Chapter 17: Preoperative Nursing Management

The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurses preoperative assessment of an elderly patient? Elderly patients have a smaller lung capacity than younger patients. Elderly patients require higher medication doses than younger patients. Elderly patients have less physiologic reserve than younger patients. Elderly patients have more sophisticated coping skills than younger patients.

Elderly patients have less physiologic reserve than younger patients.

A nurse in the preoperative holding area is admitting a woman prior to reduction mammoplasty. What should the nurse include in the care given to this patient? Select all that apply. Establishing an IV line Verifying the surgical site with the patient Taking measures to ensure the patients comfort Applying a grounding device to the patient Preparing the medications to be administered in the OR

Establishing an IV line Verifying the surgical site with the patient Taking measures to ensure the patients comfort

The nurse is caring for a patient who is admitted to the ER with the diagnosis of acute appendicitis. The nurse notes during the assessment that the patients ribs and xiphoid process are prominent. The patient states she exercises two to three times daily and her mother indicates that she is being treated for anorexia nervosa. How should the nurse best follow up these assessment data? Inform the postoperative team about the patients risk for wound dehiscence. Evaluate the patients ability to manage her pain level. Facilitate a detailed analysis of the patients electrolyte levels. Instruct the patient on the need for a high-sodium diet to promote healing.

Facilitate a detailed analysis of the patients electrolyte levels.

The nurse is planning the care of a patient who has type 1 diabetes and who will be undergoing knee replacement surgery. This patients care plan should reflect an increased risk of what postsurgical complications? Select all that apply. Hypoglycemia Delirium Acidosis Glucosuria Fluid overload

Hypoglycemia Acidosis Glucosuria

The nurse is creating the care plan for a 70-year-old obese patient who has been admitted to the postsurgical unit following a colon resection. This patients age and increased body mass index mean that she is at increased risk for what complication in the postoperative period? Hyperglycemia Azotemia Falls Infection

Infection

You are providing preoperative teaching to a patient scheduled for hip replacement surgery in 1 month. During the preoperative teaching, the patient gives you a list of medications she takes, the dosage, and frequency. Which of the following interventions provides the patient with the most accurate information? Instruct the patient to stop taking St. Johns wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents. Instruct the patient to continue taking ephedrine prior to surgery due to its beneficial effect on blood pressure. Instruct the patient to discontinue Synthroid due to its effect on blood coagulation and the potential for heart dysrhythmias. Instruct the patient to continue any herbal supplements unless otherwise instructed, and inform the patient that these supplements have minimal effect on the surgical procedure.

Instruct the patient to stop taking St. Johns wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents.

A nurse is providing preoperative teaching to a patient who will soon undergo a cardiac bypass. The nurses teaching plan includes exercises of the extremities. What is the purpose of teaching a patient leg exercises prior to surgery? Leg exercises increase the patients muscle mass postoperatively. Leg exercises improve circulation and prevent venous thrombosis. Leg exercises help to prevent pressure sores to the sacrum and heels. Leg exercise help increase the patients level of consciousness after surgery.

Leg exercises improve circulation and prevent venous thrombosis.

An OR nurse will be participating in the intraoperative phase of a patients kidney transplant. What action will the nurse prioritize in this aspect of nursing care? Monitoring the patients physiologic status Providing emotional support to family Maintaining the patients cognitive status Maintaining a clean environment

Monitoring the patients physiologic status

During the care of a preoperative patient, the nurse has given the patient a preoperative benzodiazepine. The patient is now requesting to void. What action should the nurse take? Assist the patient to the bathroom. Offer the patient a bedpan or urinal. Wait until the patient gets to the operating room and is catheterized. Have the patient go to the bathroom.

Offer the patient a bedpan or urinal.

The nurse is caring for a hospice patient who is scheduled for a surgical procedure to reduce the size of his spinal tumor in an effort to relieve his pain. The nurse should plan this patient care with the knowledge that his surgical procedure is classified as which of the following? Diagnostic Laparoscopic Curative Palliative

Palliative

A 90-year-old female patient is scheduled to undergo a partial mastectomy for the treatment of breast cancer. What nursing diagnosis should the nurse prioritize when planning this patients postoperative care? Risk for Delayed Growth and Development related to prolonged hospitalization Risk for Decisional Conflict related to discharge planning Risk for Impaired Memory related to old age Risk for Infection related to reduced immune function

Risk for Infection related to reduced immune function

The nurse is caring for a patient in the postoperative period following an abdominal hysterectomy. The patient states, I dont want to use my pain meds because theyll make me dependent and I wont get better as fast. Which response is most important when explaining the use of pain medication? You will need the pain medication for at least 1 week to help in your recovery. What do you mean you feel you wont get better faster? Pain medication will help to decrease your pain and increase your ability to breath. Dependency is a risk with pain medication, but you are young and wont have any problems. Pain medication can be given by mouth to prevent the risk of dependency that you are worried about. The pain medication has not been shown to affect your risk of a slowed recovery. You will move more easily and heal more quickly with decreased pain. Dependence only occurs when it is administered for an extended period of time.

You will move more easily and heal more quickly with decreased pain. Dependence only occurs when it is administered for an extended period of time.

The clinic nurse is doing a preoperative assessment of a patient who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the patients medical history, the nurse notes that this patient had a kidney transplant 8 years ago and that the patient is taking immunosuppressive drugs. For what is this patient at increased risk when having surgery? Rejection of the kidney Rejection of the implanted lens Infection Adrenal storm

infection

The nurse is checking the informed consent for a 17-year-old who has just been married and expecting her first child. She is scheduled for a cesarean section. She is still living with her parents and is on her parents health insurance. When obtaining informed consent for the cesarean section, who is legally responsible for signing? Her parents Her husband The patient The obstetrician

the patient

The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP? Actions aimed at increasing participation of families in planning care Actions aimed at preventing surgical site infections Actions aimed at increasing interdisciplinary collaboration Actions aimed at promoting the use of complementary and alternative medicine (CAM)

Actions aimed at preventing surgical site infections

The nurse is caring for a 78-year-old female patient who is scheduled for surgery to remove her brain tumor. The patient is very apprehensive and keeps asking when she will get her preoperative medicine. The medicine is ordered to be given on call to OR. When would be the best time to give this medication? As soon as possible, in order to alleviate the patients anxiety As the patient is transferred to the OR bed When the porter arrives on the floor to take the patient to surgery After being notified by the OR and before other preoperative preparations

After being notified by the OR and before other preoperative preparations

The nurse is performing a preoperative assessment on a patient going to surgery. The patient informs the nurse that he drinks approximately two bottles of wine each day and has for the last several years. What postoperative difficulties can the nurse anticipate for this patient? Alcohol withdrawal syndrome immediately following surgery Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink Alcohol withdrawal syndrome upon administration of general anesthesia Alcohol withdrawal syndrome 1 week after his last alcohol drink

Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink

The nurse is planning patient teaching for a patient who is scheduled for an open hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises during this teaching session. when is the best to provide teaching? Upon the patients admission to the postanesthesia care unit (PACU) When the patient returns from the PACU During the intraoperative period As soon as possible before the surgical procedure

As soon as possible before the surgical procedure

The nurse is preparing a patient for surgery. The patient states that she is very nervous and really does not understand what the surgical procedure is for or how it will be performed. What is the most appropriate nursing action for the nurse to take? Have the patient sign the informed consent and place it in the chart. Call the physician to review the procedure with the patient. Explain the procedure clearly to the patient and her family. Provide the patient with a pamphlet explaining the procedure.

Call the physician to review the procedure with the patient.

The surgical nurse is preparing to send a patient from the presurgical area to the OR and is reviewing the patients informed consent form. What are the criteria for legally valid informed consent? Select all that apply. Consent must be freely given. Consent must be notarized. Consent must be signed on the day of surgery. Consent must be obtained by a physician. Signature must be witnessed by a professional staff member.

Consent must be freely given. Consent must be obtained by a physician. Signature must be witnessed by a professional staff member.

The nurse is preparing to send a patient to the OR for a scheduled surgery. What should the nurse ensure is on the chart when it accompanies the patient to surgery? Select all that apply. Laboratory reports Nurses notes Verification form Social work assessment Dieticians assessment

Laboratory reports Nurses notes Verification form

A patient is on call to the OR for an aortobifemoral bypass and the nurse administers the ordered preoperative medication. After administering a preoperative medication to the patient, what should the nurse do? Encourage light ambulation. Place the bed in a low position with the side rails up. Tell the patient that he will be asleep before he leaves for surgery. Take the patients vital signs every 15 minutes.

Place the bed in a low position with the side rails up.

A patient is scheduled for a bowel resection in the morning and the patients orders include a cleansing enema tonight. The patient wants to know why this is necessary. The nurse should explain that the cleansing enema will have what therapeutic effect? Preventing aspiration of gastric contents Preventing the accumulation of abdominal gas postoperatively Preventing potential contamination of the peritoneum Facilitating better absorption of medications

Preventing potential contamination of the peritoneum

The nurse is doing preoperative patient education with a 61-year-old male patient who has a 40-pack per year history of cigarette smoking. The patient will undergo an elective bunionectomy at a time that fits his work schedule in a few months. What would be the best instruction to give to this patient? Reduce smoking by 50% to prevent the development of pneumonia. Stop smoking at least 6 weeks before the scheduled surgery to enhance pulmonary function and decrease infection. Aim to quit smoking in the postoperative period to reduce the chance of surgical complications Stop smoking 4 to 8 weeks before the scheduled surgery to enhance pulmonary function and decrease infection.

Stop smoking 4 to 8 weeks before the scheduled surgery to enhance pulmonary function and decrease infection.

The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The childs parents are thought to be en route to the hospital but have not yet arrived. No other family members are present and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to save her life. How should the need for informed consent be addressed? A social worker should temporarily sign the informed consent. Consent should be obtained from the hospitals ethics committee. Surgery should be done without informed consent. Surgery should be delayed until the parents arrive.

Surgery should be done without informed consent.

The admitting nurse in a short-stay surgical unit is responsible for numerous aspects of care. What must the nurse verify before the patient is taken to the preoperative holding area? That preoperative teaching was performed That the family is aware of the length of the surgery That follow-up home care is not necessary That the family understands the patient will be discharged immediately after surgery.

That preoperative teaching was performed

The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this patients diagnosis of type 1 diabetes affect the care that the nurse plans? The nurse should administer a bolus of dextrose IV solution preoperatively. The nurse should keep the patient NPO for at least 8 hours preoperatively. The nurse should initiate a subcutaneous infusion of long-acting insulin. The nurse should assess the patients blood glucose levels vigilantly.

The nurse should assess the patients blood glucose levels vigilantly.

in anticipation of a patients scheduled surgery, the nurse is teaching her to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the patient? The patient should take three deep breaths and cough hard three times, at least every 15 minutes for the immediately postoperative period. The patient should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs. The patient should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs. The patient should rapidly inhale, hold for 30 seconds or as long as possible, and exhale slowly.

The patient should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs.

The PACU nurse is caring for a patient who has been deemed ready to go to the postsurgical floor after her surgery. What would the PACU nurse be responsible for reporting to the nurse on the floor? Select all that apply. The names of the anesthetics that were used The identities of the staff in the OR The patients preoperative level of consciousness The presence of family and/or significant others The patients full name

The patients preoperative level of consciousness The presence of family and/or significant others The patients full name

The nurse is preparing a patient for surgery prior to her hysterectomy without oophorectomy. The nurse is witnessing the patients signature on a consent form. Which comment by the patient would best indicate informed consent? I know Ill be fine because the physician said he has done this procedure hundreds of times. I know Ill have pain after the surgery but theyll do their best to keep it to a minimum. The physician is going to remove my uterus and told me about the risk of bleeding. Because the physician isnt taking my ovaries, Ill still be able to have children.

The physician is going to remove my uterus and told me about the risk of bleeding.

You are the nurse caring for an unconscious trauma victim who needs emergency surgery. The patient is a 55-year-old man with an adult son. He is legally divorced and is planning to be remarried in a few weeks. His parents are at the hospital with the other family members. The physician has explained the need for surgery, the procedure to be done, and the risks to the children, the parents, and the fianc. Who should be asked to sign the surgery consent form? The fianc The son The physician, acting as a surrogate The patients father

The son

You are caring for an 88-year-old woman who is scheduled for a right mastectomy. You know that elderly patients are frequently more anxious prior to surgery than younger patients. What would you increase with this patient to decrease her anxiety? Analgesia Therapeutic touch Preoperative medication Sleeping medication the night before surgery

Therapeutic touch

The nurse is providing preoperative teaching to a patient scheduled for surgery. The nurse is instructing the patient on the use of deep breathing, coughing, and the use of incentive spirometry when the patient states, I dont know why youre focusing on my breathing. My surgery is on my hip, not my chest. What rationale for these instructions should the nurse provide? To prevent chronic obstructive pulmonary disease (COPD) To promote optimal lung expansion To enhance peripheral circulation To prevent pneumothorax

To promote optimal lung expansion

The nurse is caring for a patient who is experiencing pain and anxiety following his prostatectomy.Which intervention will likely best assist in decreasing the patients pain and anxiety? Administration of NSAIDs rather than opioids Allowing the patient to increase activity Use of guided imagery along with pain medication Use of deep breathing and coughing exercises

Use of guided imagery along with pain medication

The nurse is performing a preadmission assessment of a patient scheduled for a bilateral mastectomy. Of what purpose of the preadmission assessment should the nurse be aware? Verifies completion of preoperative diagnostic testing Discusses and reviews patients health insurance coverage Determines the patients suitability as a surgical candidate Informs the patient of need for postoperative transportation

Verifies completion of preoperative diagnostic testing

A clinic nurse is conducting a preoperative interview with an adult patient who will soon be scheduled to undergo cardiac surgery. What interview question most directly addresses the patients safety? What prescription and nonprescription medications do you currently take? Have you previously been admitted to the hospital, either for surgery or for medical treatment? How long do you expect to be at home recovering after your surgery? Would you say that you tend to eat a fairly healthy diet?

What prescription and nonprescription medications do you currently take?

A 77-year-old mans coronary artery bypass graft has been successful and discharge planning is underway. When planning the patients subsequent care, the nurse should know that the postoperative phase of perioperative nursing ends at what time? When the patient is returned to his room after surgery When a follow-up evaluation in the clinical or home setting is done When the patient is fully recovered from all effects of the surgery When the family becomes partly responsible for the patients care

When a follow-up evaluation in the clinical or home setting is done

The nurse is caring for a trauma victim in the ED who will require emergency surgery due to injuries. Before the patient leaves the ED for the OR, the patient goes into cardiac arrest. The nurse assists in the successful resuscitation and proceeds to release the patient to the OR staff. When can the ED nurse perform the preoperative assessment? When he or she has the opportunity to review the patients electronic health record When the patient arrives in the OR When assisting with the resuscitation Preoperative assessment is not necessary in this case

When assisting with the resuscitation

A patient is admitted to the ED complaining of severe abdominal pain, stating that he has been vomiting coffee-ground like emesis. The patient is diagnosed with a perforated gastric ulcer and is informed that he needs surgery. When can the patient most likely anticipate that the surgery will be scheduled? Within 24 hours Within the next week Without delay because the bleed is emergent As soon as all the days elective surgeries have been completed

Without delay because the bleed is emergent

One of the things a nurse has taught to a patient during preoperative teaching is to have nothing by mouth for the specified time before surgery. The patient asks the nurse why this is important. What is the most appropriate response for the patient? You will need to have food and fluid restricted before surgery so you are not at risk for choking. The restriction of food or fluid will prevent the development of pneumonia related to decreased lung capacity. The presence of food in the stomach interferes with the absorption of anesthetic agents. By withholding food for 8 hours before surgery, you will not develop constipation in the postoperative period.

You will need to have food and fluid restricted before surgery so you are not at risk for choking.