Chapter 17 PrepU Questions

The nurse concludes that teaching about pain management was effective when the client states:

"I will support my incision with my hands when I do my coughing and deep breathing exercises." Rationale: Splinting of the incision provides support to the incision and helps to control pain.

A patient with a history of alcoholism and scheduled for an urgent surgery asks the nurse, "Why is everyone so concerned about how much I drink?" What is the best response by the nurse?

"It is important for us to know how much and how often you drink to help prevent surgical complications." Rationale:Alcohol use and alcoholism can contribute to serious postoperative complications. If the medical and nursing staff is aware of the use or abuse, measures can be implemented proactively to prevent complications. Although alcohol may interfere with a medication's effectiveness, it does not determine the amount of pain medications that are prescribed following surgery. Even though this is a required screening question and counselors can be made available for those who want help, those are not the best responses to answer the patient's question.

For the patient who is taking aspirin, it is important to stop taking this medication at least how many day(s) prior to surgery?

7 rationale:Aspirin should be stopped at least 7 to 10 days before surgery. The other timeframes are incorrect.

The nurse expects informed consent to be obtained for insertion of:

A gastrostomy tube Rationale:Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following?

Cheeseburger, french fries, coleslaw, and ice cream Rationale: Important nutrients for wound healing include protein; vitamins A, B-complex, C, and K; arginine, magnesium, copper, and zinc; and water. The diet should be sufficient in carbohydrates and low to moderate in fats. The cheeseburger option is high in fat and low in vitamin C.

The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is:

Diagnostic Rationale:: A biopsy is a type of diagnostic surgery.

The nurse concludes that further teaching about diaphragmatic breathing is needed when the client:

Exhales forcefully with a short expiration rationale:Diaphragmatic breathing should be performed gently and fully.

The nurse is reviewing a preoperative informed consent when preparing the client for surgery. Which contents of the informed consent are required? Select all that apply.

Explanation of procedure • Potential risks • Benefits of surgery • Description of alternatives rationale:Informed consents should be in writing and contain an explanation of procedure and risks, description of benefits and alternative, an offer to answer questions about procedure, ability to withdraw consent, and statement informing the client if the protocol differs from customary procedure. An estimated time of procedure and personnel present are not required in the informed consent.

The nurse is caring for a client needing emergency surgery. Which preoperative teaching should be omitted to prepare the client for surgery?

Frequency of postoperative vital signs Rationale:The least helpful postoperative teaching that could be omitted due to the need to obtain emergency surgery is explaining the frequency of postoperative vital signs. This is not essential information to improve client participation in their postoperative recovery. Coughing and deep breathing is essential in the immediate postoperative period. Clients are often concerned about postoperative pain so instruction on pain medication can decrease anxiety. Knowledge of the surgical procedure must be explained by a physician when signing a surgical consent.

A patient asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate?

It prevents aspiration and respiratory complications Rationale:The major purpose of withholding food and fluid before surgery is to prevent aspiration, which can lead to respiratory complications. Preventing overhydration, decreasing urine output, and decreasing blood sugar levels are not major purposes of withholding food and fluid before surgery.

An inappropriate nursing action implemented to keep the client safe includes:

Moving the client swiftly Rationale:National Patient Safety goals for the surgical client include verification of the client and protecting the client from physical harm.

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:

Notify the surgeon. Rationale:Preoperative medication can impair the thinking ability of the client. FFor informed consent to be valid, the client must be competent to give consent. The surgery will be canceled.

A nurse is witnessing a patient sign the consent form for surgery. After the patient signs the consent form, the patient starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?

Request that the surgeon come and answer the questions Rationale:

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing. Rationale:In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate?

Allow the client to wear dentures. Rationale: Dentures, jewelry, glasses, and prosthetic devices are removed prior to surgery.

The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which of the following values would be of greatest concern to the nurse?

Potassium 6.2 mEq/L Rationale:Hyperkalemia places the client at risk for surgical complications.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure?

The patient participates willingly in the preoperative preparation. Rationale: The nurse knows that the patient understands the surgical intervention when the patient participates in preoperative preparation. The other answers pertain to the patient experiencing decreased fear or anxiety, not knowledge about the procedure.

A parent of a 16-year-old patient asks the nurse, "How could the surgeon operate without my consent?" What is the best response given by the nurse?

"Your child had life-threatening injuries that required immediate surgery." Rationale:In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the patient's or parent's informed consent. Informed consent must be obtained before any invasive procedure. A minor cannot consent for a surgical procedure. Two doctors' opinions do not overrule the need to obtain informed consent.

What is the blood glucose level goal for a diabetic patient who will be having a surgical procedure?

80 to 110 mg/dL Rationale: Although the surgical risk in the patient with controlled diabetes is no greater than in the patient without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes (Alvarex et al., 2010). Frequent monitoring of blood glucose levels is important before, during, and after surgery.

A physically fit 86-year-old is scheduled for right knee replacement. What factor in this client makes them at increased risk for surgery?

Age Rationale: On admission, the nurse reviews preoperative instructions, such as diet restrictions and skin preparations, to ensure the client has followed them. If the client has not carried out a specific portion of the instructions, such as withholding foods and fluids, the nurse immediately notifies the surgeon. He or she identifies the client's needs to determine if the client is at risk for complications during or after the surgery. General risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition. In this scenario the risk to the client is age, the other options are incorrect according to the scenario described.

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign?

An open reduction of a fracture Rationale:Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?

During the preoperative period Rationale: The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit that could interfere with learning. Pain could interfere with the learning process, following a surgical procedure. At the time of discharge, both pain and timeliness may be an issue in understanding and obtaining care needed during the postoperative time.

A patient is scheduled to have a cholecystectomy. Which of the nurse's finding is least likely to contribute to surgical complications?

Osteoporosis Rationale: Osteoporosis is most likely not going to contribute to complications related to a cholecystectomy. Pregnancy decreases maternal reserves. Diabetes increases wound-healing problems and risks for infection. Urinary tract infection decreases the immune system, increasing the chance for infections

The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician?

When the patient's blood ammonia concentration reaches 180 mg/dL Rationale:The liver is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality; preoperative improvement in liver function is a goal. Careful assessment may include various liver function tests