pre op

The patient donated a kidney, and early ambulation is included in the plan of care, but the patient refuses to get up and walk. What rationale should the nurse explain to the patient for early ambulation?

"Early walking is the best way to prevent postoperative complications."

Which patient would be at highest risk for hypothermia after surgery?

A 75-yr-old patient with repair of a femoral neck fracture after a fall

An older adult patient is having surgery. What risk areas will the nurse need to be especially aware of for this patient during surgery? a. Sterility b. Paralysis c. Urine output d. Skin integrity

D.Skin integrity

The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer?

Epinephrine and/or vasopressin

The nurse is caring for a Native American patient 2 days after a thoracotomy for tumor resection. What would be the most appropriate action if the patient does not report any pain?

Identify possible reasons for denial of pain.

melena

black tarry stool

misoprostol

eicosanoid preparation used for pts taking lots of NSAIDs Cytotec prostaglandin

atelectasis

collapsed lung; incomplete expansion of alveoli

The nurse is providing discharge teaching to a patient who has had a laparoscopic cholecystectomy at an ambulatory surgery center. Which statement, if made by the patient, indicates an understanding of the discharge instructions?

"I will have someone stay with me for 24 hours in case I feel dizzy."

An older adult patient who had surgery is displaying manifestations of delirium. What priority action would benefit this patient?

Check the preoperative assessment for previous delirium or dementia.

The circulating nurse is caring for a patient during a colon resection. What observation made by the nurse is immediately recognized as a violation of aseptic technique? a. A glove contacts the leg of the table that supports the sterile field. b. The cuff of the scrub nurse's sterile gown contacts the sterile field. c. The sterile field was established at 0650, and the current time is 0900. d. Bacteria are present in the nares and upper respiratory passages of the nurse.

A. A glove contacts the leg of the table that supports the sterile field.

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 patient's rights. B. Try to change the patient's mind. C. Call surgery to cancel the procedure. D. Tell the family they cannot interfere

A. Advocate for the patient's rights.

An older adult patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply.)? A.Fluid balance history B. Attitude about surgery C. Foods the patient dislikes D. Current mobility problems E. Current cognitive function F. Patient's opinion about the surgeon

A.Fluid balance history D. Current mobility problems E. Current cognitive function

Which information in the preoperative patient's medication history is most important to communicate to the health care provider? 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.

ANS: B Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.

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 the surgery.

ANS: B 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. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.

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

ANS: B 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. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient understands the surgical procedure and signs the consent form.

Which topic is most important for the nurse to discuss preoperatively 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

ANS: C Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.

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

ANS: C, D, E Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the patient are routine skills that are appropriate to delegate. Teaching patients about the preoperative routine and incentive spirometer use require critical thinking and should be done by the registered nurse.

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 patient's health care provider.

ANS: D Both garlic and ginkgo biloba increase a patient's risk for bleeding. The nurse should discuss the herb and supplement use with the patient's health care provider. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anesthetics is not within the nurse's scope of practice.

In planning postoperative interventions to promote repositioning, ambulation, coughing, and deep breathing, which action should the nurse recognize will best enable the patient to achieve the desired outcomes?

Administering adequate analgesics to promote relief or control of pain

While in the PACU, the patient's blood pressure drops from an admission pressure of 126/82 to 106/78 with a pulse change of 70 to 94. The nurse administers oxygen and then A. Increases the rate of the IV fluids B. Notifies the anesthesia care provider C. Performs neurovascular checks on the lower extremities D. Uses a cardiac monitor to assess the patient's heart rhythm

Answer: A Rationale: The most common cause of hypotension in the postanesthesia period is unreplaced fluid and blood loss. This situation does not warrant further assessment. The nurse needs to administer IV fluids.

The nurse is preparing to discharge a patient from the ambulatory surgery center following an inguinal hernia repair. The nurse delays the release of the patient upon discovering that the patient A. Had IV morphine 45 minutes ago B. Has an oxygen saturation of 92% C. Has not voided since before surgery D. Had one episode of vomiting 30 minutes ago

Answer: C Rationale: Patients must be able to void before discharge from an ambulatory surgery center. The procedure in this case makes voiding before surgery essential.

A patient becomes restless and agitated in the postanesthesia care unit (PACU) as he begins to regain consciousness. The first action the nurse should take is to A. Turn the patient to a lateral position. B. Orient the patient and tell him that the surgery is over. C. Administer the ordered postoperative pain medication. D. Check the patient's oxygen saturation with pulse oximetry.

Answer: D Rationale: The most common cause of emergence delirium is hypoxia. The nurse should assess the patient's oxygenation status with pulse oximetry.

When assessing a patient's surgical dressing on the first postoperative day, the nurse notes new, bright-red drainage about 5 cm in diameter. What is the priority action by the nurse?

Assess patients blood pressure and heart rate

The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia care unit (PACU). What should the nurse's initial action be upon the patient's arrival?

Assess the patients vital signs

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time?

Assessing the incision for any redness, swelling, or discharge

In caring for the postoperative patient on the clinical unit after transfer from the PACU, which care can the nurse delegate to the unlicensed assistive personnel (UAP)?

Assist the patient to take deep breaths and cough.

A patient asks a student nurse if his family member may accompany him to the surgical area. What is the best response by the nurse? a."Your family member may not enter the surgical area" b. "Your family can be with you in the preoperative holding area. c. "Your family can't be with you until the postanesthesia care unit. d. "Your family is only allowed in the conference room for preoperative teaching."

B. "Your family can be with you in the preoperative holding area.

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

B. A 40-yr-old woman who is scheduled for an open cholecystectomy

Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply.)? a. Documenting intraoperative care b. Keeping track of irrigation solutions for monitoring of blood loss c. Passing instruments and supplies to the surgeon by anticipating his or her needs d. Coordinating the flow and activities of members of the surgical team in the surgical suite e. Performing the count of sponges, needles, and instruments used during the surgical procedure

B. Keeping track of irrigation solutions for monitoring of blood loss c. Passing instruments and supplies to the surgeon by anticipating his or her needs E. Performing the count of sponges, needles, and instruments used during the surgical procedure

The nurse is preparing a patient for a surgical procedure. Before admitting the patient into the perioperative suite, what documents must the nurse make sure are in the chart of the patient (select all that apply.)? a. Electrocardiogram b. Signed consent form c. Functional status evaluation d. Renal and liver function tests e. A history and physical examination report

B. Signed consent form E. A history and physical examination report

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."

The perioperative nurse is supervising the surgical technologist before the arrival of the patient in the operating room for an exploratory laparotomy. Which action, if taken by the surgical technologist, would require the nurse to intervene? a. The surgical technologist holds hands away from the body and above the elbows at all times. b. The surgical technologist scrubs the fingers and hands first followed by the forearms and elbows. c. After a surgical scrub, the surgical technologist puts on a sterile gown and one pair of sterile gloves. d. When wearing a sterile gown and gloves, the surgical technologist is able to organize the equipment on the sterile field.

C. After a surgical scrub, the surgical technologist puts on a sterile gown and one pair of sterile gloves.

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.

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.

The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus; weighs 146 kg; and is 5 feet 8, inches 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

The nurse is performing a preoperative assessment for a patient scheduled for a surgical procedure. What is the rationale for the nurse's careful documentation of the patient's current medication list? A. Some medications may alter the patient's 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.

The surgical team in the operating room performs a surgical time-out just before starting hip replacement surgery. Which action would be part of the surgical time-out? a. Assess the patient's vital signs and oxygen saturation level. b. Check the chart for a signed consent form for the procedure. c. Determine if the patient has any questions about the procedure. d. Have the patient verify the procedure and the location of the surgery.

D. Have the patient verify the procedure and the location of the surgery. Correct

An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply.)? 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. Information about where in the hospital she will be taken postoperatively E. Information about performing postoperative deep-breathing and coughing exercises

A patient is being prepared for a surgical procedure. What is the priority intervention by the nurse prior to the start of the procedure according to the National Patient Safety Goal (NPSG)? a. Prevention of infection b. Improved staff communication c. Identify patients at risk for suicide. d. Patient, surgical procedure, and site are checked.

D. Patient, surgical procedure, and site are checked.

The perioperative nurse is reviewing the chart of a patient who is being admitted into the operating room for a laminectomy. What information obtained from the chart review should the nurse discuss with the anesthesiologist? a. The patient's grandmother developed hypothermia during a craniotomy. b. The patient's mother developed contact dermatitis related to a latex allergy. c. The patient's brother developed nausea after surgery with general anesthesia. d. The patient's father developed an elevated temperature during a recent surgery

D. The patient's father developed an elevated temperature during a recent surgery.

On admission to the emergency department, a patient with cardiomyopathy has an ejection fraction of 10%. On assessment, the nurse notes bilateral crackles and shortness of breath. Which additional assessment finding would most indicate patient decline?

Decreased level of consciousness

A patient having abdominal surgery had an estimated blood loss of 400 mL and received 300 mL of 0.9% normal saline. Postoperatively, the patient's blood pressure is 70/48 mm Hg. What treatment does the nurse anticipate administering?

IV fluid administration

What laboratory finding is consistent with a medical diagnosis of cardiogenic shock?

Increased blood urea nitrogen (BUN) and serum creatinine (Cr) levels

A patient is admitted to the postanesthesia care unit (PACU) after abdominal surgery. Which assessment, if made by the nurse, is the best indicator of respiratory depression?

Increased carbon dioxide pressure

A nurse is caring for an unconscious patient who has just been admitted to the postanesthesia care unit after abdominal hysterectomy. How should the nurse position the patient?

Left lateral position with head supported on a pillow

A patient is having elective cosmetic surgery performed on the face and will be staying in the facility for 24 hours after surgery. What is the nurse's postoperative priority for this patient?

Manage oxygenation status

a patient had surgery at an ambulatory surgery center. Which criteria support that this patient is ready for discharge (select all that apply.)? a. Vital signs baseline or stable b. Minimal nausea and vomiting c. Wants to go to the bathroom at home d. Responsible adult taking patient home e. Comfortable after IV opioid 15 minutes ago

a. Vital signs baseline or stable b. Minimal nausea and vomiting d. Responsible adult taking patient home

atropine

anticholinergic antispasmodic that may be administered preoperatively to relax smooth muscles 手术时减少唾液分泌用，一般会以静脉注射或肌肉注射给药

While the perioperative nurse is transporting a patient to the operating room for general surgery, the patient states, "I am a Jehovah's Witness, and I am worried about blood transfusions." What would be the best response by the nurse to this patient's statement? a. "I will make sure that you do not receive a blood transfusion during this surgery." b. "Would you like to sign the consent form just in case you need blood during surgery?" c. "Do you have someone I can contact in an emergency if you need a blood transfusion?" D. "Tell me what you would like done if it is determined that you need blood replacement during surgery."

d. "Tell me what you would like done if it is determined that you need blood replacement during surgery."

Native American

hold pain

thoracotomy

incision into the thorax

eicosanoid

lipids derived from arachidonic acid

delirium

mental disorder marked by confusion

laparoscopic

minimally invasive

hysterectomy

removal of uterus

midazolam

sedative benzo 术前口服咪唑安定可显著延长强效吸入麻醉药的作用时间。

laminectomy

the surgical removal of a lamina, or posterior portion, of a vertebra

cosmetic surgery

the surgical specialty to improve a person's physical appearance