Chapter 4 Nursing Care of Patients Having Surgery

The nurse suspects that a patient recovering from surgery in the postanesthesia recovery unit (PACU) is developing malignant hyperthermia. Place these interventions in the order in which they should be performed. Choice 1. Administer oxygen with a nonrebreather mask. Choice 2. Check IV access. Choice 3. Notify the anesthesia provider. Choice 4. Administer Dantrolene.

. Answer: 1, 2, 3, 4 Explanation: Choice 1. As soon as the nurse suspects malignant hyperthermia is occurring, oxygen should be administered by nonrebreather mask. Oxygen is necessary to support tissues that rapidly become hypermetabolic. Choice 2. The nurse should then be certain that IV access is still patent and should notify the anesthesia provider. The IV access step is done first as it is quick and if not patent, can be restarted while the anesthesia provider responds. Choice 3. The nurse should then be certain that IV access is still patent and should notify the anesthesia provider. The IV access step is done first as it is quick and if not patent, can be restarted while the anesthesia provider responds. Choice 4. Dantrolene is given IV, so a patent IV is essential.

The nurse is preparing to teach a patient scheduled for surgery on performing diaphragmatic breathing. Place the steps of this breathing technique in the order in which the nurse should teach the patient. Choice 1. Sit up straight in bed. Choice 2. Place hands lightly on the abdomen. Choice 3. Breathe in deeply through the nose. Choice 4. Hold breath for five seconds. Choice 5. Completely exhale through pursed lips.

. Answer: 1, 2, 3, 4, 5 Explanation: Choice 1. The patient should be placed in high or semi-Fowler's position. Choice 2. The patient should be asked to place hands lightly on the abdomen. Choice 3. The patient should be asked to take a deep breath in through the nose. Choice 4. The patient should be asked to hold the breath to the count of five. Choice 5. The patient should be asked to exhale completed through pursed lips.

The nurse is reviewing the patient's current medications as a part of preparation for an elective surgery. What information should the nurse reinforce with the patient? A. "Continue to take your regular prescribed dose of warfarin (Coumadin) until told otherwise." B. "You may take your regular herbal supplements up until the day before surgery." C. "Discontinue your antihypertensive medications two days prior to surgery." D. "Stop taking your daily aspirin at least three days prior to surgery."

. Answer: A Explanation: A. Anticoagulant medications, including warfarin (Coumadin), should be discontinued prior to surgery to prevent excessive blood loss during surgery. 2. Herbs or nutritional supplements that impair clotting should be discontinued 2 weeks prior to surgery. 3. Antihypertensive medications will be analyzed by the healthcare provider on an individual basis. 4. Anticoagulant medications should be discontinued prior to surgery to prevent excessive blood loss during surgery. These include aspirin.

The intraoperative nurse is caring for a patient in the maintenance phase of anesthesia. Which actions should the nurse prepare to provide to the patient at this time? Select all that apply. A. Prepare the skin. B. Participate in the surgical procedure. C. Position the patient for the surgical procedure. D. Assess oxygen saturation level. E. Measure blood pressure and heart rate.

. Answer: A,B,C Explanation: A. During the maintenance phase of anesthesia, the skin is prepared. B. During the maintenance phase of anesthesia, the surgery is performed. C. During the maintenance phase of anesthesia, the patient is positioned. 2. The anesthesiologist monitors the patient's blood pressure, heart rate, and oxygen saturation level at this time. 5. The anesthesiologist monitors the patient's blood pressure, heart rate, and oxygen saturation level at this time.

A patient is having a surgical procedure with conscious sedation. Which patient information should be provided to the healthcare provider before administering the anesthesia to the patient? Select all that apply. A. The patient has a history of snoring. B. The patient wants to be asleep for the procedure. C. The patient drank a cup of coffee two hours ago. D. The patient's father was hypertensive. E. The patient has a history of gout.

. Answer: A,C Explanation: A. While all of this information leads to a greater understanding of the patient, that the patient snores is essential information at this time. C. While all of this information leads to a greater understanding of the patient, that the patient is not NPO is essential information at this time. 3. That the patient wishes to be asleep for the procedure is not essential information. 4. That the patient's father was hypertensive is not essential information at this time. 5. That the patient has a history of gout is not essential information at this time.

The nurse is preparing to assist during a surgical procedure. For which reason should the surgical scrub be completed? Select all that apply. A. Apply an antimicrobial residue on the skin. B. Prevent the need to wear surgical gloves during the procedure. C. Remove dirt, skin oils, and transient microorganisms from the skin. D. Improve patient safety by removing the number of organisms on personnel. E. Sterilize the skin.

. Answer: A,C,D Explanation: A. One purpose of a surgical scrub is to leave an antimicrobial residue on the skin to inhibit the growth of microbes for several hours. C. One purpose of a surgical scrub is to remove dirt, skin oils, and transient microorganisms from the skin. D. One purpose of a surgical scrub is to improve patient safety by removing the number of organisms on personnel. 3. A surgical scrub does not take the place of wearing surgical gloves during an operative procedure. 1. The skin cannot be sterilized

An older patient recovering from total hip replacement surgery 8 hours ago has not been able to void spontaneously. Which actions should the nurse take to assist this patient? Select all that apply. A. Increase fluids. B. Turn onto the left side. C. Insert an indwelling urinary catheter. D. Palpate the bladder for distention. E. Complete a bladder scan at the bedside.

. Answer: A,D,E Explanation: A. Promote fluid intake as allowed, monitoring intake and output. D. Assess for bladder distention if the patient has not voided within 7 to 8 hours after surgery. E. Use a portable ultrasound scanner to determine the amount of urine in the bladder. 2. Turning onto the left side will not promote urinary elimination. 4. Urinary catheterizations should be avoided to reduce the potential for urinary tract infections and urethral trauma. .

The nurse is assessing a patient who has returned to the care area after surgery. What should the nurse do to ensure the patient receives appropriate care? A. Schedule the patient for vital signs assessments every four hours. B. Check the physician's orders to see if preoperative orders have been reordered. C. Orient the patient to person, place, and time. D. Assess the patient's mental status.

. Answer: B Explanation: B. The medical record needs to be checked to ensure that all orders written before surgery have been reordered after surgery, since the patient's condition has changed. 2. Even though vital signs should be assessed according to hospital policy, the frequency of a postoperative patient's vital signs assessment will be more frequent than every four hours. 3. Orienting the patient to person, place, and time, is an activity of the PACU nurse. 4. Assessing the patient's mental status is an activity of the PACU nurse.

A patient is having an epidural catheter inserted for pain control after surgery. What should the nurse realize is an advantage of using this method of pain medication for this patient? B. Improved bowel activity 2. Faster wound healing 3. Earlier ambulation 4. Improved appetite

. Answer: B Explanation: B. This type of intraspinal anesthesia provides safe and effective pain relief for patients of all ages with less risk of adverse effects than general anesthesia. 2. Patient-controlled epidural analgesia does not cause faster wound healing. 3. Patient-controlled epidural analgesia does not cause earlier ambulation. 4. Patient-controlled epidural analgesia does not improve appetite.

A patient is scheduled for total hip replacement surgery. What medication should the nurse provide to the patient prior to the surgical procedure? A. Antacid B. Antiemetic C. Antibiotic D. Anticholinergic

. Answer: C Explanation: C. Antibiotics are given preoperatively to orthopedic patients to prevent postoperative infections. 2. Antacids increase the gastric pH and reduce the volume of gastric fluid. 3. Antiemetics enhance gastric emptying. 4. Anticholinergics reduce oral and respiratory secretions to decrease the risk of aspiration and vomiting.

An older patient recovering from surgery is given an antiemetic for nausea. Which manifestation indicates to the nurse that this patient is experiencing a possible reaction to the medication? A. Confusion B. Dry mouth C. Involuntary muscle movements D. Breakthrough vomiting

. Answer: C Explanation: C. Antiemetics, such as Metoclopramide (Reglan) and ondansetron (Zofran) , can have tranquilizing effects as well as cause an extrapyramidal reaction. The patient would demonstrate involuntary movements, muscle tone changes, and abnormal posturing. 2. Elderly patients may also experience drowsiness, which reduces orientation, after being given antiemetics. 3. A dry mouth may be experienced as a result of having been or currently being unable to have oral intake. 4. Breakthrough vomiting is not an indication of an adverse reaction.

A patient is scheduled for extraction of a cataract. How should the nurse classify this patient's surgical procedure? A. Minor diagnostic B. Major constructive C. Minor elective D. Major elective

. Answer: C Explanation: C. Surgical procedures are classified according to purpose, risk factor, technique, and urgency. Cataract extraction would be considered a minor elective surgery. Minor procedures carry minimal risk and minimal physical assault. 2. A minor diagnostic surgery is used to determine or confirm a condition. 3. Major constructive procedures require extensive physical assault and/or serious risk. Constructive procedures are used to build tissue/organs which are absent. 4. Major elective procedures are suggested to the patient by the physician but there is little risk if they are not performed.

The nurse in the same-day surgical care area is preparing a patient for surgery. What should the nurse do to ensure that this patient has a successful recovery from the surgery? A. Measure intake and output. B. Assess vital signs. C. Limit pain control measures since the patient will need to ambulate when leaving after the surgery. D. Provide teaching and additional resources to help the patient when at home.

. Answer: D Explanation: D. Because the postoperative phase does not end until recovery is complete, the nurse's role as educator is vital as the patient nears discharge. As the patient prepares to recuperate at home, the nurse provides information and support as needed for self-care. Written guidelines, directions, and information should accompany all aspects of teaching. Opportunities for patient and family teaching are often brief, necessitating an organized, coordinated effort. 2. The nurse may or may not need to measure the patient's intake and output. 3. The nurse will assess all surgical patients' vital signs. 4. The nurse should ensure the patient's pain is controlled and not limit pain medication.

After providing a preoperative sedative, the nurse notes that the surgical consent form has not been signed by the patient. What should the nurse do? A. Ask the patient to sign the consent form. B. Send the patient for surgery with an unsigned consent form. C. Phone the operating room suite to notify the nurse that the patient has not signed the consent form. D. Contact the surgeon.

. Answer: D Explanation: D. The patient should be aware and alert before signing the consent form. The nurse should contact the surgeon in the event the patient receives preoperative sedative medication and has not yet signed the consent for surgery form. The surgeon who performs a procedure is responsible for obtaining the patient's consent for care. 2. The nurse should not ask the patient to sign the consent form if the patient is under the influence of a sedative. 3. The nurse should not send the patient for surgery with an unsigned consent form. 4. The nurse should not phone the operating room suite to notify the nurse that the patient has not signed the consent form.

) A patient believes that scheduled surgery is minor since it will be done as an outpatient. How should the nurse respond to this patient? A. "Every surgical procedure is serious, and I will make sure you have information to have a successful recovery." B. "You are right." C. "If it were more serious, you would be admitted to the hospital." D. "Your insurance plan does not cover inpatient surgical procedures. That's why your surgery is being done as an outpatient."

1. Answer: A Explanation: A. The complexity of the surgery and recovery and the expected level of care needed on completion of the surgery are the major differences between inpatient and outpatient surgical procedures. The outpatient surgical patient and family must cope with the additional stress of needing to learn a great deal of information in a short span of time. The nurse should explain that every surgical procedure is serious and that the patient will be given information to have a successful recovery. 2. The nurse should not agree with the patient about outpatient surgery being minor. 3. The nurse does not know if the patient needs to be admitted to the hospital. 4. The nurse does not have enough information about the patient's insurance coverage to make the statement about the patient having surgery as an outpatient.

The nurse is preparing to discharge a patient after having outpatient surgery. Which criteria should the nurse use to determine whether the patient is eligible to be discharged? Select all that apply. A. Patient's expressed readiness to go home B. Stable vital signs C. No nausea or dizziness D. Pain controlled E. Adequate urine output

1. Answer: B,C,D,E Explanation: B. Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. C. Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. D. Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. E. Following outpatient surgery, the patient will be discharged after meeting the institution's criteria, which typically include tolerance of fluids or food, stable vital signs, absence of nausea or dizziness, pain control, adequate urine output, as well as patient being oriented and demonstrating understanding of postoperative instructions. 5. The patient's expressing readiness to go home is not a criterion that would make him or her eligible for discharge after outpatient surgery.

A patient scheduled for outpatient surgery asks why admission to the hospital is not required. What should the nurse explain as an advantage of having outpatient surgery? A. Ability to use home care for postoperative care in the home. B. Reduced use of postoperative medications. C. Reduced risk of healthcare-associated infections. D. Inadequate staffing on the surgical care areas.

1. Answer: C Explanation: C. Advantages to outpatient surgery include a reduced risk of healthcare-associated infections. 2. The patient may or may not have home care for postoperative care in the home. 3. There is no evidence to suggest that patients who have outpatient surgery use fewer postoperative medications. 4. Saying that staffing on the surgical care areas is inadequate would be inappropriate.

A patient being prepared for surgery has been diagnosed with dehydration. Which laboratory values support the diagnosis for this patient? A. Hemoglobin and hematocrit B. Glucose C. White blood cell count D. Platelet count

Answer: A Explanation: A. An increase in hemoglobin and hematocrit levels would indicate dehydration. 2. An alteration in glucose level could indicate impaired glucose metabolism or inadequate glucose level. 3. An alteration in white blood cell count could indicate an infection or immune deficiencies. 4. An alteration in platelet count could indicate a malignancy or clotting deficiency disorder.

The nurse determines that a patient recovering from spinal anesthesia is experiencing complications from the anesthesia. Which should the nurse expect to be provided to this patient? Select all that apply. A. Caffeine B. Vasoactive medication C. Analgesics D. Intravenous fluids E. Epidural blood patch

Answer: A,C,D,E, Explanation: A. Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include caffeine. C. Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include analgesics. D. Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include hydration. E. Leakage of cerebrospinal fluid (CSF) into the epidural space can cause reduced CSF pressure and postoperative headaches. Treatment may include an epidural blood patch. 5. Vasoactive medications are used if hypotension occurs.

A patient recovering from surgery reports a pain level of 6 on a 0-10 pain scale but refuses additional pain medication to avoid becoming addicted. On which concept should the nurse focus when responding to this patient? A. Physical dependence on pain medication is uncommon during the short-term postoperative use. B. This patient already might have an addiction problem. C. This patient might benefit from a placebo dose. D. The physician should be notified to discuss pain management.

Answer: A Explanation: A. Patients might fear addiction or physical dependence on pain medications, especially opioids, postoperatively. The duration of use is typically short term, and this concern should be discussed, but is not anticipated to occur. 2. The patient who already has an addiction problem most likely would be requesting more medication, not refusing it. 3. The patient is verbalizing pain, so administration of a placebo is unethical, against patient rights for pain management, and should not be administered. 4. It is within the scope of the nurse to review and make decisions with the patient regarding safe use of pain medications that have been ordered by the physician. The physician does not need to be called at this time unless the nurse's interventions with the patient are unsuccessful.

A patient recovering from surgery, experiences a deep vein thrombosis (DVT). Which preoperative exercise should the nurse identify as being ineffective for this patient? A. Leg exercises B. Deep breathing and coughing C. Use of incentive spirometry D. Splinting when coughing

Answer: A Explanation: A. Preoperative patient teaching includes leg exercises in order to reduce the onset of the complication deep vein thrombosis. The development of a DVT indicates teaching was ineffective. 2. Deep breathing and coughing are helpful to prevent complications of pneumonia and atelectasis. 3. Use of incentive spirometry is helpful to prevent complications of pneumonia and atelectasis. 4. Splinting when coughing is taught so that thoracic and abdominal incisions are maintained and protected from an increase in intra-abdominal pressure that occurs when coughing.

A patient's postoperative wound has sanguineous drainage with a thick, reddish appearance. In which phase of healing is this patient's wound? A. Inflammatory 2. Proliferative 3. Stationary 4. Remodeling

Answer: A Explanation: A. The inflammatory phase begins with the surgical incision. Sanguineous drainage contains both serum and red blood cells and has a thick, reddish appearance. 2. The proliferative phase begins within 2 to 3 days after surgery. 3. Stationary is not a phase of wound healing. 4. In the remodeling phase, scar tissue is remodeled by a process of collagen synthesis and breakdown to increase its strength. This phase begins about 3 weeks after surgery and can continue for 6 or more months.

An older patient is recovering from a surgical procedure. What should the nurse do to ensure the patient is comfortable? A. Provide warm blankets. B. Limit movement to once every eight hours. C. Explain all activities using a loud voice. D. Limit fluids.

Answer: A Explanation: A. The older patient may need extra blankets for warmth. This is what the nurse should do to ensure for the patient's comfort. 2. The patient should be carefully turned and repositioned frequently to prevent the onset of pressure ulcers. 3. The nurse should speak in a low tone and not loudly. 4. The older patient needs an adequate fluid intake and may not need to have fluids limited.

A patient received lorazepam (Ativan) as preoperative medication. What should the nurse assess when caring for this patient? A. Respiratory depression B. Nausea and vomiting C. Confusion D. Rash

Answer: A Explanation: A. The patient who received lorazepam (Ativan) should be monitored for respiratory depression, hypotension, lack of coordination, and drowsiness. 2. Nausea and vomiting is not associated with the use of lorazepam (Ativan). 3. Confusion is not associated with the use of lorazepam (Ativan). 4. Rash is not associated with the use of lorazepam (Ativan).

A patient who is being admitted for surgery asks why information is being collected about the use of herbal and natural supplements. How should the nurse respond to this patient? A. "Herbal supplements may interact with anesthetic agents." B. "Herbal remedies may cause pain relievers to be ineffective." C. "The physician is in charge of medications." D. "There is no need to take these preparations."

Answer: A Explanation: A. The use of herbal supplements must be documented prior to surgery. It is possible for these elements to interact with anesthetic agents. 2. Herbal remedies have not been shown to render analgesics ineffective. 3. Stating that the physician is in charge of medications does not adequately respond to the patient's inquiry. 4. Stating that there is no need to take these prescriptions does not adequately respond to the patient's inquiry.

While the nurse is assisting a patient recovering from epidural anesthesia to ambulate, the patient becomes dizzy and has a blood pressure of 78/48 mmHg. What actions should the nurse take? Select all that apply. A. Notify the anesthesiologist. B. Continuously monitor blood pressure. C. Prepare to administer intravenous fluids. D. Prepare to administer vasoactive medications. E. Notify the pharmacy to obtain atropine.

Answer: A,B,C,D Explanation: A. Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. B. Atropine is not indicated in the treatment of this adverse effect of epidural anesthesia. C. Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. D. Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications. 5. Hypotension is common with epidural. Blood pressure should be monitored and, if critical hypotension occurs, the anesthesia provider should be alerted and expected to increase intravenous fluids and administer vasoactive medications.

An older patient having preoperative diagnostic testing has an elevated carbon dioxide level. What should the nurse be monitoring for this patient? A. Serum potassium level B. Serum sodium level C. Respiratory status and arterial blood gases D. Intake and output

Answer: C Explanation: C. A patient with an altered carbon dioxide level could have a history of emphysema, chronic bronchitis, asthma, pneumonia, or respiratory acidosis, or it could be caused by vomiting or nasogastric suctioning. The best nursing intervention for this patient would be to monitor the patient's respiratory status and arterial blood gases. 2. A review of the potassium level is not the most beneficial to this patient at this time. 3. A review of the sodium level is not the most beneficial to this patient at this time. 4. A review of the intake and output is not the most beneficial to this patient at this time.

A patient who has reacted poorly to general anesthesia in the past is scheduled for surgery to repair a rotator cuff tear. For which types of anesthesia should the nurse prepare educational materials for this patient? Select all that apply. A. Epidural B. Spinal C. Topical D. Nerve block E. Local nerve infiltration

Answer: A,D Explanation: A. Spinal anesthesia is effective for approximately 90 minutes. Surgeries of the lower abdomen, perineum, and lower extremities are likely to use this type of regional anesthesia. D. Nerve blocks are accomplished by injecting an anesthetic agent at the nerve trunk to produce a lack of sensation over a specific larger area, such as an extremity. 2. Topical anesthesia would not be an option for this case. 3. Epidural blocks are local anesthetic agents injected into the epidural space, outside the dura mater of the spinal cord. It is indicated for surgeries of the shoulders. 5. Local nerve infiltration is achieved by injecting an anesthetic agent around a local nerve to suppress sensation over a limited area of the body. This technique may be used when a skin or muscle biopsy is obtained or when a small wound is sutured.

An older patient who is preparing for surgery wants to wear glasses and keep a hearing aid in place until receiving anesthesia. Which nursing response demonstrates accurate therapeutic communication? A. "You cannot keep those in." B. "I will contact the surgery department to discuss your requests." C. "The policies in the surgery unit will not allow it." D. "Certainly, you can keep them for that time."

Answer: B Explanation: 1. To decrease confusion and assist in communication, hearing aids and glasses should be used when appropriate and possible. The nurse will need to check with the surgical department first before granting the patient's wish. 2. As a patient advocate, the nurse is responsible for making an inquiry. 3. The nurse does not have the authority to make decisions on behalf of the surgical department. 4. The nurse should not give information that may be inaccurate

During the assessment of a postoperative patient's bowel sounds, the nurse auscultates absent sounds over all four abdominal quadrants. For which reason should the nurse identify interventions for this patient? A. Normal bowel function B. Paralytic ileus C. The onset of flatus D. The onset of stool

Answer: B Explanation: B. A distended abdomen with absent bowel sounds may indicate paralytic ileus. 2. Normal bowel sounds are low in pitch. 3. The onset or presence of flatus is accompanied by bowel sounds. 4. The onset of stool is accompanied by bowel sounds.

An older patient, recovering from surgery, is prescribed a soft diet. Which age-related change does this type of diet support? A. Reduced intestinal absorption B. Decline in gastric motility C. Lactose intolerance D. Gall bladder insufficiency

Answer: B Explanation: B. A soft diet helps with a change in gastrointestinal functioning in the older adult. 2. Reduced intestinal absorption is not a gastrointestinal age-related change. 3. Lactose intolerance can occur at many ages. 4. Gall bladder insufficiency is not a gastrointestinal age-related change.

An older patient is being prepared for orthopedic surgery. For what potential risk should the nurse plan care? A. Prolonged effects of anesthesia because of herbal supplements B. Decreased tolerance of general anesthesia C. Wound dehiscence D. Decreased cognitive acuity

Answer: B Explanation: B. Older adults have age-related changes that affect physiologic, cognitive, and psychosocial responses to the stress of surgery in addition to decreased tolerance of general anesthesia and postoperative medications and delayed wound healing. 2. No information is provided to indicate the use of herbal supplements. 3. Despite delayed wound healing, there is no information to support the increased risk for wound dehiscence. 4. Cognition remains stable in older adults, but information processing slows.

A patient having a hernia repair as an outpatient asks why hospitalization afterward is not required. Which response is appropriate for the nurse to make? Select all that apply. A. "It is cheaper for the insurance company if you go home today." B. "You have less risk of getting an infection at home." C. "The government won't let you stay. D. "If you ask the healthcare provider, the hospital will probably let you stay." E. "You will probably be more comfortable in your own bed at home."

Answer: B, E Explanation: B. An advantage of outpatient surgery is reduced risk of healthcare-associated infection. E. An advantage of outpatient surgery is less physiologic stress. 3. While it is probably cheaper for the insurance company for the patient to go home and there are governmental regulations about hospital admission and Medicare, this is not the best time to bring those concepts into the conversation. 4. While it is probably cheaper for the insurance company for the patient to go home and there are governmental regulations about hospital admission and Medicare, this is not the best time to bring those concepts into the conversation. 5. It is also not advisable to infer that the hospital has a decision to make in whether the patient stays or goes home.

After complaining of discomfort from a surgical procedure, the patient voices fear of addiction with taking analgesics as prescribed. What information should be provided to the patient regarding these concerns? Select all that apply. A. "Patients should be screened for addiction potential prior to being given narcotics." B. "Addiction to opioid analgesics is rare when used for short-term postoperative pain management." C. "I'll turn the TV on to help distract you from your pain." D. "Psychological tolerance is not commonly experienced by patients who take narcotic analgesics during the postoperative experience." E. "Pain tolerance and the need for opioid analgesics are individualized."

Answer: B,D,E Explanation: B. The use of opioid analgesics during the postoperative period is rarely associated with physical dependency concerns. D. The use of opioid analgesics during the postoperative period is rarely associated with psychological dependency concerns. E. The pain management needs of patients will vary and should be managed individually. 4. Screening is not routinely recommended for surgical patients. 5. This does not address the patient's need for pain control or the patient's concern over addiction from postoperative opioid analgesics.

A patient being prepared for surgery has a history of chronic obstructive pulmonary disease. Which diagnostic test may be completed prior to this patient's surgical procedure? A. CT scan of the brain B. Lumbar puncture C. Pulmonary function tests D. Abdominal MRI

Answer: C Explanation: C . Pulmonary function studies may be performed with patients who have chronic obstructive pulmonary disease to determine the extent of respiratory dysfunction. 2. There is no reason for a CT scan of the brain to be completed. 3. There is no reason for a lumbar puncture to be completed. 4. There is no reason for an abdominal MRI to be completed.

) A patient being discharged is concerned about being overmedicated because of receiving a prescription for Demerol 50 mg by mouth when 10 mg of morphine was given through the intravenous catheter in the hospital. How should the nurse respond to this patient? A. "The doctor is making sure that you do not have any pain once you go home." B. "I will get the doctor so he can explain what is going on with your condition." C. "Oral doses need to be higher than those given through an IV." D. "All patients have more pain when they go home so the doctor is making sure you have enough medication."

Answer: C Explanation: C. Oral doses of analgesics are not equal to parenteral doses. The oral dose of an opioid such as morphine, codeine, or hydromorphone may be two to five times higher than the parenteral dose to achieve equivalent pain relief. This is what the nurse should explain to the patient. 2. The physician is not making sure the patient has no pain at home. 3. The nurse does not need to get the physician to explain the patient's condition. 4. Not all patients have more pain when they are discharged after surgery.

A patient with a history of sleep apnea is experiencing difficulty maintaining an airway during conscious sedation. What should the nurse do to assist this patient?. A. Begin artificial ventilations. B. Measure oxygen saturation. C. Prepare to administer a reversal agent D. Apply prescribed oxygen via face mask.

Answer: C Explanation: C. Patients with a history of sleep apnea may have difficulty with conscious sedation. The nurse should prepare to administer a reversal agent to the patient. 2. The patient may or may not need artificial ventilations at this time. 3. The nurse should have been measuring the patient's oxygen saturation throughout the procedure. 4. The patient is having difficulty maintaining an airway so applying oxygen via face mask may not be appropriate.

A patient diagnosed with emphysema is being prepared for surgery. What laboratory value should the nurse review to obtain information about the patient's respiratory status? A. White blood cell count B. Serum creatinine C. Carbon dioxide D. Blood urea nitrogen

Answer: C Explanation: C. The carbon dioxide level will be elevated in a patient with emphysema. This is the laboratory value that would provide information about the patient's respiratory status. 2. The white blood cell count would provide information regarding an infection or immune deficiency. 3. The serum creatinine level provides information about the patient's renal status. 4. The blood urea nitrogen level also provides information about the patient's renal status.

An older patient, being prepared for surgery, has a low glomerular filtration rate. Which aspect of the patient's care should the nurse realize this finding will impact? A. Postoperative activity level B. Intraoperative bleeding C. Oxygenation status D. Medication dosages

Answer: D Explanation: D. A patient susceptible to renal insufficiency is at risk for fluid volume overload in the perioperative period and for accumulation of metabolic by-products and medications dependent on renal clearance. When this risk is known, renal function testing may be performed preoperatively. It is evaluated on the basis of glomerular filtration rate (GFR), which is estimated by using serum creatinine (reported as the eGFR) or by measuring urinary creatinine. Creatinine is a stable product of muscle mass; it is filtered by the kidneys or secreted by the kidney tubules. In kidney failure, serum creatinine rises and the GFR is low. The best indicator of GFR is the creatinine clearance, a comparison of both serum and urinary creatinine levels. Medication dosages will need to be adjusted for the older patient with a low glomerular filtration rate. 2. The glomerular filtration rate will not impact the patient's postoperative activity level. 3. The glomerular filtration rate will not impact the amount of intraoperative bleeding. 4. The glomerular filtration rate will not impact the patient's oxygenation status.

An older adult patient being prepared for surgery is scheduled for an electrocardiogram. What should the nurse explain to the patient regarding the purpose of this test? A. It is used to diagnose preexisting cardiac disease. B. It is one way to validate laboratory values C. It is a predictor of surgical procedure success. D. It is routine for all patients having general anesthesia.

Answer: D Explanation: D. An electrocardiogram (ECG) is ordered routinely for patients undergoing general anesthesia when they are over 40 years of age or have cardiovascular disease. 2. The electrocardiogram might detect preexisting cardiac disease but will not diagnose disease. 3. The electrocardiogram will not validate laboratory values. 4. The electrocardiogram is not used to predict the success of surgical procedures.

The nurse is caring for a patient recovering from surgery conducted in the previous 24 hours. What should the nurse do to assist this patient with pain control? A. Administer prescribed analgesics when the patient requests something for pain. B. Assist the patient to a more comfortable position to reduce the amount of pain. C. Offer the patient a back rub to reduce the amount of pain. D. Administer prescribed analgesics around the clock.

Answer: D Explanation: D. Established, persistent, severe pain is more difficult to treat than pain that is at its onset. Postoperative analgesics should be administered at regular intervals around the clock to maintain a therapeutic blood level. 2. Administering analgesics as needed (prn) lowers this therapeutic level; delays in medication administration further increase pain intensity. "As needed" administration of analgesics is not recommended in the first 36 to 48 hours postoperatively. 3. The nurse could help the patient into a more comfortable position to reduce the amount of pain; however, the nurse should provide the patient with the prescribed analgesics around the clock. 4. The nurse could offer the patient a back rub to reduce the amount of pain; however, the nurse should provide the patient with the prescribed analgesics around the clock.

An older patient is receiving an NSAID for postoperative pain. What should the nurse assess in this patient? A. Blood pressure B. Respiratory rate C. Heart rate D. Urine output

Answer: D Explanation: D. NSAIDs can be given safely to older patients, but they should be observed closely for side effects, particularly gastric and renal toxicity. The nurse should monitor the patient's urine output to determine renal function. 2. NSAIDs do not usually affect blood pressure. 3. NSAIDs do not usually affect respiratory rate. 4. NSAIDs do not usually affect heart rate.

The nurse is assisting a postoperative patient in using an incentive spirometer. Which postoperative complication is this nurse attempting to avoid? A. Deep vein thrombosis B. Hemorrhage C. Pulmonary embolism D. Atelectasis

Answer: D Explanation: D. Promoting lung expansion and systemic oxygenation of tissues is a goal in preventing atelectasis. Nursing care includes assisting with incentive spirometry. 2. Deep vein thrombosis is not related to incentive spirometer use. 3. Hemorrhage is not related to incentive spirometer use. 4. Pulmonary embolism is not related to incentive spirometer use.

A patient is being transferred from the operating room to the recovery room. In which phase of the surgical process will the nurse in the recovery room provide care? A. Preoperative B. Intraoperative C. Restorative D. Postoperative

Answer: D Explanation: D. The postoperative phase begins when the patient is admitted to the recovery room and ends with the patient's recovery from the surgical intervention. 2. The preoperative phase is prior to surgery. 3. The intraoperative phase occurs during the surgery. 4. Restorative is not a phase of the surgical experience.

The nurse is planning care to support the cognitive-psychosocial status for an older patient having surgery. Which intervention would be appropriate for this patient? A. Set limits with the patient. B. Tell the patient that his physician will make all care decisions. C. Remind the patient that the call bell is for emergencies only. D. Provide time for teaching and learning.

Answer: D Explanation: D. To support the older patient's cognitive-psychosocial status, the nurse should provide ample time for teaching and learning. 2. The nurse should not treat the older patient as a child by setting limits. 3. The nurse should not treat the older patient as a child by stating that all care decisions will be made by the physician. 4. The nurse should not treat the older patient as a child by reminding that the call bell is for emergencies only.