Chapter 17 Test Questions: Preoperative Care

The nurse is reviewing the laboratory results for a preoperative patient. Which study result should be brought to the attention of the surgeon immediately? a. Serum K+ of 3.8 mEq/L b. Hemoglobin of 15 g/dL c. Blood glucose of 100 mg/dL d. White blood cell (WBC) count of 18,500/μL

d. White blood cell (WBC) count of 18,500/μL

The surgical unit nurse has just received a patient with a history of smoking from the postanesthesia care unit. Which action is most important at this time? a. Auscultate for adventitious breath sounds. b. Obtain the blood pressure and temperature. c. Teach the patient about harmful effects of smoking. d. Ask the health care provider to prescribe a nicotine patch.

a. Auscultate for adventitious breath sounds.

Which information in the preoperative patient's medication history is most important to communicate to the health care provider before surgery? a. The patient takes garlic capsules every day. b. The patient quit using cocaine 10 years ago. c. The patient uses acetaminophen for aches and pains. d. The patient took a prescribed sedative the previous night.

a. The patient takes garlic capsules every day.

A patient who is scheduled for a therapeutic abortion tells the nurse, "Having an abortion is wrong." Which functional health pattern should the nurse further assess? a. Value-belief b. Cognitive-perceptual c. Sexuality-reproductive d. Coping-stress tolerance

a. Value-belief

Patient-Centered Care: A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying, "I just want this over." What should the nurse do to promote a positive surgical outcome for the patient? a. Ask the patient what her specific concerns are about the surgery. b. Redirect the patient's attention to the necessary preoperative preparations. c. Reassure the patient that the surgery will be over soon and she will be fine. d. Tell the patient she should not be so anxious because she is having a common, safe surgery.

a. Ask the patient what her specific concerns are about the surgery.

The nurse is preparing a patient for transport to the operating room. The patient is scheduled for a right knee arthroscopy. What actions should the nurse take at this time (select all that apply)? a. Ensure that the patient has voided. b. Verify that the informed consent is signed. c. Complete preoperative nursing documentation. d. Verify that the right knee is marked with indelible marker. e. Ensure that the history and physical examination (H&P), diagnostic reports, and vital signs are on the chart.

a. Ensure that the patient has voided. b. Verify that the informed consent is signed. c. Complete preoperative nursing documentation. d. Verify that the right knee is marked with indelible marker. e. Ensure that the history and physical examination (H&P), diagnostic reports, and vital signs are on the chart.

Many common herbal products taken cause surgical problems. Which herbs listed subsequently should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (select all that apply)? a. Garlic b. Fish oil c. Valerian d. Vitamin E e. Astragalus f. Ginkgo biloba

a. Garlic b. Fish oil d. Vitamin E f. Ginkgo biloba

What type of procedural information should be given to a patient in preparation for ambulatory surgery (select all that apply)? a. How pain will be controlled b. Any fluid and food restrictions c. Characteristics of monitoring equipment d. What odors and sensations may be experienced e. Technique and practice of coughing and deep breathing, if appropriate

a. How pain will be controlled b. Any fluid and food restrictions e. Technique and practice of coughing and deep breathing, if appropriate

A 59-yr-old man scheduled for a herniorrhaphy in 2 days reports that he takes ginkgo daily. What is the priority intervention? a. Inform the surgeon, since the procedure may have to be rescheduled. b. Notify the anesthesia care provider, since this herb interferes with anesthetics. c. Ask the patient if he has noticed any side effects from taking this herbal supplement. d. Tell the patient to continue to take the herbal supplement up to the day before surgery.

a. Inform the surgeon, since the procedure may have to be rescheduled.

During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem? a. Obesity b. Dehydration c. Enlarged liver d. Decreased peripheral pulses

a. Obesity

A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of surgery. What response does the nurse expect when the ACP is notified? a. Surgery will be done as scheduled. b. Surgery will be rescheduled for the following day. c. Surgery will be postponed for 8 hours after the fluid intake. d. A nasogastric tube will be inserted to remove the fluids from the stomach.

a. Surgery will be done as scheduled.

When the nurse prepares to administer a preoperative medication to a patient, the patient tells the nurse that she really does not understand what the surgeon plans to do. a. What action should be taken by the nurse? b. What condition of informed consent has not been met in this situation?

a. The nurse should notify the surgeon because the patient needs further explanation of the planned surgery. b. Clear understanding of the information

A 17-yr-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which intervention is most appropriate? a. Witness the permit after the surgeon obtains consent. b. Call a parent or legal guardian to sign the permit since the patient is under 18. c. Notify the hospital attorney that an emancipated minor is consenting for surgery. d. Obtain verbal consent since written consent is not necessary for emancipated minors.

a. Witness the permit after the surgeon obtains consent.

The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing? a. Witnessing the patient's signature b. Obtaining informed consent from the patient for the surgery c. Verifying that the consent for surgery is truly voluntary and informed d. Ensuring that the patient is mentally competent to sign the consent form

a. Witnessing the patient's signature

A patient is scheduled for a hemorrhoidectomy at an ambulatory surgery center. An advantage of performing surgery at an ambulatory center is a decreased need for a. diagnostic studies and perioperative medications. b. preoperative and postoperative teaching by the nurse. c. psychologic support to alleviate fears of pain and discomfort. d. preoperative nursing assessment related to possible risks and complications.

a. diagnostic studies and perioperative medications.

An overweight patient (BMI 28.1 kg/m2) is scheduled for a laparoscopic cholecystectomy at an outpatient surgery setting. The nurse knows that a. surgery will involve multiple small incisions. b. this setting is not appropriate for this procedure. c. surgery will involve removing a part of the liver. d. the patient will need special preparation because of obesity.

a. surgery will involve multiple small incisions.

Which statement by a patient scheduled for knee surgery is most important to report to the health care provider before surgery? a. "I have a strong family history of cancer." b. "I had a heart valve replacement last year." c. "I had bacterial pneumonia 3 months ago." d. "I have knee pain whenever I walk or jog."

b. "I had a heart valve replacement last year."

A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take? a. Notify the dietitian about the specific food allergies. b. Alert the surgery center about a possible latex allergy. c. Reassure the patient that all allergies are noted on the health record. d. Ask whether the patient uses antihistamines to reduce allergic reactions.

b. Alert the surgery center about a possible latex allergy.

Which topic should the nurse discuss preoperatively with a patient who is scheduled for an open cholecystectomy? a. Care for the surgical incision b. Deep breathing and coughing c. Oral antibiotic therapy after discharge d. Medications to be used during surgery

b. Deep breathing and coughing

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I don't understand what the doctor said about the surgery." Which action should the nurse take next? a. Provide a thorough explanation of the planned surgical procedure. b. Notify the surgeon that the informed consent process is not complete. c. Give the prescribed preoperative antibiotics and withhold sedative medications. d. Notify the operating room nurse to give a complete explanation of the procedure.

b. Notify the surgeon that the informed consent process is not complete.

A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take? a. Withhold the usual scheduled insulin dose because the patient is NPO. b. Obtain a blood glucose measurement before any insulin administration. c. Give the patient the usual insulin dose because stress will increase the blood glucose. d. Give half the usual dose of insulin because there will be no oral intake before surgery.

b. Obtain a blood glucose measurement before any insulin administration.

A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse's preoperative intervention to maintain patient safety? a. The patient has never had general anesthesia. b. The patient is planning to drive home after surgery. c. The patient drank a sip of water 4 hours before arriving. d. The patient's insurance does not cover outpatient surgery.

b. The patient is planning to drive home after surgery.

What is the reason for using preoperative checklists on the day of surgery? a. The patient is correctly identified and preoperative medications administered. b. All preoperative orders and procedures have been carried out and documented. c. Voiding is the last procedure before the patient is transported to the operating room. d. Patients' families have been informed as to where they can accompany and wait for patients.

b. All preoperative orders and procedures have been carried out and documented.

The patient tells the nurse in the preoperative setting that she has noticed she has a reaction when wearing rubber gloves. What is the most appropriate action? a. Notify the surgeon so that the surgery can be cancelled. b. Ask additional questions to assess for a possible latex allergy. c. Notify the OR staff at once so they can use latex-free supplies. d. No action is needed because the patient's rubber sensitivity has no bearing on surgery.

b. Ask additional questions to assess for a possible latex allergy.

A patient who normally takes 40 units of glargine insulin (long acting) at bedtime asks the nurse what to do about her dose the night before surgery. The best response would be to have her a. skip her insulin altogether the night before surgery. b. get instructions from her surgeon or HCP on any insulin adjustments. c. take her usual dose at bedtime and eat a light breakfast in the morning. d. eat a moderate meal before bedtime and then take half her usual insulin dose.

b. get instructions from her surgeon or HCP on any insulin adjustments.

The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery. The results are white blood cell (WBC) count 10.2 × 103/µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 × 103/µL. Which action should the nurse take? a. Notify the surgeon and anesthesiologist immediately. b. Ask the patient about any symptoms of a recent infection. c. Continue to prepare the patient for the surgical procedure. d. Discuss the possibility of blood transfusion with the patient.

c. Continue to prepare the patient for the surgical procedure.

The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. The patient reports use of garlic and Ginkgo biloba. Which action by the nurse is appropriate? a. Teach the patient that these products may be continued preoperatively. b. Advise the patient to stop the use of herbs and supplements at this time. c. Discuss the herb and supplement use with the patient's health care provider. d. Reassure the patient that there will be no interactions with anesthetic agents.

c. Discuss the herb and supplement use with the patient's health care provider.

A patient undergoing an emergency appendectomy has been using St. John's wort to prevent depression. Which complication should the nurse expect in the postanesthesia care unit? a. Increased blood pressure b. Increased physical discomfort c. Increased anesthesia recovery time d. Increased postoperative wound bleeding

c. Increased anesthesia recovery time

When caring for a preoperative patient on the day of surgery, which actions can the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) a. Teach incentive spirometer use. b. Explain routine preoperative care. c. Obtain and document baseline vital signs. d. Remove nail polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room.

c. Obtain and document baseline vital signs. d. Remove nail polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room.

Five minutes after receiving the ordered preoperative midazolam by IV injection, the patient asks to get up to go to the bathroom to urinate. Which action by the nurse is most appropriate? a. Perform a straight catheterization. b. Assist the patient to the bathroom. c. Offer the patient a urinal or bedpan. d. Tell the patient that a catheter will be placed in the operating room.

c. Offer the patient a urinal or bedpan.

The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife answers most questions that are directed to the patient. Which action should the nurse take when doing the teaching? a. Use printed materials for instruction so that the patient will have more time to review the material. b. Direct all the teaching toward the wife because she is the obvious support and caregiver for the patient. c. Provide additional time for the patient to understand preoperative instructions and carry out procedures. d. Ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.

c. Provide additional time for the patient to understand preoperative instructions and carry out procedures.

A patient who takes a diuretic and a β-blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery? a. Hematocrit 36% b. Blood pressure 144/82 c. Serum potassium 3.2 mEq/L d. Pulse rate 54-58 beats/minute

c. Serum potassium 3.2 mEq/L

The nurse is preparing a patient on the morning of surgery. The patient prefers not to remove a wedding ring, saying, "I've never taken it off since the day I was married." How should the nurse respond? a. Have the patient sign a release form and leave the ring on. b. Tell the patient that the hospital is not liable for loss of the ring. c. Suggest that the patient give the ring to a family member to hold. d. Inform the operating room personnel that the patient is wearing a ring.

c. Suggest that the patient give the ring to a family member to hold.

The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 cups of coffee every day. b. The patient stopped taking aspirin 10 days ago. c. The patient's father died after general anesthesia for abdominal surgery. d. The patient drank 4 ounces of apple juice 6 hours before coming to the hospital.

c. The patient's father died after general anesthesia for abdominal surgery.

A 38-yr-old woman is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment must be communicated to the anesthesiologist and surgeon before surgery? a. The patient's lack of knowledge about postoperative pain control b. The patient's history of an infection following a cholecystectomy c. The patient's report that her last menstrual period was 8 weeks ago d. The patient's concern about being able to resume lifting heavy items

c. The patient's report that her last menstrual period was 8 weeks ago

Priority Decision: When the nurse asks a preoperative patient about allergies, the patient reports a history of seasonal environmental allergies and allergies to a variety of fruits. What should the nurse do next? a. Note this information in the patient's record as hay fever and food allergies. b. Place an allergy alert wristband that identifies the specific allergies on the patient. c. Ask the patient to describe the nature and severity of any allergic responses experienced from these agents. d. Notify the anesthesia care provider (ACP) because the patient may have an increased risk for allergies to anesthetics.

c. Ask the patient to describe the nature and severity of any allergic responses experienced from these agents.

A common reason that a nurse may need extra time when preparing older adults for surgery is their a. difficulty coping. b. limited adaptation to stress. c. diminished vision and hearing. d. need to include caregivers in activities.

c. diminished vision and hearing.

Preoperative considerations for older adults include (select all that apply) a. using only large-print educational materials b. speaking louder for patients with hearing aids. c. recognizing that sensory deficits may be present. d. providing warm blankets to prevent hypothermia. e. teaching important information early in the morning.

c. recognizing that sensory deficits may be present. d. providing warm blankets to prevent hypothermia.

A patient has received atropine before surgery and reports a dry mouth. Which action by the nurse is appropriate? a. Check for skin tenting. b. Notify the health care provider. c. Ask the patient about any weakness or dizziness. d. Explain that dry mouth is an expected side effect.

d. Explain that dry mouth is an expected side effect.

During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic studies? a. Electrocardiogram (ECG) and chest x-ray b. Serum glucose and complete blood count (CBC) c. Arterial blood gases (ABGs) and coagulation tests d. Blood urea nitrogen (BUN), serum creatinine, and electrolytes

d. Blood urea nitrogen (BUN), serum creatinine, and electrolytes

Which procedures are done for curative purposes (select all that apply)? a. Gastroscopy b. Rhinoplasty c. Tracheotomy d. Hysterectomy e. Herniorrhaphy

d. Hysterectomy e. Herniorrhaphy

A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. What should the nurse do first? a. Tell the patient to come back tomorrow, since he ate a meal. b. Have the patient void before giving any preoperative medications. c. Proceed with the preoperative checklist, including site identification. d. Notify the anesthesia care provider of when and what the patient last ate.

d. Notify the anesthesia care provider of when and what the patient last ate.

A priority nursing intervention to aid a preoperative patient in coping with fear of postoperative 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 rating scale.

d. explain the pain management plan, including the use of a pain rating scale.