Quiz 3 PreOp Chapter 50: Care of Surgical Patients

28. While assessing a patient scheduled for hip replacement surgery, the nurse notes that the patient is at a high risk for venous thromboembolism. Which factor led the nurse to this conclusion? a. Age of 30 years b. Active chemotherapy c. Active antihypertensive treatment d. Body mass index (BMI) of 20 kg/m 2

Rationale Active chemotherapy treatment may predispose a patient having hip replacement to venous thromboembolism (VTE). The risk factors for VTE also includes an age over 60, not 30, dehydration, and body mass index (BMI) of 30 kg/m 2 or greater, not 20 kg/m 2. Antihypertensive treatment will not cause a change in blood clotting and therefore will not raise the risk for VTE. pp. 1265, 1266

9. After assessing a 5'6" 19-year-old patient who has appendicitis, the nurse documents the body weight of the patient as 90 kg. Which factor puts the patient at risk for death? a. Blood glucose of 90 mg/dL b. Prothrombin time of 11 seconds c. Blood urea nitrogen of 15 mg/dL d. Blood pressure of 150/98 mm Hg

Rationale A 5'6" 19-year-old patient weighing 90 kg is obese, which can cause hypertension. The patient's blood pressure of 150/98 mm Hg is high and may result in death or other complications in the patient. A normal blood glucose level is 100 mg/dL, so the patient's blood glucose of 90 mg/dL is comparatively safe. A prothrombin time of 11 seconds is normal and will not subject the patient to cardiovascular risk. A blood urea nitrogen of 15 mg/dL is normal as well. p. 1263

11. While assessing a patient scheduled for hip replacement surgery, the nurse notes that the patient is at a high risk for venous thromboembolism. Which factor led the nurse to this conclusion? a. Age of 30 years b. Active chemotherapy c. Active antihypertensive treatment d. Body mass index (BMI) of 20 kg/m 2

Rationale Active chemotherapy treatment may predispose a patient having hip replacement to venous thromboembolism (VTE). The risk factors for VTE also includes an age over 60, not 30, dehydration, and body mass index (BMI) of 30 kg/m 2 or greater, not 20 kg/m 2. Antihypertensive treatment will not cause a change in blood clotting and therefore will not raise the risk for VTE. pp. 1265, 1266

4. The nurse works in an ambulatory surgical center. The nurse checks the vital signs of patients in the preoperative period. What would the vital signs indicate? Select all that apply. a. Patient's stability b. Correction of abnormalities c. Fear and stress d. Health of the patient e. Baseline for intraoperative assessment

Rationale In the preoperative period, the nurse checks for the patient's vital signs to ensure health and stability. They also serve as a baseline for intraoperative assessment. The vital signs do not indicate correction of abnormalities. The vital signs do not assess the fear and stress of the patient. p. 1280

16. The primary health care provider instructs the nurse, "Administer no more than three enemas to a patient until the patient is clear." Which conditions is the three-enema limit aiming to prevent? Select all that apply. a. Anemia b. Hypokalemia c. Thrombocytopenia d. Low blood urea nitrogen (BUN) e. Fluid and electrolyte imbalance

Rationale Administering enemas until the patient is clear means that no solid fecal material will be eliminated in the last emesis. However, enemas should be limited to only three doses, because too many may lead to fluid and electrolyte imbalance and/or hypokalemia. Anemia commonly occurs due to malnutrition or heavy blood loss, but not as a result of enemas. Thrombocytopenia is a deficiency of platelets, which is not a result of enemas. Blood urea nitrogen (BUN) drops due to fluid overload, not enemas. p. 1279

22. What are advantages of conscious sedation versus general anesthesia? Select all that apply. a. The patient maintains an independent airway. b. The patient has the ability to respond to verbal stimuli. c. There is a reduction of fear and anxiety. d. There is loss of sensation at the surgical site. e. The patient is unable to recall the surgery.

Rationale Advantages of conscious sedation include the patient's ability to maintain an independently patent airway and respond to verbal stimuli. Conscious sedation usually results in a reduction of fear and anxiety associated with surgery compared with general anesthesia. Local anesthesia involves a loss of sensation at the surgical site. During conscious sedation, the patient is able to recall the surgical procedure. Study Tip: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it. p. 1284

17. While providing perioperative care to a 78-year-old patient, the nurse instructs the patient to ambulate and then sit in the chair every 2 hours following surgery. What is the rationale behind this nursing intervention? Select all that apply. a. To reduce the risk of diabetes b. To maintain optimal residual capacity of the lungs c. To decrease gastric reflux and indigestion d. To reduce the risk for pressure ulcers e. To maintain a healthy blood pressure level

Rationale Ambulation and frequent repositioning of the patient following surgery helps maintain optimal residual capacity by increasing the amount of new air brought into lungs with each inspiration. Ambulation and elevation of the thoracic region help reduce gastric reflex and indigestion. Moving around also relieves the risk for pressure ulcers to which older adult patients may be susceptible. Moving around does not reduce the risk for diabetes. Maintaining adequate fluid balance and minimizing stress to the heart helps maintain optimal blood pressure levels. p. 1264

19. A patient diagnosed with appendicitis is advised to have surgery. After collecting the patient's medical history, the nurse anticipates that the surgery will be postponed. Which option may necessitate surgical postponement? a. The patient takes aspirin for cardiovascular disease. b. The patient takes gentamicin for infection. c. The patient takes neomycin for infection. d. The patient is on prednisone therapy

Rationale Aspirin is an anticoagulant that increases the risk of bleeding during surgery. Therefore, the surgery should be delayed to reduce the risk of hemorrhage. Gentamicin and neomycin are antibiotics, which do not cause any complications with the surgery. Prednisone is a corticosteroid, which suppresses the immune system. However, the surgery need not be postponed because of this drug. p. 1270

1. A patient is being assessed for factors that may increase the risk of surgery. Which medical conditions increase the risk of surgery? Select all that apply. a. Diabetes mellitus b.Upper respiratory tract infection c. Fever d. Obstructive sleep apnea e. Headache

Rationale Diabetes mellitus increases the risk of developing infection and delays wound healing. Upper respiratory tract infections increase the risk of respiratory complications during anesthesia. Fever increases the risk of fluid and electrolyte imbalance. Obstructive sleep apnea may lead to airway obstruction if opioids are administered. A headache does not increase the risk of surgery. p. 1268

12. A patient is scheduled for a coronary artery bypass graft (CABG) surgery under general anesthesia. When asked about general anesthesia, what information should the nurse include when explaining it to the patient? Select all that apply. a. General anesthesia includes anesthetizing the entire body. b. General anesthesia includes anesthetizing only the affected part. c. General anesthesia is administered through the subcutaneous route. d. General anesthesia is administered through intravenous route or inhalation. e. General anesthesia involves calculation of the drug amount based on the patient's condition and duration of surgery.

Rationale General anesthesia involves anesthetizing the entire body. This is the preferred method of anesthesia in major surgeries like CABG. The route of administration is intravenous (IV) or inhalation. The amount of drug required is calculated by the anesthetist and depends on the patient's status, weight, duration of surgery, etc. Local anesthesia anesthetizes only the affected part, and the common route of drug administration is subcutaneous. p. 1283

18. The nurse is assessing a patient who takes insulin and is scheduled for surgery. The nurse suspects that the patient may be at risk of hypoglycemia. Which patient statement supports the nurse's conclusion? a. "I take gingko to improve memory." b. "I take ginseng to lower my blood pressure." c. "I am on warfarin therapy for a prosthetic valve." d. "I am on prednisone therapy for a recurrent skin rash."

Rationale Ginseng is an herbal therapy, which helps relieve stress. However, ginseng stimulates the secretion of insulin, thereby reducing blood glucose levels and increasing the risk of hypoglycemia for a patient who takes insulin therapy. Gingko is an herbal supplement, which is useful for the treatment of dementia. However, gingko increases the risk of hemorrhage because it is an anticoagulant; it does not cause hypoglycemia. Warfarin is an anticoagulant, which increases the risk of hemorrhage, but does not cause hypoglycemia with insulin therapy. Prednisone is a corticosteroid, which suppresses the immune system. Prednisone is associated with the risk of hyperglycemia. p. 1270

20. Which conditions may increase the risk for infection in a patient after surgery? Select all that apply. a. Dementia b. Atelectasis c. Chemotherapy d. Diabetes mellitus e. Bone marrow alterations

Rationale Immunodeficiency due to chemotherapy or bone marrow alterations may increase the risk of infection in a patient after surgery. After surgery, a patient who has diabetes mellitus may be more susceptible to infection due to hyperglycemia. Dementia and atelectasis do not compromise a patient's immune system and increase the incidence of infection. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options . p. 1265

14. In the month leading up to surgery, which nutrients should the patient focus most on consuming to promote tolerance of the procedure and enhanced recovery? Select all that apply. a. Calcium b. Iron c. Vitamin B 12 d. Vitamin C e. Folate

Rationale Increased intake of iron, vitamin B 12, and folate is recommended at least 28 days before scheduled surgery to ensure adequate nutrition and promote a speedy recovery. Although calcium and vitamin C do not necessarily enhance recovery, calcium is important for bone health, and vitamin C is important for boosting the immune system. p. 1263

30. In the month leading up to surgery, which nutrients should the patient focus most on consuming to promote tolerance of the procedure and enhanced recovery? Select all that apply. a. Calcium b. Iron c. Vitamin B 12 d. Vitamin C e. Folate

Rationale Increased intake of iron, vitamin B 12, and folate is recommended at least 28 days before scheduled surgery to ensure adequate nutrition and promote a speedy recovery. Although calcium and vitamin C do not necessarily enhance recovery, calcium is important for bone health, and vitamin C is important for boosting the immune system. p. 1263

8. The laboratory findings of a patient scheduled for a colostomy show a hemoglobin (Hgb) level of 7 g/dL and a red blood cell (RBC) count of 3 million cells/mcL. Which nursing action is appropriate in this situation? a. Monitoring oxygen saturation b. Monitoring body temperature c. Repositioning the patient every two hours d. Providing warm blankets and intravenous fluids

Rationale Normal hemoglobin (Hgb) levels are 14 to 18 g/dL, and normal red blood cell (RBC) counts are 4.7 to 6.1 million cells/mcL. Reduced levels of hemoglobin (Hgb) of 7 g/dL and RBC counts of 3 million cells/mcL decrease the patient's ability to carry adequate oxygen to tissues. Therefore, the physician will likely order transfusion of blood products, and the nurse will monitor oxygen saturation levels frequently. Monitoring vital signs will help prevent complications during surgery. Repositioning the patient every 2 hours helps reduce the risk for pressure ulcers. Warm blankets and intravenous fluids are provided to a patient with changes in thermoregulation. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 1265

29. The patient's medical history shows that the patient scheduled for surgery has obstructive sleep apnea (OSA). Which complications might the patient experience during and after surgery? Select all that apply. a. Hypoxia b. Hypothermia c. Hypoglycemia d. Decreased cardiac output

Rationale Obstructive sleep apnea (OSA) is a disorder of sleep and wakefulness resulting from the obstruction of the upper airway during sleep. OSA results in hypoxia, which makes it difficult for the heart to pump effectively, thereby decreasing the cardiac output during and after surgery and causing an increase in sympathetic output, which causes a significant increase in blood pressure. Hypothermia is common in infants and older adults during surgery, but OSA does not cause it. The body responds to surgery as a form of trauma, which can result in hyperglyce

13. The patient's medical history shows that the patient scheduled for surgery has obstructive sleep apnea (OSA). Which complications might the patient experience during and after surgery? Select all that apply. a. Hypoxia b. Hypothermia c. Hypoglycemia d. Decreased cardiac output e. Increased blood pressure

Rationale Obstructive sleep apnea (OSA) is a disorder of sleep and wakefulness resulting from the obstruction of the upper airway during sleep. OSA results in hypoxia, which makes it difficult for the heart to pump effectively, thereby decreasing the cardiac output during and after surgery and causing an increase in sympathetic output, which causes a significant increase in blood pressure. Hypothermia is common in infants and older adults during surgery, but OSA does not cause it. The body responds to surgery as a form of trauma, which can result in hyperglycemia, but OSA does not play a part in that. p. 1265

21. The nurse is reviewing the medical records of four patients preoperatively. Which patient will the nurse carefully observe for a drop in oxygen saturation during surgery?

Rationale Opioids increase the risk of airway obstruction in patients who have obstructive sleep apnea, so Patient A is at a higher risk for a drop in oxygen saturation during surgery. General anesthetic agents depress cardiac function, not respiratory function, so Patient B is not as prone to a drop in oxygen saturation. Patient C, who has heart failure, should regularly maintain a beta-blocker medication regimen to prevent cardiac collapse during surgery, but oxygen saturation is less of a concern. Nonsteroidal antiinflammatory drugs may increase the risk for abnormal bleeding in Patient D, but not for decreased oxygen saturation. p. 1268

15. A patient who is latex sensitive is scheduled for a cholecystectomy. What special precautions are required for the patient? Select all that apply. a. Use stopcocks to inject the medications. b. Draw the medications from well-closed vials. c. Remove all latex products from the operating room. d. Use a nonlatex breathing circuit with a plastic mask and bag. e. Schedule the surgery as the last case of the day.

Rationale Special care should be taken for a patient who has a latex sensitivity. Using stopcocks to inject drugs rather than latex ports reduces the chances of a latex allergy reaction. Removing all latex products from the operating room helps to prevent severe reactions in the patient. Using a nonlatex breathing circuit with a plastic mask and bag helps to prevent latex reactions. All of the contents must be latex free. Medication should not be drawn from well-closed vials because they increase the chances of latex allergic reactions. Medications should be drawn directly from opened vials. Scheduling the surgery as the first case of the day in the operating room ensures that any latex dust has been removed from the room overnight by ventilation. p. 1283

23. The nurse is reviewing the laboratory reports of a patient who is scheduled for surgery and suspects that the patient has an increased risk of bleeding. Which laboratory finding supports the nurse's conclusion? a. Prothrombin time (PT), 11 seconds b. Platelet count, 100,000 cells/mm 3 c. International normalized ratio (INR), 0.86 d. Activated partial thromboplastin time (aPTT), 35 seconds

Rationale The normal platelet count is 150,000 - 400,000 cells/mm3. However, the patient has a platelet count of 100,000 cells/mm 3, indicating an increased risk of hemorrhage. The normal prothrombin time is 11 to 12.5 seconds. Therefore, the patient's PT is in the normal range. The normal international normalized ratio (INR) is 0.86 to 1.27. Therefore, the patient's INR is normal. The normal activated partial thromboplastin time is 30 to 40 seconds. The patient has a partial thromboplastin time of 35 seconds, which is normal. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly to see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 1274

5. The nurse is reviewing the laboratory reports of a patient who is scheduled for surgery and suspects that the patient has an increased risk of bleeding. Which laboratory finding supports the nurse's conclusion? a. Prothrombin time (PT), 11 seconds b. Platelet count, 100,000 cells/mm 3 c. International normalized ratio (INR), 0.86 d. Activated partial thromboplastin time (aPTT), 35 seconds

Rationale The normal platelet count is 150,000 - 400,000 cells/mm3. However, the patient has a platelet count of 100,000 cells/mm 3, indicating an increased risk of hemorrhage. The normal prothrombin time is 11 to 12.5 seconds. Therefore, the patient's PT is in the normal range. The normal international normalized ratio (INR) is 0.86 to 1.27. Therefore, the patient's INR is normal. The normal activated partial thromboplastin time is 30 to 40 seconds. The patient has a partial thromboplastin time of 35 seconds, which is normal. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly to see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 1274

7. The nurse is providing preoperative teaching to a patient who will have abdominal surgery the following day. Which patient statement indicates the need for further teaching? a. "I should avoid defecating before the surgery." b. "I should avoid solid food 8 hours before the surgery." c. "I should avoid liquids 2 hours before the surgery." d. "I may use mouthwash before the surgery."

Rationale The patient is scheduled for an abdominal surgery and should have an empty bowel. Therefore, the patient should defecate completely before the surgery. The patient is undergoing abdominal surgery, so the patient should have an empty stomach to reduce nausea. Therefore, the patient should avoid solid food 8 hours before the surgery and liquids 2 hours before the surgery. Patients may have a dry mouth while they are on NPO status prior to the surgery. Therefore, the patient can use mouthwash to rinse the mouth and then spit it out. p. 1279

10, A patient is scheduled for surgery. The patient is being prepared to receive medication. Which actions should the nurse perform before starting any treatment? Select all that apply. a. Ask about the patient's family medical history. b. Check consent forms for accuracy. c. Measure vital signs. d. Ask the patient to do coughing exercises. e. Ask the patient to use the bathroom.

Rationale The patient must sign a consent form before receiving any medications. Surgery cannot be legally or ethically performed until a patient understands the need for a procedure, the steps involved, risks, expected results, and alternative treatments. The nurse should check the consent form before the patient goes to the operating room (OR). Vital signs should be measured to evaluate the patient's stability. All nursing care measures such as assisting the patient to the bathroom should be completed before the patient receives any premedication. Asking for a family history is irrelevant before starting premedication. Coughing exercises should be taught in the preoperative period. It is not an action to be done before starting premedication. p. 1283

27. A patient is scheduled for surgery. The patient is being prepared to receive medication. Which actions should the nurse perform before starting any treatment? Select all that apply. a. Ask about the patient's family medical history. b. Check consent forms for accuracy. c. Measure vital signs. d. Ask the patient to do coughing exercises. e. Ask the patient to use the bathroom.

Rationale The patient must sign a consent form before receiving any medications. Surgery cannot be legally or ethically performed until a patient understands the need for a procedure, the steps involved, risks, expected results, and alternative treatments. The nurse should check the consent form before the patient goes to the operating room (OR). Vital signs should be measured to evaluate the patient's stability. All nursing care measures such as assisting the patient to the bathroom should be completed before the patient receives any premedication. Asking for a family history is irrelevant before starting premedication. Coughing exercises should be taught in the preoperative period. It is not an action to be done before starting premedication. p. 1283

24. The nurse is performing preoperative assessment of patients who are scheduled for surgery the next day. Which patients are most at risk for a latex allergy? Select all that apply. a. The patient with a history of spina bifida b. The patient who has diabetes mellitus c. The patient who has an allergy to apples d. The patient who has a spinal cord injury e. The patient who has a urogenital abnormality

Rationale The patient with spina bifida, the patient who has a spinal cord injury, and the patient with a urogenital abnormality should be assessed for latex allergy. Patients with spina bifida, spinal cord injuries, and urogenital abnormalities have had repeated exposure to latex products throughout their lives. These patients have been exposed to latex urinary catheters and examination gloves. This repeated exposure may lead to the development of a latex allergy. Patients who have diabetes mellitus do not use latex products for managing their disease, so they do not have an increased risk. Patients who have allergies to bananas, chestnuts, kiwi fruit, avocados, and tomatoes may have a cross-sensitivity to latex. Study Tip: A mnemonic for the allergies that show cross-sensitivity to latex is TBACK:Tomatoes, Bananas, Avocados, Chestnuts, and Kiwi. Think of a silly visual to accompany the mnemonic, such as a latex bandage on the BACK of a T-shirt. p. 1269

3. The nurse is performing preoperative assessment of patients who are scheduled for surgery the next day. Which patients are most at risk for a latex allergy? Select all that apply. a. The patient with a history of spina bifida b. The patient who has diabetes mellitus c. The patient who has an allergy to apples d. The patient who has a spinal cord injury e. The patient who has a urogenital abnormality

Rationale The patient with spina bifida, the patient who has a spinal cord injury, and the patient with a urogenital abnormality should be assessed for latex allergy. Patients with spina bifida, spinal cord injuries, and urogenital abnormalities have had repeated exposure to latex products throughout their lives. These patients have been exposed to latex urinary catheters and examination gloves. This repeated exposure may lead to the development of a latex allergy. Patients who have diabetes mellitus do not use latex products for managing their disease, so they do not have an increased risk. Patients who have allergies to bananas, chestnuts, kiwi fruit, avocados, and tomatoes may have a cross-sensitivity to latex. Study Tip: A mnemonic for the allergies that show cross-sensitivity to latex is TBACK:Tomatoes, Bananas, Avocados, Chestnuts, and Kiwi. Think of a silly visual to accompany the mnemonic, such as a latex bandage on the BACK of a T-shirt. p. 1269

2. A 40-year-old patient needs surgical removal of an inflamed gall bladder. What screening tests should the nurse anticipate the surgeon to prescribe? Select all that apply. a. Electrocardiogram b. Electroencephalogram c. Chest x-ray d. Blood sugar levels e. Bone density scan

Rationale The screening tests focus on the body systems that are likely to be affected by the surgery. The electrocardiogram (ECG) and chest x-ray help to determine the heart and lung function. Blood sugar levels help to determine postoperative wound healing and chances of infection. The electroencephalogram (EEG) is required in patients suffering from epilepsy and other brain-related disorders. A bone density scan is performed in females after menopause and is not required for this type of procedure. p. 1273

25. A 40-year-old patient needs surgical removal of an inflamed gall bladder. What screening tests should the nurse anticipate the surgeon to prescribe? Select all that apply. a. Electrocardiogram b. Electroencephalogram c. Chest x-ray d. Blood sugar levels e. Bone density scan

Rationale The screening tests focus on the body systems that are likely to be affected by the surgery. The electrocardiogram (ECG) and chest x-ray help to determine the heart and lung function. Blood sugar levels help to determine postoperative wound healing and chances of infection. The electroencephalogram (EEG) is required in patients suffering from epilepsy and other brain-related disorders. A bone density scan is performed in females after menopause and is not required for this type of procedure. p. 1273

26. A patient is scheduled for a laparoscopic cholecystectomy. Of what benefits of the ambulatory surgery should the nurse inform the patient? Select all that apply. a. The shorter operative time b. The cost savings c. Increased recovery time d. Less risk of health care-associated infections e. Increased hospital stay

Rationale There are benefits for the patient who has ambulatory surgery. Anesthetic drugs that metabolize rapidly with few aftereffects allow shorter operative times and faster recovery times. Ambulatory surgery is also cost effective, because it allows for a shorter hospital stay, and thus reduces the possibility of acquiring nosocomial infections. Major surgeries involving a longer stay in the hospital require a longer recovery time. Test-Taking Tip: If different choices oppose each other, they are not likely to both be correct. For instance, in this question, two of the choices are "cost savings" and "increased hospital stay." An increased hospital stay would add costs and would not be cost effective. Thus two of these choices are in conflict with each other, so only one of those two is likely to be correct. Because saving money is a benefit and the question asks for benefits, it is the correct choice. pp. 1270-1271

6. A patient is scheduled for a laparoscopic cholecystectomy. Of what benefits of the ambulatory surgery should the nurse inform the patient? Select all that apply. a. The shorter operative time b. The cost savings c. Increased recovery time d. Less risk of health care-associated infections e. Increased hospital stay

Rationale There are benefits for the patient who has ambulatory surgery. Anesthetic drugs that metabolize rapidly with few aftereffects allow shorter operative times and faster recovery times. Ambulatory surgery is also cost effective, because it allows for a shorter hospital stay, and thus reduces the possibility of acquiring nosocomial infections. Major surgeries involving a longer stay in the hospital require a longer recovery time. Test-Taking Tip: If different choices oppose each other, they are not likely to both be correct. For instance, in this question, two of the choices are "cost savings" and "increased hospital stay." An increased hospital stay would add costs and would not be cost effective. Thus two of these choices are in conflict with each other, so only one of those two is likely to be correct. Because saving money is a benefit and the question asks for benefits, it is the correct choice. pp. 1270-1271