided during surgery because they increase the risk for other complications. IV preparations are not useful for the evacuation of the bowels.
The nurse is attending to an older patient scheduled for hip-replacement surgery. What observations in the patient indicate a poor nutritional status? Select all that apply. 1 Urinary incontinence 2 Presence of brittle nails 3 Decrease in serum protein level 4 Clubbed fingertips 5 Decrease in skin turgor
Presence of brittle nails Decrease in serum protein level Decrease in skin turgor The presence of brittle nails, a decrease in serum protein levels, and a decrease in skin turgor indicate a poor nutritional status in an older patient. Urinary incontinence is indicative of decreased muscle strength or kidney function. Chronic lack of oxygen causes swelling at the base of the nail beds resulting in clubbed fingertips.
Which factors can increase the risk for anesthesia-related complications? Select all that apply. 1 Presence of cardiac problems 2 Alcohol and illicit substance use 3 Excessive sleep before giving anesthesia 4 Dietary changes such as low fat intake 5 Age related changes in kidney and liver function
Presence of cardiac problems Alcohol and illicit substance use Age related changes in kidney and liver function Patients with cardiac problems such as myocardial infarction, coronary artery disease, and angina are prone to anesthesia complications. Alcohol and illicit substance use can alter the patient's responses to anesthesia and pain medication. Age-related changes in kidney and liver function may delay the elimination of anesthetic agents, increasing the risk for adverse drug reactions. Excessive sleep and low fat intake are not the factors that precipitate risks for anesthesia related complications.
Before obtaining informed consent, the surgeon explains sufficient information about the surgical procedure to the patient. Which action related to informed consent, performed by the nurse, would need correction? 1 Verifying whether the consent form is signed 2 Serving as a witness to the signature of the patient 3 Clarifying facts that have been presented by the surgeon 4 Providing detailed information about the surgery to be performed
Providing detailed information about the surgery to be performed A surgeon is responsible for providing detailed information about the surgery to be performed. The nurse is not responsible for providing these details, as it may increase anxiety levels in the patient. It is the role of the nurse to verify whether the consent form is signed. The nurse is responsible for serving as a witness for the signature of the patient. The nurse should clarify the facts that have been already presented by the surgeon in case the patient needs further clarification.
A patient is scheduled for a cholecystectomy. For which pre-existing conditions may medication be allowed with a sip of water before surgery? Select all that apply. 1 Seizures 2 Constipation 3 Hypertension 4 Cardiac disease 5 Respiratory disease
Seizures Hypertension Cardiac disease Respiratory disease Drugs for seizures, hypertension, cardiac diseases, and respiratory diseases are allowed with sip of water before surgery to avoid complications during surgery. Constipation would not affect the outcome of cholecystectomy, and does not require medication before surgery.
After reviewing a patient's laboratory reports, the anesthesia team suggests that the surgeon reschedule the cardiac surgery. The nurse recognizes that which laboratory parameter needs correction before surgery? 1 Serum potassium level of 6.5 mmol/L 2 Serum sodium level of 144 mmol/L 3 Serum chloride level of 105 mmol/L 4 Hemoglobin level of 16 g/dL
Serum potassium level of 6.5 mmol/L Increased potassium levels can increase the risk for dysrhythmias when anesthesia is administered; therefore, a serum potassium level of 6.5 mmol/L needs to be corrected before surgery. A serum sodium level of 144 mmol/L, serum chloride level of 105 mmol/L, and hemoglobin level of 16 g/dL are within the normal ranges.
A preoperative patient smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? 1 Instruct the patient to quit smoking. 2 Teach about the dangers of tobacco. 3 Teach the importance of incentive spirometry. 4 Tell the patient where the smoking lounge is.
Teach the importance of incentive spirometry. Incentive spirometry is good for lung hygiene; it encourages deep-breathing. The nurse can suggest quitting or advise about the dangers of tobacco, but it is not therapeutic to instruct it at this time. Directing the patient to the smoking lounge is not helpful or therapeutic.
Which postoperative nursing intervention is most important to perform to reduce the risk of deformities in older patients? 1 Teach the patient about turning and positioning techniques. 2 Determine the patient's normal activity levels. 3 Orient the patient to his or her surroundings. 4 Tell the patient to change position every 2 hours.
Teach the patient about turning and positioning techniques. Increased incidence of deformities is seen in patients with osteoporosis or arthritis. Teaching patients about turning and positioning will help prevent the complications of immobility. The nurse should determine normal activity levels in patients who have decreased cardiac output or increased blood pressure. The nurse orients the patient to his or her surroundings in cases of sensory deficits. Suggesting that the patient change position every 2 hours will help increase blood flow to an area; it also changes external pressure patterns in patients with dry skin.
The nurse is attending to a patient who had an appendectomy. What nursing intervention does the nurse perform for this patient? 1 Prevents the patient from getting out of bed the day after surgery. 2 Instructs the patient to perform leg exercises in the supine position. 3 Teaches the patient to splint the wound when turning in bed. 4 Instructs the patient to turn every 6 hours in bed.
Teaches the patient to splint the wound when turning in bed. The patient should be taught to splint the wound when turning in bed; pain drugs will be given as needed to reduce anxiety and pain during this activity. The patient is generally encouraged to get out of bed the day after surgery; the nurse can assist the patient into a chair or with ambulation. The patient should be taught to perform leg exercises with the head of the bed elevated to 45 degrees, and instructed to turn at least every 2 hours after surgery when confined to bed.
Which nursing intervention is appropriate for a preoperative patient with dry skin and less subcutaneous fat? 1 Applying tape to the skin 2 Padding the body prominences 3 Having the patient rest on overlays 4 Teaching the patient to change position every 2 hours
Teaching the patient to change position every 2 hours Changing position frequently helps promote blood flow to an area and changes the external pressure patterns. This in turn helps reduce the surgical risk factor of skin excoriation. Applying tape can damage the skin on its removal and should be avoided. Padding can protect the risk areas but does not increase blood flow to the surgical sites and does not reduce the risk of dry skin. Overlays redistribute body weight and thus reduce pressure ulcers in the patient.
A patient is scheduled for a below the knee amputation. What is best practice regarding site preparation? 1 Two independent licensed practitioners mark the surgical site. 2 The patient showers at the hospital for surgery. 3 The surgeon and the patient confirm and mark the site. 4 The surgical site is shaved and cleansed.
The surgeon and the patient confirm and mark the site. Whenever possible, best practice dictates that the surgical site should be marked by an independent licensed practitioner and the patient prior to the procedure. While having two independent licensed practitioners is adequate for marking a surgical site, it is not the best practice per The Joint Commission's National Patient Safety Goals (NPSGs). The patient is normally instructed to wash with special soap one to two days before the surgery. Electric clippers are to be used for hair removal because shaving increases the risk for infection by creating skin abrasions.
A patient is scheduled for surgery. Which laboratory and/or diagnostic tests are routinely carried out before any surgery is performed? Select all that apply. 1 Urinalysis 2 Electrolyte levels 3 Hemoglobin level 4 MRI examination 5 Blood type and screen
Urinalysis Electrolyte levels Hemoglobin level Blood type and screen Laboratory tests before the surgery help to obtain baseline data about the patient's health and help to predict potential complications. Urinalysis provides information about any abnormal substances in the urine; any imbalance in electrolyte levels may affect anesthesia and the outcome of surgery. Hemoglobin level is essential to know if the body can tolerate hemodynamic changes during the surgery. Blood type and screen must be known in case a blood transfusion is required. An MRI examination would be performed only based on patient need, medical history, and the nature of the procedure; it is not a routine test before surgery.
The nurse is preparing a patient for abdominal surgery. How does the nurse reduce chances of infection during skin preparation? 1 Instructs the patient to take a shower using an antiseptic solution. 2 Instructs the patient to clean the surgical area thoroughly. 3 Uses electrical hair clippers or chemical depilatory for hair removal. 4 Shaves the patient's hair a day before surgery.
Uses electrical hair clippers or chemical depilatory for hair removal. The patient's hair should be clipped with electrical hair clippers or a chemical depilatory should be used for hair removal instead of shaving off the hair. Bacteria found in hair follicle and nicks in the skin caused by shaving predispose the skin to infection. The surgeon may ask the patient to shower using an antiseptic solution and clean around the surgical area thoroughly; this reduces contamination of the surgical field and reduces the number of organisms at the site. The Centers for Disease Control and Prevention (CDC) recommends that if shaving is necessary, hair is to be removed using disposable sterile supplies and aseptic principles immediately before the start of the surgical procedure.
