Medical-Surgical Chapter 42: Care of the Surgical Patient

The nurse is caring for a patient prior to surgery who makes minimal eye contact during preoperative teaching. Which measure will the nurse take? A. Stop the preoperative teaching. B. Reduce the amount of eye contact used by the nurse. C. Politely ask the patient to please listen to the instructions. D. Ask another staff nurse to take over the care of this patient.

Reduce the amount of eye contact used by the nurse. Rationale: If the patient seems uncomfortable with eye contact, it may be a cultural norm, or a sign of respect towards the nurse. Consider using minimal eye contact with this patient.

The nurse is preparing an in-service for the nursing staff about moderate sedation. Which point would be emphasized in the presentation? A. There will be temporary paralysis and loss of sensation in the legs. B. There is a risk of aspiration and laryngeal spasm after extubation. C. Resuscitation equipment should be readily available. D. Patients have a risk for thrombus because of prolonged positioning.

Resuscitation equipment should be readily available. Rationale: Resuscitation equipment must be readily available in case the patient has respiratory depression or cardiac dysrhythmia. Recovery is rapid and relatively less risky than other types of anesthesia. The patient is not routinely intubated.

Which is a true statements regarding medications and surgery? (Select all that apply.) A. Review of the patient's current medication regimen is essential to promote a safe surgical outcome. B. An acutely ill patient may receive several medications in a perioperative setting at one time. C. The patient's chart should be flagged to alert all health care providers to the patient's allergy status. D. Herbal remedies and dietary supplements need not be included in the patient's medication review, because these are natural products. E. Asking a patient about drug and alcohol use is intrusive and is a violation of patient confidentiality protocols.

Review of the patient's current medication regimen is essential to promote a safe surgical outcome. An acutely ill patient may receive several medications in a perioperative setting at one time. The patient's chart should be flagged to alert all health care providers to the patient's allergy status. Rationale: Herbal remedies and dietary supplements should be included in the patient's medication review; even though they are natural, they act like medications and may interact or potential other medications or interfere with surgical procedures. It is not a intrusion or a violation of confidentiality protocols to ask about drug and alcohol use. These factors could cause serious harm if not disclosed to the surgical team.

Which question would the nurse ask to evaluate the efficacy of prescribed ondansetron? A. "How would you rate your pain on a scale of 1 to 10?" B. "Did the medication help relieve the nausea?" C. "Did the medication help you relax and feel less anxious?" D. "When was the last time you had a bowel movement?"

"Did the medication help relieve the nausea?" Rationale: Ondansetron is an antiemetic that helps reduce perioperative and postoperative nausea and vomiting.

The patient is instructed to discontinue taking nonsteroidal anti-inflammatory drugs (NSAIDs) for several days before surgery. What is the best explanation for withholding this medication? A. "NSAIDs increase susceptibility to postoperative bleeding." B. "NSAIDs impair healing during the postoperative period." C. "NSAIDs interact with the medications used for anesthesia." D. "NSAIDs are associated with an increase in postoperative infections."

"NSAIDs increase susceptibility to postoperative bleeding." Rationale: NSAIDs inhibit platelet aggregation and may prolong bleeding and increase susceptibility to postoperative bleeding.

Which instruction is the nurse most likely to give to the patient before administering the preoperative medication? A. "Please go to the bathroom and void." B. "Let me mark the operative site." C. "I am going to draw a blood sample." D. "Please sign the consent form."

"Please go to the bathroom and void." Rationale: The patient is instructed to get up and void before getting the medication because drowsiness is a side effect. Urinary retention is also a common complication after surgery. The surgeon should mark the site and obtain consent. Most preoperative checklists require noting that the site has been marked and that the consent form is signed. All laboratory tests are usually completed at this point.

During the preoperative teaching session, a patient voices concerns about waking up during surgery. Which response would the nurse give to the patient? A. "The anesthesia given during surgery will not war off and allow you to take up." B. "The anesthesiologist monitors for this and will provide medications as needed." C. "There is a very small chance of waking towards the end of the surgical procedure." D. "Don't be concerned; emergence from anesthesia is very rare."

"The anesthesiologist monitors for this and will provide medications as needed." Rationale: Anesthesia is maintained through a combination of inhalation and IV medications. Emergence from anesthesia occurs when the procedure is completed and reversal agents are given.

The nurse is evaluating the patient's understanding of the preoperative teaching. Which question would the nurse ask? A. "Do you have any questions about the postoperative care?" B. "Would you like written information about the care?" C. "Did you understand everything I told you about the care?" D. "What questions do you have about the postoperative care?"

"What questions do you have about the postoperative care?" Rationale: "What...?" is an open-ended question. This allows the patient to seek information and the nurse can determine areas where the patient needs clarification. The other questions are closed-ended and do less to encourage the patient to speak.

The nurse is caring for a patient who must undergo a breast biopsy. The patient begins to cry softly and says, "I can't believe this is happening to me." Which response would the nurse use first? A. "Do you need more information about the procedure?" B. "The biopsy is a minor procedure, there are very few risks." C. "Don't worry, everything will be okay; we'll take care of you." D. "You seem scared; tell me what you are thinking about."

"You seem scared; tell me what you are thinking about." Rationale: The patient may experience fear of the unknown, fear of cancer, or fear of death. Long-term concerns include mutilation, change of lifestyle, or impact on the family. First the nurse would address the feelings and then ask the patient to expand on her fears. Based on assessment findings, the other options might be used.

Which patient is most likely to have problems related to medications that are given in the perioperative setting? A. 23-year-old woman who uses alternative and complementary therapies. B. 73-year-old woman who takes multiple medications for several chronic conditions. C. 56-year-old man who recently started an oral antidiabetic medication. D. 7-year-old child who occasionally uses a rescue inhaler for asthma.

73-year-old woman who takes multiple medications for several chronic conditions. Rationale: While all of these patients have the potential for adverse reactions and drug-drug interactions, the older patient with polypharmacy and chronic health conditions is the most vulnerable.

Which assessment will the nurse perform first to detect paralytic ileus in a postoperative patient who had abdominal surgery? A. Review medication list B. Assess frequency of flatus. C. Measure abdominal girth. D. Auscultate bowel sounds.

Auscultate bowel sounds. Rationale: Absent bowel sounds suggest a paralytic ileus; abdominal surgery, peritoneal trauma, or severe metabolic disease increase the risk. The nurse would expect to hear 5-30 gurgles per minute. Slowed or absent peristalsis will lead to decreased flatus, no bowel movements, and abdominal distention. Medications, especially opioids, can slow peristalsis and cause constipation.

A patient who had surgery on the left hip says, "This sounds crazy, but my arm hurts since I had my surgery." What would the nurse do first? A. Check the operating records for patient's position during the operation. B. Call the surgeon and inform him/her of the new-onset arm pain. C. Assess the arm for pulse, sensation, movement, pain, and temperature of skin. D. Give the patient a mild pain medication and elevate the arm on a pillow.

Assess the arm for pulse, sensation, movement, pain, and temperature of skin. Rationale: The nurse would assess the extremity for the new report of discomfort. Based on assessment findings, the nurse could consider the other options. (Postoperatively, the patient could have an embolus or a deep vein thrombus. Positioning on the operating table could put pressure on tissues or nerves. Patient could also have a problem that is not directly related to surgery; for example, bursitis.)

The nurse is preparing to assist the surgeon who is performing a procedure using moderate sedation. Which nursing action is the most important during the procedure? A. Monitoring intake and output B. Administering the medication C. Assisting the surgeon D. Assessing vital signs

Assessing vital signs Rationale: The surgeon is frequently focused on the procedure and relies on the nurse to monitor the patient. Monitoring vital signs is necessary to detect adverse effects of the medication or the procedure.

Which will the nurse do to help prevent respiratory complications in a patient postoperatively? A. Assist the patient to deep breathe and cough after all types of surgeries. B. Encourage the patient to use the incentive spirometer device 10 breaths every 4 hours. C. Teach the patient how to use the incentive spirometer within the first 4 hours after surgery. D. Assist the patient to ambulate within a few hours of surgery, unless contraindicated.

Assist the patient to ambulate within a few hours of surgery, unless contraindicated. Rationale: Ambulation within a few hours of surgery helps return cardiovascular and respiratory functions to normal more quickly. Because coughing increases intracranial pressure, it is usually contraindicated in cranial-related and spinalrelated surgeries. It is also contraindicated after eye surgery. The nurse should encourage the patient to use the incentive spirometer device 10 breaths every hour. The best time to teach the patient about the incentive spirometer is in the preoperative phase.

The patient is being prepared to go to the operating room. With proper instructions, which tasks can be delegated to the UAP? Select all that apply. A. Compare current vital signs to baseline measurements. B. Assist the patient to remove personal clothing and don a hospital gown. C. Check the IV pump rate and the IV insertion site. D. Assist the patient to move from the bed to the stretcher. E. Ensure that the preoperative checklist is complete. F. Apply antiembolic stockings.

Assist the patient to remove personal clothing and don a hospital gown. Assist the patient to move from the bed to the stretcher. Apply antiembolic stockings. Rationale: The UAP can assist the patient to remove any personal clothing, don hospital attire, apply the antiembolic stockings, and move from the bed to the stretcher. Comparing data, checking IV sites and equipment, and completing the postoperative list are nursing responsibilities.

The patient is to have nothing by mouth (NPO) starting at midnight the night before surgery. Which task can be delegated to the UAP? A. Give the patient small sips of water if he reports thirst. B. Assist with oral care, but instruct the patient not to swallow fluids. C. Obtain small hard candy for the patient to suck on. D. Check the patient's intravenous fluids every 2 hours.

Assist with oral care, but instruct the patient not to swallow fluids. Rationale: The UAP can assist with oral care; however, the patient and the UAP should be instructed that fluids should not be swallowed. During NPO, patients usually are not given any fluid. The exception could be small sips of water to take certain medications. Some surgeons will allow the patient to have small hard candies, but sucking hard candies does stimulate peristalsis, so this is not standard practice for all patients who are NPO. UAPs are not responsible for checking IV fluids.

Which task is the responsibility of the scrub nurse? A. Sends for the patient at the proper time B. Checks medical record for completeness C. Performs and confirms patient assessment D. Assists with surgical draping of patient

Assists with surgical draping of patient Rationale: The scrub nurse performs actions that require sterile handling. The circulating nurse is considered nonsterile and can perform tasks that require asepsis. He/she helps the scrub nurse and surgeons maintain sterility.

The patient had surgery 10 hours ago. The UAP tells the nurse that the blood pressure (BP) is 96/60 mm Hg. The baseline BP is usually around 120/78. Which action would the nurse take first? A. Check the patient for signs and symptoms of hypovolemic shock. B. Tell the UAP to go back and repeat the BP and report back. C. Tell the UAP to take and report BP and pulse every 5 minutes for 15 minutes. D. Call the surgeon and report the low reading of 96/60.

Check the patient for signs and symptoms of hypovolemic shock. Rationale: First the nurse would check the patient. If there are no obvious signs or symptoms of shock, then the nurse would instruct the UAP to take and report BP and pulse to determine a trend. A lower-than-baseline blood pressure is not uncommon after surgery.

What is a routine type of sedation that might be used for a surgical procedure that does not require complete anesthesia but rather a depressed level of consciousness? A. Local anesthesia B. Bier block C. Regional anesthesia D. Conscious sedation (Moderate sedation)

Conscious sedation (Moderate sedation) Rationale: Conscious sedation, also known as moderate sedation, is a routine type of sedation that might be used for a surgical procedure that does not require complete anesthesia but rather a depressed level of consciousness. A patient under conscious sedation must independently retain a patent airway and airway reflexes and be able to respond appropriately to physical and verbal stimuli. Local anesthesia involves loss of sensation at the desired site. The anesthetic agent can be injected or applied topically. Bier block, also known as intravenous regional anesthesia, is when an anesthetic agent is injected via an IV line into an extremity below the level of a tourniquet after blood has been withdrawn. Regional anesthesia results in loss of sensation in an area of the body. The method of induction influences the portion of sensory pathways that is anesthetized.

What is the purpose of administering neomycin, sulfonamides, or erythromycin before bowel surgery? A. Decreases likelihood of bowel perforation B. Prevents urinary tract infections C. Detoxifies the gastrointestinal intact D. Reduces the risk of pneumonia

Detoxifies the gastrointestinal intact Rationale: Before bowel surgery, medication (neomycin, sulfonamides, erythromycin) may be given over a period of days to detoxify and sterilize the gastrointestinal tract.

Which is an accurate statement regarding the older adult facing surgery? A. Older adults undergoing surgical procedures have lower mortality and morbidity rates than younger adults. B. Older patients tend to recover more quickly from surgery than younger patients. C. Disorientation or toxic reactions can occur in the older adult after the administration of anesthetics, sedatives, or analgesics. D. Preoperative and postoperative teaching should require less time with the older adult than it does with young adults.

Disorientation or toxic reactions can occur in the older adult after the administration of anesthetics, sedatives, or analgesics. Rationale: Disorientation or toxic reactions can occur in the older adult after the administration of anesthetics, sedatives, or analgesics. These reactions are often present for days after administration of the medication.

Which postoperative assessment would the nurse make to comply with the facility policy based on the "times 4" factor? A. Take vital signs, checks IV, incisional sites, and any tubes 4 times every hour for 4 hours, then every hour for 4 hours, then every 4 hours for 4 days. B. Does vital signs and general assessments every 15 minutes times 4 (for 4 times), every 30 minutes times 4, every hour times 4, then every 4 hours. C. Takes pulse, blood pressure, respiratory rate, and pulse oximeter readings every 15 minutes times 4 (for 4 times), then every hour until assessments approximate baseline. D. Does vital signs, checks IV, incisional sites, tubes, and postoperative orders every 15 minutes times 4 (for 4 times), then delegates vital signs every hour times 4 hours.

Does vital signs and general assessment every 15 minutes times 4 (for 4 times), every 30 minutes times 4, every hour times 4, then every 4 hours.

The patient is in the induction stage of anesthesia. Which activity will most likely be taking place? A. Positioning the patient to perform the surgical procedure. B. Decreasing the dosage of anesthetic agents. C. Cleaning, shaving, and preparing the skin. D. Establishing and verifying placement of the endotracheal tube.

Establishing and verifying placement of the endotracheal tube. Rationale: In the induction phase, the patient is awake and the administration of anesthetic agents begins. The stage is completed when the patient loses consciousness, and endotracheal intubation is established, and placement verified.

The nurse is obtaining a history prior to a surgical procedure. Which patient report warrants further investigation because of a possible latex allergy? A. Had sore throat after having a nasogastric tube inserted for stomach decompression. B. Developed a large hematoma in the antecubital fossa after donating blood. C. Experienced severe swelling of the labia after urinary catheterization. D. Had skin irritation after dermabrasion to remove a small precancerous growth.

Experienced severe swelling of the labia after urinary catheterization. Rationale: Urinary catheters are frequently made of latex and swelling is one symptom of allergic response.

Which is the usual interval at which nursing assessments, including vital signs, are monitored in the postoperative phase? A. Fifteen minutes times 4; every 30 minutes times 4; every hour times 4; then every 4 hours B. Five minutes times 4; every 10 minutes times 4; every 30 minutes times 4; then every hour C. Thirty minutes times 4; every hour times 4; then every 4 hours D. Four hours followed by once a shift

Fifteen minutes times 4; every 30 minutes times 4; every hour times 4; then every 4 hours Rationale: The usual interval at which nursing assessments, including vital signs, are monitored in the postoperative phase is every 15 minutes times 4; every 30 minutes times 4; every hour times 4; then every 4 hours. This "times four" gauge is the maximum time that should elapse between assessments. Five minutes times 4 is not the typical interval of assessments routinely performed by nurses. Thirty minutes times 4 leaves too much time between assessments for optimal patient safety and monitoring of potential postoperative complications. Four hours followed by once a shift is far beneath the standard of care generally accepted on postoperative units. Potential patient complications would be missed

Which preoperative patient teaching topics are a nursing responsibility? Select all that apply. A. Gastrointestinal cleansing preparation B. Need for assistive devices postoperatively (e.g. crutches) C. Date and time of the surgery D. Risks and benefits of the procedure E. Written pre- and postoperative instructions

Gastrointestinal cleansing preparation. Need for assistive devices postoperatively (e.g. crutches). Risks and benefits of the procedure. Written pre- and postoperative instructions. Rationale: Surgeon provides information regarding the actual surgical procedure, as well as the risks, benefits, and possible outcomes. Nurse is responsible for teaching about the other topics.

The nurse is caring for a patient after emergency surgery. The patient has been taking antihypertensive medications for several years. For which side effect related to the antihypertensive medications for several years. For which side effect related to the antihypertensive medications would the nurse monitor? A. Bradypnea B. Hypotension C. Tachycardia D. Diaphoresis

Hypotension Rationale: Antihypertensives interact with anesthetic agents to cause hypotension. (Note to student: When patients have emergency surgery, there may be insufficient time to do the typical preoperative preparations [e.g., NPO, withholding medications, bowel prep]. Thus, the nurse would monitor for complications [e.g., vomiting, medication-anesthesia interactions, constipation]).

What is the significance of the nurse's signature on the preoperative checklist? A. Specifies that the preoperative medication was given. B. Delegates care on the list to the appropriate staff members. C. Indicates the nurse assumes responsibility for care on the list. D. Confirms that the patient understands the preoperative care.

Indicates the nurse assumes responsibility for care on the list. Rationale: The nurse who does the preoperative care signs the list, thereby taking responsibility for the care on the list. Medication, tasks completed by delegation, and teaching are included in the care prior to surgery.

Which stage of general anesthesia includes the administration of anesthetic agents and endotracheal intubation? A. Induction B. Maintenance C. Emergence D. Stage IV

Induction Rationale: Induction is the stage of general anesthesia that includes the administration of anesthetic agents and endotracheal intubation. The maintenance phase of anesthesia includes positioning the patient, preparation of the skin for incision, and the surgical procedure itself. During the emergence phase of anesthesia, anesthetics are decreased and the patient begins to awaken. Because of the short half-life of today's anesthetic agents, emergence may occur in the operating room. Stage IV begins with the cessation of respirations and must be avoided, or it will necessitate the initiation of cardiopulmonary resuscitation and may lead to death.

The patient is in the PACU and is having difficulty maintaining a patent airway after extubation. Which intervention would be used to maintain a patent airway until the patient is fully conscious? A. Ventilate using a bag-valve-mask. B. Use an oral suction catheter. C. Give oxygen per nasal cannula. D. Insert an oral airway.

Insert an oral airway. Rationale: An oral airway can be inserted to keep the airway open (keeps tongue from obstructing airway). Bag-valve-mask is used when patients are not breathing. Oral suctioning (also, side-lying position or elevation of the head) decreases the likelihood of aspirating secretions. Oxygen is administered to maintain saturation, but the airway must be open for oxygen to pass into the lungs.

After surgery, which food would the nurse suggest to the patient that are specific for building and repairing body tissue? A. Variety of foods but avoid processed sugar B. Lean meat and low-fat dairy products C. Whole grain breads and cereals D. Seasonal fruits and leafy green vegetables

Lean meat and low-fat dairy products Rationale: Patients are generally encouraged to eat well-balanced diets, but protein foods are specific for building and repairing body tissues.

The patient will undergo the removal of a benign cyst form his hand in the health care provider's (HCP) office. Which type of anesthesia is the patient most likely to receive? A. Regional anesthesia B. Local anesthesia C. Moderate sedation D. Intrathecal anesthesia

Local anesthesia Rationale: Local anesthesia is commonly used for minor surgical procedures such as a biopsy of a superficial skin lesion.

A mastectomy is scheduled for an 81-year-old patient. What is the highest priority during the immediate postoperative recovery period? A. Assessing for confusion B. Managing airway C. Managing pain D. Monitoring bleeding

Managing airway Rationale: In the immediate postoperative period, all patients are at risk for aspiration related to nausea and vomiting and will have impaired abilities to manage secretions. Older patients have additional problems related to age.

The patient had surgery at 10:00 AM. At 6:00 PM, the nurse notes that the patient has not voided since returning from surgery. What would the nurse do first? A. Help the patient to the toilet and open the faucet so that water runs. B. Palpate above the symphysis pubis to check for bladder distention. C. Call the surgeon and obtain an order for catheterization. D. Help the patient get up and ambulate to stimulate urination.

Palpate above the symphysis pubis to check for bladder distention. Rationale: The nurse would check for distention first and then consider the other options.

The anesthesiologist has written the order to transfer the patient from PACU to the medical-surgical unit. Which assessment finding would delay the transfer? A. Patient is awake, but nausea and some vomiting continue. B. Patient is breathing normally, but reports a sore throat and cough. C. Patient is crying and reports pain related to the surgical incision. D. Patient has decreased blood pressure and pulse is increasing.

Patient has decreased blood pressure and pulse is increasing. Rationale: The patient must have stable vital signs before he/she is transferred to the medical-surgical unit. If the order for transfer has been written, the PACU nurse would be responsible for informing the anesthesiologist about the unstable vital signs. Nausea, vomiting, a sore throat, and incisional pain are expected.

The surgeon is preparing to explain a procedure to the patient and obtain informed consent. Which information is the most vital to relate to the surgeon before he/she enters the patient's room? A. Patient has been talking about refusing the surgery. B. Patient had a hypoglycemic episode 3 hours ago. C. Patient's laboratory reports that are not available yet. D. Patient received morphine and a sedative 1 hour ago.

Patient received morphine and a sedative 1 hour ago. Rationale: If consent is obtained while the patient is under the influence of consciousness altering substances (even if prescribed), the consent is not considered valid. The other information is also relevant and the surgeon should be advised.

The nurse is preparing to discharge a patient from an ambulatory surgery setting. How does the nurse determine when the patient is ready to be discharged? A. Patient states he is ready to drive himself home. B. Patient is groggy, but readily arouses to normal stimuli. C. Patient reports that pain is controlled and nausea has ceased. D. Family is available and willing to take responsibility.

Patient reports that pain is controlled and nausea has ceased. Rationale: The ambulatory surgery patient is released to home so the patient must be alert, and pain, nausea, and vomiting must be controlled. The patient is not allowed to drive himself home and family's willingness to assume responsibility does not absolve the nurse from making decisions about the patient's safety.

The newly hired nurse is told that morning medications are generally withheld on the day of surgery. The nurse is most likely to clarify withholding which medication? A. Phenytoin B. Warfarin sodium C. Famotidine D. Acetaminophen

Phenytoin Rationale: Phenytoin is a antiseizure medication. Warfarin sodium, an anticoagulant, is usually discontinued several days before the surgery. Famotidine is an antiulcer medication and may be given prophylactically in the postsurgical period. Acetaminophen is used postoperatively for mild pain.

The patient will soon be transferred from the PACU to the nursing unit. Which tasks can be delegated to the UAP? Select all that apply. A. Place bed in a high position and adjust side rails for safety. B. Obtain a clean gown and extra pillows for positioning. C. Set up suction equipment and test function. D. Get stethoscope, thermometer, and sphygmomanometer. E. Check the function of the IV pump. F. Place bed pads to protect linens from drainage.

Place bed in a high position and adjust side rails for safety. Obtain a clean gown and extra pillows for positioning. Get stethoscope, thermometer, and sphygmomanometer. Place bed pads to protect linens from drainage. Rationale: The UAP can obtain most of the equipment but is not responsible for checking the function of pumps or suction equipment. The nurse should ensure that these items are functional, as they are likely to be needed when the patient arrives.

The nurse is caring for a postoperative patient who has preexisting type 2 diabetes. Which assessment is most relevant to a complication associated with diabetes? A. Decreased pain sensation B. Bloody emesis C. Poor wound healing D. Hypoventilation

Poor wound healing Rationale: Any of these findings warrant further investigation; however, for diabetic patients, there is an increased susceptibility for infection and poor wound healing. Decreased or altered pain sensation can be an issue for patients with diabetes if blood vessels or nerves are damaged by poorly controlled blood glucose. Bloody emesis could be related to many conditions (e.g., esophageal varices, Curling's ulcer, perforation). Hypoventilation is a problem for patients with preexisting respiratory disorders.

The nurse is reviewing the presurgical laboratory results for a patient who has a history of cardiac problems. Which abnormal results is of greatest concern? A. Sodium: 146 mEq/L (146 mmol/L) B. Blood glucose: 130 mg/dL (7.2 mmol/L) C. Blood urea nitrogen: 25 mg/dL (8.9 mml/L) D. Potassium: 5.8 mEq/L (5.8 mmol/L)

Potassium: 5.8 mEq/L (5.8 mmol/L) Rationale: Abnormal potassium levels can cause cardiac dysrhythmias. Normal ranges include: potassium 3.5-5 mEq/L; sodium 136-145 mEq/L; blood glucose 70-110 mg/dL; blood urea nitrogen 10-20 mg/dL.

Which is true regarding preoperative teaching? A. The best time for preoperative education is 1 to 2 hours before the surgery is scheduled. B. In preoperative teaching, the nurse should primarily use questions that can be answered "yes" or "no" to verify patient understanding. C. Preoperative information helps lessen anxiety, reduce the amount of anesthesia required, decrease postoperative pain, and reduce corticosteroid production. D. Referring the patient to support groups is not an appropriate nursing intervention during the preoperative phase

Preoperative information helps lessen anxiety, reduce the amount of anesthesia required, decrease postoperative pain, and reduce corticosteroid production. Rationale: By decreasing postsurgical complications through preoperative teaching, wound healing occurs more rapidly. The best time for preoperative education is in the surgeon's office before the surgery is scheduled.

Which data set is most important to note prior to starting the skin preparation before surgery? A. Temperature, turgor, and dryness of skin; history of dehydration and electrolyte imbalance B. Presence of infection, irritation, bruises, or lesions on skin; history of skin allergies C. Underlying structures such as veins, arteries, or nerves; history of peripheral vascular disease D. Color of skin, sensation to touch, and hair distribution; history of peripheral neuropathy

Presence of infection, irritation, bruises, or lesions on skin; history of skin allergies Rationale: Skin infections could be a source of wound infection. Bruises, irritation, and lesions should be noted as preexisting conditions of the surgical procedure. Skin allergies impact the types of solutions, medications, and equipment that contact the skin.

The postoperative patient reports chest pain. He has difficulty breathing, a productive cough, and his skin is flushed and moist. Which action would the nurse take first? A. Raise the head of the bed. B. Auscultate the lung sounds. C. Report signs and symptoms to the HCP. D. Administer supplemental oxygen.

Raise the head of the bed. Rationale: Raising the head of the bed immediately helps relieve the dyspnea. Instinctively, the patient will struggle to sit upright. The nurse would use the other actions after raising the head of the bed.

The patient is undergoing spinal anesthesia and the patient's position has to be slightly adjusted during the procedure. Which occurrence is cause for greatest concern? A. Slight decrease in blood pressure B. Loss of sensation in both feet C. Slowing of respiratory rate D. Inability to freely move the legs

Slowing of respiratory rate Rationale: In spinal anesthesia, an anesthetic is introduced into the cerebrospinal fluid and bodily movement can affect the flow of the anesthesia up and down the spinal cord. Slowing of the respiratory rate suggests that the level of anesthesia is causing respiratory paralysis; the patient may require resuscitation. A decrease in blood pressure is also serious because of possible vasodilation. Loss of sensation and decreased movement of the lower extremities are expected.

The patient is scheduled to undergo a urologic procedure in the surgical suite. The patient will be conscious during the procedure. Which type of anesthesia will most likely be used? A. Nerve block B. Epidural anesthesia C. Spinal anesthesia D. Local anesthesia

Spinal anesthesia Rationale: Spinal anesthesia is often used for lower abdominal, pelvic, and lower extremity procedures; urologic procedures; or surgical obstetrics. For more information, page 1280-1281

The postsurgical patient manifests hypotension; tachycardia; restlessness; apprehension; and cold, moist, pale skin. How would the nurse interpret these findings and which action would the nurse take first? A. Suspects hypoglycemia and administer IV 10% dextrose per standard protocol. B. Suspects a panic attack and administers a PRN (as needed) dose of lorazepam. C. Suspects airway obstruction and inserts an oral airway using nursing judgment. D. Suspects hypovolemic shock and administers oxygen per standard protocol.

Suspects hypovolemic shock and administers oxygen per standard protocol. Rationale: Postoperative patients are at risk for hypovolemic shock. Signs/symptoms include hypotension; tachycardia; restlessness; apprehension; and cold, moist, pale, or cyanotic skin. Standard protocol in most facilities includes (1) administer oxygen; (2) raise legs above the level of the heart; (3) increase the rate of IV fluid; (4) notify anesthesiologist and surgeon; (5) medications as prescribed; and (6) assess response to interventions.

Which patient has a contraindication for deep coughing after surgery? A. The patient who had abdominal surgery B. The patient who had pneumonia before surgery C. The patient who had intracranial surgery D. The patient who had thoracic surgery

The patient who had intracranial surgery Rationale: Coughing increases intracranial pressure; therefore, coughing is contraindicated for patients with intracranial surgery.

Which is true regarding preoperative medication? A. After receiving preoperative medication, the patient is generally encouraged to ambulate on the nursing unit to encourage deep breathing. B. The patient who has received an opioid analgesic usually requires a larger amount of anesthetic once in surgery. C. The preoperative medication reduces respiratory tract secretions. D. After surgery, all preoperative medications are automatically resumed for the patient.

The preoperative medication reduces respiratory tract secretions. Rationale: Preoperative medications reduce the patient's anxiety and reduce respiratory tract secretions. After receiving preoperative medication, the patient must remain in bed. The nurse institutes safety procedures, such as the bed in low position, side rails up (or per agency policy) , and monitoring of the patient every 15 minutes until the patient leaves for surgery. The patient who has received an opioid analgesic usually requires a smaller amount of anesthetic once in surgery. Surgery usually stops all medications prescribed before surgery. The surgeon will prescribe medication as necessary after surgery.

Which is the true statement regarding informed consent? A. Informed consent occurs when the nurse discusses the surgical procedure, risks, and alternatives with the patient. B. The best time to have the patient sign the consent form is after receiving the preoperative medication, because the patient will be more relaxed. C. If the patient's life is in danger and the family members cannot be located, the surgeon may not legally perform surgery. D. The witness of a consent form is only verifying that this is the person who signed the consent and that it is a voluntary consent.

The witness of a consent form is only verifying that this is the person who signed the consent and that it is a voluntary consent. Rationale: The witness of a consent form is only verifying that this is the person who signed the consent and that it is a voluntary consent. The witness (often a nurse) is not verifying that the patient understands the procedure.

For a patient with a sequential compression device (SCD), which instructions would the nurse give to the unlicensed assistive personnel (UAP)? A. Remove the cuffs to assess skin integrity and provide skin care. B. Numbness or tingling is expected; remind the patient to wiggle the toes. C. Turn the pump off and remove the cuffs prior to ambulating the patient. D. Leave the SCD in place on the legs and plugged in for at least 72 hours.

Turn the pump off and remove the cuffs prior to ambulating the patient. Rationale: The SCD can be disconnected for 30 minutes for ambulation and may be delegated to the UAP. Assessing the skin integrity, numbness, and tingling is the LPN/LVN's responsibility and can not be delegated to the UAP.

A UAP is temporarily assigned to assist in the PACU. When would the nurse intervene? A. UAP places an emesis basin near the bedside. B. UAP assists the patient to a side-lying position. C. UAP places a pillow underneath the patient's head. D. UAP puts the side rails up and the call light within reach.

UAP places a pillow underneath the patient's head. Rationale: A pillow is not placed under the head because this may cause the tongue to obstruct the airway. The other actions are correct.

The patient says that he has been smoking for years and is likely to continue to smoke before and after his surgery. Which piece of equipment is the most important to reinforce with the patient? A. Normal range for pulse oximeter B. Use of incentive spirometer C. Use of patient-controlled analgesia pump D. Operation of the call bell

Use of incentive spirometer Rationale: Smoking increases the risk for pneumonia and atelectasis; use of the incentive spirometer decreases the risk for respiratory complications. The patient's reading on pulse oximeter is likely to be lower than normal or low-normal because of the smoking. Patient controlled analgesia pump and call bell are also important, but are less related to the issue of smoking.

When is the best time to perform preoperative teaching? A. When the surgery is scheduled B. Morning of the surgery C. At least 2 weeks preoperatively D. When the nurse has extra time

When the surgery is scheduled Rationale: The ideal time for teaching is when the surgery is scheduled because anxiety is not too high and most patients will want to know what to expect. Teaching too far in advance would affect retention of the information. The teaching should not be delayed (or hastened) because of the nurse's schedule.