Periop Week 10
A general principal of anesthesia management for elderly surgical patients is "less is good." a. True b. False
Answer: A
A recent innovation that has allowed more specific placement of endotracheal tubes in pediatric patients is the microcuff endotracheal tube. a. True b. False
Answer: A
A thorough preoperative mental status assessment of an elderly patient should include which of the following components? 1. General appearance, mood, and affect 2. Short-term and long-term memory 3. Judgment and problem solving 4. Language preference a. 1, 2, and 3 b. 1 and 2 c. 1 and 4 d. 2, 3, and 4
Answer: A
AORN standards recommend that security items be washed by parents prior to surgery to decrease the risk of surgical site infection. a. True b. False
Answer: A
Although certain laboratory test results are expected to be outside the normal adult range in elderly patients, these "normal abnormal" values increase elderly surgical patients' risks. a. True b. False
Answer: A
Decreased homeostatic capacity is the most critical aspect of the aging process that affects perioperative nursing care of elderly patients. a. True b. False
Answer: A
Galvin and Curley suggested specific interventions for use with pediatric patients, including: a. protecting areas of skin to skin contact. b. sheepskin under all bony prominences. c. towels to prevent pooling of solutions. d. use of rolled towels/diapers for positioning.
Answer: A
Hypothermia below 34° C can contribute to increased blood loss by: a. decreasing platelet counts and lengthening thrombin times. b. decreasing platelet counts and lengthening prothrombin times. c. peripheral vasodilatation. d. thinning the blood through increased blood cell death due to shivering.
Answer: A
Pop culture can create fears in children, specifically a fear of not being all the way asleep during surgery and feeling pain. a. True b. False
Answer: A
The goal of the use of premedication with anxiolytics is to: a. allay anxiety. b. hasten induction. c. placate parents. d. sedate the child.
Answer: A
Viable options used to familiarize children with surgery include: a. books, videos, and virtual tours. b. detailed written instructions c. interactive computer games d. preoperative phone calls
Answer: A
Which of the following statements are true? a. Aged skeletal muscle cells are more likely than younger skeletal muscle cells to undergo cell death as a result of physical inactivity. b. The reductions in skeletal muscle tone and contractility that occur with aging are due primarily to changes in muscle mass. c. Muscles do not lose any tone with aging if they are exercised regularly. d. The rate and extent of muscle changes is determined almost entirely by exercise and does not have a genetic component.
Answer: A
An 89 year-old man is in the preoperative area. During the pre-operative assessment he reveals that he has increasing difficulty understanding conversations with his grandchildren. Which of the following is the most likely diagnosis? a. Presbycusis b. Sociocusis c. Ototoxicity d. Acoustic neuroma What actions or tools would you use to improve communication with this patient? a. Increase the volume of your voice when questioning this man. b. Ignore the patient, he can't hear you anyway. c. Talk to his family instead of the patient. d. Use either an amplification device or your stethoscope to increase volume during communication. Which of the following has been shown to be of benefit in reducing pressure ulcer incidence in the perioperative period? a. Preoperative nutritional supplements. b. 1 inch foam mattress on operating table and turn patient every 4 hrs. c. Standard sheepskin on operating table. d. Specialized foam mattress overlay on operating table.
Answer: A Answer: D Answer: D
A 2010 Cochrane review established that parentpresent induction was obligatory for patients with preoperative apprehension. a. True b. False
Answer: B
Adolescents can hide body jewelry from their parents. This is a fact that perioperative nurses need to be aware of, and nurses should therefore question adolescents about body jewelry in front of their parents to ensure full disclosure. a. True b. False
Answer: B
Adolescents tend to have varied reactions to surgery, including all of the following except: a. anger. b. cowardice. c. depression. d. willfulness.
Answer: B
At what age can a child benefit from the following activities: investigate, lay a hand on, come into contact with, and check out medical supplies? a. Eight b. Four c. Seven d. Three
Answer: B
Discharge topics to cover with parents include of the following, except a. activity restrictions and return-to-school dates. b. appropriate disciplinary tactics. c. nutritional needs. d. signs of wound infection.
Answer: B
Distraction with play, books, or video games can completely alleviate a child's pain. a. True b. False
Answer: B
Elderly surgical patients are at increased risk for skin breakdown related to 1. decreased vascularity of the skin. 2. decrease in the number of pressure and touch receptors and free nerve endings. 3. decrease in demos thickness. 4. increase in the number of sebaceous and sweat glands. a. 1, 3,and 4 b. 1, 2,and 3 c. 2, 3, and 4 d. 1, 2 ,and 4
Answer: B
Emergence delirium can be mislabeled and confused with a. indulgence. b. pain and fear. c. stubbornness. d. willfulness.
Answer: B
Hypovolemic shock can occur when neonates, infants, and toddlers lose as little as a. 1.5% of blood volume. b. 10% of blood volume. c. 15 % of blood volume. d. 5% of blood volume.
Answer: B
If children see that their parents trust the nurses and doctors, they will have absolutely no fear of surgery. a. True b. False
Answer: B
Managing pain in toddlers requires specific questioning, highlighting the surgical incision location. a. True b. False
Answer: B
NPO guidelines developed by the ASA for children include: a. breast milk no more than 6 hours before surgery. b. clear liquids up until 2 hours before surgery. c. formula no more than 4 hours before surgery. d. juice 2 hours be for surgery.
Answer: B
Nursing staff members need to question parents about recent respiratory infections because of the potential for a. emergence delirium due to poor oxygenation. b. laryngospasm. c. post-op infections. d. respiratory depression.
Answer: B
PRN pain medication is best for children because of parents' fear of overdose and addiction. a. True b. False
Answer: B
Pediatric medications are age-based for dosage guidance. a. True b. False
Answer: B
Short surgical procedures (ie, lasting less than one hour) do not compromise elderly patients' circulatory status or lead to decubitus ulcer formation. a. True b. False
Answer: B
The vasoconstrictive response to cold is blunted in elderly individuals, making them more prone to shivering when hypothermic. a. True b. False
Answer: B
Why is a finding of an S4 in an older adult a more common finding? a. The increase in the incidence of congestive heart failure. b. Decreased compliance of the left ventricle. c. Sclerosis of the mitral and aortic valves. d. Turbulent blood flow from the vena cava into the right atrium.
Answer: B
___________________ is the most common fluid and electrolyte imbalance among elderly individuals. a. Hypokalemia b. Dehydration c. Hypercalcemia d. Hypematremia
Answer: B
A 76 year-old woman is transferred from a rehab facility to the hospital after falling and fracturing her right hip. She was recovering from a recent bout of pneumonia and exacerbation of her COPD that has left her in a weakened state. She uses a combined steroid and long-acting beta agonist inhaler and takes oral steroids for exacerbations. She is not oxygen dependent. She has not been diagnosed with dementia but feels she has been more forgetful over the past year. She is hydrated, her pain is controlled with narcotics, and surgery is planned for this evening under general anesthesia. Which of the following would be most likely to reduce her risk of delirium? a. Start low dose intravenous haloperidol and continue for 48 hours postoperatively. b. Start oral donepezil and continue indefinitely. c. Obtain a preoperative comprehensive geriatric evaluation to develop a multifactorial risk reduction strategy. d. Provide stress doses of intravenous steroids perioperatively. e. Avoid opioid analgesia after surgery.
Answer: C
An elderly patient remarks during his preoperative assessment, "I've had a good life." Select the developmental task of aging that is reflected in this patient's comment. a. Body transcendence vs. body preoccupation b. Adjusting to one's infirmities c. Ego integrity vs. despair d. Identity vs. confusion
Answer: C
Concerns unique to the pediatric history and physical include: a. birth history and pregnancy compilations. b. colds and preop labs. c. recent immunizations, history of respiratory syncytial virus, and diaper rash. d. the presence of adult teeth or congenital abnormalities.
Answer: C
During your preoperative assessment of a 92 year old retired construction worker who now lives in an assisted-living facility, you note bluish-purple lesions on the patient's arms. You identify these discolorations as: a. Seborrheic keratoses. b. Solar lentigo. c. Senile purpura. d. Sebaceous hyperplasia.
Answer: C
Elderly individuals are more affected by alcohol than younger individuals for which reasons? a. With age, total body fat decreases. b. With age, total body water increases. c. The central nervous system becomes more sensitive to the sedative effects of alcohol with age. d. a and b only.
Answer: C
Fears that are common to virtually all children include all of the following except: a. loss of control. b. pain. c. recovery. d. separation anxiety.
Answer: C
Hypothermia in the neonate can create a cascade of events leading to hypoxia. Which of the following is the accurate sequence of events? a. Anaerobic metabolism, decreased oxygen consumption, pulmonary vasoconstriction. b. Anaerobic metabolism, pulmonary vasoconstriction, respiratory acidosis. c. Peripheral vasoconstriction, increased oxygen consumption, respiratory acidosis. d. Peripheral vasodilatation, increased oxygen consumption, respiratory alkalosis.
Answer: C
In rare instances, which premedication is given intramuscularly to highly uncooperative or combative children? a. Clonidine b. Diazepam c. Ketamine d. Midazolam
Answer: C
Progressive loss of neurons, gradual decrease in cerebral blood flow and oxygen consumption, and decreased numbers of receptor sites for neurotransmitters can cause which of the following effects in elderly surgical patients? 1. Decreased sensitivity to inhaled anesthetics, narcotics, and barbiturates 2. Increased sensitivity to local anesthetics 3. Increased risk for perioperative delirium 4. Increased risk for postoperative cognitive function loss a. 1, 2, and 4 b. 1, 2, and 3 c. 2, 3, and 4 d. 1, 2, 3, and 4
Answer: C
The most common pattern of hearing loss among older adults is: a. Unilateral sensorineural. b. Unilateral conductive. c. Bilateral symmetric sensorineural. d. Bilateral symmetric conductive.
Answer: C
Which of the following statements about site marking is not correct? a. Alternate site marking can decrease the risk of skin tattooing. b. Site marking should be considered when parents object to marking the child. c. Site marking should always be used for neonates, infants, and toddlers. d. Site marking should be used when the patient is uncooperative with the process.
Answer: C
A 92 year-old man who lives alone independently presented at his PCP office after noticing dark black stools. His hemeoccult in the office was positive. His hemoglobin and hematocrit were 7.1 and 22. His creatinine is 1.7. His only other comorbid condition is an MI one year ago. What is the most likely diagnosis? a. Hemorrhoids. b. Anal tear after large stool. c. Descending colon cancer. d. Ruptured diverticulum. What is his renal function with a creatinine of 1.7? a. His renal function is at 10% of normal. b. He is older so we know his creatinine does not accurately reflect renal function. c. An estimated creatinine clearance can be calculated using the Cockcroft-Gault equation. d. His renal function is within normal limits.
Answer: C Answer: C
According to the American Nurses Association's Scope and Standards of Gerontological Nursing Practice, Second Edition1, nurses should develop plans of care for elderly patients 1. in conjunction with the older person and appropriate others. 2. by setting mutual goals and priorities with the older person. 3. by addressing therapeutic, preventive, restorative, and rehabilitative needs of the older person. 4. by facilitating continuity of care as the older person moves to various care settings. a. 1 and 2 b. 2 and 3 c. 2, 3, and 4 d. 1, 2, 3, and 4
Answer: D
An elderly patient in acute renal failure may present with a. azotemia and oliguria. b. hypotension or hypertension. c. altered mental status. d. all of the above.
Answer: D
Cognitive impairment in elderly surgical patients may cause memory deficits, problem-solving difficulties, and delayed or altered information processing related to 1. thyroid dysfunction. 2. vitamin deficiencies. 3. adverse medication reactions. 4. cerebral vascular accidents. 5. depression. a. 1, 2, and 4 b. 1, 2, 4, and 5 c. 1, 3, and 4 d. 1, 2, 3, 4, and 5
Answer: D
Examples of procedure-specific discharge instructions include all of the following except a. cast care. b. excessive swallowing post tonsillectomy. c. gastrostomy tube care. d. pain control medications.
Answer: D
Functional changes in elderly patients' vision most often are caused by a. presbyopia. b. decreased color discrimination and depth perception. c. increased sensitivity to glare. d. all of the above.
Answer: D
In addition to vision changes, what other age-related sensory changes can affect the perioperative nursing care of elderly surgical patients? 1. Presbyopia 2. Hyposmia 3. Decreased vibratory sense 4. Decreased sense of touch a. 1, 2, and 3 b. 1, 3, and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4
Answer: D
Intraoperative hypothermia increases elderly surgical patients' risks for a. increased blood loss related to impaired platelet function and coagulation cascade abnormalities. b. impaired venous access and abnormal pulse oximetry readings. c. increased affinity of hemoglobin for oxygen with decreased oxygenation at the tissue level. d. all of the above.
Answer: D
Postop apnea in infants and neonates is a recognized until they reach: a. 44 weeks post-conceptual age. b. 6 weeks post-conceptual age. c. 2 months post-conceptual age. d. 60 weeks post-conceptual age.
Answer: D
Preoperative functional assessment of elderly surgical patients includes obtaining information about a. physical functioning (eg, bathing, dressing, continence, feeding). b. instrumental factors (eg, transportation, housekeeping, meal preparation, medication). c. living situations and related home factors (eg, physical barriers, steps, accessibility of bathrooms). d. all of the above.
Answer: D
Sedation is appropriate for pediatric patients, except when a. appropriate dosage ranges are used. b. cautious patient selection is used. c. staff members are proficient in rescue techniques. d. the parent or patient refuses.
Answer: D
The use of which monitor is most important during the inhalation induction of a child? a. Blood pressure cuff b. Capnography c. EKG leads d. Pulse oximeter
Answer: D
When positioning elderly patients for surgical procedures, perioperative nurses must consider which of the following comorbid processes? a. Osteoporosis b. Osteoarthritis c. Sensory deficits d. All of the above
Answer: D
When teaching an elderly surgical patient new concepts about postoperative self-care, perioperative nurses should a. allow ample time for teaching because individuals' speed of processing new information slows with normal aging. b. relate new information to patients' previous life experiences. c. ensure that patients use their hearing aids and eyeglasses during teaching sessions. d. all of the above.
Answer: D
Which of the following vital signs needs to be addressed in an 85 year-old female? a. Respiratory rate of 22. b. Heart rate of 96. c. Temperature of 96.8°F. d. Blood pressure of 142/92.
Answer: D
An 87 year-old woman, Ms. L., found a lump on her monthly BSE. She lives independently, works full time and takes public transportation to work as she stopped driving a year ago. She uses bilateral hearing aides and glasses. She is being prepared for surgery of lumpectomy with lymph node dissection. What factors would make this surgery appropriate for an 87 year old-woman? a. She is highly functional and independent. b. She is cognitively intact and able to arrange for assistance in the postoperative period. c. She is too old and should not have this surgery. d. A and C e. A and B f. None of the above Ms. L. is at higher risk in the post operative period than a younger patient for: a. Dementia b. Sundowning c. Delirium d. Depression Actions for Ms. L. in the preoperative setting and perioperative setting that would mitigate this risk would be: a. Allowing family to remain with the patient for as long as possible and as soon as possible postoperatively. b. Allow her to keep her glasses and hearing aides on until immediately before she is anesthetized. c. Attempt local anesthesia over general anesthesia. d. All of the above. During Ms. L.'s preoperative assessment she mentions that she is planning on going home alone to her own home upon discharge. Based on the information you have: a. Ms. L. must go home with her children or have one of them stay with her. b. It would be safest for Ms. L. to arrange to have some constant companionship for the 24-48 hours following discharge. c. Going home alone is an appropriate plan. d. You should contact her children and tell them one of them must stay with her.
Answer: E Answer: C Answer: D Answer: B
