Ch. 14 Care of PreOp AQ
Which preoperative drug is administered to a patient when rapid emptying of stomach is needed?
Metoclopramide
Colostomy surgery is categorized as what type of surgery?
Palliative
A nurse is preparing an 82-year-old patient to undergo a graft for an abdominal aortic aneurysm. Which assessment is important for the nurse to report to the surgeon?
Patient reports correct month and day, but not year.
Which nursing intervention is appropriate for a preoperative patient with dry skin and less subcutaneous fat?
Teaching the patient to change position hours
What is the purpose of having a patient sign an informed consent form before surgery?
It protects the patient from unwanted procedures.
For the patient who is scheduled to undergo a total hip replacement, which complaint requires further evaluation by the nurse? 1 "It's difficult to have a bowel movement." 2 "I feel tired after that medication." 3 "I have dull, achy pain in my right calf." 4 "These stockings feel really tight."
"I have dull, achy pain in my right calf." An ache or dull pain in the lower extremity could be symptom of deep vein thrombosis, which if dislodged, could potentially cause a fatal condition such as pulmonary embolism. Sedatives and analgesics are routinely given preoperatively to calm and ease patient's fears and or concerns, which may increase drowsiness. The application of sequential compression stockings (SCDs) and compression stockings is used to decrease cardiovascular complications such as venous thromboembolism (VTE) in perioperative patients.
The nurse is instructing a patient about the use of antiembolism stockings. Which statement by the patient indicates the need for further teaching?
"These stockings will prevent blood clots.!
When completing the preoperative assessment, which question should the nurse ask the patient?
"What medications are you currently taking?'
The nurse is preparing a patient for surgery, and is planning to administer propofol. Which responses given by the patient would lead to administration of an alternate drug? Select all that apply.
'I am allergic to eggs. 'I am allergic to peanuts. I am allergic to soy products.
Preoperatively, the nurse instructs a patient about reducing the risk of infection at the surgical site. Which statement made by the patient indicates a need for further teaching?
'I should avoid using soap when bathing on the day of surgery."
The nurse teaches expansion breathing exercises to a patient who is scheduled for chest surgery. Which statement made by the patient indicates the need for further teaching?
'I should exhale by moving my lower rib cage inward first, and then chest.'
A nurse is conducting a preoperative assessment for a patient who will have a coronary artery bypass graft. Which statement by the patient suggests understanding of the preoperative instructions? 1 "I shaved my chest for the surgery this morning." 2 "I ate a piece of dry toast 30 minutes ago." 3 "I have not used herbal supplements for two weeks." 4 "I took my metoprolol this morning with a sip of water."
'I took my metoprolol this morning with a sip of water! Cardiac patients routinely require medications such as beta blockers, nitroglycerin, and antibiotics before and during the procedure. The patient demonstrates understanding of preoperative instructions if he or she reports having taken the metoprolol with a sip of water on the morning of the surgery. Surgical care improvement measures prohibit shaving the surgical site, as this intervention increases the patient's risk of infection. Although the exact amount of time a patient must be nothing per mouth (NPO) before surgery is controversial, the American Society of Anesthesiologists (ASA) recommends a reduced NPO time of 6 or more hours for easily digested solid food and 2 hours for clear liquids; therefore the patient should not have eaten within 30 minutes of the preoperative assessment. The surgeon may recommend that some drugs, including over-the-counter drugs such as aspirin, other non-steroidal anti-inflammatory drugs (NSAIDs), and herbal supplements, be stopped 1 week prior to surgery.
Which of a nursing student's statements regarding informed consent prior to surgery indicates a need for further teaching?
'Informed consent does not designate who is performing the surgery or whether others will be present during procedure.
While gathering patient history during the preoperative phase, what statement would be most concerning pertaining to anesthesia?
'My mother spiked a fever right after her hip replacement.'
Which statement by the novice nurse best demonstrates an understanding of preoperative teaching?
'Please sign both consents for anesthesia and blood products.
The nurse is educating a family member of a patient who is having surgery. Which statement by the family member indicates a need for further teaching?
'The type of anesthesia used is what determines the length of the patient's stay in the postanesthesia unit (PACU)."
Which teaching by the nurse during the preoperatie perod best informs the patient regarding the primary purpose of the device shown in the image?
'This device will help you keep your lungs expanded after surgery.'
The nurse is providing patient education regarding external pneumatic compression devices. Which statement by the patient demonstrates effective teaching?
'You will apply these before my surgery.'
A patient is scheduled to have a total hysterectomy at 0930. Which is the most appropriate time to give the patient preoperative prophylactic antibiotics?
0915
The nurse cares for a patient who is scheduled for cardiovascular Which assessment finding is most surgery. important for the nurse to report to the primary health.care provider?
Absence of peripheral pulses
The nurse is providing preoperative care to a patient who is diagnosed with type I diabetes mellitus. Which order does the nurse anticipate implementing?
Administer a reduced dose of insulin.
A patient is scheduled for abdominal surgery. Which operative stage is most suitable for inserting the patient's nasogastric tube? 1 After the surgery 2 One hour before surgery 3 Two hours before surgery 4 After the induction of anesthesia
After the induction of anesthesia A nasogastric (NG) tube is placed after the induction of anesthesia in the patient undergoing abdominal surgery. At this stage, the insertion is less disturbing to the patient and is easier to perform. The NG tube is not placed after the surgery because the purpose of the NG tube is to decompress or empty the stomach during the surgery. The NG tube is not placed 1 or 2 hours before surgery because it is disturbing to the patient and is difficult to perform.
What symptom will the nurse observe in a preoperative patient with anxiety? Select all that apply. anger constipation crying decreased heart rate urinary frequency
Anger Crying Urinary frequency
Why are prophylactic antibiotics discontinued within 24 hours after a gastric surgery? Select all that apply.
Antimicrobial resistance Risk for clostridium infection Risk outweighs the benefits of the drug
A patient reports uncomfortable sensations such as itching, sweating, and heat when wearing sequential compression boots. Which intervention would help the patient reduce the uncomfortable sensations?
Apply antiembolism stockings.
A patient is going to have minimally invasive surgery (MIS). What is an example of a minimally invasive surgery? 1 Partial Mastectomy 2 Radical prostatectomy 3 Arthroscopy 4 Mitral valve replacement
Arthroscopy Minimally invasive surgery is surgery that can be performed in a body cavity or body area through one or more endoscopes, such as arthroscopy. Partial mastectomy is a simple surgery. Radical prostatectomy is a radical surgery. Mitral valve replacement is major surgery.
What is autologous blood? 1 A "bloodless surgery" 2 Blood from a universal blood donor 3 Blood from the patient prior to surgery 4 Blood donated by a patient's family member
Blood from the patient prior to surgery
A 78-year-old patient is about to undergo cardiac surgery. Which assessment data has the highest priority?
Blood glucose 218 mg/dL
A health care provider has ordered a potassium intravenous drip for a patient with a potassium level of 3.2 mEq/L. Which surgical procedure would the nurse most likely to administer this medication for?
Bowel resection
The nurse is caring for a perioperative patient. How does the nurse intervene in managing the perioperative temperature of the patient?
By measuring the temperature within 15 minutes after anesthesia administration
After examining a patient's respiratory status, the nurse anticipates a chronic lack of oxygen. Which evaluation criterion leads the nurse to this conclusion?
Clubbing of fingertips
A patient with back pain is scheduled for spinal surgery. What examinations does the nurse anticipate in the preoperative order set for this patient? Select all that apply.
Computed tomography (CT) scan Magnetic resonance imaging (MRI)
Which condition of a patient with obesity is responsible for increasing the risk for poor wound healing? Select all that apply.
Decreased nutrients Fewer blood vessels Low amounts of collagen
Which information is most appropriate to communicate to the next shift nurse about a 74-year-old patient who is recovering from right hip surgery?
Decreàsed lung sounds
Which nursing action will help prevent fatigue in a patient diagnosed with a decrease in cardiac output?
Determining the patient's normal activity levels
Which intervention by the nurse involves promoting surgical care improvement project (SCIP) core measures?
Discontinuing prophylactic antibiotics within one day of surgery time.
Which clinical manifestations in a patient indicate poor fluid or nutritional status? Select all that apply.
Dull hair Brittle nails Muscle wasting Skin turgor changes
An unidentified patient from the emergency department requires immediate surgery, but he is not conscious and no one is with him. What must the nurse, who is verifying the informed consent, do?
Ensure written consultation of two noninvolved physicians.
Which drug is prescribed to a patient for stimulating red blood cell production prior to surgery? 1) Morphine 2) Scopolamine 3) Barbiturates 4) Epoetin alpha
Epoetin alpha Epoetin alpha stimulates the production of red blood cells and is often given to patients before, during, and after surgery. Morphine is an opioid and does not stimulate red blood cell production. Scopolamine and barbiturates are anesthetic agents and have no role in the production of red blood cells.
Which statements regarding the Patient Self-Determination Act (PSDA) are true? Select all that apply.
It grants patients the right to have advance directives (ADs). Documents such as a living will durable of attorney are mandated. The PSDA grants patients the right to provide legally binding instructions to health care providers about their wishes regarding treatment.
The nurse is caring for a postoperative patient. Which instructions should the nurse provide to the patient for deep diaphragmatic breathing? Select all that apply.
Inhale and exhale as gently as possible. Take a deep breath through the nose and mouth.
The nurse is reviewing a plan of care for a preoperative patient who is experiencing anxiety. Which of the plan's interventions needs revision?
Instructing the patient to avoid visiting friends 24 hours before surgery
During the perioperative phase, a patient is advised to perform coughing and splinting. What may be the reasons behind this practice? Select all that apply.
It expels secretions. It prevents atelectasis. It keeps the lungs clear. It prevents pneumonia.
Which explanation supports the use of electrical clippers and depilatories to remove hair at the surgical site? 1) It is the easiest method. 2) It helps with wound healing. 3) It reduces the potential for infection. 4) It is a less time-consuming method.
It reduces the potential for infection. Hair clipping with electrical clippers and use of depilatories at the surgical site reduces the potential for infection because it reduces the risk of introducing a break in the skin. The shaving of hair creates a potential for infection; the method is not an easy one and does not help in wound healing. The method of hair removal for surgery is based on the prevention of complications and infection; time is not a factor.
Which religious group's members will typically not accept blood transfusions because of their religious convictions?
Jehovah's Witnesses
What should the nurse assess for in a patient whose potassium levels are high? 1 Alkalosis 2 Malnutrition 3 Kidney impairment 4 Excessive use of diuretics
Kidney impairment Kidney impairment can be the underlying cause of elevated potassium, and this must be checked prior to surgery. Malnutrition, alkalosis, and excessive use of diuretics would lead to decreased potassium levels.
A patient has an allergy to bananas. To which other allergy may the patient be susceptible?
Latex
A patient has developed a pulmonary embolism. Which measurement is essential when ordering an antiembolism stocking size for the patient? 1 Leg length 2 Foot length 3 Height 4 Weight
Leg length Antiembolism stockings must be an accurate fit for the patient's leg. Therefore, measurement of the patient's leg length and circumference is essential before ordering the stocking size. A correct size is required for maximum benefit. Measuring the foot length, and patient's height and weight is not useful for stocking size.
During autologous donation, the patient's own blood is used during or after surgery if it is needed. What is provided by the blood collection center to the patient after autologous blood donation?
Matching tag
Which surgery is an example of a surgical procedure performed only to relieve the symptoms of a disease? 1Revision of scars 2Cholecystectomy 3Nerve root resection 4Total joint replacement
Nerve root resection is a palliative surgery performed to relieve the symptoms of a disease process, but it does not cure. Revision of scars is a cosmetic surgery performed primarily to alter or enhance personal appearance.Cholecystectomy is a curative surgery performed to resolve a health problem by repairing or removing the cause.Total joint replacement is an elective surgery planned for correction of a nonacute problem
A patient scheduled for surgery at the ambulatory health care clinic is asked to maintain 'NPO status' after midnight, on the night before surgery. What does the instruction about NPO status indicate? 1 Anesthesia will be administered during surgery. 2 No food should be consumed after midnight, on the night before surgery. 3 Regular vitamins may be taken with a sip of water if required. 4 Cigarette smoke should be avoided at least 2 hours before surgery.
No food should be consumed after midnight, on the night before surgery.
The nurse is caring for a patient who is scheduled for back surgery. The patient's medical history includes gastroesophageal reflux disease (GERD). During transport to the operating room, the patient complains of burning chest pain which he rates as '8' on a pain scale of 0 to 10. Which nursing action is most appropriate? 1 Cancel the surgery 2 Administer pain medication 3 Notify the surgeon and anticipate a cardiology consult 4 Position the patient upright and reassess after 5 minutes
Notify the surgeon and anticipate a cardiology'consult
The nurse is reviewing laboratory data for a 56-year-old male who is scheduled to undergo left lower lobectomy in two hours. Which result would require the nurse to notify the physician immediately? 1 Hemoglobin 13.5 g/dL 2 Blood urea nitrogen 18 mg/dL 3 Potassium 3.3 mEq/dL 4 Sodium 142 mEq/L
Potassium 3.3 mEq/dL The normal range for serum potassium is 3.5 to 5.0 mEq/dL
A patient with hemorrhoids is being prepared for surgery the next day. Which therapy can help the patient in evacuating the bowels? 1 Enema 2 Dandelion 3 IV preparation 4 Potent laxatives
Potent laxatives Potent laxatives may help this patient with evacuating the bowels. Enemas are not the best solution because they may cause severe anorectal discomfort for the patient with hemorrhoids, as well as other side effects. Although some people may use dandelion, an herb, to increase bowel movements, there is no scientific evidence that it is effective. Herbal drugs are also avoided during surgery because they increase the risk for other complications. IV preparations are not useful for the evacuation of the bowels.
A patient has an allergy to shellfish. Which other substance may the patient be allergic to in conjunction with the shellfish allergy?
Povidone-iodine
Which factors can increase the risk for anesthesia-related complications? Select all that apply.
Presence of cardiac problems Alcohol and illicit substance use Age related changes in kidney and liver function
Before obtaining informed consent, the surgeon explains sufficient information about the surgical procedure to the patient. Which action related to informed consent, performed by the nurse, would need correction?
Providing detailed information about the surgery to be performed
A patient's preoperative chest x-ray is abnormal. What occurrence is likely to develop in the patient if surgery were to proceed?
Pulmonary complications
A patient is being prepared for gastrointestinal surgery and undergoes a bowel preparation. Why is this preoperative procedure done? 1Decrease expected blood loss during surgery 2 Eliminate any risk of infection 3 Ensure that the bowel is sterile 4 Reduce the number of intestinal bacteria
Reduce the number of intestinal bacteria Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria. Decreasing expected blood loss and sterilizing the bowel are not the goals of a bowel preparation. While the bowel prep may reduce the number of intestinal bacteria, it will not completely eliminate the risk of infection.
What is the primary reason for the placement of drains in the perioperative patient?
Removing fluid from the surgical site
Which condition is called oliguria? 1 Scanty urination 2 Painful urination 3 Bloody urination 4 Frequent urination
Scanty urination Oliguria refers to the scanty output of urine, which may be caused by hypoperfusion of the kidneys. Dysuria is the term used for painful urination. Hematuria is the term used for the presence of blood in the urine. Frequent urination is called polyuria.
A patient is scheduled for a cholecystectomy. For which pre- existing conditions may medication be allowed with a sip of water before surgery? Select all that apply.
Seizures Hypertension Cardiac disease Respiratory disease
Which food is contraindicated in patients with povidone-iodine allergy?
Shellfish
The nurse who is caring for a patient preoperatively determines that the patient is at risk for cardiac failure based on what laboratory result?
Sodium level of 158 mmol/L
An older patient's adult child tells the nurse that the patient does not want life support. What does the nurse do first?
Talk to the patient.
Which postoperative nursing intervention is most important to perform to reduce the risk of deformities in older patients?
Teach the patient about turning and positioning techniques.
The nurse is attending to a patient who had an appendectomy. What nursing intervention does the nurse perform for this patient?
Teaches the patient to splint the wound when turning in bed.
A patient is scheduled for emergency abdominal The surgery. patient is unable to give consent and has no family. Who can appoint a legal guardian for the patient?
The court
Which information must be provided to the patient when obtaining informed consent for surgery? Select all that apply.
The reason for and nature of the surgery The risks associated with the use of anesthesia The available options and their possible risks The risks associated with the surgical procedure and its potential outcomes
What is the primary reason for establishing vascular access in the preoperative patient? 1 To hydrate the patient 2 To reduce the chance of infection 3 To deliver a general anesthetic 4 To warm the patient
To deliver a general anesthetic Vascular access is established in the preoperative patient primarily for administering a general anesthetic. It is used to give drugs and fluids before, during, and after surgery. Vascular access may be used to hydrate a dehydrated patient or a patient at risk for dehydration; however, it is not the primary reason vascular access is established. Vascular access is not used to reduce the chance of infection. Vascular access may be used to deliver warmed fluids to a patient with severe hypothermia.
Which is an example of an elective surgery?
Total knee replacement
A 46-year-old female who was involved in a high-speed, head- on motor vehicle accident arrives at the emergency department by ambulance. The patient sustained multiple fractures and requires immediate surgery to stop massive internal hemorrhaging. The patient is unconscious and no family or spouse is present. Which action does the nurse anticipate?
Transporting the patient directly to surgery
A patient is scheduled for surgery. Which laboratory and/or diagnostic tests are routinely carried out before any surgery is performed? Select all that apply.
Urinalysis Electrolyte levels Hemoglobin level Blood type and screen
Which topics are included in preoperative patient teaching? Select all that apply. 1 Splinting 2 Incisional care 3 Pain management 4 Incentive spirometry 5 Lower extremity exercises
splinting pain management incentive spirometry lower extremity exercises
