Preoperative Care- Elsevier Questions (test#1)

The patient scheduled for surgery asks the nurse why cefazolin has been prescribed by the health care provider. Which response by the nurse is accurate?

"Cefazolin is an antibiotic given for two days to prevent postoperative infection." Rationale: Cefazolin is a cephalosporin-type antibiotic that reduces the risk of postoperative infection. When used as prophylaxis, it commonly is used for 48 hours.

A patient with diabetes is waiting in the preoperative holding area and asks the nurse if the daily insulin dose should be taken. Which response is the most appropriate?

"I will check with the surgeon and let you know." Rationale: If a diabetic patient on insulin is due for surgery, it is important to get clear instructions from the surgeon regarding the insulin administration. The surgeon may choose to avoid the dose or give an adjusted dose based on the blood sugar levels.

A patient is instructed not to have anything to eat or drink eight hours prior to surgery. When arriving to the preoperative holding area, the patient informs the nurse they ate eggs and toast about two hours ago. Which response by the nurse is most appropriate?

"I will inform the anesthesia care provider and surgeon to see what the options are." Rationale: The nurse should inform the anesthesia care provider and surgeon that the patient has ingested solid foods two hours prior to surgery so that the options for surgery can be discussed. The surgery will most likely be delayed, since this increases the patient's risk for complications, such as aspiration.

Which statement by the nurse reflects a correct understanding of the older adult surgical patient when teaching a preoperative class to a group of older adults?

"I will watch the participants for signs of excessive anxiety." Rationale: Be particularly alert when assessing and caring for the older adult surgical patient. An event that has little effect on a younger adult may be overwhelming to the older patient. Emotional reactions to impending surgery and hospitalization often intensify in the older adult. Help to decrease anxieties and fears, as well as maintain and restore the self-esteem of the older adult during the surgical experience.

The nurse is preparing to administer a preoperative dose of cefazolin prior to an open cholecystectomy. Which explanation by the nurse about why the patient is receiving this medication is accurate?

"It will prevent postoperative surgical-site infection." Rationale: Cefazolin has enhanced activity against a wide variety of gram-negative organisms and is being used for perioperative prophylaxis against infection at the surgical site. The bowel has a wide variety of bacterial flora that could contaminate the abdominal cavity during surgery.

A preoperative patient asks why the dose of warfarin is being withheld. Which response by the nurse is most accurate?

"This medication could cause excessive bleeding during surgery if it is not stopped beforehand." Rationale: Warfarin is an anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, the patient's clotting parameters are monitored as a means of ensuring that the effects of the medication are reversed.

While performing preoperative teaching, the patient asks when to stop drinking water before the surgery. Which response by the nurse is accurate?

"You can drink clear liquids up to two hours before surgery." Rationale: Practice guidelines for preoperative fasting state that the minimum fasting period for clear liquids is two hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to have nothing by mouth after midnight.

When teaching a patient about the benefits of ambulatory surgery compared to inpatient surgery, which information is accurate? Select all that apply.

-It involves minimal laboratory tests. -It requires fewer preoperative medications. -It reduces the risk of hospital-acquired infections. Rationale: Ambulatory surgeries are often preferred over inpatient surgeries. These surgeries are usually minimally invasive, involve minimal laboratory tests, and require fewer preoperative medications. Because the patient recovers comfortably at home, there is no risk of hospital-acquired infections. These surgeries are less costly for both patients and insurers

A patient scheduled for surgery has been NPO since midnight, and the surgery is delayed for several hours. The patient reports being hungry and having a headache due to missing morning coffee. Which actions would the nurse implement in this situation? Select all that apply.

-Keep the patient apprised of the situation -Tell the anesthesia care provider about the situation Rationale: NPO restrictions are used to prevent aspiration and vomiting during surgery. All food, including soft foods, should be avoided before surgery because it can lead to these complications. Patients who are NPO from midnight frequently complain of hunger and thirst while waiting for surgery. The nurse should keep the patient updated on the situation and aware that he or she has not been forgotten. Patients who regularly drink caffeine in the morning often experience a "caffeine withdrawal" headache when fasting. The nurse should talk to the anesthesia care provider and ask if the patient can consume clear liquids; if permission is given, clear liquids and coffee should be offered, but not until after the anesthesia care provider has approved it.

The nurse is caring for a patient with renal dysfunction who is scheduled for surgery. Which nursing interventions are a priority in this situation? Select all that apply.

-Obtain renal function test preoperatively. -Report to the perioperative team if the patient has a problem voiding. Rationale: Many drugs are metabolized and excreted by the kidneys. A decrease in renal function can lead to altered drug response and unpredictable drug elimination. Hence, a renal function test is necessary before the surgery. If the patient has a problem voiding, the nurse should inform the perioperative team because the patient might exhibit improper voiding postoperatively.

During a preoperative teaching session, a patient asks the nurse about the effects of opioid medications. Which information would the nurse include in the explanation? Select all that apply.

-Opioids decrease intraoperative pain. -Opioids relieve pain during preoperative procedures. -Opioids decrease intraoperative anesthetic requirements. Rationale: Opioid drugs are often used before surgery to decrease intraoperative pain and anesthetic requirements. They also help relieve pain during preoperative procedures.

Which patients would require administration of preoperative antibiotics? Select all that apply.

-Patients with known coronary artery disease -Patients undergoing gastrointestinal surgery -Patients undergoing joint replacement surgery -Patients with a history of valvular heart diseases Rationale: In patients with a history of valvular heart disease, antibiotics may be administered to prevent infective endocarditis. Gastrointestinal surgery carries a risk of wound contamination and calls for antibiotic treatment. In joint replacement surgeries, wound infections can have serious consequences; therefore it is prudent to give antibiotics.

Which nursing actions are important to carry out when preparing a patient for surgery? Select all that apply.

-Remove cosmetics, nail polish, and artificial nails. -Remove jewelry in piercings if electrocautery devices will be used. -Remove all prosthetics, including dentures, contact lenses, and glasses. -Ascertain that the patient has an empty bladder before going to operating room. Rationale: *The patient should remove all cosmetics to facilitate observation of skin color during surgery. Nail polish and artificial nails should be removed to help in assessing capillary refill and pulse oximetry. *If electrocautery devices will be used, all jewelry in piercings should be removed as a safety measure. All prostheses, including dentures, contact lenses, and glasses, should be removed to prevent loss and damage. *The nurse should ascertain that the patient's bladder is empty before going to the operating room because involuntary voiding can happen under the effect of sedatives administered during surgery. *If the patient uses a hearing aid, it should be left intact to help the patient hear properly and be able to follow instructions.

When can a patient revoke the consent for the surgery? Select all that apply.

-When the patient is partially informed -Just before the scheduled surgery time -After the patient has signed the consent form -When the patient is in the preoperative holding area Rationale: Patients can revoke the consent at any time before the scheduled surgery. Patients can refuse the surgery even when they are in the preoperative holding room, assuming they are conscious and able to make the decision for themselves. The informed consent can be revoked whether a patient has received full or partial information, even at the very last minute.

An older adult patient has been admitted for a bilateral mastectomy and breast reconstruction surgery. Which topics would the nurse include in the patient's preoperative teaching plan? Select all that apply.

-Where in the hospital she will be taken postoperatively -How to perform postoperative deep-breathing and coughing exercises Rationale: During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay.

The nurse would instruct a patient to stop taking multivitamins for how long before surgery?

1 day Rationale: Multivitamin tablets can help increase nutritional status, and they can be taken until 1 day before surgery.

The nurse needs to instill different eyedrops into a preoperative patient's eyes. How many minutes would the nurse wait between each set of eyedrops?

5 minutes Rationale: It is important to administer the drugs as ordered and on time to adequately prepare the eye for surgery. If there are multiple sets of eyedrops, the nurse has to maintain at least a 5-minute interval between each set of drops.

Before a patient is admitted to the operating room, which preoperative documentation must be attached to the chart, according to The Joint Commission?

A complete physical examination Rationale: The Joint Commission requires that patients admitted to the OR have a documented physical examination report attached to the chart. This document explains in detail the overall status of the patient for the surgeon and other members of the surgical team

Which pre-op patient would the nurse most closely monitor for bleeding as a result of medication being taken?

A man who is taking clopidogrel after the placement of a coronary artery stent Rationale: Any drug that inhibits platelet aggregation, such as clopidogrel, represents a bleeding risk.

An alert patient unable to be weaned from a ventilator needs a tracheostomy but is refusing the procedure. The family insists the surgery be performed. Which action would the nurse to take?

Advocate for the patient's rights Rationale: The nurse must act as the patient's advocate and assist the patient with fulfilling their wishes. However, as the patient's advocate, the nurse must be sure the patient knows the risks and benefits of refusing tracheostomy.

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. Which action is the most appropriate for the nurse to take?

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

A patient with diabetes who takes insulin is scheduled for a surgery. Which instruction would the nurse tell the patient about insulin injections around the time of the surgery?

An adjusted insulin dose may be given before surgery based on the patient's history of glucose control. Rationale: The surgeon or the anesthesia care provider (ACP) may vary the usual insulin dose based on the patient's history of glucose control. Serum or capillary glucose levels are measured the morning of surgery to establish baseline levels.

Which potential complication might a patient experience if he or she consumes a meal heavy with garlic the day before a surgery?

An increase in bleeding during the surgery Rationale: Increased consumption of garlic may increase bleeding tendency in the patient. Increased bleeding, especially related to a surgical procedure, could result in reduced blood volume and lead to shock. *Patients taking kava and valerian may experience excessive sedation. *Patients taking multivitamins on an empty stomach on the day of the surgery may experience excessive nausea and vomiting after the surgery. *Patients who eat astragalus and ginseng will have increased BP before and during the surgery.

While collecting a preoperative history, the patient reports to the nurse a history of diffuse skin rashes when hospitalized in the past as well as food allergies to bananas and avocados. Which action would the nurse take?

Ask additional questions to assess for a possible latex allergy. Rationale: The nurse would ask additional screening questions to determine the patient's risk for a latex allergy. Risk factors for latex allergy include a history of contact dermatitis and allergies to certain foods such as eggs, avocados, bananas, chestnuts, potatoes, and peaches. Latex precaution protocols should be used for patients identified as having a positive latex allergy test result or a history of signs and symptoms related to latex exposure.

How would the nurse ensure a patient scheduled for surgery is not pregnant?

By checking human chorionic gonadotropin (hCG) level Rationale: To check for pregnancy status, hCG levels are measured.

A patient with Alzheimer's dementia and confusion arrives via ambulance from a long-term care facility to the preoperative area for placement of a feeding tube, and there is no documentation of consent for the procedure. Which action would the nurse take?

Contact the family member identified as the patient's power of attorney on the patient's medical record so the surgeon can obtain consent. Rationale: The nurse should review the patient's medical record to locate next of kin or power of attorney to request consent, which is obtained by the surgeon. If the legal guardian has not been informed by the surgeon of the need for the procedure, possible complications, and alternative treatments, the consent cannot be obtained

The nurse is preparing a patient for surgery when they state, "I am terrified to be put to sleep. What if I don't wake up?" Which priority action would the nurse take?

Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient. Rationale: If the nurse identifies that the patient has fear of anesthesia, inform the ACP immediately so that he or she can talk further with the patient. Reassure the patient that a nurse and ACP will be present at all times during surgery.

A patient going for surgery today informs the nurse she they took kava last night to help her sleep. Which action would the nurse take?

Inform the anesthesiologist of the patient's recent use of kava. Rationale: Kava may prolong the effects of certain anesthetics. Thus the anesthesiologist needs to be informed of recent ingestion of this herbal supplement. While kava may be helpful for managing mild insomnia, the nurse should reinforce that this type of supplement should not be taken within 24 hours of a surgical procedure due to its potential interaction with anesthesia. Patients should not take anything before surgery without the health care provider's knowledge.

A patient is scheduled for surgery in one week and reports that he takes a fish oil capsule daily. Which intervention would be the priority?

Inform the health care provider because the procedure may need to be rescheduled Rationale: Fish oil dietary supplements can increase bleeding during and after surgery. The health care provider should determine how long it should be discontinued before surgery. Telling the patient to stop taking the fish oil 1 day before surgery would still place the patient at risk for bleeding.

Which action would the nurse take upon learning that a patient scheduled for surgery uses the herb ginkgo regularly?

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

A woman is admitted to the hospital for an elective surgery. Her laboratory reports reveal that she is pregnant. Which action would the nurse take immediately?

Inform the surgeon. Rationale: In this case, the priority is safety of the patient and fetus, so the nurse would immediately inform the surgeon. The surgeon will make the decision regarding the surgery. Because anesthetics can put the mother and fetus at risk, exposure to anesthetics should be avoided.

After signing a witnessed consent for surgery, the patient decides they no longer want to have the procedure. The patient has one adult child but no other immediate family. Which action would the nurse take next?

Inform the surgeon. Rationale: The patient has the right to revoke the consent at any time; however, this should be reported to the medical staff who obtained the consent, because knowing this would help in planning the next steps.

During a preoperative evaluation, the patient reports to the nurse regular use of ginseng. Which action would the nurse take?

Inform the surgeon. Rationale: The priority intervention is to inform the surgeon. The gastrectomy needs to be rescheduled. The nurse should suggest that the patient discontinue the use of ginseng because ginseng increases BP before and during surgery.

Prior to a first-ever surgery, a patient reports taking alprazolam the night before for anxiety. Preoperative vital signs include BP 158/88, heart rate (HR) 96, and respiratory rate (RR) 24. Which action would the nurse take?

Notify the anesthesia care provider (ACP). Rationale: In determining the psychologic status of the patient, the nurse notes the patient's anxiety, which is supported by restlessness and the elevated BP and HR. The nurse should notify the ACP after assessing the cause of the anxiety or fear that the patient is experiencing. The patient may only need to talk about surgery, about concerns with the unknown or with body image, or about past experiences in order to relieve the anxiety; the nurse cannot assume that lack of knowledge is the cause of the anxiety.

When signing the consent, a patient states that the health care provider has not really explained what is involved in the surgical procedure. Which action will the nurse take?

Notify the health care provider about the conversation with the patient and delay the signature. Rationale: The patient should not be asked to sign a consent form unless the procedure has been explained to his or her satisfaction. The nurse should notify the health care provider, who has the responsibility for obtaining consent. The health care provider must provide the information and clarify any confusion.

When reviewing preoperative forms, the nurse notices that the patient's informed consent is not signed. Which action would the nurse take?

Notify the health care provider to obtain consent for surgery Rationale: The informed consent for the surgery must be obtained by the health care provider. The nurse can witness the signature on the consent form and verify that the patient (or the caregiver if the patient is a minor, unconscious, or mentally incompetent to sign) understands the informed consent.

A patient scheduled for heart valve replacement surgery voices general concern about the surgery. Which method would be useful to help decrease this patient's anxiety?

Provide web-based and audio-visual teaching materials about the surgery. Rationale: Providing web-based and audio-visual teaching materials about the surgery is an effective way to help address and individualize the patient's concerns and to decrease anxiety.

During a preoperative assessment, the patient states that he developed allergic skin rashes when exposed to rubber gloves a few years ago. Which concern would the nurse review the patient's medical record for?

Reactions to latex Rationale: A patient with a history of any allergic reactions has a greater potential for hypersensitivity to drugs given during anesthesia. Patients need to be screened specifically for latex allergies by checking the history of reactions that suggest an allergy to latex.

A patient scheduled for surgery has been using a nonsteroidal anti-inflammatory drug (NSAID) for pain. Which effect might the NSAID have postoperatively?

Risk for postoperative bleeding will increase. Rationale: Although analgesics are required for surgical patients, the use of NSAIDs should be stopped before surgery because these drugs are associated with increased postoperative bleeding.

The nurse is to administer preoperative medications for a patient who is scheduled for surgery at 7:30: cefazolin IV to be infused 30 minutes before surgery, midazolam IV before surgery, and a scopolamine patch behind the ear. Which medication would the nurse administer first?

Scopolamine Rationale: The scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin will be given at 7 to allow infusion 30 minutes before surgery. The midazolam, a short-acting benzodiazepine, is used as a sedative.

A patient is refusing to remove her wedding ring on the morning of surgery. Which action would the nurse take first?

Secure the ring according to agency policy and document the encounter. Rationale: Secure the ring according to agency policy; it is customary to tape a patient's wedding band to the finger and make a notation on the preoperative checklist that the ring has been taped in place. It should be documented in the chart after the ring is taped securely to the finger.

The nurse reviews data from a female patient scheduled for surgery. Based on the information in the electronic health record (EHR), which follow-up test would the nurse request to be ordered before this patient's surgery? *Takes hydrochlorothiazide 50mg every morning....

Serum potassium Rationale: The nurse would request a serum potassium level because the patient takes a diuretic. It will be important for electrolyte levels to be within a safe range prior to the surgery.

Which factor must the nurse be aware of regarding a patient's medication regimen and preparation for surgery?

Some medications are contraindicated for use with anesthetics. Rationale: Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that it has been communicated to the anesthesiologist.

Which information about the risk of postoperative bleeding would the nurse include in the teaching plan for a patient who is scheduled for surgery in two weeks?

Stop taking herbal medicines; they may increase the risk of postoperative bleeding. Rationale: Herbal medicines increase the risk of bleeding, so the patient should be advised to stop all herbal supplements two to three weeks before any surgical procedure. *Ginseng can increase BP before surgery, so it should not be taken. *Aspirin has antiplatelet action and can cause bleeding, so it should be avoided during perioperative care. *Other supplements that increase the risk of bleeding include fish oil, garlic, vitamin E, and ginkgo.

The nurse assesses a patient's serum potassium level prior to surgery. Which reason in the patient's history would prompt this nurse's action?

The patient is on diuretic therapy. Rationale: A patient who is on diuretic therapy needs to be evaluated for serum potassium levels to assess if there is an electrolyte imbalance.

Which statement is accurate regarding the hydration status of an older adult being prepared for surgery?

There is a narrow margin of safety between overhydration and underhydration in elderly patients. Rationale: The capacity to adapt to changes in fluid levels is low in older adult patients. The safety margin is very low between dehydration and overhydration, so the nurse should focus on the preoperative fluid balance history of this patient.

Which action will the nurse take for a patient who takes diuretics and is going for surgery?

Which action will the nurse take for a patient who takes diuretics and is going for surgery? Rationale: People who take diuretics are at risk of developing low potassium levels due to fluid and sodium loss. Low potassium levels may be detrimental to cardiac health, and surgery may pose additional harm.