AHN NCLEX REVIEW CH 2
Which of the following are true statements regarding medications and surgery? (Select all that apply.)
-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. -Review of the patient's current medication regimen is essential to promote a safe surgical outcome. Review of the patient's current medication regimen is essential; the use of multiple medications predisposes patients to adverse drug reactions and interactions with other medications. Numerous medications may be given in the perioperative setting. The patient's chart should be flagged to alert all health care providers to the patient's allergy status; the patient with a history of allergic responsiveness has a greater potential for demonstrating hypersensitivity reactions to anesthetic agents. 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 potentiate other medications or interfere with surgical procedures.
What should the nurse do to help prevent respiratory complications in a patient postoperatively?
Assist the patient to ambulate within a few hours of surgery, unless contraindicated. 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 spinal-related surgeries. It is also contraindicated after cataract 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.
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?
Conscious sedation (Moderate sedation) 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.
Which of the following is an accurate statement regarding the older adult facing surgery?
Disorientation or toxic reactions can occur in the older adult after the administration of anesthetics, sedatives, or analgesics. 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. Older adults undergoing surgical procedures have higher mortality and morbidity rates than younger adults. Older patients tend to recover more slowly from surgery than younger patients; recovery can be affected by the level of mental functioning, coping ability, and support systems. Preoperative and postoperative teaching may require extra time with the older adult. Teaching should be given at the level of the patient's understanding; directions should be repeated and reinforced.
What is the usual interval at which nursing assessments, including vital signs, are monitored in the postoperative phase?
Fifteen minutes times 4; every 30 minutes times 4; every hour times 4; then every 4 hours 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.
What stage of general anesthesia includes the administration of anesthetic agents and endotracheal intubation?
Induction 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.
Which of the following statements regarding culture and ethnic considerations is considered to be a true statement?
Native Americans are often stoic when ill. Native Americans are often stoic when ill. Complaints of pain to the nurse may be in general terms and undertreatment of pain is common. Verbal consent has more meaning than written consent among Arab Americans because it is based on trust. Chinese Americans may not ask for pain medications after surgery and may require education about pain relief. Direct eye contact may be avoided and considered disrespectful to many Southeast Asians and American Indians.
Which of the following is true regarding preoperative teaching?
Preoperative information helps lessen anxiety, reduce the amount of anesthesia required, decrease postoperative pain, and reduce corticosteroid production. Preoperative information helps lessen anxiety, reduce the amount of anesthesia required, decrease postoperative pain, and reduce corticosteroid production. 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. In verifying patient understanding of information, the nurse should avoid questions that can be answered "yes" or "no." Rather, the nurse should ask questions and encourage responses. If the surgical procedure has potential long-term effects, support groups may be contacted to offer support postoperatively.
Which of the following is true regarding preoperative medication?
The preoperative phase is the optimal time to introduce the concept of patient-controlled analgesia (PCA) to the patient. An introduction to PCA preoperatively is advantageous because the patient is better able to comprehend the concept and operation of the equipment. 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, 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 ordered before surgery except for conditions of long-standing duration, such as Dilantin for seizure control. The surgeon will reorder medication as necessary after surgery.
Which is the true statement regarding informed 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. 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. Informed consent occurs when the surgeon discusses the surgical procedure, risks, and alternatives with the patient. Consent should not be obtained if the patient is disoriented, unconscious, mentally incompetent, or, in some agencies, under the influence of sedatives. If the patient's life is in danger and the family members cannot be located, the surgeon may legally perform surgery.
