Chapter 18: Preoperative Care

About how many hours should a patient fast (regular meals) before surgery?

8 or more

When administering a preoperative medication orally (PO), what is the most important nursing action, assuming that no special instructions were given? 1. Give the medicine with a glass of milk. 2. Give the medicine with a small sip of water. 3. Give the medicine 5 minutes before going to the operating room. 4. Give the medicine the previous night before surgery.

2. The preoperative medication should be given with a small sip of water 60-90 minutes before shifting the patient to the operating room. The medication should not be given only 5 minutes before going to the operating room because affects of the medication will not begin to potentiate yet. The patient should not be given large amounts of fluid or milk orally, as it can increase the chances of regurgitation and asphyxia during surgery under the effects of anesthetics.

A 75-year-old patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply)? 1. Fluid balance history 2. Attitude about surgery 3. Foods the patient dislikes 4. Current mobility problems 5. Current cognitive function 6 Patient's opinion about the surgeon

1. Fluid balance history 4. Current mobility problems 5. Current cognitive function Preoperative fluid balance history is especially critical for older adults as they have reduced adaptive capacity that puts them at greater risk for over- and under-hydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognition function is especially crucial for intraoperative and postoperative evaluation as they are more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon is important for all patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more important for older patients than it is for all patients.

A patient is scheduled for a gastrectomy. During the preoperative evaluation, the patient reports taking ginseng regularly. What should the nurse suggest to the patient? 1. Inform the surgeon. 2. Take vitamin E in addition to the ginseng. 3. Decrease the dose of ginseng. 4. Replace the ginseng with another herbal drug.

1. Inform the surgeon. The priority intervention is to inform the surgeon. The gastrectomy needs to be rescheduled. The next priority is to suggest the patient discontinue the use of ginseng, because ginseng increases blood pressure before and during surgery. Vitamin E should not be taken because it can increase bleeding. Decreasing the dose of ginseng will not remove the risk. Use of any herbal product should be discontinued 2-3 weeks before surgery, because such medicines may increase the risk of postoperative bleeding.

The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the rationale for this surgical procedure? 1. It is to prevent malignancy. 2. It is to alleviate symptoms. 3. It is to cure the malignancy. 4. It is to provide cosmetic improvement.

1. It is to prevent malignancy. Removing a mole that is changing is to prevent as well as diagnose malignancy. There are no symptoms to alleviate mentioned or cosmetic problems for this patient.

The nurse asks the patient scheduled for a total hip replacement to sign the operative permit as directed in the health care provider's preoperative prescriptions. The patient states that the health care provider has not really explained what is involved in the surgical procedure. What is the most appropriate action by the nurse? 1. Notify the health care provider about the conversation with the patient and delay the signature 2. Ask family members to clarify the information for the patient 3. Have the patient sign the form and explain the procedure to the patient 4. Have the patient sign the consent form and ask the health care provider to discuss again before surgery

1. Notify the health care provider about the conversation with the patient and delay the signature. The patient should not be asked to sign a consent form unless the procedure has been explained to his or her satisfaction. The nurse should notify the health care provider, who has the responsibility for obtaining consent. The health care provider must provide the information and clarify any confusion. It is not acceptable for the family to explain the procedure. The nurse cannot explain the procedure or ask the patient to sign the form without proper instruction and information.

Primary purposes of a patient interview: (3)

1. Obtain patient's health information 2. Provide and clarify information about the planned surgery, including anesthesia 3. Assess the patient's emotional state and readiness for surgery, including their expectations

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? 1. Offer the patient to use the urinal/bedpan after explaining the need to maintain safety. 2. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. 3. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. 4. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

1. Offer the patient to use the urinal/bedpan after explaining the need to maintain safety. The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. The other options would not be safe for the patient.

About how many hours should a patient fast (clear liquids) before surgery?

2

A patient has provided an informed consent for an elective tubal ligation under general anesthesia. The nurse recalls that the patient can revoke the consent for the surgery at what stage? Select all that apply. 1. After the surgery has started 2. Just before the scheduled surgery time 3. When the patient is in the preoperative holding area 4. When the patient is partially informed 5. After the patient has signed the consent form

2, 3, 4, 5

The nurse is assessing a patient who is scheduled for an appendectomy and orders a serum potassium analysis. What is the reason for the nurse's action? 1. The patient is a chronic smoker. 2. The patient is on diuretic therapy. 3. The patient has a prosthetic heart valve. 4. The patient is on antihypertensive medication.

2. A patient who is on diuretic therapy needs to be evaluated for serum potassium levels to assess if there is an electrolyte imbalance. A patient who is a chronic smoker may develop pulmonary complications during or after the surgery and should stop smoking at least 6 weeks before the surgery. A serum potassium analysis is not required. Patients with prosthetic heart valves are at risk of developing valvular heart disease; therefore, a cardiology consultation is often required before the surgery. Patients who are on antihypertensive medication must discontinue the medication before the surgery. The antihypertensive medication taken with anesthetic agents will predispose the patient to shock.

At an emergency medical center, an unconscious patient needs to undergo surgery. There are no family members or friends available. What action should the nurse take regarding obtaining consent for the surgery? 1. Call the local magistrate to get consent for the surgery. 2. Proceed with plans for surgery, as consent is not required for a true medical emergency. 3. Avoid giving any treatment, as it is illegal to treat without consent. 4. Obtain consent from a legally appointed representative.

2. A true medical emergency may override the need to obtain consent. When immediate medical treatment is needed to preserve life and the patient is incapable of giving consent, the next of kin may give consent. If reaching the next of kin is not possible, the physician may begin treatment without written consent. Calling the local magistrate to get consent for the surgery is not necessary. Treatment should not be avoided; the priority should be to save the life of the patient. If a patient is unconscious, a legally appointed representative or responsible family member may give written permission, but in this case, no one is available.

During the preoperative assessment of a patient, the nurse finds that the patient is on diuretics. What is the most important nursing intervention before surgery? 1. Administer antibiotic prophylaxis. 2. Have a serum potassium level drawn. 3. Apply a compression device to the legs. 4. Administer vasoactive drugs as advised.

2. Have a serum potassium level drawn. People who take diuretics are at risk of developing low potassium levels due to fluid and sodium loss. Low potassium levels may be detrimental to cardiac health, and surgery may pose additional harm. Antibiotic prophylaxis is given if the patient has valvular heart disease. Compression devices can be applied to the legs if the patient has a risk of deep vein thrombosis. Vasoactive drugs are administered if the patient has hypertension.

A nurse is caring for a patient five days after the patient had abdominal surgery. The patient begins to cough up blood. What term is used for this condition? 1. Homeostasis 2. Hemoptysis 3. Hematemesis 4. Hematocrit

2. Hemoptysis is the coughing up of blood or bloody sputum from the lungs or airway. The nurse should report this to the surgeon or anesthesia care provider. Homeostasis refers to fluid electrolyte balance. Vomiting of blood is called hematemesis. Hematocrit is a blood investigation.

The nurse is admitting a patient to the same-day surgery unit. The patient tells the nurse that the patient was so nervous that the patient took kava last evening to help with sleep. Which nursing action would be most appropriate? 1. Tell the patient that using kava to help sleep often is helpful. 2. Inform the anesthesiologist of the patient's recent use of kava. 3. Tell the patient that the kava should continue to help with relaxation before surgery. 4. Inform the patient about the dangers of taking herbal medicines without consulting a health care provider.

2. Inform the anesthesiologist of the patient's recent use of kava. Kava may prolong the effects of certain anesthetics. Thus the anesthesiologist needs to be informed of recent ingestion of this herbal supplement. Patients should not take anything before surgery without the health care provider's knowledge.

A patient asks the nurse whether he can take his regularly scheduled insulin on the morning of surgery. What is the most appropriate nursing action? 1. Tell the patient to take the same dose as he is currently taking every day. 2. Inform the surgeon of the patient's insulin use and ask whether the dose needs to be adjusted. 3. Inform the patient to skip the insulin dose on the morning of surgery. 4. Tell the patient to take half the usual dose on the morning of surgery.

2. Inform the surgeon of the patient's insulin use and ask whether the dose needs to be adjusted. If the patient is taking insulin for diabetes, the nurse should inform the surgeon in order to obtain prescriptions concerning the insulin dose to be given on the day of surgery. Low or high blood sugar can lead to complications during surgery; therefore, blood sugar should be strictly controlled. The patient should not skip or reduce the dose himself but should consult the surgeon and adjust the dose, if advised.

A patient gives consent for surgery to the surgeon and a senior nurse witnesses the consent. Now the patient wishes to revoke the consent. The patient has one adult child but no other immediate family. What action should the nurse take next? 1. Inform the adult child. 2. Inform the surgeon. 3. Try to persuade the patient to continue with the surgery. 4. Inform the senior nurse who witnessed the consent from the patient.

2. Inform the surgeon. The patient has the right to revoke the consent at any time; however this should be reported to the concerned medical staff who obtained the consent, as knowing this would help in planning the next steps. The information need not be given to the patient's son if he did not witness the informed consent. The nurse should not try to persuade the patient to change her mind; all the pertinent information should already have been provided to the patient earlier. The senior nurse need not be notified.

When transporting the patient to an operating room, which concern is the first priority for the nurse? 1. Premedication 2. Safety of the patient 3. Laboratory tests 4. Preoperative assessments

2. Safety of the patient When transporting the patient to the operating room, the nurse's primary concern should be the patient's safety. The nurse should help the patient to move from the hospital bed to the stretcher. The side rails should be raised. The patient may be transported to the operating room by stretcher or wheelchair. If no sedatives have been given, the patient may even walk accompanied to the operating room. Premedication, assessments, and laboratory values are major concerns during the preoperative period but not when transporting the patient.

A patient who is addicted to a recreational drug has been taking herbal medicine for two months and has discontinued the recreational drug. The patient is scheduled for a cholecystectomy. How should the nurse promote patient safety during surgery? 1. Suggest that the patient reschedule the surgery. 2. Instruct the patient to discontinue the herbal medicine. 3. Instruct the patient to discontinue recreational drugs immediately. 4. Suggest the patient increase the dose of herbal medicine.

2. Some herbal medicines may increase the risk of postoperative bleeding, so patients are advised to stop taking herbal medicines 2-3 weeks before surgery. The surgery should not be rescheduled as the delay may cause complications. Stopping some recreational drugs suddenly can result in withdrawal symptoms. Increasing the dose of herbal medicine may increase the risk of postoperative bleeding.

The patient has a prescription for cefotetan (Cefotan) 1 g intravenous piggyback (IVPB) q12h for six doses for cellulitis. Available is a vial filled with 1 g of cefotetan powder. The instructions state to "dilute each 1 g with 5 mL of sterile water." After reconstituting the medication, how many milliliters of solution should the nurse draw up for dosage preparation? 1. 0.1 mL 2. 1 mL 3. 5 mL 4. 6 mL

3. 5 mL The nurse initially adds 5 mL of sterile water to the vial of powder on the basis of the direction to add 5 mL of sterile water per gram of medication; the vial contains 1 g. Once reconstituted, the concentration of the solution is 1 g/5 mL. Using ratio and proportion, multiply 1 by x and multiply 5 × 1 to yield 1x = 5. Divide 5 by 1 to yield 5 mL.

Which preoperative patient has the greatest risk of bleeding as a result of his or her medication? 1. A woman who takes metoprolol (Lopressor) for the treatment of hypertension. 2. A man whose type 1 diabetes is controlled with insulin injections four times daily. 3. A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent. 4. A man who recently started taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia.

3. A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent. Any drug that inhibits platelet aggregation, such as clopidogrel, represents a bleeding risk. Insulin, metoprolol , and finasteride are less likely to contribute to a risk for bleeding.

During a preoperative assessment, what is the primary reason for recording accurately the patient's current medication? 1. Some medications may alter the patient's perceptions about surgery. 2. Some anesthetics alter renal and hepatic function, causing toxicity of other drugs. 3. Some medications may interact with anesthetics, altering the potency and effect of the drugs. 4. Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

3. Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that they have been communicated to the anesthesia care provider. Medications generally do not alter the patient's perceptions about surgery. The anesthetics may interact with the other medications, but it is not likely to alter renal and hepatic function. Routine medications are not always held during surgery, and dosage and schedule adjustments are not always necessary. Routine medications may or may not be prescribed for use the day of surgery.

As the nurse is preparing a patient for outpatient surgery, the patient wants to give his hearing aid to his wife so it will not be lost during surgery. Which action by the nurse should be taken in this situation? 1. Give the hearing aid to the wife as he wishes. 2. Tape the hearing aid to his ear to prevent loss. 3. Encourage the patient to wear it for the surgery. 4. Tell the surgery nurse that he has his hearing aid out.

3. Encourage the patient to wear it for the surgery. Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before he returns home for recovery.

When completing a preoperative assessment before surgery, the nurse finds that the patient is taking the herb ginkgo. What is the most appropriate nursing action? 1. Inform the patient to discontinue the herb and return the next day. 2. Tell the patient that the herb is safe and continue with surgery preparation. 3. Inform the surgeon, as the surgery would need to be rescheduled. 4. Tell the patient that consuming herbs is an unhealthy practice.

3. Inform the surgeon, as the surgery would need to be rescheduled. Ginkgo tends to cause increased bleeding; therefore, the nurse should inform the surgeon if the patient has been using it so that the surgery can be rescheduled. Any herb should be discontinued 2 to 3 weeks before the surgery, as it may have adverse effects. The nurse should not comment on whether the practice of taking the herb is healthy or not.

What is the primary reason for accurately recording the patient's current medications during a preoperative assessment? 1. Some medications may alter the patient's perceptions about surgery. 2. Many anesthetics alter renal and hepatic function, causing toxicity of other drugs. 3. Some medications may interact with anesthetics, altering the potency and effect of the drugs. 4. Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

3. Some medications may interact with anesthetics, altering the potency and effect of the drugs. Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that they have been communicated to the anesthesia care provider. Routine medications may or may not be prescribed for use the day of surgery.

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 1. she must be NPO after breakfast. 2. she needs to be NPO after midnight. 3. she can drink clear liquids up to 2 hours before surgery. 4. she can drink clear liquids up until she is moved to the OR.

3. she can drink clear liquids up to 2 hours before surgery. Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.

About how many hours should a patient fast (breast milk) before surgery?

4

A 47-year-old preoperative patient with suspected bowel obstruction asks why his or her dose of warfarin (Coumadin) is being withheld. Which response by the nurse is most accurate? 1. "This medication may increase respiratory depression associated with anesthetic agents and must be avoided." 2. "All unnecessary medications are stopped before surgery to prevent you from vomiting under anesthesia." 3. "This medication is contraindicated with the type of anesthesia you are receiving." 4. "This medication could cause excessive bleeding during surgery if it is not stopped beforehand."

4. "This medication could cause excessive bleeding during surgery if it is not stopped beforehand." Warfarin is an anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, the patient's clotting parameters are monitored as a means of ensuring that the effects of the medication are reversed. Warfarin is not associated with respiratory depression and does not interact with anesthesia. Medications are held before surgery; the most correct reason for holding this medication is related to the increased risk of bleeding during and following surgery.

A diabetic patient who is on insulin is scheduled for a thyroidectomy. What should the nurse tell the patient about insulin injections around the time of the surgery? 1. Insulin should be given only after the surgery. 2. Insulin should be stopped one day before surgery. 3. Insulin should be stopped at least one week before surgery. 4. Insulin will be given after arrival in the preoperative holding area.

4. Blood glucose levels should be well maintained in diabetic patients, so they should be given a dose of insulin in the preoperative holding room or operating room. Insulin is injected subcutaneously if insulin is given only after surgery, maintaining the sugar level during surgery would be difficult. Stopping insulin one day or one week before surgery is not advised.

During the preoperative assessment of a patient, the nurse finds that the patient has been drinking whiskey daily for 10 years. How should the nurse help prevent postoperative complications related to alcohol intake? 1. Instruct the patient to replace whiskey with a different beverage. 2. Recommend to the patient to reduce the frequency of alcohol intake. 3. Permit the patient to consume alcohol until the day before surgery. 4. Instruct the patient to stop consuming alcohol under medical supervision.

4. Chronic alcohol use can place the patient at risk because of lung, gastrointestinal, or liver damage. When liver function is decreased, metabolism of anesthetic agents is prolonged, nutritional status is altered, and the chances for postoperative complications are increased. Refraining from alcohol consumption may lead to alcohol withdrawal complications during lengthy surgery or in the postoperative period. Alcohol withdrawal can be dangerous, but the risk can be avoided with appropriate planning and management. Replacement of the beverage is not an option, as doing so may have unintended negative consequences. Reducing the frequency of alcohol intake also increases the chances of complications. If the patient continues to consume alcohol before the day of surgery, he may experience complications during the perioperative period.

A priority nursing intervention to assist a preoperative patient in coping with fear of anesthesia would be to 1. Administer an antianxiety medication to the patient. 2. Teach the patient to use guided imagery to help manage fear 3. Describe the type of anesthesia expected with the patient's particular surgery. 4. Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient.

4. If the nurse identifies that the patient has a fear of anesthesia, inform the ACP immediately so that he or she can talk further with the patient. Reassure the patient that a nurse and ACP will be present at all times during surgery. The nurse could use guided imagery to help manage fear or administer an antianxiety medication (if prescribed), but these interventions do not address directly the reason behind the patient's fear, so they would not be the priority. It is not within the nurse's scope of practice to describe the type of anesthesia he or she will receive.

A 70-year-old woman has been admitted prior to having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply)? 1. Information about various options for reconstructive surgery 2. Information about the risks and benefits of her particular surgery 3. Information about risk factors for breast cancer and the role of screening 4. Information about where in the hospital she will be taken postoperatively 5. Information about performing postoperative deep-breathing and coughing exercises

4. Information about where in the hospital she will be taken postoperatively 5. Information about performing postoperative deep-breathing and coughing exercises During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The specific risks and benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory.

It is 6:00 AM. The anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 7:30 AM: cefazolin (Ancef) IV to be infused 30 minutes before surgery; midazolam (Versed) before surgery and scopolamine patch (Transderm Scop) behind the ear. Which medication should the nurse administer first? 1. Cefazolin (Ancef) 2. Fentanyl (Sulimaze) 3. Midazolam (Versed) 4. Scopolamine (Transderm Scop)

4. Scopolamine (Transderm Scop) The scopolamine patch (Transderm Scop) will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin (Ancef) will be given at 7:00 AM to allow infusion 30 minutes before surgery. Fentanyl (Sulimaze) is a narcotic and was not ordered preoperatively. The midazolam (Versed), a short-acting benzodiazepine, is used as a sedative.

During a preoperative assessment, the nurse places the highest priority on determining the patient's current medications with the understanding that: 1. All medications are held on the day of surgery 2. Medications may cause the patient to be unable to make informed decisions 3. The patient's healing may be delayed if medications are taken before surgery 4. Some medications are contraindicated for use with anesthetics

4. Some medications are contraindicated for use with anesthetics Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that it has been communicated to the anesthesiologist. Although most medications are not administered on the day of surgery, and some medications (mainly steroids) may delay healing, the greatest priority is to ensure prescribed medications will not interact with anesthesia used.

Five minutes after the patient receives preoperative sedative medication by intramuscular (IM) injection, he or she asks to get up to go to the bathroom to urinate. What is the most appropriate action by the nurse? 1. Request a second nurse to help transport the patient to the bathroom. 2. Insert a Foley catheter in preparation for surgery. 3. Ask the patient to try to hold it because the patient will have a catheter soon. 4. Offer the patient a urinal and provide privacy.

4. The prime issue after administration of a sedative or opioid analgesic medication is safety. Providing the patient with a urinal and providing privacy allows the patient to stay in bed, but also allows the patient to void. Because these medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. A Foley catheter is not indicated at this time, and it is not reasonable to ask the patient to wait until the surgery is underway.

About how many hours should a patient fast (light meals) before surgery?

6

About how many hours should a patient fast (nonhuman milk, infant formula) before surgery?

6

The nurse is preparing a patient for transport to the OR. The patient is scheduled for a right knee arthroscopy. What actions should the nurse take at this time? (SATA) 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 makred with indelible marker E. ensure that H&P, diagnostic reports, and vital signs are on the chart.

A,B,C,D,E. All of these are actions that are needed to ensure that the patient is ready for surgery. In addition, the nurse should verify that the ID band and allergy band (if applicable) are one; the patient is not wearing any cosmetics; nail polish has been removed; valuables have been removed and secured; and prosthetics such as eyeglasses and dentures have been removed and secured.

Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgicval patient? (SATA) A. Garlic B. Fish Oil C. Valerian D. Vitamin E E. Astragalus F. Ginkgo biloba

A,B,D,F. Valerian may cause excess sedation, and Astragalus may increase blood pressure before and during surgery. All other herbs increase bleeding risk.

What type of procedural information should be given to a patient in prepartion for ambulatory surgery? (SATA) 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,B,E. Procedural information includes what wll or should be done for surgical preparation, including what to bring and what to wear to the surgery center, length and type of food/fluid restrictions, physical preparation required, pain control, need for coughing and deep breathing (if appropriate), and procedures done before and during surgery such as vital signs, IV lines, and how anesthesia is adminsitered. The other options are sensory and process information

A patient is schedule for a hemorrhoidectomy at an ambulatroy day-surgery center. An advantage of performing surgery at an ambulatroy center is a decreased need for: A. laboratory tests 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. Ambulatory surgery is usually less expensive and more convenient, generally involving fewer laboratory tests, fewer preoperative and postoperative medications, less acquired infections. However, the nurse is still responsible for assessing, supporting, and teacing the patient who is undergoing surgery, regardless of where the surgery is performed.

A patient who is being admitted to the suricla 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 this patient? A. Ask the patient what her specific concerns are about the surgery. B. reassure the patient that the surgery will be over soon and she will be fine. C.Redirect the patient's attention to the necessary preoperative preparations D. Tell the patient she should not be so anxious because seh is having a common, safe surgery.

A. Excessive anxiety and stress can affect surgical recovery and the nurse's role in psychologically preparing the patient for surgery is to assess for potential stressors that could negatively affect surgery. Specific fears should be identified and addressed by the nurse by listening and by explaining planned postoperative care. Falsely reassuring the patient, ignoring her behavior, and telling her not to be anxious are not therapeutic.

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. Decreaswed peripheral pulses

A. Obesity, as well as spinal, chest and airway deformities, may compromise respiratory function during and after surgery. Dehydration may require preoperative fluid therapy and an enalrged liver may indicate hepatic dysfunction that will increase perioperative risk realted to glucose control, coagulation, and druc interactions. Weak peripheral pulses may reflect circulatory problems that could affect healing.

The nurse asks a preoperative patient to sign a surgical consent form as a 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 the surgery is truly voluntary and informed D. Ensuring the patient is mentally competent to sign the consent form.

A. The health care provider is ultimately responsible for obtaining informed consent. However, the nurse may be responsible for obtaining and witnessing the patient's signature on the consent form. The nurse may be a patient advocate during the signing of the consent form, verifying that consent is voluntary and that the patient understands the implications of consent, but the primary legal action by the nurse is witnessing the patient's signature.

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 anesthesia care provider 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 NG tube will be inserted to remove the fluids from the stomach.

A. The preoperative fasting recommendations of the American Society of Anesthesiology indicate that clear liquids may be taken up to 2 hours before surgery for healthy patients undergoing elective procedures. There is evidence that longer fasting is not necessary.

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

ANS: A A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patient's knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surgery.

A patient arrives at the ambulatory surgery center for a scheduled laparoscopy procedure in outpatient surgery. Which information is of most concern to the nurse? a. The patient is planning to drive home after surgery. b. The patient had a sip of water 4 hours before arriving. c. The patient's insurance does not cover outpatient surgery. d. The patient has not had surgery using general anesthesia before.

ANS: A After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patient's experience with surgery is assessed, but it does not have as much application to the patient's physiologic safety. The patient's insurance coverage is important to establish, but this is not usually the nurse's role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration.

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 patient's blood pressure and temperature. c. Remind the patient about harmful effects of smoking. d. Ask the health care provider about prescribing a nicotine patch.

ANS: A The nurse should first ensure a patent airway and check for breathing and circulation (airway, breathing, and circulation [ABCs]). Circulation and temperature can be assessed after a patent airway and breathing have been established. The immediate postoperative period is not the optimal time for patient teaching about the harmful effects of surgery. Requesting a nicotine patch may be appropriate, but is not a priority at this time.

A patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which response by the nurse is most appropriate? a. "Tell me more about what happened to your mother." b. "You will receive medications to reduce your anxiety." c. "You should talk to the doctor again about the surgery." d. "Surgical techniques have improved a lot in recent years."

ANS: A The patient's statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. The other statements may also address the patient's concerns, but further assessment is needed first.

A patient who is scheduled for a therapeutic abortion tells the nurse, "Having an abortion is not right." Which functional health pattern should the nurse further assess? a. Value-belief b. Cognitive-perceptual c. Sexuality-reproductive d. Coping-stress tolerance

ANS: A The value-belief pattern includes information about conflicts between a patient's values and proposed medical care. In the cognitive-perceptual pattern, the nurse will ask questions about pain and sensory intactness. The sexuality-reproductive pattern includes data about the impact of the surgery on the patient's sexuality. The coping-stress tolerance pattern assessment will elicit information about how the patient feels about the surgery.

A patient who has never had any prior surgeries tells the nurse doing the preoperative assessment about an allergy to bananas and avocados. Which action is most important for the nurse to take? a. Notify the dietitian about the food allergies. b. Alert the surgery center about a possible latex allergy. c. Reassure the patient that all allergies are noted on the medical record. d. Ask whether the patient uses antihistamines to reduce allergic reactions.

ANS: B Certain food allergies (e.g., eggs, avocados, bananas, chestnuts, potatoes, peaches) are related to latex allergies. When a patient is allergic to latex, special nonlatex materials are used during surgical procedures, and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available during surgery. The other actions also may be appropriate, but prevention of allergic reaction during surgery is the most important action.

Which information in the preoperative patient's medication history is most important to communicate to the health care provider? a. The patient uses acetaminophen (Tylenol) occasionally for aches and pains. b. The patient takes garlic capsules daily but did not take any on the surgical day. c. The patient has a history of cocaine use but quit using the drug over 10 years ago. d. The patient took a sedative medication the previous night to assist in falling asleep.

ANS: B Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.

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. Administer a lower dose of insulin because there will be no oral intake before surgery.

ANS: B Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.

Five minutes after receiving the ordered preoperative midazolam (Versed) 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. Assist the patient to the bathroom and stay with the patient to prevent falls. b. Offer a urinal or bedpan and position the patient in bed to promote voiding. c. Allow the patient up to the bathroom because medication onset is 10 minutes. d. Ask the patient to wait because catheterization is performed just before the surgery.

ANS: B The patient will be at risk for a fall after receiving the sedative, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I do not really understand what the doctor said." Which action is best for the nurse to take? a. Provide an explanation of the planned surgical procedure. b. Notify the surgeon that the informed consent process is not complete. c. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

ANS: B The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient understands the surgical procedure and signs the consent form. Integrity

A 38-year-old female is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? a. The patient's lack of knowledge about postoperative pain control measures b. The patient's statement that her last menstrual period was 8 weeks previously c. The patient's history of a postoperative infection following a prior cholecystectomy d. The patient's concern that she will be unable to care for her children postoperatively

ANS: B This statement suggests that the patient may be pregnant, and pregnancy testing is needed before administration of anesthetic agents. Although the other data may also be communicated with the surgeon and anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.

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

ANS: C Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.

A patient undergoing an emergency appendectomy has been using St. John's wort to prevent depression. Which complication would the nurse expect in the postanesthesia care unit? a. Increased pain b. Hypertensive episodes c. Longer time to recover from anesthesia d. Increased risk for postoperative bleeding

ANS: C St. John's wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.

The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife usually 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 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.

ANS: C The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.

When caring for a preoperative patient on the day of surgery, which actions included in the plan of care can the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) a. Teach incentive spirometer use. b. Explain preoperative routine 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.

ANS: C, D, E Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the patient are routine skills that are appropriate to delegate. Teaching patients about the preoperative routine and incentive spirometer use require critical thinking and should be done by the registered nurse.

A patient has received atropine before surgery and complains of dry mouth. Which action by the nurse is best? a. Check for skin tenting. b. Notify the health care provider. c. Ask the patient about any dizziness. d. Tell the patient dry mouth is an expected side effect.

ANS: D Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect. The dry mouth is not a symptom of dehydration in this case. Therefore there is no immediate need to check for skin tenting. The health care provider does not need to be notified about an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines

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 most appropriate? a. Ascertain that there will be no interactions with anesthetic agents. b. Teach the patient that these products may be continued preoperatively. c. Advise the patient to stop the use of all herbs and supplements at this time. d. Discuss the herb and supplement use with the patient's health care provider.

ANS: D Both garlic and ginkgo biloba increase a patient's risk for bleeding. The nurse should discuss the herb and supplement use with the patient's health care provider. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anesthetics is not within the nurse's scope of practice.

As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." Which response by the nurse is best? a. Have the patient sign a release and leave the ring on. b. Tape the wedding ring securely to the patient's finger. c. Tell the patient that the hospital is not liable for loss of the ring. d. Suggest that the patient give the ring to a family member to keep.

ANS: D Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used. There is no need for a release form or to discuss liability with the patient.

The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery in a few days. 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. Call the surgeon and anesthesiologist immediately. b. Ask the patient about any symptoms of a recent infection. c. Discuss the possibility of blood transfusion with the patient. d. Send the patient to the holding area when the operating room calls.

ANS: D The CBC count results are normal. With normal results, the patient can go to the holding area when the operating room is ready for the patient. There is no need to notify the surgeon or anesthesiologist, discuss blood transfusion, or ask about recent infection.

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

ANS: D The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.

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. Pulse rate 58 beats/minute d. Serum potassium 3.2 mEq/L

ANS: D The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety. The lower heart rate would be expected in a patient taking a β-blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.

What kind of surgery is minimally invasive, conducted in surgical clinics, as well as other outpatient settings?

Ambulatory surgery

"ostomy"

Creation of opening into

"otomy"

Cutting into

What is the rationale for using preoperative checklists on the day of surgery? A. The patient is correctly identified B. All preoperative orders and procedures have been carried out and records are complete C. Patients' families have been informed as to where they can accompany and wait for patients D. Preoperative medications are the last procedure before the patient is transported to the operating room.

B. Preoperative checklists are a tool used to ensure that the many preparations and precautions performed before surgery have been completed and documented. Patient identification, instructions to the family, and administration of preoperative medications are often documented on the checklist, which ensures that no details are omitted.

A common reason that a nurse may need extra time when preparing older adults for surgery is their: A. ineffective coping B. limited adpatation to stress C. diminsihed vision and hearing D. need ot include caregivers in activities.

C. One of the major reasons that older adults need incrased time preoperatively is the presence of impaired vision and hearing that slows understanding of preoperative insructions and preparation for surgery.

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. Risk factors for latex allergies include a history of hay fever and allergies to foods such as avocados, kiwi, bananas, potatoes, peaches, and apricots. When a patient identifies such allergies, that patient should be further questioned about exposure to latex and specific reactions to allergens. A history of any allergic responsiveness increases the risk for hypersensitivity reactions to drugs used during anesthesia but the hay fever and fruit allergies are specifcally related to latex allergy. After identifiying the allergic reaction, the ACP should be notified, the allergy alert wristband should be applied and the note in the record will include the allergies and reactions as well as the nursing actions related to allerges.

Which procedures are done for curative purposes (SATA) A. Gastroscopy B. Rhinoplasty C. Tracheotomy D. Hysterectomy E. Herniorrhaphy

D,E. A Gastroscopy is a diagnostic procedure, Rhinoplasty is done for a cosmetic improvement, and tracheotomy is pallitave.

During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic tests? A. ECG and Chest Xray B. serum glucose and CBC C. ABGs and coagulation tests D. BUN, serum creatinine, and electrolytes

D. Theses tests are used to assess renal function and should be evaluated before surgery.

The nurse is reviewing the laboratory results for a preoperative patient. Which test result should be brought to the attention of the surgeon immediately? A. serum potassium of 3.8 mEq/L B. hemoglobin of 15 g/dL C. blood glucose of 100 mg/dL D. WBC ount of 18.5

D. This finding may indicate infection. The surgeon will probably postpone the surgery until the cause of elevated WBC count has been found.

"lysis"

Destruction

What are the different purposes of surgery?

Diagnosis, cure, palliation, prevention, cosmetic improvement, exploration

Carefully planned surgery can be referred to as?

Elective surgery

"ectomy"

Excision or removal

What are common fears associated with surgery?

Fear of death Fear of pain and discomfort Fear of mutilation or alteration in body image Fear of anesthesia Fear of disruption of life functioning

"oscopy"

Looking into

"plasty"

Repair or reconstruction

"orrhaphy"

Repair or suture

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 59-year old man is scheduled for a herniorrhaphy in 2 days. During the preoperative evaluation he reports that he takes ginkgo daily. What is the priority nursing intervention? a. Inform the surgeon, since the procedure may need 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 need to be rescheduled

An overweight patient (BMI 28.1 kg/m) 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 portion of the liver d. The patient will need special preparation because of obesity

a. Surgery will involve multiple small incisions

A 17-year-old patient with a leg fracture is scheduled for surgery. She reports that she is living with a friend and is an emancipated minor. She has a statement from the court for verification. Which intervention is most appropriate? a. Witness the permit after consent is obtained by the surgeon b. Call a parent or legal guardian to sign the permit, since the patient is under 18 c. Obtain verbal consent, since written consent is not necessary for emancipated minors d. Investigate your state's nurse practice act related to emancipated minors and informed consent

a. Witness the permit after consent is obtained by the surgeon

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

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 intervention? a. Notify the surgeon so the case can be cancelled b. Ask additional questions to assess for possible latex allergy c. Notify the OR staff immediately so that latex-free supplies can be used d. Not intervention is needed because the patient's rubber sensitivity has no bearing on surgery

b. Ask additional questions to assess for possible latex allergy

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 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 hours before coming to the surgery center. What should the nurse to first? a. Tell the patient to come back tomorrow, since he ate a meal b. Proceed with the preoperative checklist, including site identification c. Notify the anesthesia care provider of when and what the patient last ate d. Have the patient void before administering any preoperative medications

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

Preoperative considerations for older adults include (select all that apply): a. Only use 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 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

A priority nursing intervention to assist 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 the pain c. Describe the type of pain expected with the patient's particular surgery d. Explain the pain management plan, including the use of pain rating scale

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

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. Take her usual does at bedtime and eat a light breakfast in the morning c. Eat a moderate meal before bedtime and then take half of her usual insulin dose d. Get instructions from her surgeon or health care provider on any insulin adjustments

d. Get instructions from her surgeon or health care provider on any insulin adjustments