Chapter 17: Preoperative Care

1. 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? Tell me more about what happened to your mother. You will receive medications to reduce your anxiety. You should talk to the doctor again about the surgery. Surgical techniques have improved a lot in recent years.

A

17. Which statement by a patient scheduled for surgery is most important to report to the health care provider? I had a heart valve replacement last year. I had bacterial pneumonia 3 months ago. I have knee pain whenever I walk or jog. I have a strong family history of breast cancer.

A

2. 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? The patient is planning to drive home after surgery. The patient had a sip of water 4 hours before arriving. The patients insurance does not cover outpatient surgery. The patient has not had surgery using general anesthesia before.

A

5. 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? V alue-belief Cognitive-perceptual Sexuality-reproductive Coping-stress tolerance

A

7. 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? Auscultate for adventitious breath sounds. Obtain the patients blood pressure and temperature. Remind the patient about harmful effects of smoking. Ask the health care provider about prescribing a nicotine patch.

A

11. 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? Assist the patient to the bathroom and stay with the patient to prevent falls. Offer a urinal or bedpan and position the patient in bed to promote voiding. Allow the patient up to the bathroom because medication onset is 10 minutes. Ask the patient to wait because catheterization is performed just before the surgery

B

13. 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? Withhold the usual scheduled insulin dose because the patient is NPO. Obtain a blood glucose measurement before any insulin administration. Give the patient the usual insulin dose because stress will increase the blood glucose. Administer a lower dose of insulin because there will be no oral intake before surgery.

B

19. Which information in the preoperative patients medication history is most important to communicate to the health care provider? The patient uses acetaminophen (Tylenol) occasionally for aches and pains. The patient takes garlic capsules daily but did not take any on the surgical day. The patient has a history of cocaine use but quit using the drug over 10 years ago. The patient took a sedative medication the previous night to assist in falling asleep.

B

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

B

4. 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? Notify the dietitian about the food allergies. Alert the surgery center about a possible latex allergy. Reassure the patient that all allergies are noted on the medical record. Ask whether the patient uses antihistamines to reduce allergic reactions.

B

9. 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? Provide an explanation of the planned surgical procedure. Notify the surgeon that the informed consent process is not complete. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

B

10. Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for abdominal surgery for an open cholecystectomy? Care for the surgical incision Medications used during surgery Deep breathing and coughing techniques Oral antibiotic therapy after discharge home

C

12. The nurse plans to provide preoperative 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? Use printed materials for instruction so that the patient will have more time to review the material. Direct the teaching toward the wife because she is the obvious support and caregiver for the Provide additional time for the patient to understand preoperative instructions and carry out procedures. Ask the patients wife to wait in the hall in order to focus preoperative teaching with the patient himself.

C

6. A patient undergoing an emergency appendectomy has been using St. Johns wort to prevent depression. Which complication would the nurse expect in the postanesthesia care unit? Increased pain Hypertensive episodes Longer time to recover from anesthesia Increased risk for postoperative bleeding

C

14. The outpatient surgery nurse reviews the complete blood cell (CBC) 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/L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/L. Which action should the nurse take? Call the surgeon and anesthesiologist immediately. Ask the patient about any symptoms of a recent infection. Discuss the possibility of blood transfusion with the patient. Send the patient to the holding area when the operating room calls.

D

15. 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? Have the patient sign a release and leave the ring on. Tape the wedding ring securely to the patients finger. Tell the patient that the hospital is not liable for loss of the ring. Suggest that the patient give the ring to a family member to keep.

D

16. A patient has received atropine before surgery and complains of dry mouth. Which action by the nurse is best? Check for skin tenting. Notify the health care provider. Ask the patient about any dizziness. Tell the patient dry mouth is an expected side effect.

D

18. 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? The patient drinks 3 or 4 cups of coffee every morning before going to work. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. The patients father died after receiving general anesthesia for abdominal surgery.

D

20. 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 health care provider before surgery? Hematocrit 36% Blood pressure 144/82 Pulse rate 58 beats/minute Serum potassium 3.2 mEq/L

D

8. 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? Ascertain that there will be no interactions with anesthetic agents. Teach the patient that these products may be continued preoperatively. Advise the patient to stop the use of all herbs and supplements at this time. Discuss the herb and supplement use with the patients health care provider.

D