Ch. 17 - Preoperative Care

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

A. the patient is planning to drive home after surgery. rationale: the patient should not drive home and will need assistance with transportation and home care.

When caring for a preoperative patient on the day of surgery, which actions included in the plan of care can the nurse delegate to 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

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

An older adult patient is being prepared for surgery. What assessment data needs to be included for this patient. Select all? a. Fluid balance history b. attitude about surgery c. foods the patient dislikes d. current mobility problems e. current cognitive function

a, d, e.

Which statement by a patient scheduled for surgery is most important to report to the HCP. 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.

a. I had a heart valve replacement last year. rationale: a patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis.

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.

a. Tell me more about what happened to your mother. rationale: the patients statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery

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

a. Value-belief rationale: the value belief pattern includes information about conflicts between a patients values and proposed medical care.

An alert patient does not want to have a tracheostomy inserted because of extended endotracheal intubation, although family members state that they want it done. What is the best action for the nurse to take. a. Advocate for the patients rights b. Try to change the patients mind c. Call surgery to cancel the procedure d. Tell the family they cannot interfere.

a. advocate for the patients rights. rationale: the nurse must act as the patients advocate and assist the patient with fulfilling his wishes.

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 patients blood pressure and temp c. remind the patient about harmful effects of smoking d. ask the HCP about prescribing a nicotine patch

a. auscultate for adventitious breath sounds rationale: the nurse should first ensure a patent airway and check for breathing and circulation (ABCs).

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. a. It is to prevent malignancy b. it is to alleviate symptoms c. it is to cure the malignancy d. it is to provide cosmetic improvement.

a. it is to prevent malignancy.

Five mins after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom. What is the most appropriate action for the nurse to take. a. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety b. Assist the patient to the bathroom and stay next to the door to assist the 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 mins d. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room

a. offer the patient to use a urinal or bedpan after explaining the need to maintain safety. rationale: the prime issue after administration of either sedative or opioid analgesic medications is safety

A patient with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy. Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe". Which response by the nurse is the most appropriate? a. Tell me what you know about your surgery and the risks involved. b. Any surgery has risks, but we will be here to take good care of you c. You seem anxious. After you sign the consent, I can give you a sedative. d. You do not need to be concerned. your surgeon has not had any complaints.

a. tell me what you know about your surgery and the risks involved.

The nurse is providing preoperative teaching to a group of patients. To which patient should the nurse plan to teach coughing and deep breathing exercises. a. A 20 yr old man who is scheduled for a tonsillectomy b. A 40 yr old woman who is scheduled for an open cholecystectomy c. A 30 yr old woman who is scheduled for a transsphenoidal hypophysectomy d. a 50 yr old man who is scheduled for an evacuation of a subdural hematoma.

b. a 40 yr old woman who is scheduled for an open cholecystectomy rationale: patients with abdominal surgeries should be taught how to cough and deep breathe to prevent pulmonary complications such as atelectasis and pneumonia.

Which preoperative patient has the greatest risk of bleeding as a result of prescribed medication a. A woman who takes metoprolol for the treatment of hypertension b. A man who is taking clopidogrel after the placement of a coronary artery stent. c. A man whose type 1 diabetes is controlled with insulin injections four times daily d. A man who recently started taking finasteride for the treatment of benign prostatic hyperplasia.

b. a man who is taking clopidogrel after the placement of a coronary artery stent. rationale: any drug that inhibits platelet aggregation represents a bleeding risk.

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.

b. alert the surgery center about a possible latex allergy. rationale: Certain food allergies (eggs, avocados, bananas, chestnuts, potatoes, peaches) are related to latex allergies.

Lorazepam (Ativan) 1 mg IV is ordered for a patient before surgery. What is the most appropriate action for the nurse to take before the administration of this medication? a. Ask the patient about an allergy to iodine or shellfish. b. Encourage or assist the patient to the bathroom to void c. explain that the medication is used to prevent postoperative nausea d. check the lab results for the most recent serum potassium level.

b. encourage of assist the patient to the bathroom to void. rationale: the nurse should instruct the patient to void before administering preoperative medications that may interfere with balance and increase the fall risk when ambulating to the bathroom.

The nurse is admitting a patient to the same day surgery unit and the patient informs the nurse they took kava last evening to sleep. Which nursing action would be most appropriate. a. tell the patient that using kava to help sleep is often helpful b. Inform the anesthesiologist of the patients 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. inform the anesthesiologist of the patients recent use of kava. rationale: Kava may prolong the effects of certain anesthetics.

A patient informs the nurse prior to the surgical procedure that she is so nervous about the procedure and had to take a Xanax last night, but it did not relieve the anxiety. What is the priority action by the nurse. a. Review the surgery with the patient b. Notify the anesthesia care provider. c. Administer another dose of alprazolam (Xanax) d. Tell the patient that everything will be okay with the surgery.

b. notify the anesthesia care provider. rationale: the nurse should notify the ACP after assessing the cause of the anxiety or fear the patient is experiencing.

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 with-hold any ordered sedative medications d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

b. notify the surgeon that the informed consent process is not complete rationale: 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.

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.

b. obtain a blood glucose measurement before any insulin administration rationale: pre-operative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs.

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 surgery.

b. offer a urinal or bedpan and position the patient in bed to promote voiding. rationale: 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.

Which information in the pre-operative patients medication history is most important to communicate to the HCP 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.

b. the patient takes garlic capsules daily but did not take any on the surgical day. rationale: Chronic use of garlic may predispose to intraoperative and postoperative bleeding.

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

b. the patients statement that her last menstrual period was 8 wks ago rationale: the statement suggests that the patient may be pregnant, and pregnancy testing is needed before administration of anesthetic agents.

When reviewing the preoperative forms, the nurse notices that the informed consent form is not present or signed. What is the best action for the nurse to take a. Have the patient sign the consent form b. have the family sign the form for the patient c. call the surgeon to obtain consent for surgery d. teach the patient about the surgery and get verbal permission

c. call the surgeon to obtain consent for surgery rationale: the informed consent for the surgery must be obtained by the physician

Which topic is most important for the nurse to discuss pre-operatively 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

c. deep breathing and coughing techniques rationale: pre-operative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent post-op atelectasis.

A patient requests that the nurse give his hearing aid to a family member so it will not be lost in surgery. What is the appropriate action by the nurse a. Give the hearing aid to the wife as he wishes b. tape the hearing aid to his ear to prevent loss c. encourage the patient to wear it for the surgery d. tell the surgery nurse that he has his hearing aid out.

c. encourage the patient to wear it for the surgery. rationale: 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 PACU, as well as the dismissal instructions that will be given before he returns home for recovery.

The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes, weighs 146 kg, and is 5'8" tall. Which patient assessment is a priority related to anesthesia. a. has hemoglobin A1C of 8.5% b. has several seasonal allergies. c. Has a body mass index of 48.8 kg/m2 d. Has a history of postoperative vomiting

c. has a body mass index of 48.8 kg/m2 rationale: the patients body mass index is the priority because it indicates the patient is severely obese.

A nurse is assigned to provide preoperative teaching to a patient scheduled for coronary artery bypass surgery who only speaks spanish. What is the best method for the nurse to teach the patient how to use an incentive spirometer. a. Give the patient a pamphlet written in Spanish with directions on the use of the incentive spirometer b. Ask another Spanish speaking patient in the preoperative area to translate as the nurse describes the procedure. c. Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration d. Notify the postoperative unit to have a Spanish speaking nurse provide teaching on the incentive spirometer after surgery

c. have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration

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 post-op bleeding

c. longer time to recover from anesthesia rationale: St. John's wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery.

The nurse plans to provide pre-operative 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 care giver. c. Provide additional time for the patient to understand pre-operative instructions and carry out procedures. d. Ask the patients wife to wait in the hall in order to focus pre-operative teaching with the patient himself.

c. provide additional time for the patient to understand pre-operative instructions and carry out procedures. rationale: the nurse should allow more time when doing pre-operative teaching and preparation for older patients with sensory deficits.

the nurse is performing a preoperative assessment for a patient scheduled for a surgical procedure. What is the rationale for the nurses careful documentation of the patients current medication list. a. Some medications may alter the patients 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. some medications may interact with anesthetics, altering the potency and effect of the drugs. rationale: drug interactions may occur between prescribed medications and anesthetic agents used during surgery.

The nurse in an ambulatory surgery center has administered medications to a patient scheduled for general surgery: diazepam, cefazolin, and famotodine. What mode of transportation to the operating room would be the most appropriate for the nurse to arrange for this patient. a. Seated in a wheelchair accompanied by a responsible family member b. Ambulatory and accompanied by a hospital escort and a family member. c. Stretcher with side rails up and accompanied by OR transportation personnel d. Ambulatory accompanied by an OR staff member of transportation personnel.

c. stretcher with side rails up and accompanied by OR transportation personnel. rationale: the patient has received a sedative (Diazepam) and should be transported either by stretcher or wheelchair accompanied by OR transport personnel

While performing preoperative teaching, the patient asks when he is no longer able to eat or drink. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, what is the best response by the nurse. a. Stay NPO after midnight b. Maintain NPO status until after breakfast. c. You may drink clear liquids up to 2 hours before surgery d. You may drink clear liquids up until she is moved to the OR

c. you may drink clear liquids up to 2 hours before surgery. rationale: practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours.

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 patients health care provider.

d. discuss the herb and supplement use with the patients HCP rationale: both garlic and ginkgo biloba increase a patients risk for bleeding.

An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patients preoperative teaching? Select all 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 0600, the anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 0730: cefazolin IV to be infused 30 mins before surgery, midazolam before surgery, and scopolamine patch behind the ear. Which medication should the nurse administer first. a. Cefazolin b. Fentanyl c. midazolam d. scopolamine

d. scopolamine rationale: the scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic.

The outpatient surgery nurse reviews the complete blood cell 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/uL, hemoglobin 15 g/dL, hematocrit 45%, platelets 150 ' 103/uL. 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.

d. send the patient to the holding area when the operating room calls rationale: the CBC count results are normal.

A patient who takes a diuretic and a b-blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the HCP before surgery a. Hematocrit 36% b. Blood pressure 144/82 c. pulse rate 58 bpm d. serum potassium 3.2 mEq/L

d. serum potassium 3.2 mEq/L rationale: the low potassium level may increase the risk for intraoperative complications such as dysrhythmias.

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 patients 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

d. suggest that the patient give the ring to a family member to keep rationale: Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used.

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

d. tell the patient dry mouth is an expected side effect rationale: anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect.

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 patients father died after receiving general anesthesia for abdominal surgery.

d. the patients father died after receiving general anesthesia for abdominal surgery. rationale: the information about the patients father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication