Exam # 1 Pre-Operative Phase

Question 0

What are the 6 reasons surgeries are performed?

Answer 0

1) Diagnosis - i.e., lymph node biopsy
2) Curative - i.e., excision of a tumor or inflamed appendix
3) Palliative - i.e., cutting nerve root to relieve pain, colostomy to bypass obstruction.
4) Cosmetic - i.e., scar revision
5) Prevention - i.e., removal of pre malignant mole, mastectomy if strong family Hx of breast cancer exists.
6) Exploratory - i.e., exploratory laparotomy (ostomies & otomies)

Question 1

Define Ambulatory Surgery Centers (ASC)

Answer 1

Includes centers that provide outpatient surgical services not requiring an overnight stay, independent diagnostic and testing facilities, and health provider’s offices.

Question 2

What are the 5 classifications of surgery?

Answer 2

1) Emergent - PT requires immediate attention without delay.
2) Urgent - PT requires prompt attention within 24-48 hours.
3) Planned/Required -PT needs to have surgery within a few weeks or months.
4) Elective - PT should have surgery but failure to have surgery will not be catastrophic.
5) Optional - PT decides wether or not to have the surgery base on personal preference.

Question 3

Give 6 examples of circumstances that require Emergency Surgeries?

Answer 3

1) Severe bleeding
2) Bladder or intestinal obstruction
3) Fractured skull
4) Extensive burns
5) Gunshot or stab wounds
6) Abdominal Aortic Aneurism

Question 4

Give 2 examples of circumstances that require Urgent Surgery?

Answer 4

1) Acute gallbladder infection

2) Kidney or ureteral stones

Question 5

Give 4 examples of circumstances that necessitates Planned/Required Surgeries?

Answer 5

1) Prostatic hyperplasia without bladder obstruction
2) Thyroid disorders
3) Cataracts
4) Tumor removal

Question 6

Give 4 examples of circumstances that require Elective Surgery?

Answer 6

1) Repair of scars
2) Simple hernia
3) Vaginal repair
4) Hysterectomy

Question 7

Give an example of an optional surgery?

Answer 7

Cosmetic surgery

Question 8

When does the Preoperative Phase begin and end?

Answer 8

The Preoperative Phase begins when the decision to proceed with the surgical intervention is made, and ends with the transfer of the patient onto the OR table.

Question 9

In which 4 circumstances are informed consent necessary?

Answer 9

1) Invasive Procedures - Such as surgical incisions, biopsies, cystoscopy, or paracentesis.
2) Procedures requiring sedation/anesthesia.
3) Non surgical procedures such as arteriography that carries more than slight risk to the patient.
4) Procedures involving radiation.

Question 10

What are the 4 BMI categories?

Answer 10

1) Underweight - < 18.5
2) Normal - 18.5 - 24.9
3) Overweight - 25 - 30
4) Obese - > 30

Question 11

When does the Intraoperative Phase of surgery begin and end?

Answer 11

The Intraoperative begins when the patient is transferred into the OR table and ends with admission to the PACU

Question 12

What are the 3 areas of the surgical area?

Answer 12

1) Unrestricted Zone - Where street clothes can be worn.
2) Semi-restricted Zone - Scrub clothes and caps.
3) Restricted Zone - Scrub clothes, shoe covers, caps and masks.

Question 13

Define the following:

1) Ectomy
2) Lysis
3) Orrhaphy
4) Scopy
5) Ostomy
6) Otomy
7) Plasty

Answer 13

1) Ectomy - To take out
2) Lysis - To breakdown
3) Orrhaphy - To to repair or suture
4) Scopy - To look/view
5) Ostomy - To make an opening
6) Otomy - To cut into or make an incision
7) Plasty - To repair or rebuild

Question 14

What can cause an Abdominal Aortic Aneurism

Answer 14

Can be caused by old age or trauma

Question 15

What is the difference between the 2 following surgical settings:

1) Inpatient
2) Ambulatory Care (Outpatient)

Answer 15

1) Inpatient - Includes same day admission and patients are admitted (meaning they stay for an extended time).
2) Ambulatory Care (Outpatient) - Cheaper, typically uses regional anesthesia, and only does minor surgery.

Question 16

What are the 9 things that should be included in a complete preoperative nursing assessment ?

Answer 16

1) Psychological Status - Fear, anxiety, etc.
2) Physiological Factors - Individual risk factors
3) Baseline Data - Used for comparison
4) Documentation - Surgical site and side
5) Medication - Includes OTC meds, herbs, alcohol, tobacco and recreational drugs.
6) Lab and Diagnostic Tests
7) Cultural/Ethnic Factors - JWs and Muslims
8) Consent Signed
9) Allergies

Question 17

Which electrolyte is the most important to monitor perioperatively and why?

Answer 17

Potassium, because it can cause arrhythmias

Question 18

Who’s responsible for explaining the procedure to the patient Nd who signs the informed consent?

Answer 18

The Surgeon is responsible for explaining the procedure and the nurse is responsible for making sure the patient understands the procedure.
Informed Consent is signed by both the Surgeon and the patient.

Question 19

How can you assess for latex allergy in a patient?

Answer 19

Ask the patient if they Re allergic to stone fruits, i.e., Kiwi, bananas etc.

Question 20

What is the effect of recreational drug when the patient is in the hospital setting?

Answer 20

Medication administration (i.e., opioids) may not be as effective because the have built up a tolerance.

Question 21

What are the 8 common fears patients generally have of surgery?

Answer 21

1) Fear of the unknown
2) Loss of control
3) Pain
4) Death
5) Disfigurment
6) Anesthesia
7) Financial ramifications
8) Irrational fears

Question 22

What are two ways to promote psychological readiness before surgery?

Answer 22

1) Active Listening - Ask open ended questions

2) PreOp Teaching - May include I/S, C&DB, early ambulation, and pain control after surgery.

Question 23

Give 4 examples of teaching that can be done preoperatively?

Answer 23

1) Post-op equipment and dressings (i.e., tubes, sore throat from ET).
2) Elastic Compression Stockings
3) Intermittent Compression Devices
4) Family Teaching (i.e., visiting, OR communication, PACU)

Question 24

Name 3 postop exercises a patient can be taught to do in bed that will help return blood to the heart.

Answer 24

1) Isometric quads 2) Gluteal squeeze 3) Ankle pumps

Question 25

What are the 5 components of the nursing assessment for the cardiovascular system?

Answer 25

1) Baseline vitals should be recorded 2) Bleeding and clotting times 3) Lab reports 4) Prophylactic antibiotics 5) EKG

Question 26

Your patient has a productive cough with green sputum. Who should you report this to and what might he or she order?

Answer 26

Report it to the surgeon who may order a culture and sensitivity

Question 27

What should be involved in a preoperative nursing assessment of the respiratory system?

Answer 27

1) Inquire about recent airway infections - procedure may be cancelled because of increased risk of Laryngotracheobronchitis/bronchospasm or ⬇ SaO2 2) Inquire if patient smokes

Question 28

Who can sign the consent form on behalf of the patient?

Answer 28

Anyone noted on the power of attorney

Question 29

Renal dysfunction contributes to what 4 complications which are contraindicated for surgery?

Answer 29

1) F&E imbalances 2) ⬆ risk of infection 3) Impaired wound healing 4) Altered response to drugs and their elimination

Question 30

Who should you report problems affecting neck or lumbar spine to?

Answer 30

The Anethesiologist

Question 31

(T/F) The patient can still have hyperglycemia even when he or she is NPO because they might be under stress

Answer 31

True

Question 32

Patients should be asked preoperatively about diabetes and insulin use. What 5 conditions are diabetic patients at risk for?

Answer 32

1) Hypo/hyperglycemia 2) Ketosis 3) Cardiovascular alterations 4) Delayed wound healing 5) Infection

Question 33

(T/F) Serum glucose test must be done the morning of surgery in order to establish a baseline.

Answer 33

True

Question 34

What things can affect F&E status?

Answer 34

1) Vomiting, diarrhea, or difficulty swallowing 2) Certain drugs like diuretics 3) Bowel preps 4) NPO status (may lead to dehydration)

Question 35

(T/F) Poor nutrition and dehydration affects wound healing, which is why surgeons sometimes hold off surgeries of older people until they are properly nourished and hydrated.

Answer 35

True

Question 36

How do you calculate Cardiac Output

Answer 36

CO = SV x HR

Question 37

What are the preoperative gerontological concerns for the following systems: 1) Cardiovascular 2) Respiratory 3) Renal 4) Musculoskeletal

Answer 37

1) Cardiovascular - ⬇ CO, ⬆ BP, ⬇ peripheral circulation, arrhythmias. 2) Respiratory - ⬇ vital capacity, ⬇ O2 sat 3) Renal - ⬇ GFR, ⬇ renal blood flow 4) Musculoskeletal - ⬇ lean body mass, osteoperosis, osteoarthritis

Question 38

Why might a bolus of corticosteroids be given IV immediately before and after surgery?

Answer 38

Because cardiovascular collapse can occur if discontinued suddenly.

Question 39

What is the effect of the interaction of Anesthetics with the following drugs: 1) Corticosteroids 2) Diuretics 3) Phenothiazines (Thorazine) 4) Tranquilizers (Diazepam) 5) Antibiotics 6) Anticoagulants 7) MAO Inhibitors

Answer 39

1) Corticosteroids - CV collapse can occur if discontinued suddenly, so a bolus is given immediately before and after surgery 2) Diuretics - ⬆ respiratory depression from electrolyte imbalance 3) Phenothiazines (Thorazine) - ⬆ hypotension 4) Tranquilizers (Diazepam) - ⬆ anxiety, tension and seizures 5) Antibiotics - Apnea and respiratory paralysis 6) Anticoagulants - ⬆ bleeding 7) MAO Inhibitors - ⬆ hypotension

Question 40

Name 12 herbs that potentiate the effects of or increase bleeding when taken with NSAIDs.

Answer 40

1) Bilberry fruit 2) Chondroitin 3) German or Hungarian chamomile 4) Dong quai 5) Fenugreek 6) Garlic 7) Ginger 8) Melatonin 9) Pau D'arco 10) Red clover 11) Tumeric 12) Willow

Question 41

What is the effect of taking St. John's Worth with Ibuprofen?

Answer 41

Mean residence time of ibuprofen may be ⬇

Question 42

What is the effect of taking Acetaminophen with Watercress?

Answer 42

Watercress inhibits the oxidative pathway of acetaminophen metabolism

Question 43

What is the effect of taking Gingko with Aspirin

Answer 43

Increases bleeding tendencies

Question 44

Which 4 herbs are contraindicated when taking Opioids?

Answer 44

1) Dan Shen 2) Kava Kava 3) Sarsaparilla - ⬆ elimination of sedatives 4) Valerian - ⬆ effects of sedatives

Question 45

What is the effect of taking taking Fentanyl with the following herbs: 1) Grapefruit 2) St. John's Wort

Answer 45

1) Grapefruit - ⬆ concentration of fentanyl leading to adverse effects 2) St John's Wort - Affects metabolism of fentanyl

Question 46

List the 4 integral parts of a Legal Consent?

Answer 46

1) Adequate disclosure 2) Sufficient comprehension 3) Voluntary consent 4) Signature - by MD, the patient and sometimes the RN will sign verifying that it was the patient who signed the form.

Question 47

What are the 6 key components of the "Adequate Disclosure" portion of an informed consent?

Answer 47

1) Diagnosis 2) Nature and purpose of Tx 3) Risks and consequences of Tx 4) Benefits/Probability of success 5) Alternative Tx 6) Prognosis without Tx

Question 48

Legal preparation for surgery requires that all forms are signed and in the patient's chart. Name 4 such forms.

Answer 48

1) Informed consent 2) Blood transfusions 3) Advance directive - Ask upon admission 4) Power of attorney

Question 49

(T/F) Permission for an informed consent may be withdrawn at any time.

Answer 49

True

Question 50

(T/F) It is the mechanical motion of hand washing, not the chemical makeup of the soap, that effectively eliminates microbes.

Answer 50

True

Question 51

Why is it important to make sure that chlorohexadine is dry before beginning a procedure that involves cauterizing?

Answer 51

Because chlorohexadine is alcohol based and is therefore flammable and a fire hazard.

Question 52

What is the difference between pharmacodynamics and pharmacokinetics?

Answer 52

1) Pharmacodynamics - What a drug does to the body | 2) Pharmacokinetics - What the body does to the drug

Question 53

What are the 3 things possibly involved in bowel prep for surgery?

Answer 53

1) NPO status 2) Enema 3) Cathartics (i.e., GoLytely) - Do not give over ice

Question 54

What are the 4 adjuncts to general anesthesia discussed in class and which one produces amnesia?

Answer 54

1) Benzodiazapines 2) Versed (produces amnesia) 3) Valium 4) Ativan

Question 55

What are the 6 properties of the following Anesthetic Adjuncts discussed in class: Benzodiazapines, versed, valium and ativan?

Answer 55

1) Relieve anxiety 2) Induce sleep 3) Produces amnesia 4) Metabolized by the liver 5) Rapidly absorbed 6) Increases respiratory depression * Remember that adjuncts do not have analgesic properties!!!

Question 56

What are the 7 side effects of the following Anesthetic Adjuncts discussed in class: Benzodiazapines, versed, valium and ativan?

Answer 56

1) CNS depression 2) Respiratory depression 3) Hypotension 4) Bradycardia 5) Drowsiness and ataxia (loss of coordination) 6) Fatigues and confusion 7) Weakness and dizziness

Question 57

What is the reversal agent (antidote) of the following Anesthetic Adjuncts discussed in class: Benzodiazapines, versed, valium and ativan?

Answer 57

Flumazenil (Romazicon)

Question 58

What are the 2 properties of the following opioids discussed in class: Morphine, Demerol, and fentanyl?

Answer 58

1) Analgesia | 2) Sedation

Question 59

What are the 5 side effects of the following opioids discussed in class: Morphine, Demerol, and fentanyl?

Answer 59

1) Respiratory depression 2) Nausea and Vomitting 3) Drowsiness 4) Hypotension and orthostatic hypotension 5) Bronchospasm in asthmatics

Question 60

What is the reversal agent (antidote) of the following opioids discussed in class: Morphine, Demerol, and fentanyl?

Answer 60

Naloxone (narcan)

Question 61

How long should you wait between the 3 BP measurements taken during an orthostatic BP hypotension measurement?

Answer 61

2-3 minutes

Question 62

Why should you be ready to restrain a patient to whom you have just administered Narcan?

Answer 62

Because the sudden return of the sensation to the pain receptors cause them to flail about.

Question 63

(T/F) The stomach makes more acid during the PeriOp process because of stress and therefore acid reducing meds are prescribed prophylactically to prevent stress ulcers.

Answer 63

True

Question 64

What are the 5 types H2 Receptor Antagonists discussed in class, how do they work and what forms are they available in?

Answer 64

1) Tagamet, pepcid, zantac, prilosec, and prevacid 2) They inhibit gastric secretion 3) They are available PO, IV and IM

Question 65

What are the 2 side effects of the H2 Receptor Antagonists discussed in class?

Answer 65

1) Skin rash (hypersensitivity) | 2) ⬇ RBCS, WBCs, and platelet synthesis

Question 66

What are the 4 types Antiemtics discussed in class, how do they work and what forms are they available in?

Answer 66

1) Reglan, droperidol, zofran, and phenegran 2) Indicated for N & V 3) Available PO, IM, IV, rectal, and transdermal

Question 67

What are the 5 side effects of the Antiemtics discussed in class?

Answer 67

1) Drowsiness from the CNS depression 2) Hypotension 3) Dry mouth from the anticholinergic effect 4) Blurred vision caused by anticholinergic dilation 5) ⬇ Coordination

Question 68

What are the 3 types of Anticholinergics discussed in class, how do they work and what forms are they available in?

Answer 68

1) Atropine, glycopyrolate, and scopolamine 2) They are used to ⬇ salivation, which prevents aspiration, prevent bradycardia, and inhibit smooth muscle contraction in the GI tract. 3) Available PO, IM, IV

Question 69

What are the 5 side effects of the Anticholinergics discussed in class?

Answer 69

1) ⬇ Parasympathetic stimulation 2) ⬇ Peristalsis 3) ⬇ Salivation 4) Urinary retention 5) CNS disturbances

Question 70

Why is it important to remove all jewelry before surgery?

Answer 70

Because the electric cauterizing used during surgery can conduct electricity through the body which can exit through jewelry anywhere on the body. If patient refuses to remove jewelry, then tape it to their body.

Question 71

Wy is it important the patient not wear any cosmetics for the surgery?

Answer 71

It is important to be able to observe the skin color. Also nail polish must be removed to for the pulse oximeter to work.

Question 72

(T/F) DNRs are suspended in the OR room.

Answer 72

True - MDs will resuscitate if the patient is dying in the OR.

Question 73

What are the 5 rights of delegation?

Answer 73

1) Right task 2) Right person 3) Right communication - Clearly state objectives & expectations 4) Right feedback - Evaluation during/after task completed 5) Right time

Question 74

(T/F) Before delegating nursing tasks to CNAs, a nurse must check for other available nurses to delegate the task to first.

Answer 74

True

Question 75

Define Delegation

Answer 75

the transfer of responsibility for the performance of an activity to another individual WHILE RETAINING ACCOUNTABILITY for the outcome. (You are still responsible)

Question 76

What is the main reason a patient is made NPO hour before surgery?

Answer 76

To prevent aspiration

Question 77

What are the 4 stages of General Anesthesia?

Answer 77

1) Stage 1 (Beginning Anesthesia) - As the patient breathes in the anesthesia mixture, warmth, dizziness and a feeling of detachment may be experienced. 2) Stage 2 (Excitement) - Characterized variously by struggling, shouting, talking, singing, laughing or crying is often avoided if the anesthetic is administered smoothly and quickly. 3) Stage 3 (Surgical Anesthesia) - Patient is unconscious. 4) Stage 4 (Medullary Depression) - When too much anesthesia has been administered. Cyanosis develops and patient could die.

Question 78

Nausea vomiting and pain may occur during surgery when spinal anesthesia is used. What can be administered to counteract this?

Answer 78

IV administration of thiopental and inhalation of nitrous oxide may prevent this.

Question 79

What three methods can be used to manage pos-op spinal anesthesia headache?

Answer 79

1) Maintain a quiet environment 2) Keep the patient lying flat 3) Keep the patient well hydrated

Question 80

(T/F) Post-op hiccups may be produced by intermittent spasms of the diaphragm and can lead to vomiting, exhaustion, and possibly wound dehiscence.

Answer 80

True

Question 81

Wy is it important to avoid the use of blanket rolls, pillow rolls, and any for of leg elevation under the knees.

Answer 81

Because they pose a risk of constricting the vessels in the leg which increases the risk of DVTs.

Question 82

Within which timeframe does Malignant Hypothermia usually manifest?

Answer 82

Malignant hypothermia usually manifests about 10-20 mins after induction of anesthesia, but can occur during the first 24 hours after surgery.

Question 83

Corticosteroids have which affect on wound healing?

Answer 83

They mask the presence of infection by impairing the normal inflammatory response.

Question 84

What is the difference between Evisceration and Dehiscence?

Answer 84

1) Evisceration - The protrusion of abdominal organs through the surgical incision. 2) Dehiscence - The partial or complete separation of wound edges.