Lewis ch 17, preoperative care

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1. A patient scheduled for an elective hysterectomy tells the nurse, I am afraid that I will die in surgery like my
mother did! Which response by the nurse is
most appropriate?

a. Tell me more about what happened to your mother.
b. You will receive medications to reduce your anxiety.
c. You should talk to the doctor again about the surgery.
d. Surgical techniques have improved a lot in recent year

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ANS: A

The patients statement may indicate an unusually high anxiety level or a family history of problems such as
malignant hyperthermia, which will require precautions during surgery. The other statements may also address
the patients concerns, but further assessment is needed first

2. A patient arrives at the ambulatory surgery center for a scheduled laparoscopy procedure in outpatient surgery. Which information is of most concern to the nurse?

a. The patient is planning to drive home after surgery.
b. The patient had a sip of water 4 hours before arriving.
c. The patients insurance does not cover outpatient surgery.
d. The patient has not had surgery using general anesthesia before

ANS: A

After outpatient surgery, the patient should not drive home and will need assistance with transportation and
home care. The patients experience with surgery is assessed, but it does not have as much application to the
patients physiologic safety. The patients insurance coverage is important to establish, but this is not usually the
nurses role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually
increase risk for aspiration

3. A 38-year-old female is admitted for an elective surgical procedure. Which information obtained by the
nurse during the preoperative assessment is
most important to report to the anesthesiologist before surgery?

a. The patients lack of knowledge about postoperative pain control measures
b. The patients statement that her last menstrual period was 8 weeks previously
c. The patients history of a postoperative infection following a prior cholecystectomy
d. The patients concern that she will be unable to care for her children postoperative

ANS: B

This statement suggests that the patient may be pregnant, and pregnancy testing is needed before
administration of anesthetic agents. Although the other data may also be communicated with the surgeon and
anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before
surgery

4. A patient who has never had any prior surgeries tells the nurse doing the preoperative assessment about an
allergy to bananas and avocados. Which action is most important for the nurse to take?

a. Notify the dietitian about the food allergies.
b. Alert the surgery center about a possible latex allergy.
c. Reassure the patient that all allergies are noted on the medical record.
d. Ask whether the patient uses antihistamines to reduce allergic reaction

ANS: B

Certain food allergies (e.g., eggs, avocados, bananas, chestnuts, potatoes, peaches) are related to latex allergies.
When a patient is allergic to latex, special nonlatex materials are used during surgical procedures, and the staff
will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them
available during surgery. The other actions also may be appropriate, but prevention of allergic reaction during
surgery is the most important action

5. A patient who is scheduled for a therapeutic abortion tells the nurse, Having an abortion is not right. Which functional health pattern should the nurse further assess?

a.
Value-belief
b. Cognitive-perceptual
c. Sexuality-reproductive
d. Coping-stress tolerance

ANS: A

The value-belief pattern includes information about conflicts between a patients values and proposed medical
care. In the cognitive-perceptual pattern, the nurse will ask questions about pain and sensory intactness. The
sexuality-reproductive pattern includes data about the impact of the surgery on the patients sexuality. The
coping-stress tolerance pattern assessment will elicit information about how the patient feels about the surge

6. A patient undergoing an emergency appendectomy has been using St. Johns wort to prevent depression.
Which complication would the nurse expect in the post anesthesia care unit?

a. Increased pain
b. Hypertensive episodes
c. Longer time to recover from anesthesia
d. Increased risk for postoperative bleedin

ANS: C

St. Johns wort may prolong the effects of anesthetic agents and increase the time to waken completely after
surgery. It is not associated with increased bleeding risk, hypertension, or increased pain

7. The surgical unit nurse has just received a patient with a history of smoking from the post-anesthesia care unit. Which action is
most important at this time?

a. Auscultate for adventitious breath sounds.
b. Obtain the patients blood pressure and temperature.
c. Remind the patient about harmful effects of smoking.
d. Ask the health care provider about prescribing a nicotine patch

ANS: A

The nurse should first ensure a patent airway and check for breathing and circulation (airway, breathing, and
circulation [ABCs]). Circulation and temperature can be assessed after a patent airway and breathing have been
established. The immediate postoperative period is not the optimal time for patient teaching about the harmful
effects of surgery. Requesting a nicotine patch may be appropriate, but is not a priority at this time

8. The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. The patient reports use of garlic and ginkgo biloba. Which action by the nurse is
most appropriate?

a. Ascertain that there will be no interactions with anesthetic agents.
b. Teach the patient that these products may be continued preoperatively.
c. Advise the patient to stop the use of all herbs and supplements at this time.
d. Discuss the herb and supplement use with the patients health care provid

ANS: D

Both garlic and ginkgo biloba increase a patients risk for bleeding. The nurse should discuss the herb and
supplement use with the patients health care provider. The nurse should not advise the patient to stop the
supplements or to continue them without consulting with the health care provider. Determining the interactions
between the supplements and anesthetics is not within the nurses scope of practic

9. The nurse is preparing to witness the patient signing the operative consent form when the patient says, I do not really understand what the doctor said. Which action is best for the nurse to take?

a. Provide an explanation of the planned surgical procedure.
b. Notify the surgeon that the informed consent process is not complete.
c. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications.
d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the
procedure

ANS: B

The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon
has clarified the surgery before having the patient sign the consent form. The nurse should communicate
directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not
within the nurses legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient understands the surgical procedure and signs the consent for

10. Which topic is
most important for the nurse to discuss preoperatively with a patient who is scheduled for abdominal surgery for an open cholecystectomy?

a. Care for the surgical incision
b. Medications used during surgery
c. Deep breathing and coughing techniques
d. Oral antibiotic therapy after discharge home

ANS: C

Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on
patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of
completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this
information. The patient does not usually need information about medications that are used intraoperative

11. Five minutes after receiving the ordered preoperative midazolam (Versed) by IV injection, the patient asks to get up to go to the bathroom to urinate. Which action by the nurse is most appropriate? a. Assist the patient to the bathroom and stay with the patient to prevent falls. b. Offer a urinal or bedpan and position the patient in bed to promote voiding. c. Allow the patient up to the bathroom because medication onset is 10 minutes. d. Ask the patient to wait because catheterization is performed just before the surgeANS: B The patient will be at risk for a fall after receiving the sedative, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room12. The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife usually answers most questions that are directed to the patient. Which action should the nurse take when doing the teaching? a. Use printed materials for instruction so that the patient will have more time to review the material. b. Direct the teaching toward the wife because she is the obvious support and caregiver for the patient. c. Provide additional time for the patient to understand preoperative instructions and carry out procedures. d. Ask the patients wife to wait in the hall in order to focus preoperative teaching with the patient himselfANS: C The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching13. A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take? a. Withhold the usual scheduled insulin dose because the patient is NPO. b. Obtain a blood glucose measurement before any insulin administration. c. Give the patient the usual insulin dose because stress will increase the blood glucose. d. Administer a lower dose of insulin because there will be no oral intake before surgeryANS: B Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring14. The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery in a few days. The results are white blood cell (WBC) count 10.2 10/L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 10 3/L. Which action should the nurse take? a. Call the surgeon and anesthesiologist immediately. b. Ask the patient about any symptoms of a recent infection. c. Discuss the possibility of blood transfusion with the patient. d. Send the patient to the holding area when the operating room callsANS: D The CBC count results are normal. With normal results, the patient can go to the holding area when the operating room is ready for the patient. There is no need to notify the surgeon or anesthesiologist, discuss blood transfusion, or ask about recent infectio15. As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, I have never taken it off since the day I was married. Which response by the nurse is best ? a. Have the patient sign a release and leave the ring on. b. Tape the wedding ring securely to the patients finger. c. Tell the patient that the hospital is not liable for loss of the ring. d. Suggest that the patient give the ring to a family member to keepANS: D Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used. There is no need for a release form or to discuss liability with the patient.16. A patient has received atropine before surgery and complains of dry mouth. Which action by the nurse is best ? a. Check for skin tenting. b. Notify the health care provider. c. Ask the patient about any dizziness. d. Tell the patient dry mouth is an expected side effectANS: D Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect. The dry mouth is not a symptom of dehydration in this case. Therefore there is no immediate need to check for skin tenting. The health care provider does not need to be notified about an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines.17. Which statement by a patient scheduled for surgery is most important to report to the health care provider? a. I had a heart valve replacement last year. b. I had bacterial pneumonia 3 months ago. c. I have knee pain whenever I walk or jog. d. I have a strong family history of breast cancer.ANS: A A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patients knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surge18. The nurse interviews a patient scheduled to undergo general anesthesia for a hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 or 4 cups of coffee every morning before going to work. b. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. c. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. d. The patients father died after receiving general anesthesia for abdominal surgeANS: D The information about the patients father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications19. Which information in the preoperative patients medication history is most important to communicate to the health care provider? a. The patient uses acetaminophen (Tylenol) occasionally for aches and pains. b. The patient takes garlic capsules daily but did not take any on the surgical day. c. The patient has a history of cocaine use but quit using the drug over 10 years ago. d. The patient took a sedative medication the previous night to assist in falling asleepANS: B Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome20. A patient who takes a diuretic and a b -blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery? a. Hematocrit 36% b. Blood pressure 144/82 c. Pulse rate 58 beats/minute d. Serum potassium 3.2 mEq/ANS: D The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety. The lower heart rate would be expected in a patient taking a b-blocker. The hematocrit is in the low normal range but does not require any intervention before surgery1. When caring for a preoperative patient on the day of surgery, which actions included in the plan of care can the nurse delegate to unlicensed assistive personnel a. Teach incentive b. Explain preoperative routine care. c. Obtain and document baseline vital signs d. Remove nail spirometer use. polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room.ANS: C, D, E Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the patient are routine skills that are appropriate to delegate. Teaching patients about the preoperative routine and incentive spirometer use require critical thinking and should be done by the registered nurse