Med-Surg CH 17 My Evolve Practice Questions

A patient with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy. Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe." Which response by the nurse is the most appropriate? A. "Tell me what you know about your surgery and the risks involved." B. "Any surgery has risks, but we will be here to take good care of you." C. "You seem anxious. After you sign the consent, I can give you a sedative." D. "You do not need to be concerned. Your surgeon has not had any complaints."

A. "Tell me what you know about your surgery and the risks involved." Rationale: The health care provider performing the surgery is responsible for obtaining the patient's consent. The nurse may witness the patient's signature on the consent form. As a patient advocate, the nurse should verify that the patient understands the surgery and the risks involved. If the nurse determines that the patient is unclear about operative plans, the nurse should contact the health care provider about the patient's need for more information. The other options provide false reassurance or do not respond to the patient's concern.

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 action should the nurse 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 obtained from the 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 Rationale: Preoperative fluid balance history is especially critical for older adults because they have reduced adaptive capacity that puts them at greater risk for over- and underhydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognition function is especially crucial for intraoperative and postoperative evaluation because they are more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon are important for all patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more important for older patients than it is for all patients.

The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the reason for this surgical procedure? A. It will prevent cancer. B. It will alleviate symptoms. C. It will cure the patient's cancer. D. It will provide cosmetic improvement.

A. It will prevent cancer. Rationale: Removing a mole that is changing is to prevent as well as diagnose cancer. There are no symptoms to alleviate mentioned or cosmetic problems for this patient.

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? A. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. B. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. C. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. D. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

A. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. Rationale: The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. The other options would not be safe for the patient.

The nurse is providing preoperative teaching to a group of patients. 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 Rationale: Patients with abdominal surgeries should be taught how to cough and deep breathe to prevent pulmonary complications such as atelectasis and pneumonia. Coughing and deep breathing is contraindicated in cranial surgeries (e.g., subdural hematoma evacuation or transsphenoidal hypophysectomy) and tonsillectomies.

Which preoperative patient has the greatest risk of bleeding as a result of prescribed medication? A. A woman who takes metoprolol for the treatment of hypertension. B. A man who is taking clopidogrel after the placement of a coronary artery stent. C. A man whose type 1 diabetes is controlled with insulin injections four times daily. D. A man who recently started taking finasteride for the treatment of benign prostatic hyperplasia.

B. A man who is taking clopidogrel after the placement of a coronary artery stent. Rationale: 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.

Lorazepam (Ativan) 1 mg IV is ordered for a patient before surgery. What is the most appropriate action for the nurse to take before administering the medication? A. Ask the patient about an allergy to iodine or shellfish. B. Encourage or assist the patient to the bathroom to void. C. Explain that the medication is used to prevent postoperative nausea. D. Check the laboratory results for the most recent serum potassium level.

B. Encourage or assist the patient to the bathroom to void. Rationale: The nurse should have the patient void before administering preoperative medications that may interfere with balance and increase the fall risk when ambulating to the bathroom. Lorazepam is a benzodiazepine that may be used for sedation and amnesia before surgery. Lorazepam does not affect serum potassium, is not contraindicated in patients with allergies to iodine or shellfish and is not indicated to prevent or treat nausea.

A patient informs the nurse prior to the surgical procedure that she is so nervous about the procedure and had to take alprazolam (Xanax) last night, but it did not relieve the anxiety. What is the priority action by the nurse? A. Review the surgery with the patient. B. Notify the anesthesia care provider (ACP). C. Administer another dose of alprazolam (Xanax). D. Tell the patient that everything will be okay with the surgery.

B. Notify the anesthesia care provider (ACP). Rationale: In determining the psychologic status of the patient, the nurse notes the patient's anxiety. The nurse should notify the ACP after assessing the cause of the anxiety or fear the patient is experiencing. The patient may only need to talk about the surgery related to the situation, concerns with the unknown or body image, or past experiences to relieve the anxiety, but 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 can also be administered during surgery. Reassuring the patient is not taking the patient's needs into account.

A patient being admitted to the same-day surgery unit informs the nurse they took kava last evening to sleep. Which nursing action would be most appropriate? A. Tell the patient that using kava to help sleep is often helpful. B. Inform the anesthesia care provider of the patient's recent use of kava. C. Tell the patient that the kava should continue to help the patient to relax before surgery. D. Inform the patient about the dangers of taking herbal medicines without consulting a health care provider.

B.Inform the anesthesia care provider of the patient's recent use of kava. Rationale: Kava may prolong the effects of certain anesthetics. Thus, the anesthesiologist needs to be informed of recent ingestion of this herbal supplement. Patients should not take anything before surgery without the health care provider's knowledge.

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." Rationale: Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.

The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes; weighs 146 kg; and is 5 feet 8, inches tall. Which patient assessment is a priority related to anesthesia? A. Hemoglobin A1C of 8.5% B. Several seasonal allergies C. A body mass index of 48.8 kg/m2 D. A history of postoperative vomiting

C. A body mass index of 48.8 kg/m2 Rationale: The patient's body mass index is the priority because it indicates the patient is severely obese. The patient's size may impair the anesthesiologist's ability to ventilate and medicate the patient properly, as well as the surgery room staff's ability to position the patient safely. The other factors are not the priority.

When reviewing the preoperative forms, the nurse notices that the informed consent form is not present or signed. What is action should 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. Rationale: The informed consent for the surgery must be obtained by the physician. The nurse can witness the signature on the consent form and verify that the patient (or caregiver if patient is a minor, unconscious, or mentally incompetent to sign) understands the informed consent. Verbal consents are not enough. The state's nurse practice act and agency policies must be followed.

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. Rationale: Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before he returns home for recovery.

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. Rationale: Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that it has been communicated to the anesthesia care provider. Routine medications may or may not be prescribed for use the day of surgery.

The nurse in an ambulatory surgery center has administered the following preoperative medications to a patient scheduled for general surgery: diazepam, cefazolin, and famotidine. What mode of transportation to the operating room (OR) would be the most appropriate for the nurse to arrange for this patient? A. Seated in a wheelchair accompanied by a responsible family member. B. Ambulatory and accompanied by a hospital escort and a family member. C. Stretcher with side rails up and accompanied by OR transportation personnel. D. Ambulatory accompanied by an OR staff member or transportation personnel.

C. Stretcher with side rails up and accompanied by OR transportation personnel. Rationale: The patient has received a sedative (diazepam) and should be transported either by stretcher (with side rails raised) or wheelchair and accompanied by either OR staff, OR transport personnel, or the nurse.

A nurse is assigned to provide preoperative teaching to a patient scheduled for coronary artery bypass surgery who only speaks Spanish. What is the best method for the nurse to teach the patient how to use an incentive spirometer? A. Give the patient a pamphlet written in Spanish with directions on the use of the incentive spirometer. B. Ask another Spanish-speaking patient in the preoperative area to translate as the nurse describes the procedure. C. Notify the postoperative unit to have a Spanish-speaking nurse provide teaching on the incentive spirometer after surgery. D. Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration.

D. Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration.

At 0600, the anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 0730: cefazolin IV to be infused 30 minutes before surgery; midazolam before surgery, and scopolamine patch behind the ear. Which medication should the nurse administer first? A. Cefazolin B. Fentanyl C. Midazolam D. Scopolamine

D. Scopolamine Rationale: The scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin will be given at 0700 to allow infusion 30 minutes before surgery. Fentanyl is an opioid and was not ordered preoperatively. Midazolam, a short-acting benzodiazepine, is used as a sedative.

An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What information should the nurse include in the patient's preoperative teaching? (Select all that apply.) A. Various options for reconstructive surgery B. The risks and benefits of her particular surgery C. Risk factors for breast cancer and the role of screening D. Where in the hospital she will be taken after surgery is over E. How to perform postoperative deep-breathing and coughing exercises

D. Where in the hospital she will be taken after surgery is over E. How to perform postoperative deep-breathing and coughing exercises Rationale: During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The surgeon would address specific risks and benefits of surgery and reconstruction options. Teaching about breast cancer screening would be inappropriate, and insensitive at this point in her disease trajectory.