Lewis ch.17 preoperative care
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? 1 "Cefazolin is an antibiotic given for two days to prevent postoperative infection." 2 "Cefazolin is an antiinflammatory drug that will help the surgical site to heal effectively." 3 "Cefazolin will prevent you from getting a stomach ulcer during the time before you are eating a full diet again." 4 "Cefazolin is an analgesic that will make it easier to tolerate the continuous passive-motion machine after surgery on the knee."
1 "Cefazolin is an antibiotic given for two days to prevent postoperative infection." Cefazolin is a cephalosporin-type antibiotic that reduces the risk of postoperative infection. When used as prophylaxis, it commonly is used for 48 hours. It is not an antiinflammatory, an analgesic, or an acid-reducer.
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? 1 "I will watch the participants for signs of excessive anxiety." 2 "This handout will do the explaining for me during the class." 3 "I will make sure the lights are bright so that they can see the materials easily." 4 "Older people are usually able to face surgeries more easily than younger people."
1 "I will watch the participants for signs of excessive anxiety." 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. Simply reading a handout may not be sufficient. Consider that sensory deficits may be present, and bright lights may bother those with eye problems. These and other changes may require more time for the older adult to complete preoperative testing and understand preoperative instructions.
The nurse would instruct a patient to stop taking multivitamins for how long before surgery? 1 1 day 2 1 week 3 4 weeks 4 8 weeks
1 1 day Multivitamin tablets can help increase nutritional status, and they can be taken until 1 day before surgery. There is no need to stop the use of multivitamins any sooner than a 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? 1 5 minutes 2 10 minutes 3 30 minutes 4 There is no wait time between instillations.
1 5 minutes 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.
During a preoperative evaluation, the patient reports to the nurse regular use of ginseng. Which action would the nurse take? 1 Inform the surgeon. 2 Advise the patient to decrease the dose of ginseng. 3 Advise the patient to take vitamin E in addition to the ginseng. 4 Advise the patient to replace the ginseng with another herbal drug.
1 Inform the surgeon. 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. Decreasing the dose of ginseng will not remove the risk. Vitamin E should not be taken because it can increase bleeding. Use of any herbal product should be discontinued two to three weeks before surgery because such medicines may increase the risk of postoperative bleeding.
When teaching a patient about the benefits of ambulatory surgery compared to inpatient surgery, which information is accurate? Select all that apply. 1 It involves minimal laboratory tests. 2 It requires fewer preoperative medications. 3 It reduces the risk of hospital-acquired infections. 4 It helps patients recover comfortably in the hospital. 5 It is more expensive for both patients and insurers.
1 It involves minimal laboratory tests. 2 It requires fewer preoperative medications. 3 It reduces the risk of hospital-acquired infections. 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.STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.
A patient taking warfarin and digoxin for treatment of atrial fibrillation is instructed to discontinue the use prior to surgery. The nurse would closely monitor this patient for which complication? 1 Pulmonary embolism 2 Increased BP 3 Excessive bleeding from incision sites 4 Increased peripheral vascular resistance
1 Pulmonary embolism Warfarin is an anticoagulant that is used to prevent mural thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could form again. If one or more detach from the atrial wall, they could travel as arterial emboli from the left atrium or as pulmonary emboli from the right atrium. Excessive bleeding would occur from excess warfarin administration, not withholding. BP and peripheral vascular resistance are not affected by warfarin.
A preoperative patient asks why the dose of warfarin is being withheld. Which response by the nurse is most accurate? 1 "This medication is contraindicated with the type of anesthesia you are receiving." 2 "This medication could cause excessive bleeding during surgery if it is not stopped beforehand." 3 "All unnecessary medications are stopped before surgery to prevent you from vomiting under anesthesia." 4 "This medication may increase respiratory depression associated with anesthetic agents and must be avoided."
2 "This medication could cause excessive bleeding during surgery if it is not stopped beforehand." 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. Warfarin is not associated with respiratory depression and does not interact with anesthesia. Medications are held before surgery; the most correct and complete reason for holding this medication is related to the increased risk of bleeding during and following 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? 1 Notify the anesthetist to evaluate the patient. 2 Ask additional questions to assess for a possible latex allergy. 3 No intervention is needed because the patient needs to have this surgery. 4 Notify the operating room (OR) staff immediately so that latex-free supplies can be used.
2 Ask additional questions to assess for a possible latex allergy. 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. Many health care facilities have created latex-free product carts that can be used for patients with latex allergies. The anesthesiologist does not need to evaluate the patient. The nurse would not ignore the situation and do nothing. The OR staff would need to be notified if the patient does have a latex allergy, but the additional screening is needed prior to this.
A patient is refusing to remove her wedding ring on the morning of surgery. Which action would the nurse take first? 1 Ask the patient's husband to convince her to remove the ring. 2 Secure the ring according to agency policy and document the encounter. 3 Have the patient's mental status assessed in preparation for surgery. 4 Note the presence of the ring in the nurses' notes section of the chart.
2 Secure the ring according to agency policy and document the encounter. 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. This request does not imply altered mental status. It is not appropriate to ask the husband to convince his wife to remove the ring, because the patient has the right to refuse to remove the ring. It should be documented in the chart after the ring is taped securely to the finger.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).
Which pre-op patient would the nurse most closely monitor for bleeding as a result of medication being taken? 1 A woman who takes metoprolol for the treatment of hypertension 2 A man who is taking clopidogrel after the placement of a coronary artery stent 3 A man whose type 1 diabetes is controlled with insulin injections four times daily 4 A man who recently started taking finasteride for the treatment of benign prostatic hyperplasia
2 A man who is taking clopidogrel after the placement of a coronary artery stent Any drug that inhibits platelet aggregation, such as clopidogrel, represents a bleeding risk. Insulin, metoprolol, and finasteride are less likely to contribute to a risk for bleeding.
Before a patient is admitted to the operating room, which preoperative documentation must be attached to the chart, according to The Joint Commission? 1 An electrocardiogram 2 A complete physical examination 3 Laboratory-test findings, including kidney- and liver-function parameters 4 All nursing subjective objective assessment plan (SOAP) notes for this admission
2 A complete physical examination 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. Laboratory test findings, SOAP notes, and electrocardiograms also may be included in the chart; however, the physical examination must always be completed and in the chart before surgery.
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? 1 Help the patient sign an "X" on the consent form representing his or her legal signature. 2 Send the patient back to the nursing home and reschedule the procedure for a future date. 3 Contact the family member identified as the patient's power of attorney on the patient's medical record so the surgeon can obtain consent. 4 Notify the nursing supervisor of the lack of consent and request special permission for emergent status so the surgical procedure can be completed.
3 Contact the family member identified as the patient's power of attorney on the patient's medical record so the surgeon can obtain consent. 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. Sending the patient back to the nursing home and rescheduling the procedure does not assist the patient in receiving appropriate care. It is illegal to obtain consent from a confused patient by getting him or her to sign an "X." Placement of a feeding tube is not an emergent surgery that can forego legal consent.
Which action would the nurse take upon learning that a patient scheduled for surgery uses the herb ginkgo regularly? 1 Tell the patient that consuming herbs is an unhealthy practice. 2 Tell the patient to discontinue the herb and return the next day. 3 Inform the surgeon, because the surgery would need to be rescheduled. 4 Tell the patient that the herb is safe and continue with surgery preparation.
3 Inform the surgeon, because the surgery would need to be rescheduled. 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.
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? 1 Review the surgery with the patient. 2 Administer another dose of alprazolam. 3 Notify the anesthesia care provider (ACP). 4 Reassure the patient that everything will go well with the surgery.
3 Notify the anesthesia care provider (ACP). 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. Medication administration will be prescribed by the ACP if needed, but medications also can be administered during surgery. Reassuring the patient is not taking the patient's needs into account.
When reviewing preoperative forms, the nurse notices that the patient's informed consent is not signed. Which action would the nurse take? 1 Have the patient sign the consent form. 2 Have the family sign the form for the patient. 3 Notify the health care provider to obtain consent for surgery. 4 Teach the patient about the surgery and get verbal permission.
3 Notify the health care provider to obtain consent for surgery. 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. Verbal consent is not enough. The state's nurse practice act and agency policies must be followed.
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? 1 Herbal use 2 Sulfur allergy 3 Reactions to latex 4 Respiratory diseases
3 Reactions to latex 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. Checking the history of sulfur allergy, herbal medication, and respiratory diseases would not help, because these conditions do not cause skin reactions.
As part of a preoperative history, a patient reports that their father died due to sudden cardiac arrest. Which action would the nurse take? 1 Check the platelet count. 2 Check the hematocrit level. 3 Review the electrocardiogram. 4 Continue with the history.
3 Review the electrocardiogram. Because the patient's father died due to sudden cardiac arrest, there is a chance that the patient may have a similar predisposition or condition. Reviewing the electrocardiogram of the patient is essential because it can give information about cardiac disease. Some diseases run in families, and the patient's risk of developing them should be determined. The platelet count report gives information about coagulation status. The hematocrit report gives information about anemia, immune status, and infection. The patient may be affected, so the nurse shouldn't just continue with the admission without reviewing the electrocardiogram.
Which statements would the nurse include when teaching a patient with a body mass index (BMI) of 45 about the potential complications of abdominal surgery caused by obesity? Select all that apply. 1 Access to the surgical site is easy. 2 Recovery from anesthesia is faster. 3 The risk of wound infection is higher. 4 Anesthesia administration is more difficult. 5 The risk of a postoperative incisional hernia may be higher.
3 The risk of wound infection is higher. 4 Anesthesia administration is more difficult. 5 The risk of a postoperative incisional hernia may be higher. Because adipose tissue is less vascular than other tissue, the healing of the incisional site is slow, creating a high risk of wound infection. It is difficult to administer anesthesia in obese patients due to the stress on the cardiopulmonary system caused by the increased body weight. Postoperatively, there is a high risk of incisional hernia due to increased stress on the sutures in obese patients. Due to fat deposits, access to the surgical site may be difficult in an obese patient. Some anesthetic agents are stored by adipose tissue and stay in the body for longer time, so the patient may recover slowly from anesthesia.
Which concern would be the first priority for the nurse when transporting a patient to the operating room? 1 Premedication 2 Laboratory tests 3 Safety of the patient 4 Preoperative assessments
3 Safety of the patient When transporting the patient to the operating room, the nurse's primary concern should be the patient's safety. The nurse should help the patient to move from the hospital bed to the stretcher. The side rails should be raised. The patient may be transported to the operating room by stretcher or wheelchair. If no sedatives have been given, the patient may even walk accompanied to the operating room. Premedication, assessments, and laboratory values are major concerns during the preoperative period but not when transporting the patient.Test-Taking Tip: Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way.
How would the nurse ensure a patient scheduled for surgery is not pregnant? 1 By taking an x-ray 2 By checking a hematocrit (Hct) level 3 By checking international normalized ratio (INR) level 4 By checking human chorionic gonadotropin (hCG) level
4 By checking human chorionic gonadotropin (hCG) level To check for pregnancy status, hCG levels are measured. X-rays of the abdomen are harmful to a fetus, so they should always be avoided in women of reproductive age if pregnancy is suspected. Hct levels indicate the hemoglobin level in the blood. INR is used to check for coagulation status.
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? 1 Tell the patient to stop taking the dietary supplement on the day before surgery. 2 Notify the anesthesia care provider because this product interferes with anesthetics. 3 Ask the patient if he has noticed any side effects from taking this dietary supplement. 4 Inform the health care provider because the procedure may need to be rescheduled.
4 Inform the health care provider because the procedure may need to be rescheduled. 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. Fish oil does not interfere with anesthetics. The nurse could ask the patient if he has any side effects from the fish oil, but it is not a priority.
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. 1 Offer soft foods to the patient. 2 Give black coffee to the patient. 3 Give clear liquids to the patient. 4 Keep the patient apprised of the situation. 5 Tell the anesthesia care provider about the situation.
4 Keep the patient apprised of the situation. 5 Tell the anesthesia care provider about the situation. 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.
During the preoperative nursing assessment of a patient, which questions would the nurse ask to determine if the patient has a latex allergy? Select all that apply. a. "Do you take any herbal supplements?" b. "Have you ever had hay fever or asthma?" c. "Do you have a history of allergy to any specific drug?" d. "Do you work or have you worked in the rubber industry?" e. "Are you allergic to food items like eggs and chestnuts?"
b. "Have you ever had hay fever or asthma?" d. Do you work or have you worked in the rubber industry?" e. "Are you allergic to food items like eggs and chestnuts?"